MAR
18
0

Dentists and Their Hobbies

 

 

Hobbies eh? Who has the time for them? With the crazy hours that many dentists work, the very word hobby would likely be something they come across when they read about the lives of other people, but I’m used to something that I heard back when I was active in Politics.

“Give a task to a busy person and they’ll find a way to get it done.”

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  1105 Hits
1105 Hits
FEB
22
2

To ORE or not to ORE, is that even the question?

This is one of those flashback/PTSD moments. It takes me back to a very stressful period in my life when I came close to ending it at various moments. The process of registering as a dentist in the UK for someone who was from outside the EU/EEA was onerous.

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  2903 Hits

Copyright

© Pramod Subbaraman, GDPUK Ltd, 2024

Recent Comments
Stephen Henderson

Very encouraging!

Thanks for writing this Pramod, sharing the immense challenges that you have overcome with grit determination and no doubt humour.... Read More
Friday, 23 February 2024 12:25
Pramod Subbaraman

??

Thank you Stephen
Friday, 23 February 2024 13:07
2903 Hits
JAN
07
1

Mr Dentist vs. The GDC (Not Yet Aired on ITVX)



The aim of this blog is to compare the scandalous, criminal, modus operandii of the PO and the methods of the UK regulator of dentistry, the General Dental Council [GDC]. There are many, many similarities in the way they persecute their "underlings" by abusing their power, and their institutionally ingrained, total lack of corporate insight.


Following the TV programme and the national outcry; politicians have now got involved in the idea of stopping the involvement of the PO in appeals by postmasters. This interference in justice, and in the fight to maintain power, the PO continues to delay the outcome of clearing the names of every single sub postmaster who has been convicted, injured, or lost money. This behaviour is the same as GDC being involved in appeals against its' own decisions. This has created a duplicate, in the denial of the basic human right to unfettered justice.

 

What has gone wrong in our UK QUANGO based governance system? The Government seems unwilling or unable to control the excesses of the QUANGO. The QUANGO gets involved too far into the quasi-judicial process. The QUANGO wishes to be judge, jury, appeal court, and the executioner. The balance of power has gone way too far towards these seemingly unaccountable bodies.

 

This must change urgently as this power has been used malevolently, yet their actions are still being justified by the GDC, and the Post Office.

Governance malfunctioning continues, and GDPUK has a further news story [due to be published in early January] on the same topic whereby an appeal in the High Court strongly supported by an eminent Judge against the GDC, is now to be appealed against by GDC, at further excessive legal cost to registrants.

There are so many examples of the GDC's egregious institutional behaviour, too many to list here.

During the last decade, GDC were pursuing so many dentists for alleged offences, they almost ran out of money, and this funding was and is raised entirely from its' registrants.  To repair their finances, GDC decided unilaterally to increase its' financial reserves to remain at around £30 million, this was done by taking about £750 from each of 40,000 registrants over a few years, and placing those monies in its reserve fund which must earn a good sum annually.

During this time the GDC Fitness to Practise [FTP] operation was faced with long delays in justice, and this delay remains today. The Professional Standards Authority report condemns this aspect of the GDC operations year after year, yet nothing changes. 

In this period the GDC advertised, [only the once, we believe] in a national newspaper, for more complaints against dentists. This was not repeated due to the enormous exclamation it produced. Was this part of a plan to investigate more dentists and build a larger quasi-non-governmental empire?

The tragic topic of suicides: Sadly, the ITV drama did refer to suicide and depressive illness caused by the PO treatment of sub-Postmasters. Unfortunately dental colleagues are only too aware of this issue in dentistry too. The GDC have been questioned for many years on this matter. They have not had to grace to answer this question properly despite multiple FoI requests.

GDC and their output of information: GDPUK does have an axe to grind; the GDC press and media office continues to refuse to engage with GDPUK, and it’s team of writers. That is, unless one of their junior managers emails us by accident.

Others have also found GDC far from co-operative, and this management style reflects the PO methods. Freedom of Information requests have become possibly the only way to seek answers, and there are multiple [dental] authors who specialise in carefully crafting artful requests to get some information released. It is apparent GDC devote significant resources dedicated to the dark arts of not responding at all, delaying responses, not answering the question, and then of course, redacting answers before sending out.

A simple solution to this would be insight by the GDC as a whole. The Council members and the executive officers. Make the press office transparent, give answers to questions in an honest way, do not act as if there is something to hide in every single enquiry. The present behaviour tells all colleagues across the nation – GDC is guilty of bad behaviour, it is doing everything to obfuscate. And this behaviour in hiding the facts further increases the profession’s suspicion of corporate malpractice.

