The General Dental Council Corporate Strategy 2015 – 2018 1 The General Dental Council 2015 – 2018 About the GDC The General Dental Council (GDC) is the UK-wide statutory regulator of just over 100,000 members of the dental team, which comprises 40,000 dentists and 60,000 dental care professionals - dental nurses, clinical dental technicians, dental hygienists, dental technicians, dental therapists, and orthodontic therapists. The GDC is overseen by a Council of 12 members, 6 lay and 6 registrants. Our legislation, the Dentists Act 1984 sets us the following objectives: - To protect the public To protect, promote and maintain the health, safety and well-being of the public To promote and maintain confidence in the dental profession To promote and maintain proper professional standards and conduct for members of those professions. The way in which we protect the public and maintain confidence in the dental profession is by ensuring dental professionals meet our standards and deliver safe and appropriate care to patients. Our legislation currently provides us with powers: - - To grant registration only to those dental professionals who meet our education and training requirements and the requirements we set around health and good character. Only those who are registered with us can practise dentistry in the UK. To set standards for providers of dental education and training in the UK To set standards of conduct, performance and ethics for the Dental Team To investigate Fitness to Practise complaints against dental professionals and where appropriate take action through our Fitness to Practise process To require dental professionals to keep their skills up to date through our Continuing Professional Development requirements. In addition, we provide the Dental Complaints Service (DCS) which resolves complaints between private patients and dental professionals. Our purpose “We want patients and the public to be confident that the treatment that they receive is provided by a dental professional who is properly trained and qualified and who meets our standards. If the quality of care or treatment or the behaviour of a registrant is not acceptable, we will investigate a complaint from a patient or other party and take action if appropriate.” 2 Our values We aim to demonstrate the following in all that we do: Fairness – we aspire to treat everyone we deal with fairly. Transparency – we are open about how we work and how we reach decisions. Responsive - we can adapt to changing circumstances. Respect – we treat our partners, our registrants and our employees with respect. 3 About this strategy – Patients, Professionals, Partners, Performance This document sets out the General Dental Council’s strategy for the next 3 years. It sets out our ambition in 4 key areas: - Patients: We will put patient and public protection at the heart of what we do and use our powers to improve the quality of dental care in the UK. - Professionals: - We will support dental professionals to deliver high quality dental treatment - Partners: - We will work with our partners in the dental sector to protect patients, improve the quality of dental care and make the system of dental regulation in the UK more effective. - Performance: - We will become a high performing regulator which has the confidence of patients, the public and dental professionals. By the end of this 3 year period we intend to be a high performing and efficient regulator and to have brought about significant improvements in the quality of dental care for patients through supporting dental professionals to deliver high standards of care and through providing better information to patients. We will also work with our partners to reform the overall system of dental regulation in the UK and the dental complaints system so that it works more effectively and efficiently. We will base all of this in evidence and make the most of the data that we have available to us. 4 Dentistry in the UK in 2015 – the context for this strategy. The GDC has developed this strategy at a time when a number of significant changes within the provision of dental care are occurring. Patient’s needs and expectations about the quality of care are also changing. These changes, which are set out below, have informed our thinking about what we want to achieve over the next 3 years and how the GDC as a patient focussed regulator ought to respond to these challenges. Dental care and the changing nature of provision Oral health in the UK has improved steadily over the last 40 years although there are still wide variations both regionally and demographically. The highest levels of dental disease can be seen in more economically disadvantaged areas 1 2 3 and tooth extraction is the number one cause of hospital admissions for children which suggests a need for a greater focus on preventative dentistry, particularly for young children.4 5 However, the oral health of people aged 16-24 is much better than those who are over 45, and as a result those over 45 are much more likely to continue to require remedial and restorative work (such as dentures and replacing fillings ) than the younger generation. At the same time, cosmetic dental treatments – including tooth whitening, the use of implants and veneers – are becoming more commonplace, and patients who choose these treatments