Education, Regulation, Representation and Remuneration in Dentistry

Education, regulation, IN BRIEF • Elucidates the principal roles of the

key boards, committees, associations, GENERAL representation and remuneration societies and councils related to dentistry. • Provides a useful resource for those applying to higher specialist training, in dentistry – who does what? as well as those with an interest in the dental political arena. S. Tabiat-Pour,1 T. Pepper2 and N. L. Fisher3 • Empowers the reader to understand who does what in the business of dentistry. VERIFIABLE CPD PAPER

Dentistry in the United Kingdom demands a wide range of supportive and regulative bodies, the roles of which are intertwined, overlapping and changeable. The interaction between these bodies is not always clear, and often the present-day role of the body is far removed from its original purpose. Consequently, the system can appear daunting and opaque. Even so, a thorough understanding of this topic is requisite for those considering applying for higher specialist training, and pertinent for practitioners with an interest in the dental political arena. We hope this paper goes some way towards unravelling the tangle of boards, committees, associations, societies and councils that commonly influence dentistry, and provides a starting point for those interested in increasing their knowledge of the profession at the strategic level.

INTRODUCTION landscape. In the interests of simplicity, not each of whom has areas of responsibility In the current politicofinancial climate, all all detail has been given for each country related to their appointment (for instance, public sector organisations – in particular the of the UK, but wherever possible we have the Parliamentary Under-Secretary of State NHS – are experiencing a period of unprec- outlined the distinguishing factors. for Public Health is responsible for public edented change.1 Within this turbulent and health measures such as fluoridation, while evolving environment is the organisational DEPARTMENT OF HEALTH (DH) the Parliamentary Under-Secretary of State machinery engaged with the day-to-day The Department of Health is the UK gov- for Quality is responsible for dentistry, education, regulation, representation and ernment department with overall responsi- among other things). The DH’s Permanent remuneration of dentists in the UK. However, bility for health and social care in England. Secretary is a civil servant who does not the interaction between these bodies is not The devolved governments of the United play a political role, does not change with always clear, and often the contemporary Kingdom each have their own health governments, and is responsible for the role of the body is disparate from the pur- departments, namely the Department of overall efficient running of the DH. The pose for which it was originally conceived. Health and Social Services (Welsh Assembly majority of healthcare in England is deliv- Despite these difficulties, a thorough under- Government), the Health Directorates (The ered by NHS bodies, and this close link standing of this topic is requisite for those Scottish Government), and the Department between the NHS and the DH is reflected in considering applying for higher specialist of Health, Social Services and Public Safety the fact that the NHS Chief Executive – the training and pertinent for practitioners with (Northern Ireland Executive). While every government’s principal adviser on all NHS an interest in the dental political arena. department is responsible for elements issues – also works for the DH. This paper aims to outline the prin- of its own health policy and service, the There are six chief professional officers cipal roles of the key boards, commit- DH deals with non-devolved matters and working for the Department of Health, of tees, associations, societies and councils issues common to all systems. which the Chief Dental Officer (CDO) is one related to dentistry, as well as the interplay The DH does not deliver care services (the others being Chief Medical, Nursing, between them, in order to confer a broad directly but develops policy according Health Professions, Pharmaceutical and understanding of this somewhat nebulous to decisions taken in Parliament. The Scientific Officers). The CDO is the profes- Secretary of State for Health, a Cabinet sional head of dental staff and provides the 1*Specialist Registrar in Restorative Dentistry, Guy’s appointment, is responsible for the DH and government with expert knowledge on all Dental Hospital, 2Consultant in Restorative Dentistry, Guy’s & St. Thomas’ Hospital NHS Foundation Trust, accountable to Parliament. He or she is matters relating to dentistry in England, as Guy’s Hospital, Great Maze Pond, London, SE1 9RT; appointed by the Crown after nomination well as providing leadership and dissemi- 3Medical student, King’s College London, Guy’s Campus, London, SE1 1UL by the Prime Minister. The Department nating policy to the profession through let- Correspondence to: Ms Sara Tabiat-Pour is led by the various Health Ministers*, ters and CDO Update. Separate CDOs work Email: [email protected] for the devolved governments in Scotland, Refereed Paper *Minister of State for Health, Minister of State for Care Wales, and Northern Ireland. Accepted 9 December 2010 Services, Parliamentary Under-Secretary of State for DOI: 10.1038/sj.bdj.2011.340 Quality (Lords), and the Parliamentary Under-Secretary A series of 25 National Clinical Directors ©British Dental Journal 2011; 210: 431-438 of State for Public Health (also known as tsars) work for the DH. They

