Mind your business

GDC President Hew Mathewson offers some essentials from a new guidance document on sound management principles in the ‘business of dentistry’ [Feature article from 'Summons' Spring 2008]

MANAGEMENT responsibility – two words that are increasingly familiar to thousands of dentists who run a practice or clinic. Back in June of last year the General Dental Council launched a consultation on draft guidance concerning the responsibilities of registrants when acting in a business capacity. This was prompted by changes in the amended Dentists Act which came into force in July 2006 and opened up the ‘business of dentistry’ to dental care professionals as well as dentists. All members of the registered dental team can now receive payment for dental treatment, own practices and laboratories and employ other members of the dental team.

In light of these changes, the Council felt that it would be helpful to give guidance to registrants about their responsibilities in running a business. In February the GDC published the final document – but what is the guidance in essence?

Putting patients’ interests first

Guidance on principles of management responsibility covers those who:

  • own, or have responsibility for, dental practices or dental laboratories
  • manage within dental healthcare organisations
  • manage within educational establishments
  • have responsibility for conducting clinical trials
  • are directors of Dental Bodies Corporate (DBCs).
Encourage staff to raise any concerns they have about the activity of the organisation… create an environment which ensures that staff can raise concerns comfortably

The document expands upon core GDC guidance, enshrined in Standards for dental professionals, which requires registrants always to act in the best interests of their patients, whether they manage people or resources. That means you have a professional responsibility as a manager, as well as a clinician, and must follow this guidance whether you yourself are managed by another person who may or may not be a GDC registrant. How does this work? Here are some suggestions, by no means exhaustive.

Put patients’ interests before your own or those of any colleague, organisation or business. If conflicts threaten your primary duty to prioritise patients’ interests, raise your concerns formally with management colleagues, with external professional bodies, with MDDUS or with the GDC.

Here are two examples. First, by August, all dental nurses must be registered: if boards and trusts continue to rely on general nurses to replace registered dental nurses, for instance in maxillofacial units, then registrants should raise their concerns. Second, if directors of a DBC pressure a registrant to promote expensive or unnecessary treatments, then he or she must protest.

Make sure you work within your knowledge and competence as a director or manager. Keep up-to-date with, and use, guidance on necessary knowledge, skills and attitudes. If you have an employer, they should support you in this. Individual registrants should read widely, and seek advice and support from MDDUS and their professional representative organisation.

Be aware of your legal responsibilities as a director, owner or manager and make sure that you fulfil them. In the same way that an HR director keeps up to date with changes in employment law, you must keep up with your legal responsibilities. Read widely and seek advice if necessary.

Understand and fulfil your legal and ethical responsibilities in relation to equality and diversity. Responsibility for equality and diversity applies to how you treat everyone – employees and patients. It’s not only a matter of employment law but also service provision, such as access to the building and services generally.

You cannot discriminate against HIV-positive patients; your cross-infection control should be effective. Think about physical access for disabled patients and your responsibilities under disabilities discrimination legislation.

When you take on a management role, you face legal and ethical responsibilities on such issues as ionising radiation, disposing of hazardous waste, controlled drugs, etc. You must also be familiar with new laws on vetting potential employees and ensuring that they are not barred from “controlled activity” – essentially, access to your patients.

Justify the trust that your patients, the public, those you direct or manage, and other colleagues, have in you by always acting honestly and fairly. This is essential as a director, owner or manager. No doubt you have told MDDUS how many clinical sessions you work and of every service you provide to ensure you pay appropriate indemnity fees. It means that if something goes wrong, your patients – and you – will be protected.

Make sure that you do not compromise the interests of patients by allowing financial or other targets to have a negative influence on the quality of care provided by those you direct or manage. Financial and business pressures are very real, as I know myself. Beware of perverse incentives clouding your judgement about what’s right for your patients. Guard against such distortions.

Ensure that if you delegate managerial responsibilities, the person you delegate to is competent to do what you are asking. As with delegating clinical responsibility, you are still responsible and accountable for ensuring that employees know what they’re doing. If you fail to check whether an employee is competent and something goes wrong, then having delegated carelessly, you are accountable.

Make sure that early warning systems are in place. You should ensure that the organisation you work for has adequate early warnings of any concerns about the health, behaviour or professional performance of any staff you direct or manage, or of concerns about any aspect of the clinical or administrative environment, and that such concerns are addressed promptly and effectively.

Appraisals, health assessments, supervision, induction – such systems are all pretty standard stuff. Ensure that they are implemented. However, if you are dissatisfied with the clinical environment – the standard of premises or of equipment – and you are in a position to resolve the problem, then you must. Blaming senior managers isn’t good enough.

Raise important concerns with colleagues. If you have any concerns that an organisational decision or any activity within the organisation would put patients at risk, make sure that you raise that concern with your colleagues. This includes any decisions or actions that may compromise patient safety, or the wider public interest, such as dishonesty or incompetence. Do the right thing: raise the alarm.

Promoting compliance

In addition to your own behaviour, the guidance also concerns the behaviour of others within your organisation. As a director, owner or manager within an organisation, you are in a position to influence the way in which the organisation works and the way in which the people within it work. You can also make sure that people you direct or manage are familiar with the GDC’s Standards for dental professionals and its supporting guidance. For instance, as a registrant director of several practices within a DBC, it’s your responsibility to ensure that unregistered practice managers respect patient confidentiality. And if you manage a small dental team, it’s important to ensure that the unregistered receptionist takes patient confidentiality as seriously as registrants do.

All members of the dental team who have to register with us are individually responsible and accountable for their own actions and for the treatment or processes which they carry out. Make sure you don’t compromise the ability of anyone you manage to comply with standards, for instance by cutting consultation times.

Encourage staff to raise any concerns they have about the activity of the organisation, including any risks that the health, behaviour or performance of colleagues may present to the safety of patients or the wider public. Create an environment which ensures staff can raise concerns comfortably.

If anything mentioned in this article comes as a surprise, ask MDDUS for advice. Meanwhile, we at the GDC will keep you informed of any regulatory changes in dentistry. You can sign up for email alerts at www.gdc-uk.org.

Guidance on principles of management responsibility is on the GDC website (www.gdc-uk.org), and in hard copy on request (call 0845 222 4141).

Mr Hew Mathewson is president of the General Dental Council