often do so as consumers. Dental services in the UK are delivered through a mixed economy – a mix between private provision and NHS provision and private funding and NHS funding The value of the dentistry market in the UK is thought to amount to £5.73 billion a year, with NHS spending on dental treatment accounting for around 58% and private spending on dental treatment accounting for 42%, although around 80% of the total amount of treatment provided to patients is undertaken by the NHS with about 20% provided outside NHS services.6 The dominant model of dental provision is of an independent practice which is owned by a practising dentist or associates, who has a contract with the NHS and who employs a range of other dental care professionals such as dental nurses, dental hygienists and therapists, although dental hygienists and dental technicians are often themselves independent contractors. However, this model is changing. In February 2014 it was estimated that corporate groups operating 3 or more dental practices provided 22% of the capacity of UK primary dental care (as measured by the number of practices and the number of dentists). This has increased significantly over the past 4 years – in 2010, the corporate market share was 12%.7 The setting where dentistry is provided is also changing. Demographic change means that older people are increasingly receiving care in care homes or through visits to their own homes. In England in 2014, over 100,000 domiciliary care visits in dentistry took place. This trend towards care outside of the traditional dental practice is likely to increase as the population ages. In addition, dental professionals will 1 http://www.dhsspsni.gov.uk/adhexecutivesummary.pdf http://www.hscic.gov.uk/article/3740/Dental-Health-Survey-of-Children-and-Young-People 3 http://www.england.nhs.uk/2014/02/19/improve-dental-cta/ 4 https://www.rcseng.ac.uk/fds/policy/documents/fds-report-on-the-state-of-childrens-oral-health 5 https://www.rcseng.ac.uk/fds/media-centre-1/press-releases-and-statements/children-hospitalised-unnecessarily-from-toothdecay-experts-warn#.VRloLOE7fwA 6 Office of Fair Trading: ‘Dentistry - An OFT market study’ May 2012 page 4 para 1.2 7 Laing and Buisson Dentistry UK Market Report 2014 page 109 2 5 need to be equipped to meet the challenge of providing care to the 1 million people expected to have dementia by 2021. We will respond to these changes by ensuring that we have a full understanding of patients’ needs and expectations across the range of settings where the different forms of dental care are provided and the challenges faced by Dentists working for different organisations and in different settings. We will use this knowledge to inform our Standards, the Education and Training of Dentists and our requirements relating to Continuing Professional Development. The dental workforce In order to meet the changes in the nature of dental provision, the dental workforce is adapting. In England, in 2008 dentists made up 39% of the dental team but this proportion had dropped to 37% by 2013 and there has been an expansion in the numbers of dental nurses, dental technicians and orthodontic therapists practising.8 The Department of Health in each of the 4 countries along with their associated workforce planning bodies are looking at ways in which the skills mix within dentistry may be adjusted so that Dental Care Professionals play a greater role in providing care, including leading on preventative programmes and helping improving links with patients and the community. Many of the changes to the role of DCPS and the restructuring of the dental practice team are likely to be reinforced by planned changes to the NHS dental contract.9 The GDC has supported this new flexibility through introducing Direct Access, whereby patients can gain access to a Dental Professional without first being referred by a dentist. However, the changes expected as a result of this have been slow to arrive due mainly to legislative restrictions elsewhere. The UK, is a net importer of dentists – currently around 17% of the dentists registered with the GDC obtained qualifications in other parts of the European Economic Area and around 11% qualified outside of Europe. This is of significant benefit to dentistry and patients in the UK but it means that the GDC and the NHS need to ensure that those who trained outside the UK have sufficient language skills to communicate effectively and are able to adapt effectively to working, in particular, within the NHS system. The GDC will have new powers to assess the English language competence of European dental professionals from 2016 and will need to work more closely with European regulators to share information about dental professionals who have failed to meet our standards. We will work with education and training providers and workforce planning bodies across the UK to ensure that the dental workforce is fit for the challenges of the 21st century. We will also ensure that our own Continuing Professional Development and registration requirements reflect these changes. Patient’s concerns and expectations about dentistry. The vast majority (96%) of patients who have been to see a dentist in the last year are satisfied with the treatment that they receive, with over 60% saying that they are very satisfied. However, these