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essentially spearhead change, each over- England consists of ten regional§ Strategic independent from SHA and DH control seeing the implementation of a National Health Authorities (SHAs), which hold and represent one element of the govern- Service Framework‡ or strategy for key their local NHS Trusts – Primary Care ment’s decentralisation of public services. health issues (such as cancer or diabetes), Trusts, Acute Trusts, Ambulance Trusts, Approximately two thirds of hospitals or key patient groups (for example, chil- Care Trusts and Mental Health Trusts – to have currently achieved Foundation Trust dren). In this role they also work with the account for their performance. SHAs are status; the g overnment’s aim is for all Royal Colleges to ensure that changes in directly accountable to the DH and NHS NHS Trusts to become Foundation Trusts health and social services are reflected in Chief Executive, and are responsible for by 2013. Foundation Trusts are regulated training and education. developing plans to improve health ser- by Monitor,|| a body that reports directly The future role of the Department vices in their area as well as ensuring that to Parliament and that has been proposed of Health is proposed to feature a radi- DH directives and policy are integrated to become a full economic regulator for cal reduction in NHS functions, thereby into local health service plans. the NHS.1 allowing greater focus on improving At the time of writing, approximately public health.1 80% of the £100 billion NHS budget is NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE (NICE) directly allocated by the DH to primary NATIONAL HEALTH SERVICE (NHS) care trusts (PCTs). PCTs are responsible for The National Institute for Clinical The NHS began operating in July 1948 with assessing the needs of their local population Excellence was established in 19995 with the ambition that ‘Everybody, irrespective and ensuring that there is a comprehensive the aim of promoting clinical excellence in of means, age, sex or occupation shall array of primary care and public health England and Wales and establishing parity have equal opportunity to benefit from services available (for example, dentistry, across regions with regard to the range the best and most up-to-date medical and pharmacy and optician services). PCTs also of treatments available, thereby abolish- allied services available… services should play a large role in commissioning second- ing the so-called postcode lottery that was be comprehensive and free of charge…’.2 ary care. In 2006 their number was reduced apparent at the time. In 2005 NICE merged However, within a few years the cost of from 303 to 152 with the aim of combining with the Health Development Agency6 to providing a fully comprehensive service services and reducing costs. Six of these become the National Institute for Health had soared beyond the Government’s most PCTs are Care Trusts – agreements between and Clinical Excellence – a special pessimistic predictions. In an attempt to the NHS and local authorities resulting in health authority (SpHA, an Arm’s Length mitigate its effect, patient charges were a close relationship between health and Body – see Table 1) of the NHS in England implemented for dentistry, prescriptions, social care. While the services that PCTs only. Its future role will include develop- and spectacles. deliver are all NHS-funded, they may be ing quality standards for adult social care.7 Today the NHS is the world’s largest pub- provided by private companies (for exam- NICE publishes guidance in three areas: licly-funded healthcare service. Although ple, Independent Sector Treatment Centres). health technologies (for example, ozone funded centrally from national taxation, A health White Paper1 proposes to phase out treatment), clinical practice (for example, the devolved administrations manage their PCTs and SHAs by 2013, moving respon- dental recall intervals), and public health NHS services separately.3 Strictly speak- sibility for commissioning the majority of (for example, smoking cessation services). ing, the health service in England solely health services to consortia of GP practices The decisions it makes with regard to its carries the title ‘NHS’, with the other UK (who will likely buy in support from other guidance are intended to be apolitical, being services designated ‘NHS Wales’, ‘NHS organisations, such as local authorities, vol- based entirely on clinical efficacy and cost- Scotland’, and ‘Health and Social Care untary organisations and the independent effectiveness. NICE’s public health guidance in Northern Ireland’ (HSC). However, the sector4). Primary care dentistry (and other is applicable solely to England; the remain- systems are similar in many respects and, family services such as community phar- der of its guidance is applied in varying subtle differences (for example, prescrip- macy and primary ophthalmic services) is amounts to Wales, Northern Ireland, and tion fees) aside, they are generally referred likely to be outwith this, most probably Scotland, dependent on government agree- to as a single, unified system. Indeed, a being the responsibility of a newly created ment. Since 2002 in England, and 2003 in resident in one country of the UK can independent NHS Commissioning Board Wales, the NHS has been legally obligated freely seek treatment in another country derived from the current NHS Management to fund medicines and treatments within of the UK. Board of the DH. three months of recommendation by NICE’s In 2002, the government created Acute Trusts manage hospitals and technology appraisal board.8 Strategic Health Authorities in England. employ the clinical and non-clinical Three organisations in Scotland provide These are controlled by the DH and manage workforce therein. Foundation Trusts analogous functions to NICE in England. the regional NHS on behalf of the Secretary are those Acute Trusts that have dem- NHS Quality Improvement Scotland (NHS of State for Health. There were originally onstrated financial judiciousness and as QIS) processes NICE technology apprais- 28 SHAs, but in 2006 this number was a result have been granted greater fis- als and discerns their validity for NHS reduced. The current NHS hierarchy in cal and operational autonomy. They are Scotland. The Scottish Intercollegiate Guidance Network (SIGN) was formed ‡A systematic approach to improving quality across §North East, North West, Yorkshire and the Humber, healthcare sectors through defined national standards, West Midlands, East Midlands, South West, South Cen- service models, and performance measures tral, East of England, London, and South East Coast ||An Arm’s Length Body – see Table 1