The Care Quality Commission [CQC], another regulator of dental practice, cannot be spared from criticism here, either. They announced their arrival on the scene about 15 years ago, by publicly threatening dental practices with closure if they did not comply with their petty impositions of tasks and non existent regulations. The CQC has in itself spawned an industry of compliance experts to ensure a dental practice is not closed down. They have ruled by fear for many years, with threats to close the livelihood of dental practices. One example of their stupid over-reach, for more than a decade, every dental practice had to have a nutrition policy for their patients - even though patients do not eat or need to be fed for their dental practice visits. It is confirmed "meeting nutritional needs" remains one of the eleven core standards demanded by CQC. 



The ITV programme, a sensitive and sympathetic tale, has exposed some of the systemic issues within our nation. Individuals in influential roles in the Post Office, indifferent to the concerns of the sub-postmasters, they ignored outside investigations, and prolonged the ongoing problems for the victims.

This unfortunate reality is evident daily to our self-serving politicians, and this TV drama has brought it to the top of the national agenda. It's essential for politicians to reflect deeply, a truly long hard look at the harm being caused in the name of running our country.

Whether this is about the GDC or the Post Office, this is really about the abuses of power by people who hold those reins. The power of unaccountable civil servants or Quangos [from traffic wardens, housing officers to name but two groups) have over the general public. How they systematically exert that power over us daily, it certainly seems unjustified, and more than unreasonable.

Our politicians must establish a stronger framework of accountability to elevate standards comprehensively. After they make a transparent solution in the management and style of the PO, their next target for total reform must be the GDC.

 

1. The ITV page for the programme

2. CQC Regulation 14 

  2749 Hits

Copyright

© Tony Jacobs, GDPUK.com 2024

Recent comment in this post
Jim Page

Thank you for all you do for t...

Dear Tony I have now been retired for over 10 years but can I thank you for all you do for the profession that my grandfather, my ... Read More
Monday, 08 January 2024 17:34
2749 Hits
NOV
27
0

The Crossing of Greenland Pt. II



For the past couple of days, we’d been skiing in that ping pong ball again, the continuous white-out making us long for the day when we would see a horizon. On day 19, we were unsurprised to wake up to zero visibility and the morning satellite phone call to Norway failed to fill us with optimism for the day ahead. A storm was due to hit that evening, the high wind speeds making it too dangerous to continue. 

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  1755 Hits

Copyright

© Cat Burford, GDPUK Ltd, 2023

1755 Hits
OCT
17
0

The Polar Adventure continues to Greenland

Greenland – a country we could all locate on a map with relative ease, but a place that is otherwise a mystery to many. For those that choose to venture there, it is often a once-in-a-lifetime experience, the ultimate goal being to cross the Greenland ice sheet, the second largest body of ice on the planet.

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  2079 Hits
2079 Hits
JUL
20
0

How to buy a dental practice in six key steps — advice from specialist dental lawyers

 

Buying dental practice edited

Looking to buy a dental practice? Here, corporate law and dental specialists Eugene Pena and Kirsty McKenzie-Hopkins explore the six key steps in the purchase process, answering the most common questions from budding buyers.

 

1. Find the right legal team

In our experience, no transaction is ever the same. Once you have found the right practice and are in a position to start the buying process, your first step should be to find the right lawyers to represent you and guide you through the process. You can instruct lawyers even before you’ve made an offer.

You should consider working with lawyers that specialise in the dental sector — in particular, those with significant experience in buying and selling dental practices.

Most sellers are keen on a speedy transaction, so having the right team in place will put you in the best possible position.

 

2. Consider funding

Next, you’ll need to know how the purchase is going to be funded. Most lenders will require you to have a deposit, so having this ready and being able to show how this amount has accumulated will save you time further down the line.

The more information you have available at the outset, the better. Knowing what type of security the bank will take will also help your lawyers to determine what additional work (if any) will be required.

 

3. Terminate your contract

Buying a practice can be a lengthy process. Most first-time buyers are also associates working elsewhere and are required to give notice to terminate their contract.

Timing when to hand your notice in is key. While this decision is ultimately yours, having expert lawyers who are aware of the process and the intricacies involved in dental transactions, as well as the potential issues that may arise, can help to ensure that you aren’t left without work. They can provide guidance and help to reduce the risk of you being left without a source of income.