satisfaction rates differed according to the background of patients – for example, 65% of those from white 8 9 Centre for Workforce Intelligence – A strategic review of the future dentistry workforce December 2013 Centre for Workforce Intelligence – A strategic review of the future dentistry workforce December 2013 6 backgrounds were very satisfied compared to 39% from ethnic minority groups and older people were more likely to be very satisfied than younger people.10 However, patients often express a number of concerns about the care that they receive. Their main concern relate to treatment costs, and being unable to judge whether treatment costs are reasonable. They also have concerns about treatment quality, specifically being unable to judge the quality of the care they receive and they want a better understanding of the quality standards that they should expect. Over the next 3 years we will listen more closely to patients about their concerns. We will provide patients with more information about what they can expect when they visit a dentist and we will use our powers to improve the quality of care that they receive focussing on those areas where they express most concern. Patients are also dissatisfied with the dentistry complaints system, and tend not to know how to make a complaint and whether it would be acted upon. These concerns about dentistry are reflected in a growing number of complaints which tend to go to a range of different organisations across the dental system. As an illustration - in 2013-14, the total number of complaints relating to dentists in England was over 12,000 (including Fitness to Practise complaints made to the GDC 3099, to NHS England 6,97311, to CQC 1043 and to the Dental Complaints Service 1068). We do not know whether these complaints are about the same issue and about the same dentist but we do recognise that the overall system of handling patient complaints in dentistry is inefficient and ineffective and requires reform. Our own experience of handling and resolving complaints about private dentistry through the Dental Complaints Service has very high satisfaction rates amongst dental professionals and patients and we consider that this model could have wider application elsewhere. We will work with our partners to reform the system of dental complaints in the UK so that patients have their concerns addressed in a timely fashion and by the right organisation. Our overall understanding of the nature of dental complaints and what they are about is limited. Yet they provide an excellent data source for understanding those areas of practice within dentistry which require improvement. Knowing more about the nature of complaints could lead to changes to how dentists are trained and educated and how we set our standards. We want to shift our emphasis to reducing the issues that give rise to a complaint. In order to do this we aim to build our knowledge of the causes of complaints and the barriers which dental professionals face in meeting our standards. We will do this through analysing our own data and carrying out research which we will use to inform our standards and the training and education to dental professionals. The overall system of dental regulation in the UK and the need for reform The GDC is just one organisation which regulates dentistry in the UK. The NHS in England and Wales holds a performers list of NHS dentists which covers around 95% of registered primary care dentists and provides the NHS with powers to manage the performance of dentists and to prevent unsuitable dentists 10 General Dental Council Patient and Public Research 2014. 11 Health and Social Care Information Centre Data on Written Complaints in the NHS 2013-14 http://www.hscic.gov.uk/catalogue/PUB14705/datawrit-comp-nhs-2013-2014-rep.pdf. The GDC data is for 2014. CQC 2013-14. 7 from working in the NHS. These powers are very similar to the GDCs and similar powers exist within the NHS in Scotland and the Health Service in Northern Ireland. Dentists working for the NHS are also held to account for their performance under their contracts with the health service. The Care Quality Commission (CQC) in England, the Healthcare Inspectorate in Wales (HIW) and the Regulatory and Quality Improvement Agency in Northern Ireland (RQIA) inspect and regulate the premises where dental services are provided. The Francis report into Mid Staffordshire NHS Trust made it clear that collaborative working between the professional regulators and those that regulate dental practices (CQC, HIW, RQIA, HCIS) and the NHS is necessary if patients are to be protected. 