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Table 1 Arm’s Length Bodies of relevance to dentistry Arm’s Length Body subtype Special Health Authority Non-Departmental Public Body Executive Agency Definition An independent body, but subject to ministerial A body which has a role in the A body which is still part of, and direction like other NHS bodies. SpHAs provide processes of national government, but accountable to, the DH but responsible a service to the public and/or the NHS, and is not a government department or for a particular business area and generally provide a service for the whole part of one.9 Also known as a ‘quango’ managerially and budgetarily separate population of England, rather than for a particular local community7

Examples NICE, NHSBSA CQC, Monitor, DDRB MHRA

essential quality standards they face a Parliament variety of measures including public warn- Department ings, fines, suspension, or deregistration. of Health CDO Since April 2010, NHS Trusts have been required to register with the CQC in order SHAs x 10 COPDEND to operate legally. Private and NHS dental practices must be registered with the CQC Foundation Acute PCTs x 152 NICE NHSBSA by April 2011. It is proposed that in the Trusts Trusts future, the CQC will operate a joint licens- Primary Primary ing regime with Monitor, as well as act- Care Care Dentistry Medicine ing as host organization for HealthWatch England, which will be established as an independent patient champion.7

Regulated Regulated by CQC GENERAL DENTAL COUNCIL (GDC) by Monitor The General Dental Council is dentistry’s Fig. 1 Simplified schematic of current NHS organisation structure with relevance to dentistry regulatory body in the UK – it is one of 13 health and social care regulators.# The in 1993 and develops clinical practice the DRS to interview and examine patients, GDC itself is overseen by the Council for guidelines; in 2005 it was subsumed into as well as review clinical records and Healthcare Regulatory Excellence (CHRE), NHS QIS. Lastly, the Scottish Medicines inspect practices. In the near future the which also oversees the other eight health Consortium (SMC) issues advice to NHS NHSBSA will undergo commercial review profession regulatory bodies. Scotland on the suitability of all newly in order to identify potential opportunities The GDC evolved in 1956 from its pre- licensed medicines for NHS use within for greater private sector involvement.7 decessor, the Dental Board of the General 12 weeks of product availability. Medical Council, after the 1956 Dentists CARE QUALITY COMMISSION (CQC) Act acknowledged that the dental pro- NHS BUSINESS SERVICES In 2009, another Arm’s Length Body, the fession had earned the right to self-gov- AUTHORITY (NHSBSA) Care Quality Commission, replaced the ernment. The GDC’s prime purpose is the The NHS Business Services Authority is Healthcare Commission, Mental Health Act protection of patients and the public inter- another special health authority. It replaced Commission, and the Commission for Social est through the maintenance of a register the Dental Practice Board (as well as sev- Care Inspection.11 The CQC now regulates all of qualified dentists and, latterly, dental eral other authorities and agencies) in health and social care services in England care professionals (DCPs). Only individuals 2006.10 Among other wide-ranging func- (both public and independent sectors; see listed on the registers are legally permitted tions – from managing the NHS pension Figure 1) with the aim of ensuring consist- to carry out the practice of dentistry.12 scheme to administrating the European ent standards of quality across the services. Originally, non-lay members of the GDC Health Insurance Card (EHIC) – it provides The CQC is concerned with the ‘provider’ of were dentists elected by the registrants. payment to dentists for work undertaken these services (which may be an individual, Following the Shipman Inquiry13 and pro- on an NHS contract and produces statistics partnership, or organisation running, for posals in a subsequent government White relating to NHS dentistry. By processing instance, a hospital, nursing home, ambu- Paper,14 in 2009 the Council became a fully NHS dental transactions at a national level lance service, or voluntary organisation) appointed body15,16 and currently consists with other NHS transactions it is able to rather than individual clinicians, who are of 12 lay members, eight dentists, and four take advantage of economies of scale. registered with their own regulatory bodies. Within the NHSBSA, the Dental Reports from the CQC are intended to be #The others being the General Medical, Optical, Pharmaceutical, Chiropractic, Osteopathic, and Social Reference Service (DRS) exists to provide patient-centric and are released into the Care Councils, the Nursing and Midwifery Council, quality assurance for clinical dentistry in public domain. If providers do not meet Health Professions Council, Pharmaceutical Society of Northern Ireland, Scottish Social Services Council, the General and Personal Dental Services. Care Council for Wales, and the Northern Ireland PCTs or Local Health Boards¶ may request ¶The Welsh equivalent of an SHA Social Care Council