 

4. Recruit your team

You may be eager to make your mark as soon as you get the keys to the practice, but recruitment is a big issue in most sectors and dentistry is no exception.

You may be acquiring a well-established practice with members of staff that have worked there for many years. While there are regulations that protect employees’ rights, it’s possible to implement certain changes (known as measures) — but you’ll need to consider how any changes (whether big or small) would affect the workforce.

It’s usually a good idea to maintain the status quo (provided that it’s working) until you’ve embedded yourself with the team.

 

5. Register with the CQC

Be prepared to go through a CQC (Care Quality Commission) registration process. This may differ depending on the type of practice you’re looking to acquire.

First time buyers may be asked to attend a fit person interview with a CQC assessor, so preparation is key. Again, having lawyers who are familiar with the CQC process is crucial to enable a smooth purchase. Your solicitor may even be able to make the application for you.

 

6. Manage time effectively

Finally, a simple but critical piece of advice — don’t leave things until the last minute. Set time aside to deal with matters related to your purchase — sometimes, the last thing you want is to read an email from your lawyer or action any documents, but always try to keep your end goal in mind. Make sure that you know what you’re signing up to and allow time to negotiate any points that you’re not fully comfortable with.

If, for example, you have agreed that the seller will be remaining as an associate, try to finalise the agreement in advance of the exchange of contracts. Even if you have agreed headline terms with the seller, circumstances may have since changed — so you don’t want to be renegotiating terms late in the transaction.

 

How we can help

Buying a dental practice may well be one of the biggest decisions you ever make. Avoiding common pitfalls by having an expert legal team with specialist dental experience makes a huge difference. You need a team that can calmly guide you through each step of the process.

We are proud to provide market-leading legal solutions to dental practices across the UK. Our dental team contains true specialists who understand the unique pressures you face.

We play an active role in the market for dental practice sales and purchases, working alongside third-party brokers to ensure smooth transactions. Advice is provided across multiple specialist practice areas, including practice sales and acquisitions, property acquisition or leasing, property disputes, regulatory (including a CQC application service), fitness to practise, litigation, international recruitment, employment and litigation.

Talk to us by calling 0151 600 3000 or complete our contact form and have a member of our team get in touch.

  2751 Hits
2751 Hits
JUL
06
0

Do I need a specialist dental lawyer when buying or selling a practice?

Specialist-lawyers_edited

We’re in the middle of a cost-of-living crisis and dentists are not exempt. When buying or selling a dental practice — likely one of the most important decisions in your life — cashflow is key. So should you spend money instructing a specialist dental lawyer or go with a generalist ‘high street’ option?

In our latest Q&A with leading law firm Brabners, corporate law and dental specialists Eugene Pena and Kirsty McKenzie-Hopkins weigh up the pros and cons.

Niche area of law

On average, dental sales and purchases take around six months to complete. However, this can be extended by a range of external factors, so a deep level of understanding and forward planning is key.

Law, like dentistry, has its specialist areas. The rules and regulations affecting the dental industry can be subject to change at both national and local levels. Instructing a specialist dental lawyer ensures that the advice you’re receiving is in-line with the most up to date law.

Dealing with complexities

There are also many dental-specific complexities during the buying or selling process that only those with years of sector expertise will know how to navigate. These include the transfer of NHS contracts from sellers to buyers, ensuring that the correct CQC (Care Quality Commission) applications are carried out, the transfer of capitation schemes and conducting due diligence.

For buyers, entering into an agreement without asking the right questions could be a costly mistake. It’s critical to take due care in reviewing all documents thoroughly. Any terms that are out of the ordinary in a standard general dental services (GDS) contract will be picked up by specialist dental lawyers, who review these regularly.

For sellers, the need to respond to specific questions about the NHS, CQC and capitation schemes is very common.

Providing tailored advice

A specialist dental lawyer will ask the right questions — tailored to your specific circumstances — and will ensure effective collaborative between you and your legal team. This is essential for smooth transactions. If issues arise, you need a legal team that can draw on its experience to get all parties back on track.

High street lawyers with little or no experience in dental practice sales and purchases may take longer to understand the process and suggest an appropriate strategy. This could cause huge delays, spiralling costs and ultimately jeopardise transactions.

Before you instruct a lawyer, think carefully about the level of support and experience you need.

How we can help

We are proud to provide market-leading legal solutions to dental practices across the UK. Our dental team contains true specialists who understand the unique pressures you face.