12 Since then the GDC has undertaken a significant effort to develop better joint working across the system through putting in place information sharing agreements and has started to develop arrangements with the NHS in England to ensure more effective collaboration at local level. However, the system of dental regulation in the UK was not designed from a blueprint but instead developed over a number of years, with new layers of regulation being added on to older ones. Many who work in the system believe that more can be done to delineate the roles and responsibilities of each organisation and dental professionals frequently express concerns that the overall system of dental regulation is fragmented, overly burdensome and inefficient. They also believe that the professional regulator deals with too many issues which could better be resolved at local level. Reform is needed if the overall system of dental regulation is to work as efficiently and effectively as it can and the GDC is committed to working with its partners over the next 3 years to develop an improved model of dental regulation. Trust and Confidence in the performance of dental regulation Our own research13 with patients and the public indicates that confidence in the regulation of dental professionals is high (96% “very satisfied” or “fairly satisfied”). When asked about confidence in the GDC’s ability to regulate dental professionals 77% said that they had confidence. However, our surveys also indicate that there is less satisfaction amongst GDC registrants with the performance of the GDC. Our 2013 registrant survey found that 67% were in some way confident, with just over a quarter 26% saying that they were not confident. As a result, we recognise that the GDC has some way to go to improve public, patient and registrant trust in the organisation and the regulatory system that we operate. We also recognise that some of this lack of confidence in the GDC is due to some of the difficulties that we have had in our own performance, mainly as a result of a significant increase in fitness to practise complaints in the recent past. Over the next 3 years we will focus on delivering improvements to the performance of our statutory functions so that patients and professionals can be confident in the services that we provide 12 http://www.midstaffspublicinquiry.com/report http://www.gdcuk.org/Newsandpublications/research/Pages/researchitem.aspx?AspXPage=g_87ABE1FB415648AEAA531FA5A647B256:%2540T itle%3D2013%2520Annual%2520Patient%2520and%2520Public%2520Survey 13 8 If patients and the public are to have confidence in professional regulation, radical reform is also needed to the law which is outdated and antiquated. The GDC is often prevented from introducing innovations and efficiencies because the legislation which we operate under is now nearly 35 years old. The last government worked with the professional regulators and the Law Commission to revise the legislative framework which the GDC and other professional regulators operate under. We will continue to work with other regulators and the government to push for legislative changes to bring professional regulation into the 21st century 9 Patients, Professionals, Partners, Performance – turning our ambitions into action We have chosen to set a number of objectives in relation to the 4 key aspects of our work and we have set out below the activities that we will undertake to deliver these objectives over the next 3 years. Our intention is that we will be held to account by patients, professionals and our partners for delivering on these aims and objectives. - Patients: We will put patient and public protection at the heart of what we do and use our powers to improve the quality of dental care in the UK. - Professionals: - We will support dental professionals to deliver high quality dental treatment - Partners: - We will work with our partners in the dental sector to protect patients, improve the quality of dental care and make the system of dental regulation in the UK more effective. - Performance: - We will become a high performing regulator which has the confidence of patients, the public and dental professionals 10 Patients Strategic Aim: We will put patient and public protection at the heart of what we do and use our powers to improve the quality of dental care in the UK. By 2018 we will be a patient-focussed organisation that takes into account the views and experiences of patients when taking decisions. We will work with our partners and dental professionals to ensure that patients’ experience of dental care improves and that patients are empowered to make informed choices about their dental treatment. Patients: Objective 1 To gain a full understanding of patients’ needs and expectations so these can be reflected in all the work we do. Over the next 3 years we will do the following to meet this objective: We will undertake research and gather data to gain a better understanding of how patients of all ages and backgrounds use dental services in a range of settings from care homes to high street practices to hospitals. We will use this information to identify ways in which we can enhance the patients’ experience of dental care. We will increase our engagement with patients’ bodies and consumer groups– such as Healthwatch England, Community Health Councils in Wales, Patient and Client Council Northern Ireland, the Patients Association, National Voices and Which? – so that we can draw on this opinion to inform our understanding of dental care quality. We will draw on our UK-wide, online patients panel to gather views on individuals’ experiences of dental treatment. We will use other direct channels of communicating with patients, for example through hosting consultation events. We will review our governance arrangements and ensure that there is an effective way for patients’ views to be heard in our decision making. Patients: Objective 2: To promote and enforce standards that take full account of patients’ needs and legitimate expectations. Over the next 3 years