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DCPs.17 The Council sets standards for pro- Table 2 Dental specialist lists by date of inauguration. Figures in parentheses denote fessional conduct, and indirectly controls minimum training duration in years (whole-time equivalents) the undergraduate curriculum by setting 1998 1999 2000 2008 the learning outcomes of dental undergrad- uates.18 The Council also provides quality Oral surgery (3) Oral medicine (5) Oral pathologya (4) Special care dentistry (3) assurance** for undergraduate dental edu- Restorative dentistry (5) Oral microbiology (5) cation, inspecting all UK dental schools Dental and maxillofacial Dental public health (4) every six years. Courses are checked annu- radiology (4) ally in the interim by means of a ‘monitor- Surgical dentistryb ing form’ in which the course provider must Endodontics (3) detail progress made with respect to the recommendations and requirements out- Periodontics (3) 19 lined in the GDC’s inspection report. The Prosthodontics (3) GDC also deals with complaints, adminis- Paediatric dentistry (3) ters the Overseas Registration Exam, makes decisions regarding registrants’ fitness to Orthodontics (3) practise, and from 201420 will determine aThis specialty was renamed ‘Oral and maxillofacial pathology’ in 2008 following a request from the British Society for Oral and Maxillofacial Pathology. bIn 2007 the Surgical Dentistry list was closed and dentists on this list were transferred to a reconfigured Oral Surgery list the suitability of dentists for revalidation. These wide-ranging functions are carried out by a variety of dedicated commit- regarding duplication and over-burden- training, and SHAs are responsible for tees, boards, and working groups within some regulation. Consequently, an agree- supporting workforce planning and the the GDC. ment30 has been reached which coordinates commissioning of postgraduate medical As well as maintaining the register of how the respective organisations will dis- and dental education (PGMDE), the remit dentists and DCPs, the GDC maintains the charge their roles and responsibilities. The of postgraduate Dental Deans extends to specialist lists.21 As far back as 1991 the GDC Memorandum states that the GDC has the cover delivery of all NHS-related post- indicated its intention to identify individual lead role in relation to concerns about indi- graduate education and training, including dental specialties, with the aim of protect- viduals’ fitness to practise, performance the provision of CPD. Since 2006, when ing patients from unwarranted claims of and conduct, with the CQC taking the lead the Dental Vocational Training Authority specialist expertise.22 A subsequent report in relation to concerns about providers’ ceased to exist, postgraduate dental dean- by the CDO23 supported the introduction of compliance with regulations. Additionally, eries have also taken on responsibility for specialist lists and also took into account both organizations will ensure that there is providing quality assurance for Dental the recommendations of the Calman no duplication of enforcement by agreeing Foundation training and advising PCTs Report24 that were shaping postgraduate that only one organization will act at a on assessing equivalence to VT. medical training. The report confirmed the time where appropriate.30 In addition to these responsibilities, the GDC as having ‘overall supervisory respon- deaneries play a role in workforce plan- sibility for courses of training leading to COMMITTEE OF POSTGRADUATE ning (that is, the recruitment and retention DENTAL DEANS AND DIRECTORS formal qualifications as a practitioner of (COPDEND) of dentists and DCPs), ensuring adequate specialised dentistry with ultimate respon- training opportunities are available to sibility for the award of a Certificate of England is divided into eleven geographic meet the future needs of the NHS, and Completion of Specialist Training (CCST)’. regions‡‡ (not in all cases coincident with the maintaining a database of dentists in However, an arrangement25–27 was reached SHA boundaries), each with a Postgraduate specialty training through the allocation whereby the Royal Colleges, specialist soci- Dental Dean or Director (plus one Defence of National Training Numbers. In keep- eties, universities, and postgraduate Dental Dean for the UK). COPDEND is the commit- ing with this, Deans have responsibility Deans would continue to develop curricula, tee of these Dental Deans and Directors, who for the appointment of trainees, train- examinations, and training programmes are integrated within the structure and func- ing programme directors, and VT train- for the specialties. In 1998, nine specialist tions of SHAs in England.26 Lead Deans are ers, as well as for the conduct of Record lists were opened by the GDC, and these appointed to represent the deaneries where of In-Training Assessments (RITAs) have since grown to encompass 13 GDC- necessary (for instance, in liaison with the and Annual Reviews of Competence recognised specialties (Table 2). The GDC NHS, DH, or Royal Colleges); each Lead Progression (ARCPs), quality manage- are currently considering opening new Dean represents a specialty or specialties ment§§ of specialty training programmes,32 specialist lists in Implant Dentistry and and acts both as a conduit for information and the recommendation of Certificates of Maxillofacial Orthodontics.28 and a focal point for advice. Completion of Specialist Training (CCST) to The establishment of the CQC along- While the GDC provides quality assur- the GDC. side the GDC has resulted in concerns29 ance for undergraduate and specialist §§The arrangements by which the postgraduate **The policies, standards, systems and processes ‡‡London, KSS, East of England, Oxford, South deanery satisfies itself that local education and training directed to ensuring maintenance and enhancement Yorkshire/East Midlands, West Midlands, Yorkshire, providers are meeting the agreed standards through of quality31 South West, Mersey, North West, Northern robust reporting and monitoring mechanisms38

