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Health and Social Care Bill

moved Amendment No. 137: 137: After Clause 107, insert the following new Clause— ““Dentists register: non-practising dentists (1) The Dentists Act 1984 (c. 24) is amended as follows. (2) In section 15 (qualification for registration in the dentists register), after subsection (1)(a) insert— ““(aa) any person who is a graduate or licentiate in dentistry of a dental authority who no longer practises dentistry;””. (3) In section 19 (regulations with respect to the register)— (a) in subsection (1)(b) after the word ““fee”” insert the words ““, or non-practitioners reduced fee””; (b) in subsection (2A) for the words ““a person’s name”” substitute ““the name of a person who practises dentistry””; (c) after subsection (2A) insert— ““(2AA) Where the name of a person who falls within section 15(1)(aa) has been erased by virtue of failure to pay a fee prescribed under subsection (1)(b), that name shall be restored to the register on that person’s application if he pays the prescribed fee.”””” The noble Baroness said: The amendment would give to dentists, through the General Dental Council, the rights that doctors already have under the General Medical Council. When I have asked the GDC and the Department of Health why only practising dentists can be on the register, the answer has always been that there was a flaw in the Dentists Act 1984, which did not allow my profession to be treated in the same way as the medical profession. A letter from the Department of Health dated 2 April confirms that again. For clarification, I shall mention another point in that letter, which was sent following Second Reading. It states: "““You also mentioned that the General Medical Council is entitled to hold a list of non-practising doctors. I thought it might be helpful for me to clarify that is not the case. The General Medical Council holds a single register which does not differentiate between practising and non-practising doctors. A doctor can choose to remain on the register after retirement on payment of the appropriate fee. Currently there is an age related waiver of the registration fee for registrants over 65 years of age””." I was wrong in thinking that the GMC holds separate lists; it holds both practising and non-practising doctors on its list. The General Dental Council used to have an age-related reduced fee for dentists. In 2002, this was £15. In 2003, it jumped to £40—more than double—and, in 2004, it was abolished. Any dentist thereafter was asked to pay the full fee of £388. That was an almost a tenfold increase for older dentists, from £40 to almost £400. The current fee is £438. Those who believed that that was too great an increase for people not actually in practice, and therefore without an income and unable to claim tax deduction, decided not to pay. I was one. I remember that I received a notice saying that I would be ““struck off”” the register—a phrase used for malpractice. That terminology caused such offence that it was soon amended; I understand that the phrase that is now used is, ““Your name will be removed from the register””. It is believed that about 2,500 dentists who would probably have been happy to pay, say, £100 a year were struck off that year, representing lost revenue of £250,000 to the GDC. There is a further problem in that currently the register contains only the names of practising dentists who have complied with the continuing professional development—CPD—criteria. That was phased in from 2002. An annual practising certificate is available to those who have paid the annual fee of £438 and done the 250 hours of continuing professional development, 75 of which must be verifiable, over five years. There is no provision for leave of absence from the register for illness or maternity reasons and, if a dentist’s name is removed, he or she must apply for reinstatement and pay an additional fee of £110, making the fee £548. Doctors can and do remain on the medical register without a practising certificate. The difference is that only those with a practising certificate can practise. That is what I am suggesting for dentists. I consider it to be in the interests of the public and the profession that dentists should be entitled to apply the same principles to their register—that the right to practise will belong only to those who have an annual practising certificate. It is important to make it clear that I am not trying to force the General Dental Council to introduce such a system; that would be for that body to decide in consultation with the profession, I would hope. My intention is simply to remove the legal obstacle that I have been told by members and past presidents of the GDC has prevented it from doing this. I find it hard to credit that the GDC opposes my amendment and is even lobbying against it. It is only an enabling amendment. The amendment would also be appropriate when revalidation is introduced; it would avoid the need for further legislation at that time. I have a copy of an article from GMCtoday entitled, ““Your Licence to Practise””, which is about doctors. It states: "““In future, there will be three options. You may hold registration plus a licence to practise. You may decide to hold registration only, or you may take voluntary erasure from the register””." The article goes on to ask: "““Why would a doctor want to hold registration only?””." The answer, the article states, is: "““When the concept of revalidation was first introduced back in 1998, a significant number of doctors who are not in active practice expressed concern that they would lose their connection with the GMC. They saw their GMC registration as part of their professional identity. We will therefore make it possible for them to maintain their connection with the GMC by continuing to hold GMC registration, but without a licence. There will be a cost for this, although it will be less than the cost of holding a licence plus registration. However, doctors with registration only will not be able to practise. Of course, doctors who see no advantage in holding registration only will be able to take voluntary erasure from the register. This will cost them nothing””." I have received many letters of support from dentists and it is interesting to see the different angles and requirements that they have. I shall mention a few of them. The first letter is from someone who complained on three grounds. The first was that he would no longer be able to sign people’s passport applications. I do not think that non-practising doctors can do that, so that is not a relevant point. Secondly, he was unable to complete any former employees’ documents for GDC registration; in other words, he had been the principal dentist but could not sign for any of those who had worked for him unless he still had a GDC registration number. Thirdly, he stated that, "““the Dental Defence Union advises that I am not covered for discretionary assistance in respect of the Good Samaritan’s Act unless my name is on the GDC Register””." That is important, because in France the obligation is on you to be a good Samaritan. In this country, it seems that everything is against your being a good Samaritan, because people can sue you about everything. I shall read only a snippet of each letter, otherwise we would be here for days—and I have brought only a few of them. The next letter states: "““There are many retired dentists who could