we will do the following to meet this objective: We will use the data that we have about patient care to develop standards and guidance which address concerns about the quality of dental care and we will take action with our partner bodies to ensure that these concerns are addressed. We are aware that patients often do not receive enough information about their dental treatment. As a result we will work with our partners in the NHS and the systems regulators to take action to ensure that when patients receive treatment they are provided with clear information on the costs of dental care, a treatment plan and all the information that they need to make informed decisions about their care. Patients: Objective 3: To increase the information we provide to help patients make better informed judgments about their treatment 11 Over the next 3 years we will do the following to meet this objective: We will improve our online register and website so that patients can find out more information about their dental professional, including how to locate a specialist. We will explore the development of quality metrics in dentistry so that patients are clear about the quality of the care that they can expect to receive. We will produce a range of guidance to patients and their carers about what they can expect from a visit to a dental professional and what questions they should ask. We will make this guidance specific according to the type of treatment and the setting where care is provided. Patients: Objective 4: To reduce the barriers to patients raising concerns so that problems can be resolved quickly and fairly by us or a more appropriate organisation Over the next 3 years we will do the following to meet this objective: We will improve the information we provide to patients on raising concerns about dental care with the aim of removing any unnecessary barriers to speedy and fair resolution. For example, where the concern is not one we can resolve, we will redirect the patient to a more appropriate body. We will expand the role of the Dental Complaints Service so that it covers those who have prepayment plans for private dental care and we will promote the Dental Complaints Service as an example of excellent complaints handling within healthcare so that the wider healthcare system can learn from our experience. We will work with our partners (the NHS, the systems regulators and the professional bodies) to ensure that each dental practice in the UK has an effective complaints system in place so that complaints are addressed appropriately at local level. We will work with our partners to ensure that support is available to patients who make fitness to practise complaints. Our activities in relation to patients over the next 3 years 2016 2017 2018 12 Professionals Strategic Aim: We will support dental professionals to deliver high quality dental treatment By 2018 our ambition is to have a much stronger working relationship with the dental professionals we regulate. We will understand better the circumstances in which dental professionals operate, we will provide a better service to them and we will support them to deliver high quality care to patients. Professionals: Objective 1: To gain a full understanding of the implications for dental professionals and current dental practice of the decisions we take to protect patients. Over the next 3 years we will do the following to meet this objective: We will seek the views of dental professionals, their representative bodies and indemnity providers before we act to ensure we understand the practical implications of our regulatory decisions. We will undertake research and gather data to gain a better understanding of the circumstances in which dental professionals currently practice and the challenges that they face. We will use this information to inform the standards that we set and to ensure that there is a better understanding of dentistry right across the GDC. Professionals: Objective 2. To ensure that dental professionals are properly trained in the skills necessary to practise dentistry safely from the outset. Over the next 3 years we will do the following to meet this objective: We will gather data and undertake research on patient care to inform our approach to regulating the education and training of the dental profession. We will make appropriate amendments to our Standards for Education to ensure that all newly qualified dental professionals are fit to practise in accordance with current dental practice needs, recognising that the needs of the dental workforce is changing. We will continuously analyse the data that we have about the performance of education and training providers to identify areas of training which can be improved and to share examples of best practice. We will set out these lessons learned in an annual report on the state of dental education and training in the UK. 13 Professionals: Objective 3: To support dental professionals in keeping their skills up to date throughout their career. Over the next 3 years we will do the following to meet this objective: We will introduce a new scheme of enhanced Continuing Professional Development for dental professionals aimed at providing clearer guidance and support to enable them to keep their skills up to date. We will work with the dental sector to improve the quality