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Each deanery has a number of Specialist In 2005, the GDC abolished the need for

Training Committees (STCs), the Chairs candidates to hold MFDS or equivalent to • Develops curricula for speciality training of which are appointed by the regional enter specialist training,34 and in 2007 the under auspices of JCPTD SAC postgraduate dean. STCs representing the Diploma of Membership of the Joint Dental deanery may seek the advice of the rel- Faculties (MJDF) effectively replaced both • Approves curricula (Education Committee) 35 evant SAC on any matter relating to spe- MFDS and MFGDP in England. GDC cialist training. STCs meet several times Within the FDS are eight|||| intercollegi- • Appoints trainee and develops training per year to discuss all aspects of their ate Specialist Advisory Committees (SACs) programme (ARCPs, allocation of respective specialty training programmes, which advise on training in the dental Deanery numbers etc) advise the Deanery on training num- specialties. In addition, the SACs keep a • Delivers training within NHS Trust(s) bers and manpower issues, and address national register of trainees. Each SAC has Dental any difficulties that have arisen within a core group composed of:36 School/ Unit training schemes. • 4 × Faculty representatives • Examines trainee (e.g. Intercollegiate (one from each Faculty) Specialty Fellowship Examination RCS DENTAL SCHOOLS COUNCIL (DSC) • 1 × Postgraduate Dental Dean The Dental Schools Council (formerly the • 4 × Members of specialist societies • Recommends the award of a CCST upon satisfaction of assessment criteria Council of Heads and Deans of Dental • 1 × Trainee representative. Deanery