contribute to the profession in positions that do not involve clinical contact with patients, but those positions still require them to be registered””." I have been given examples about writing for or editing journals and so on. The letter continues: "““Society is losing out on a valuable source of expertise … I do not find the GDC’s attitude to be consistent with care for the public and it is not representative of the profession who pay for its existence””." Another letter states: "““Even though retired, I still write a monthly column for Dental Practice””." These are cases where people should know that these were qualified dentists. Another letter provides a different angle and states: "““My former partner … in 1990 at the age of 32, contracted an illness after doing voluntary dental work in Africa. It was ‘diagnosed’ as ME, totally debilitating and was sufficient to make him retire from clinical dentistry””." The letter goes on to state how he needed an income and so on and that he then qualified as a lawyer—and he is doing all right. This demonstrates the case of someone who is young and unable to continue practising. Perhaps he could have returned to dentistry despite that condition, but because he was so disillusioned by being removed from the register, was unable to afford to pay the fee and there was no leave of absence, he did something different. However, he is a loss to the profession. Another letter says: "““Of course there must be checks and balances. Of course the GDC must ensure the protection of the public, but its hands are tied and it cannot make the choices which it would wish””." I dispute that statement from that dentist, because, as I say, the GDC is lobbying against this proposal, as if I was trying to force it to do this. All the indemnity insurance is covered. Women dentists wanting to have a family might want leave of absence for a couple of years—but, no, if they want to do that, they must either pay the full fee for continuing professional registration or go off the register and pay the additional fee to come back. There is no provision whatever for career breaks, while doctors, of course, can have them. Someone told me that, when they had said how sad it was that they had to go off this year, they were treated very abruptly on the telephone by the GDC and got no sympathy at all. Someone else said that he was ““virtually excluded”” from his profession, which he found very hurtful. He went on to say: "““My parents made great sacrifices in the 50s to get me through Dental School””." In another letter, a man from the Society for the Advancement of Anaesthesia in Dentistry said: "““As Hon. Secretary of SAAD I am obliged to be on the register when giving advice to dentists, and when I am examining. This means that I must attend courses that have no relevance to my current situation in order to fulfil my CPD requirements””." A number of people have told me that they serve on boards or even trusts and cannot claim to be dentists because they are no longer on the register. The most interesting letter of all was from a woman dentist, who told me how hard this was fought by the profession. She said that members of the GDC had tried to get such a measure through but were told that it could not be done on legal grounds. She said that she was now 85 and that she had qualified at the age of 21 in 1944, having spent the war years studying in King’s College, London. She survived all the doodlebugs and everything else. She said: "““I followed my father into dentistry and it is a profession that has been in my family since very young””." There were seven of them, and apparently they were all dentists. She went on to say: "““It is however to be very regretfully my last””—" that is, the last year that she will be on the dental register— "““after 64 years””," and that she would, "““soon be forced off … being unable to continue undertaking the required full CPD””." She has, "““undertaken 80 hours of verifiable CPD””," but she finds that at 85 it is not easy to go on doing that, which I can understand. She says: "““You will understand therefore why I am deeply upset to have my connection with dentistry now broken and to have my name removed from the Dental Register, which will be obligatory when my current five year term of CPD finishes this year””." There is a lot more of great interest of the letter, which goes on to say: "““It would … seem that this present attitude of the Council is contributory to turning what was once a wonderful and respected profession, happy to work within the NHS, into the turmoil that we now see in the country””." The next letter is about a dental hypnotist. I cannot comment very much, as I do not know anything about dental hypnotists. In fact, it is from the man who edits the general dental practitioners’ journal, who says that he has had a lot of responses, including this response from a dental hypnotist. He says: "““Unfortunately as you probably know the GDC is lobbying quite hard against the change””." Again, I am not sure why. The final letter says, again, how the GDC has met the correspondent with only, "““negative responses despite trying to offer some solutions””." I could go on and on, but I shall not. I spoke to the GDC itself and asked it to tell me what the loophole was and why doctors could do this when dentists could not. The response from the man from the GDC was that he did not really know but would try to find out. He went on to say: "““Whether this is a fault or not depends on one’s point of view I suppose. I can imagine various ways of doing what you want—by enabling the creation of a non-practising category (with the right to use the protected titles but not to practise dentistry) or by separating completely registration and licence to practise, with different requirements in each case””." He goes on to say that he will let me know when he has more of an answer to it. That was from the GDC. I said at Second Reading that there should be a separate list. I do not care about any of the procedures of this; it is entirely a matter for the General Dental Council whether it makes a separate list. Under the revalidation scheme it may be that in due course the doctors need to list such people separately. I think that dentists, both public and private, should be treated in the same way as doctors are. I cannot understand why there should be a difference. It should be the case that you can practise if you have, in medicine, a practising certificate and, in dentistry, this annual practising certificate. If you do not have that, you cannot practise. There are many situations where it would be important for the body on which you serve to know that you had been an honourable dentist, now retired or having voluntarily ceased practice perhaps because of whatever else you are doing. There is merit in distinguishing between you and those people who have been bad dentists and who have been struck off. There is no way at the moment of knowing which category you are in. I declare a personal interest because, if the provision were introduced, I would probably pay my £100. I do not know that I would. I might be too old and, like that 84 year-old, not bother. I am not guaranteeing whether I will go back on the register, but I believe that it should be possible for dentists to do this. That is what my amendment proposes. It would simply enable the General Dental Council, in consultation with the profession, to take this action. I beg to move.