of Continuing Professional Development training and courses which dental professionals can access. We will publish an annual report on the types of complaints we receive with the aim of highlighting issues that need to be addressed through education, training and through Continued Professional Development. Professionals Objective 4: To guide dental professionals in meeting the standards we set for them, taking into account patients’ current needs. Over the next 3 years we will do the following to meet this objective: We will pass on to dental professionals our understanding of patients’ needs and provide guidance on how to meet these needs through complying with the standards we set. We will make information about our standards available to dental professionals in an engaging and accessible format using the most effective information technology so that the standards become embedded into their everyday practice. We will work with our partners in the NHS and other regulators to ensure there is support for dental professionals who are experiencing stress and signpost them to places where they can receive support. Professionals Objective 5: To take quick, fair and proportionate action through our fitness to practise process when dental professionals do not meet the standards. Over the next 3 years we will do the following to meet this objective: We will reduce the length of time it takes to investigate a complaint under our fitness to practise process. 14 We will use a change in the law to reduce the number of fitness to practise cases which go to a final hearing and we will continue to campaign for wider changes in the law to reform the way we handle complaints so that we can be more efficient and effective. We will put in place measures to ensure that dental professionals receive good customer care when they go through our Fitness to Practise process and that the stress caused by the process is minimised as far as possible. We recognise that being the subject of a fitness to practise investigation can be very stressful for a dental professional, and as well as impacting on health can impact on professional performance. We will explore how we can minimise the stress caused by the fitness to practise process itself, as well as improving signposting to appropriate means of support. We will support those registrants who act as “whistleblowers” within dentistry. We will publish guidance for dental professionals on how to raise concerns about poor practice (in relation to their duty of Candour) and will provide additional support to dental professionals who make Public Interest Disclosures to the General Dental Council through the introduction of a national helpline. Our activities in relation to professionals over the next 3 years 2016 2017 2018 15 Partners Strategic Aim: We will work with our partners in the dental sector to protect patients, improve the quality of dental care and make the system of dental regulation and complaints in the UK more effective. We recognise that the GDC can only be effective in protecting patients and supporting professionals if the wider system of dental regulation, including the role played by the NHS and the systems regulators is effective. By 2018 our ambition is to have transformed how dentistry is regulated in the UK and how complaints about dentistry are managed. We want to do this by working with our partners to build a regulatory and complaints system which ensures that the issues of concern are dealt with at the most appropriate level. Partners Objective 1 To listen to and develop effective, collaborative relationships with our partners in the NHS, other regulators, providers of education and training and the wider dental sector. Over the next 3 years we will do the following to meet this objective: We will establish a stakeholder reference group of all our partners in the Dental Sector which we will use to develop new and more effective ways of working. We will actively support the Royal Colleges in their work to improve standards in dentistry and we will work with Health Education England, NHS Education Scotland and other workforce planning bodies to ensure that the dental workforce meets the healthcare needs of the population both now and in the future. We will contribute to, and actively support, the development of new models of regulation by the Care Quality Commission, the Healthcare Inspectorate in Wales, Healthcare Improvement Scotland and the Regulation and Quality Improvement Agency in Northern Ireland. Partners Objective 2: To work with the NHS, other regulators and stakeholders to improve the overall system of dental regulation. Over the next 3 years we will do the following to meet this objective: We will work with partner bodies to ensure that concerns about the performance and conduct of a dental professional are dealt with by the appropriate body which could be the employer, the NHS, the system regulator or the GDC. We will evaluate the pilots that we have in place with the NHS in England to promote effective joint working between the GDC and the NHS at local level where there are concerns about an NHS dentist’s performance or fitness to practise. If these are successful we will roll them out across the rest of England and the other countries of the UK. 16 We will implement the recommendations of the national