Schools) is the representative body of • Awards CCST the UK’s 16 dental schools. The Dean (or Each individual SAC has additional • Maintains specialist list and quality assures training equivalent) of each dental school sits on membership to suit its particular cir- GDC the Council and attends meetings approxi- cumstances. One of the main roles of an mately three times per year to discuss mat- SAC is to develop curricula for the dental ters pertaining to dental education and specialties, which are then subject to Fig. 2 Specialty training workflow under regulation of the Gold Guide research. While the GDC set the learning GDC approval. outcomes,18 dental schools are responsible FDS maintains a network of Regional for developing curricula and assessment Advisers who represent it at a local level, specialty area for nomination to the SAC methodologies that effectively deliver covering broadly similar areas to the by the Dean. Figure 2 outlines the current these outcomes. Postgraduate Deaneries. Several Specialty specialty training workflow. Advisers are also appointed to each region, RCS England offers four journals of ROYAL COLLEGE OF and they provide specialty-specific advice relevance to dentistry. The Annals of the SURGEONS (RCS) to the Regional Adviser. Smaller specialties RCS contains peer-reviewed papers per- The Royal Colleges of Surgeons of England, are catered for by National Advisers. The taining to all branches of surgery, while Edinburgh, Glasgow, and Ireland are chari- regional Specialty Adviser often doubles the quarterly Faculty Dental Journal ties dedicated to promoting excellence in as the Chair of the Deanery’s Specialty (published by FDS) conveys expert opin- all surgical fields, including dental surgery. Training Committee. This joint appoint- ion on a wide range of issues. Finally, The Royal Colleges provide educational ment ensures close liaison between the Team In Practice and Primary Dental Care courses and examinations in the surgical higher training programme, the Deanery, from FGDP(UK) are dedicated to team- specialties, and have specialty input into and the Royal College. working and research in primary care NICE guidance as well as producing their In 2010, RCS England established dentistry respectively. own clinical guidelines. In addition, they Specialist Advisory Panels (SAPs) in order The Royal Colleges of Edinburgh, act as an advisory body to the DH, SHAs, to provide the FDS with expert advice Glasgow, and Ireland have corresponding Trusts, and GDC. for nine¶¶ of the dental specialties. SAPs’ dental faculties and offer analogous exam- There are two dental faculties within the responsibilities include advising on spe- inations to those discussed so far. Notably, Royal College of Surgeons of England – the cialty membership examinations, advis- the RCS of Edinburgh is home to the Royal Faculty of Dental Surgery (FDS), and the ing on the need for courses in the UK and Odonto-Chirurgical Society of Scotland, Faculty of General Dental Practice (FGDP), abroad in their relevant specialty, assisting which was founded in 1867 and which is each headed by a Dean. The FDS supports in the selection of examiners, and consid- the oldest dental society in the UK.37 specialists and dentists working in second- ering development of courses for special- ary care in England, while the FGDP is ded- ist CPD/revalidation. Additionally, the SAP JOINT COMMITTEE FOR POSTGRADUATE TRAINING IN icated to primary care dentists and dental will recommend a representative in their DENTISTRY (JCPTD) care professionals UK‑wide.33 Examination ||||Oral and maxillofacial surgery, oral surgery, restora- for the Diploma of Membership of the FDS tive dentistry, paediatric dentistry, orthodontics, dental In June 2010 the JCPTD replaced the (MFDS) was originally a prerequisite for public health, special care dentistry, and additional JCSTD (Joint Committee for Specialist dental specialties entry into specialist training, while the Training in Dentistry##). The JCPTD exists Diploma of Membership of the FGDP ¶¶Oral and maxillofacial surgery, oral surgery, restorative dentistry, paediatric dentistry, orthodontics, dental (MFGDP) was the first step in the career public health, special care dentistry, oral and ##Formerly the Joint Committee for Higher Training pathway for dentists in general practice. maxillofacial pathology, and oral medicine in Dentistry