We play an active role in the market for dental practice sales and purchases, working alongside third-party brokers to ensure smooth transactions. Advice is provided across multiple specialist practice areas, including practice sales and acquisitions, property acquisition or leasing, property disputes, regulatory (including a CQC application service), fitness to practise, litigation, international recruitment, employment and litigation.

Talk to us by calling 0151 600 3000 or complete our contact form and have a member of our team get in touch.

  1983 Hits
1983 Hits
JUL
03
0

Chamonix: Exploring Glacier Travel, Crevasse Recognition, Rescue and Polar Classroom Preparations

Chamonix: Exploring Glacier Travel, Crevasse Recognition, Rescue and Polar Classroom Preparations

My time in Chamonix could have got off to a better start. I was unaware of my dependence on my phone until the moment I left it on the plane seat, my reliance soon becoming painfully clear. Hotel details, navigation, pin numbers, email passwords, AirBnB address, camera-my entire life was on that device.

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  3053 Hits
3053 Hits
JUN
17
0

Emergency Oxygen and that supplier - Q&A blog by Brabners

Emergency Oxygen and that supplier - Q&A blog by Brabners

Following the news of an urgent recall of emergency oxygen cylinders from one supplier, Hewi Ma of Brabners LLP writes a Q&A blog on the topic, especially aimed at a buyer or seller, in the present timeframe.

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  1756 Hits
1756 Hits
MAY
15
0

Overseas Recruitment in Dentistry - Legal Q & A's In the Dental Business - Part Three

Legal Q & A's In the Dental Business - Part Three

 

In the third of her series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses employing overseas workers.

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  2304 Hits
2304 Hits
MAY
03
0

Training for my Antarctic Expedition

Training for my Antarctic Expedition

I was under no illusion that preparing for an expedition to the South Pole was going to be easy. It requires physical and mental preparation, developing skills and experience in navigation, glacier travel and being able to recognise and avoid crevassed terrain. The necessary tick-list I received when I started this journey, rom Steve Jones, was a definite reality check. I knew that there was a big challenge ahead of me and that I would need to push far beyond my comfort zone to achieve it. The key to my success was going to be my training.

My initial preparation began with reaching out to two polar veterans, Wendy Searle, the 7th woman to reach the South Pole solo and unsupported, and Louis Rudd MBE, the first Briton and second person to ski solo across Antarctica. As mentors, their insight, expertise and connections have been invaluable, and they have helped me to gain the skills and confidence I need to face what lies ahead.

An important aspect of my training was finding the right coach. Jon Fearne of E3 coaching has a proven track record of training female polar explorers. Every week I am sent tailored training plans, focussed on building my endurance, strength and cardiovascular fitness that are monitored through an app. I train within certain heart rate zones, the aim being, to achieve maximum performance in Antarctica without sweating, which increases the risk of hypothermia. I carry out repeated drills, such as setting up and dismantling camp in the thick gloves which I will wear on expedition. All of this is to form muscle memory and to increase speed and efficiency when out on the ice.

Training for my Antarctic Expedition

To mimic the experience of pulling of a pulk, I spend many hours hauling a tyre along the Cornish coastline. As you can imagine, this does not go unnoticed, and 18 months in, I still manage to raise a smile as someone inevitably remarks, “ooh, that looks tyring”, the sarcastic sound of the snare drum and cymbal repeating “ba-dum-tss” in my head every time!

Behind the beauty of Antarctica is isolation and danger. Its landscape is a testament to the forces of nature and it’s a full body workout to navigate the large areas of sastrugi (wind-formed ridges of snow and ice that can reach several metres in height). The upper body and core requires just as much fine tuning as my legs.

Managing my mental state during the isolation is somewhat uncertain and difficult to prepare for. I’m reassured by my positive attitude to adverse conditions during training expeditions, but I am also not naive to the fact that this might be one of the most challenging aspects. The monotony of the landscape and the lack of interaction has led to some solo expeditioners to experience hallucinations……from chats to long lost grandparents on the bus, to small bald-headed men hiding behind sastrugi, I can’t deny that I am somewhat curious as to what my hallucinations might be!

Mental training will include visualisation exercises and mindfulness practices, but in reality, I have got to hope that my mental toughness has developed throughout my life experiences.

I still have some big training milestones to achieve over the next few months, but as with everything, I am concentrating on what is next on the list to avoid feeling overwhelmed with the larger picture. May will see me back on Dartmoor for further navigation and GPS training, then toward the end of June, I’m off to Chamonix to gain experience in glacier travel and to look at my route options in detail with an ALE guide. By the time August comes, I should be fit and prepared enough to take on the most difficult test to date, a 3 and a half week crossing of the Greenland ice cap, where I will try my best to disguise my fear of polar bears, or at the very least, ensure I don’t look like their easiest meal!