Regulation of Dental Services Programme Board in England which seeks to reduce overlap, duplication and unnecessary burdens on dental professionals. We will look to extend this approach to the other 3 countries of the United Kingdom. We will build on the information sharing agreements that we have in place between the GDC and the NHS and other systems regulators to ensure that all relevant organisations are made aware, in a timely manner, of potential risks and issues of concern about dental practice, as and when they arise. Partners objective 3: To work with partners to improve the overall system of handling patient complaints about dental care. Over the next 3 years we will do the following to meet this objective: We will carry out research and gather data to determine how effective the complaints system is within both public and private dentistry in the UK with the intention of providing recommendations for improvement. Using this data we will work with our partners, including the Departments of Health, the NHS and the Parliamentary and Health Service Ombudsman to design and develop a more effective system for handling complaints so that it works effectively for patients and professionals. Our activities in relation to Partners over the next 3 years 2016 2017 2018 17 Performance Strategic Aim: We will become a high performing regulator which has the confidence of patients, the public and dental professionals. Our ambition is to be an efficient, effective and innovative regulator which meets the standards set by the Professional Standards Authority. We will be transparent about our performance and we will seek to reduce our costs whilst at the same time enhancing the quality of the services that we provide to professionals and patients. We will learn from examples of best practice elsewhere and share our examples of best practice with others. We will seek feedback on our performance so that we can continuously improve. Performance objective 1: To improve our performance across all our functions so that we become highly effective as a regulator Over the next 3 years we will do the following to meet this objective: We will reduce the time taken to investigate a fitness to practise complaint. We will improve the timeliness and accuracy of all of our fitness to practise decisions and we will quality assure decisions at all stages of our fitness to practise process. We will introduce case examiners to our Fitness to Practice process and introduce undertakings to avoid costly and unnecessary cases going to fitness to practise panels. We will improve the customer service experience by ensuring that by 2018 dental professionals will be able to manage all aspects of their registration online. We will review how we inspect education and training providers and learn lessons for improvement and implement changes. We will improve how we communicate with professionals, patients and our partners – including revising our website - and we will measure how successful we have been. We will invest in our staff, through providing high quality training and induction so that staff will be properly equipped to deliver more efficient and effective services. We will introduce a system of performance related pay to reward high performance. Performance objective 2: To improve how we manage our resources so that we become a more efficient regulator. Over the next 3 years we will do the following to meet this objective: We will reduce costs through reviewing each of aspect of our business and the organisational structure as a whole. 18 We will ensure that we only charge registrants the amount it costs us to regulate them whilst maintaining an appropriate level of reserves. We will review the location and accommodation for our staff. We will consider innovative solutions to ensure that our estate delivers value for money whilst meeting the needs of our business effectively. We will continue to review and develop our internal IT systems to ensure they meet the needs of our business, and deliver value for money. We will benchmark our performance against other regulators and we will learn from their best practice and how they have achieved efficiencies. Performance objective 3: To be more transparent about our performance so that patients, professionals and our partners can have confidence in the GDC. Over the next 3 years we will do the following to meet this objective: In addition to our annual report, we will publish an annual statement setting out how our funds are spent on each of our statutory functions and what we have done to keep costs under control. We will set challenging Key Performance Indicators for all aspects of our business to ensure continuous improvement and we will publish how our operational teams are performing against these indicators. We will undertake regular customer satisfaction surveys of those who use our services and implement what we have learnt from them. We will seek patients’, professionals’ and partners’ views on the kinds of information about our performance that we should make available. We will be transparent about how we set our budget and our fee levels. For example we will publish how we forecast our fitness to practise caseload and other key drivers of our cost base. Our activities in relation to our performance over the next 3 years 2016 2017 2018 19 20