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to facilitate an integrated continuum of Table 3 Acronym buster dental education with particular emphasis on foundation and specialist training, and ABDFT Advisory Board for Dental Foundation Training with provision for revalidation as required ABSTD Advisory Board for Specialty Training in Dentistry by the GDC.38 In this regard, internal to ALB Arm’s Length Body the JCPTD are the Advisory Boards for ARCP Annual Review of Competence Progression Dental Foundation Training and Specialty BDA British Dental Association Training in Dentistry (ABDFT and ABSTD, CCST Certificate of Completion of Specialist Training respectively). The stakeholders represented on the JCPTD are many and varied (Fig. 3). CDO Chief Dental Officer The Committee meets at least twice a year CHRE Council for Healthcare Regulatory Excellence at one of the Royal Colleges. COPDEND COmmittee of Postgraduate DENtal Deans and directors Under the JCSTD, SACs were periodically CPD Continuing Professional Development required to inspect specialty training pro- CQC Care Quality Commission grammes. However, since 2008 Deaneries DCP Dental Care Professional have taken over responsibility for the qual- DDRB Review Body on Doctors’ and Dentists’ Remuneration (‘Doctors’ and Dentists’ Review Body’) ity management of training programmes according to GDC requirements.26 DH Department of Health DRS Dental Reference Service REPRESENTATIVE BODIES DSC Dental Schools Council The British Dental Association is the larg- FDS Faculty of Dental Surgery est representative body for dental practi- FGDP Faculty of General Dental Practice tioners in the UK.39 Founded in 1880 from GDC General Dental Council the Dental Reform Committee, its original GMC General Medical Council role was concerned with prosecuting the many illegal practitioners not registered HSC Health and Social Care in Northern Ireland under the Dentists Act 1878. However, ISTC Independent Sector Treatment Centre with the 1921 Dentists Act came the Dental JCPTD Joint Committee for Postgraduate Training in Dentistry Board of the GMC which now fulfilled this MFDS Member of the Faculty of Dental Surgery role, freeing the BDA for other purposes. MFGDP Member of the Faculty of General Dental Practice The contemporary remit of the BDA is MHRA Medicines and Healthcare products Regulatory Agency multifaceted, involving trade union, sci- MJDF Member of the Joint Dental Faculties entific, professional, and service roles. The Association promotes the views and NCD National Clinical Director (‘Tsar’) concerns of the profession at a local and NDPB Non-departmental Public Body national level; it also provides guidance NHS QIS National Health Service Quality Improvement Scotland for practice management matters, advice NHSBSA National Health Service Business Service Authority sheets for use by clinical staff, as well as NICE National Institute for health and Clinical Excellence a twice-monthly journal. The BDA library NSF National Service Framework houses the most comprehensive collec- NTN National Training Number tion of dental literature in Europe, and its museum holds the largest collection of ORE Overseas Registration Examination dental artefacts in Britain. PCT Primary Care Trust The BDA is also the main advocate for PGMDE Post-Graduate Medical and Dental Education dentistry with regard to evidence submit- QUANGO Quasi-Autonomous Non-Governmental Organization ted to the Review Body on Doctors’ and RCS Royal College of Surgeons Dentists’ Remuneration (DDRB), an Arm’s RITA Record of In-Training Assessment Length Body (Table 1). The DDRB is a non- SAC Specialist Advisory Committee departmental public body which invites evidence from a variety of stakeholders SAP Specialist Advisory Panel and then provides an independent rec- SHA Strategic Health Authority ommendation to the government on how SIGN Scottish Intercollegiate Guidance Network much doctors’ and dentists’ pay should SMC Scottish Medicines Consortium increase in the following year. Notably, the SpHA Special Health Authority government has instructed the DDRB not STC Specialty Training Committee to make recommendations for the 2011/12 VT Vocational Training and 2012/13 financial years; it intends to

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and societies for DCPs are in existence: the Table 4 In a nutshell British Association of Dental Nurses, British Body Summary of role with relevance to dentistry Society of Dental Hygiene and Therapy,

DH Creates policy and disseminates to the dental profession British Association of Dental Therapists, Dental Technologists Association, and NHS Delivers services to patients Clinical Dental Technicians Association, NICE Appraises technology, clinical practice, and public health measures in order to ensure to name a few. that, if efficacious and cost-effective, they are available throughout the NHS NHSBSA Provides payment to dentists for NHS work. Numerous other functions not directly INDEMNITY PROVIDERS related to dentistry Until the late 19th century, doctors were CQC Regulates (public and independent) health and social care services in England (but note that NHS Foundation Trusts are regulated by Monitor). Undertakes and pub- personally liable for the payment of any lishes the results of providers’ performance on the quality of services compensation arising from negligence on GDC Maintains registers of dentists, specialists, and DCPs. Approves curricula for their behalf. However, in 1885, a British undergraduate and specialty training. Provides quality assurance for undergradu- doctor (David Bradley) was wrongly con- ate and specialty training programmes. Awards CCSTs. Administers ORE. Carries out disciplinary proceedings victed after an epileptic patient had a sei- zure in his surgery and awoke believing Dental Deaneries Appoint STC Chairs, training programme directors, DF1 advisers and trainers, and trainees to posts. Deliver/commission postgraduate dental training (both general she had been raped. Despite evidence to and specialty) at a local level. Conduct RITAs/ARCPs. Recommend award of CCSTs to the contrary, Dr Bradley was sentenced and GDC. Quality manage the delivery of postgraduate specialty training programmes served eight months of a two year term to GDC standards. Quality assure Dental Foundation training and advise PCTs on equivalence to VT. Input into the development of dental workforce strategy before being pardoned. There was outrage in the medical community and many took Dental Schools Develop curricula for the award of degrees and diplomas the view that the conviction would have RCS Advisory to the DH, SHAs, Trusts, and GDC. Administers postgraduate examinations. Through the SACs and JCPTD, develops curricula and assessments for specialty not resulted had expert evidence been sub- training (subject to GDC approval). Produces and approves clinical guidelines. mitted on Dr Bradley’s behalf.41 As a result Provides advice on the award of CCSTs to clinical academics of this case, the Medical Defence Union BDA/specialist Represent the profession during dealings with the government and employing was formed in 1885, and the Medical associations authorities. Promote the interests of the profession. Provide expert advice on a Protection Society shortly after in 1892 in range of issues. Publish literature to keep clinicians apprised of latest issues and best practice order to provide the funds and guidance to defend cases against their members. Indemnity providers Represent the profession in dentolegal matters. Provide guidance to minimise risk In modern times, having arrangements for professional indemnity cover is mandatory42 in order that patients can DSC be fully compensated when appropriate. GDC COPDEND Specialist dental indemnity providers that have derived from their ancestral medical organisations are now in existence.