I hope that this overview has given you just a taste of the training required. I was never in the scouts (more an air-cadet kind of girl), but their motto ‘Be Prepared’ seems a sensible one to follow and I know that I can never be too prepared for the challenge that awaits.

Perhaps spare a thought for me on a Sunday morning, knowing that whatever the weather, I’ll be out there, dragging a tyre or two, imagining myself to be on the breath-taking and unforgiving terrain of Antarctica. I definitely find myself having to dig deep, but the motivation comes from imagining the reward that awaits if I have the right mindset and put the training in.

Training for my Antarctic Expedition

  3331 Hits
3331 Hits
MAY
02
0

Dentistry’s biggest questions answered

Dentistry’s biggest questions answered

Are you struggling to recruit and retain good staff? Are you thinking about leaving the NHS and moving into private practice? Is your practice being affected by the cost-of-living crisis?

Questions! Questions! Questions!

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  724 Hits
724 Hits
APR
28
0

Sell the ‘why’, not just the ‘how’

Chris Nicholson, Practice Plan Regional Support Manager.

Practice Plan Regional Support Manager, Chris Nicholson, talks about the importance of increasing understanding in helping patients to maintain their own oral health to prevent future dental problems.

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  959 Hits
959 Hits
APR
06
0

Five reasons why now is a good time to go private.

Suki Singh

Practice Plan Area Sales Manager, Suki Singh, gives five reasons why now is a great time to make the move to private dentistry.

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  607 Hits
607 Hits
MAR
30
1

My Solo Unsupported Expedition to the South Pole

Cat Burford - Dentist & Explorer

I find myself writing this, surrounded by expedition gear, a day before leaving on a Polar training expedition in Finse, Norway. It’s fair to say that my life has never felt so busy and varied as the past 12 months since admitting to myself and the world that I would be embarking on a solo, unsupported expedition to the South Pole.

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  2334 Hits

Copyright

© Cat Burford, GDPUK, 2023

Recent comment in this post
Tony Jacobs

Good luck!

Hope it all goes well - stay safe
Tuesday, 04 April 2023 20:58
2334 Hits
MAR
24
0

Legal Q & A's In the Dental Business - Part Two

Hewi Ma of Brabner Solicitors

In the second of her series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses common legal pitfalls in the business of Dentistry.

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  6192 Hits
6192 Hits
MAR
22
0

How does the 2023 Budget affect my pension?

Pension 2023

Jeremy Hunt revealed the contents of his 2023 Budget in the House of Commons last week. Amongst announcements on household energy bills, free childcare and corporation tax, the Chancellor unveiled surprise changes to the pension tax regime that could benefit anyone who is a higher earner.

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  1181 Hits
1181 Hits
FEB
27
0

Legal Q & A's In the Dental Business

Hewi Ma of Brabner Solicitors

In the first of her new series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses common legal pitfalls in the business of Dentistry.

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  2011 Hits
2011 Hits
JAN
23
0

CSR as an aid to recruitment and retention

Zoe Close

Practice Plan Head of Sales, Zoe Close, talks to CSR expert and coach, Mark Topley, about the part CSR can play in helping practices beat the recruitment and retention crisis.

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  668 Hits
668 Hits
DEC
27
1

30 minutes to change the world – or not

30 minutes to change the world – or not

General dental practitioners are largely paid to fix things. To examine, to diagnose, to treat and to review at whatever recall period is appropriate.

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  2261 Hits
Recent comment in this post
Mark A Speight

Spot on.

.
Monday, 10 April 2023 23:01
2261 Hits
DEC
07
0

Choose the right plan provider by scrutinising the right things

Donna Hall of Practice Plan

Donna Hall examines what practice teams need to look at when choosing the right plan provider to work with.

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  850 Hits
850 Hits
DEC
01
0

Dental Volunteers Work Magic In Malawi

Eleanor Ridge

In this GDPUK exclusive interview, Guy Tuggle talks to Dental Therapist Eleanor Ridge about her recent trip to Malawi with Dentaid.

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  2574 Hits

Copyright

© GDPUK Ltd, 2022.

2574 Hits
NOV
23
0

Contract Reform – with a dash of history and art

Dental Contract Reform

Contract reform is on the agenda again – or maybe it never left. A recent paper in the BDJ from Rebecca Harris and Rachel Foskett-Tharby of NHS England describes the problem of the current dental contract as ‘wicked’ or ‘stubborn.’

