Association of Surgeons in Training responds to GMC erasure case
BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k224 (Published 19 January 2018) Cite this as: BMJ 2018;360:k224All rapid responses
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Oral and Maxillofacial Surgeons (OMFS), thanks to their dual medical and dental training, have the opportunity to have two regulators - the General Dental Council (GDC) and the GMC. Just to cheer up our medical colleagues we thought we would let you know:
The GDC charges £890 per year, with no discount for part-time work/maternity leave/sickness (an approach with has been found to be discrimination on grounds of gender when other regulators have been taken to court). If a surgeon is on the Oral Surgery Specialist list (which many OMFS surgeons are), the cost increases to £962.
When an OMFS consultant is referred to their regulators, the GMC may give a warning and the GDC may erase the surgeon from the Dental Register based on the same evidence*.
The GDC counts CPD in hours, the GMC in points, and the GDC will not accept certificates in points but rather insists on a new certificate in hours (even though the conversion ratio is 1=1).
If an OMFS consultant lets his GDC registration lapse and works outside their hospital in a room which looks to a patient like a dental surgery (e.g. has a dental chair in the room) the GDC says they would consider charging them with the 'illegal practice of dentistry' . The GDC says this would be the case even if the OMFS consultants wears a large badge that says OMFS Consultant, and it says OMFS Consultant on the door of the room. So although OMFS is a medical specialty and to practice within the OMFS curriculum dental registration is optional, because of the presence of a dental chair the GDC considers they are not performating OMFS but rather dentistry no matter what type of the clinical work they are undertaking.
Finally, although the British Assoc of Oral & Maxillofacial Surgeons has been asking the GDC to draft a Memorandum of Understanding with the GMC regarding their approach to OMFS surgeons for over 20 years, none has yet been forthcoming.
Whilst this might not encourage medical colleagues to view the GMC with affection, it would be worse....
Patrick Magennis, Anne Begley
* Review of General Dental Council and General Medical Council “fitness to practise” hearings related to maxillofacial surgery
R. Taylor, M.H. Ali, T.E. Howe, I. Varley British Journal of Oral and Maxillofacial Surgery, Vol. 55, Issue 6, p580–583.
Competing interests: No competing interests
I applaud Humm et al for illustrating the problems of reflections in junior doctors' portfolios.<1> I cannot deny the values of writing a good reflection, especially when trainees learn an important lesson. A colleague of mine once used this analogy: why did the Romans lose the recipe of concrete - it is because nobody wrote it down.
The real problem is how reflections are being misused. When trainees receive complaints, reasonable or not, their supervisors may simply tell the trainees to "just write a reflection," rather than investigating and resolving the underlying problems. This approach may be a time-saving solution to complaints. But it does not do justice for trainees, nor improve workplace safety and quality of their training.
Trainees' written reflections can be used against themselves in courts.<1> This encourages practice of defensive medicine: trainees benefit by skilfully defending themselves and putting blame on others in their reflections; they are penalised for honestly admitting their mistakes and constructively looking for ways to improve. Regardless, trainees' reflections are their own intellectual properties and should not be used without their permission.
I understand that certain NHS trusts have been criticised for lack of openness about complaints,<2, 3> and thus possibly respond by increased reporting of any trivial potential problems. This could boost the number of clinical incident reports and show the perceived image of open justice. Nevertheless, a study of 5.8 million incident reports in England showed no association between mortality or patient satisfaction outcomes and incident reporting rate.<4> Over 70% of these incidents caused no harm to patients.
Incident reports could also be misused to raise complaints against co-workers. Once at work, all foundation year doctors in the unit received an incident report, because several discharge summaries were not readily prepared that week. Amusingly, one doctor was named in the report despite being on his annual leave that week.
These incident reports, trivial or not, require trainees to follow with written reflections. McCartney commented how we could improve the NHS by doing less paperwork, and thereby having more time with patients.<5> At the end of the day, doctors’ main duty should be treating the patients, not simply the number of reflections and incident reports.
References
1. Humm GL, Sutton P, Gokani V, Mohan H. Association of Surgeons in Training responds to GMC erasure case. BMJ. 2018;360:k224.
2. Dyer C. Morecambe Bay trust is criticised for lack of openness about complaints. BMJ. 2014;348:g1860.
3. Dyer C. Health watchdog to look again at reports on maternity services at Morecambe Bay trust. BMJ. 2013;346:f4017.
4. Howell A, Burns EM, Bouras G, Donaldson LJ, Athanasiou T, Darzi A. Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data. PLOS ONE. 2015;10(12):e0144107.
5. McCartney M. Margaret McCartney: Pointless paperwork, not patients, is what GPs should avoid. BMJ. 2017;359:j4933.
Competing interests: No competing interests
When you have to deal with the GDC as one of you regulators, the GMC does not seem so bad
It was with great sympathy that I read Magennis and Begley’s letter. As a trainee in Oral Medicine, a specialty that comes under the remit of the General Dental Council, but where most specialist are also medically qualified, the cost of registration is excessive. Reluctantly, this year I was forced to remove my name from the GMC register due to the prohibitive cost of maintaining both registrations (£1,315 pa). Add in the additional costs of e-portfolios (£130), medical indemnity (£1,200), examination fees, and BMA membership (money well spent!), the total costs exceed what I earn in a month! It is a huge shame that the regulators are not more supportive of specialist trainees. One solution would be for the GMC and GDC to devise a joint registration package that accommodates the dual requirements of Oral Medicine/OMFS specialists.
Competing interests: No competing interests