Defence Dental CONCLUSION Services JCPTD CDO x 4 (Eng, Scot, Wales, NI) It is clear that dentistry in the United ABSTD ABDFT Kingdom – spanning primary and second- ary care, public and private sectors, gen- Specialist eral and specialty divisions, and the four societies constituent countries – demands a wide range of supportive and regulatory bod- FGDP & FDS SAC x 8 Trainees (eng, Edin, Glas & Ire) ies. Some of these bodies are centuries old, while others have been created in the last year. Either way, their roles are necessar- SAP x 9 ily intertwined, occasionally overlapping, and periodically reshaped and transferred Fig. 3 Key stakeholders represented on the JCPTD as defunct organizations are removed and new ones instated. Tables 3 and 4 provide determine any gross uplift for GDPs and respective specialty. In addition, special- an overview of key roles and acronyms. GMPs directly.40 ist societies generally publish a journal While we have made every effort to There are dedicated societies for most containing news and research relevant to ensure this paper remains contemporary, of the dental specialties, and these serve their specialty. Members of the specialist the fluid nature of the organisations cov- to represent the views of their members, associations form part of the RCS’ SACs. ered invariably means that there may be as well as to promote and advance their Analogous representative associations some discrepancies by the time it reaches

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print. Nevertheless, we anticipate that this directions to Health Authorities, Primary Care Trusts General Dental Council, 2008. and NHS Trusts in England. London: The Stationery 27. Joint Committee for Specialist Training in Dentistry. paper will represent a useful resource as Office, 2001. Joint Committee for Postgraduate Training in the information contained herein is oth- 9. Mellows-Facer A (ed). Key issues for the new Dentistry (JCPTD) terms of reference and standing Parliament 2010. London: House of Commons orders. London: Joint Committee for Specialist erwise spread very thinly among a myriad Library Research, 2010. p 57. Training in Dentistry, 2010. of disparate sources. Where known, we 10. Department of Health. Reconfiguring the 28. General Dental Council. Protecting patients Department of Health’s Arm’s Length Bodies. hrough the specialties. London: General Dental have indicated the likely future role of the London: DH Publications, 2004. Council, 2010. organisation in question. What is certain 11. HM Government. Health and Social Care Act 2008. 29. General Dental Council. GDC response ‑ Chapter 14. London: The Stationery Office, 2008. Department of Health consultation on the is that there will continue to be change. 12. HM Government. The Dentists Act 1984 framework for the registration of health and adult For those with relatively few years’ (Amendment) Order 2005. London: The Stationery social care providers. London: General Dental Office, 2005. Council, 2008. experience among these organisations, the 13. The Shipman Inquiry. Safeguarding patients: lessons 30. Care Quality Commission, General Dental system can appear daunting and opaque. from the past – proposals for the future. London: Council. Memorandum of understanding between The Stationery Office, 2004. the Care Quality Commission and the General It is worth investing the time to become 14. HM Government. Trust, assurance and safety – Dental Council. London: Care Quality Commission, acquainted with it, however, as under- the regulation of health professionals in the 21st Sep 2010. century. London: The Stationery Office, 2007. 31. Adapted from: General Medical Council. Quality standing the system within which you 15. General Dental Council. Minutes of special Council framework for specialty including GP training. practise is the first step to its improve- meeting, 28 Mar 2007. London: General Dental London: General Medical Council, 2010. Council, 2007. Paragraph 21. 32. UK Committee of Postgraduate Dental Deans and ment. We hope that this paper has gone 16. HM Government. General Dental Council Directors. A reference guide for postgraduate dental some way towards that understanding and (Constitution of Committees) Rules 2009. London: specialty training in the UK: The Dental Gold Guide. The Stationery Office, 2009. UK Committee of Postgraduate Dental Deans and has empowered the reader to understand 17. Department of Health. 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