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  2604 Hits
2604 Hits
OCT
23
0

Racism

Racism

In a football season where a statue has been raised in Plymouth of Jack Leslie, a black footballer, racism is in the news. Leslie played 400 times for Plymouth Argyle in the 1920’s and 30’s, scoring 137 times in the football league. Selected for the England squad in 1925, in the form of his life, he was inexplicably then dropped.

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  1827 Hits
1827 Hits
OCT
01
0

Patient complaints - inevitable but not irrevocable

 

Len D'Cruz

Suki Singh talks to dentist and Head of Indemnity at the BDA, Len D’Cruz, about the inevitability of complaints and how to prevent them from escalating.

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  1381 Hits
1381 Hits
SEP
23
0

Why now is the best time to begin your retirement planning

Paul Barnfather, Specialist Dental Financial Adviser for Wesleyan Financial Services, shares how there is a cost when delaying financial planning for retirement.

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  1793 Hits
1793 Hits
SEP
21
1

Update on antibiotic prophylaxis and infective endocarditis

Much separates the UK for the USA.

An ocean, obviously.

And language - ‘Two nations divided by a common language’- a comment variously attributed to George Bernard Shaw or possibly Oscar Wilde or even Winston Churchill. 

I mean, who knew that the exhaust pipe on your car is a muffler and the bonnet is a hood? Chips/crisps, fries/chips, pants/trousers, jelly/jam – the opportunities for misunderstanding are endless.

When it comes to the differences in advice with regard to management of patients at risk of infective endocarditis (IE), the chasm between the UK and the USA is very wide indeed.

The American Heart Association (AHA) continues to recommend that antibiotic prophylaxis (AP) is given to those undergoing invasive dental procedures (IDP) and at risk of IE.

Those at increased risk of developing IE include people with

  • acquired valvular heart disease with stenosis or regurgitation
  • hypertrophic cardiomyopathy
  • previous infective endocarditis
  • structural congenital heart disease, including surgically corrected or palliated structural conditions, but excluding isolated atrial septal defect, fully repaired ventricular septal defect or fully repaired patent ductus arteriosus, and closure devices that are judged to be endothelialised
  • valve replacement

IDPs which should be covered by AP are defined as

  • extractions and other surgical interventions such as biopsies, implant placement and periodontal surgery
  • scaling and root planning
  • endodontic treatment

The European Society of Cardiology (ESC) recommends that AP is restricted to those at highest risk of IE.

However, in the UK, since 2008, the National Institute for Health and Care Excellence (NICE) guidance has stated that “antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.”

The evidence for the use of AP before IDP’s appears to be lacking and causal links with bacteraemia’s from tooth brushing have been suggested. Despite research published in 2013 which found an increase in IE in the UK followed a decrease in AP prescriptions subsequent to the issue of the 2008 guidelines, the NICE recommendations have largely remained unchanged since then.

However, a recent paper in the Journal of the American College of Cardiology, by Martin Thornhill of Sheffield University and colleagues, provides evidence that an association between IDP’s and the development of IE in at risk individuals. Using diagnostic, treatment and hospital admission coding from almost 8 million case records, it was found that the chances of acquiring IE following extractions or other oral surgical procedures were significantly increased for those at high risk. Where AP was provided (in 32% of cases) there was a significantly reduced risk of acquiring IE. The low rate of compliance with the AHA advice about AP is possibly explained by a lack of understanding of the guidance or a belief that AP is the responsibility of the cardiologist, not the dentist.

The authors suggest that their findings “provide evidence to support the current AHA and ESC recommendations that those at highest risk of IE should receive AP before IDPs”, implying that the current NICE guidance is out of date.

NICE guidance to UK dentists continues to be that AP is not routinely recommended and that

“Healthcare professionals should offer people at increased risk of infective endocarditis clear and consistent information about prevention, including:

  • the benefits and risks of antibiotic prophylaxis, and an explanation of why antibiotic prophylaxis is no longer routinely recommended
  • the importance of maintaining good oral health
  • symptoms that may indicate infective endocarditis and when to seek expert advice
  • the risks of undergoing invasive procedures, including non‑medical procedures such as body piercing or tattooing.”

So - watch out for new guidance soon!

But for TMD, there’s a bridge over the pond!

The regular reader of this blog (there’s probably only one, I’m a born pessimist) may recall that the first in the series, back in January, discussed the management of tempero-mandibular disorders (TMD) and asked to whom patients should be referred. Given its links to other chronic pain conditions, a multi-disciplinary approach to care and management seemed appropriate.

And here’s a move towards that. A recent paper in the British Dental Journal – A commentary on Tempero-mandibular disorders: priorities for research and care – bridging from the US to the UK (Durham,J, Greene,C and Ohrbach,R) reviews work from the US indicating that ‘the current dental-focussed treatments for TMD must be re-conceptualised toward a multi-disciplinary, inter-professional team approach, involving specialists within the broader healthcare community.’ International co-operation to create registers to gather data on patients’ health and treatments should provide sufficiently large datasets to allow the development of clinical guidelines for patient care. Centres of excellence for treatment are proposed for treatment of TMD s and management of oro-facial pain. Already in the UK, a National Orofacial Pain Alliance has been set up, drawing together the expertise of oral surgeons and clinical psychologists.

So, as we move into fall, perhaps we can take a rain check on our dental differences with the USA, and wait to see how NICE has gotten on with some new guidance.

  2157 Hits

Copyright

© GDPUK Ltd 2022

Recent comment in this post
Tony Smith

Rheumatic fever

Around 1980 my Dad needed an extraction, I told my Dad to tell his dentist about his history of rheumatic fever, which he did, aft... Read More
Sunday, 02 October 2022 18:33
2157 Hits
AUG
17
2

Dental recalls – a prickly subject

Porcupine

Porcupines – literally ‘spiny pigs’ - have a gestation period of about six months, which is completely irrelevant to dentistry but a useful introduction to the subject of recall intervals for dental patients.

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  3469 Hits
Recent Comments
Tony Smith

Dental, Health examination

In the 80's on the NHS, "recalls" were 5-minute affairs, when I finished 20 minutes. As the public sees and trusts us regularly, w... Read More
Tuesday, 30 August 2022 12:26
David Rundle

6 monthlies

I have often wondered about the logic of 6 month recalls, but the experience of delaying Recalls to 9/12 months, as a result of th... Read More
Friday, 02 September 2022 14:36
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NHS Contract changes. What they said and what they meant*

NHS Contract changes. What they said and what they meant*

Your NHS dentistry and oral health update

19 July 2022 (Issue 50)

An update from Sara Hurley and Ali Sparke

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20
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Sex, Gender and Orthodontics

You don’t have to hang around on Twitter for very long these days to discover that there are some subjects you cannot raise without receiving a barrage of opinion and sometimes abuse from both sides of the argument. Accusations of being a (insert subject here)phobe are rife.

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Peter Martin

simple answer

Child orthodontic provision has been rationed much more severely in England and Wales than general dentistry since the 2006 contra... Read More
Thursday, 04 August 2022 15:08
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Dentist Self-Employed Status; To Be or Not To Be?

Worker or Self-Employed?

 

On 16th June 2022 the Employment Appeal Tribunal (EAT) handed down its decision in a case concerning a dentist claiming worker status. This is another in a long line of cases where dental associates have claimed that they are not ‘self-employed’, but instead have worker status.

There has understandably been concern amongst the dental profession that this decision will significantly impact the future of NHS dentistry. However, it is important to bear in mind that the EAT did not determine that the associate was a worker, only that the original employment tribunal’s determination that she was not had been incorrectly reasoned. The case will now return to the employment tribunal for rehearing.

Crucially, this is not a current case, in that the associate in question was working under a 2010 version of the BDA contract; a contract that since has been updated on at least two occasions.

Whilst some important points have been raised by the EAT, which may require dental practices to consider their current business model, it is important to bear in mind that the EAT has not been asked to consider the current BDA contract, which no doubt was updated as a result of the spate of cases on worker status in recent years.

In this article we set out the facts of the case and comment on the EAT’s decision; as we represented the dental practice in this matter, we have an insight into the facts and findings.

The Law

Before we review the case, it is helpful to remind ourselves of the test for worker status. A person is a worker if they work under;

  1. a contract of employment, or
  2. any other contract, whether express or implied and (if it is express) whether oral or in writing, whereby the individual undertakes to do or perform personally any work or services for another party to the contract whose status is not by virtue of the contract that of a client or customer of any profession or business undertaking carried on by the individual;

The latter is often referred to as a ‘limb B’ worker. You also have to bear in mind that a person can be self-employed for tax purposes,  but a limb B worker for employment purposes.  

What the tribunal will ask itself:

  1. Was the dentist required to perform any work personally? If the answer to this questions is no then the dentist is not a worker. If the answer to this question is yes then the tribunal will ask;
  2. Was the practice a client of the dentist and was the dentist in business in their own right? If the answer is yes then the dentist is not a worker. If the answer is no then the dentist is a worker.

When looking at the first point, the courts will look at the substitution/locum clause and whether there is any ‘fettering’, or limitation, on that clause. The more fettering there is, the more likely the dentist is required to perform the work personally.

For the second point the tribunal will consider how much control the practice has over the associate; how much the associate is integrated into the practice.

The Facts

The dental practice is a corporate with locations across the country. The dentist had originally worked in Oxford, before moving to their Kensington practice 2021. The dentist was working under a contract that said:  

In the event of the Associate’s failure (through ill health maternity paternity or other cause) to utilise the facilities for a continuous period of more than 14 days the Associate shall use his best endeavours to make arrangements for the use of the facilities by a locum tenens, such locum tenens being acceptable to the Primary Care Trust and the Company….

The dental practice argued that this locum clause meant the dentist was not required to provide the services personally. Whilst the dentist had never sent a locum herself, evidence was provide to the tribunal of other dentists within the business utilising the locum clause, for example for sickness and maternity leave.

However, the contractual term only imposed an obligation to send a locum after 14 days of not utilising the facilities. The practice in response gave witness evidence that dentists within the business, as across the profession, were entitled to send a locum at any time.

The tribunal accepted that the locum clause meant the dentist was not required to perform the services personally and her claim was rejected.

Decision

By the time the case came before the EAT, the Supreme Court had handed down its decision in Uber. Whilst the Court of Appeal overall decision was the same. The Supreme Court made it clear the test is a statutory test not a contractual test. The focus should be on the reality of the of the working relationship, not the contractual one. Whilst the contract can be helpful, the courts must look at what happens day to day.

The EAT relied on this case when determining this appeal and found that the tribunal judge had relied on contractual interpretations over statutory provisions.

The EAT went on to find that the tribunal judge was wrong to find there was no fettering on the right of substitution in this case. They considered the following were such fetters:

  • the contract only allowed the dentist to send a locum after 14 days;
  • the locum must be acceptable to the practice;
  • the fact that elements of the agreement were due to regulatory requirements (registration with the GDC, being on the performers list) this did not prevent them from being taken into account when considering the fetters on the right to send a substitute;
  • the dentist had never sent a locum, which was relevant to the issue of what the true agreement was between the parties.

In the opinion of the EAT, the above all amounted to fetters on the right to send a substitute, meaning the dentist was required to perform the services personally.

The EAT did not consider the second part of the test, which has been remitted to the tribunal to consider the point by a fresh panel. This means the dentist has not yet been found to be a worker; only that she was required to perform the services personally.

Conclusion

The BDA has since updated its template to state:

The Associate

  1. may at any time; and
  2. shall, if they are unable to utilise the facilities for a continuous period of more than 14 days, use their best endeavours to make arrangements for the use of the facilities by a locum tenens.

The question now is whether the above amendment is sufficient to avoid worker status.

If you are interested in further analysis of the case, including our tips on how practices and dental associates can work together moving forward, join our webinar on 27th July 2022 at 7pm. To sign up for this webinar please email This email address is being protected from spambots. You need JavaScript enabled to view it..

Julia Furley, Barrister and Laura Pearce, Senior Solicitor

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15
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Vaping – No Smoke Without Fire

Vaping

No doubt we have all followed a car down a road, with billows of smoke emitting from an open window, and wondering whether said vehicle was on fire. Similarly, who hasn’t been walking down a pavement and been nasally insulted by puffs of bubblegum or apple pie and custard from an enthusiastic vaper?  

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Paul Hellyer

See also this link for vaping ...

https://www.georgeinstitute.org.au/media-releases/teachers-sound-the-alarm-on-school-vaping... Read More
Friday, 22 July 2022 10:48
Paul Hellyer

Further link here re vaping, f...

https://www.thenakedscientists.com/articles/interviews/how-many-people-vape-uk... Read More
Friday, 05 August 2022 09:06
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Material facts

Composite material

Back in the past, I used to hate dental materials lectures. It all seemed so irrelevant. I just wanted to know the material worked. I couldn’t get excited about the chemistry. Oh, I remember the important stuff. 

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Just Drifting

Walking to dental school one day, I met one of our professors, carrying a cage.

A conversation ensued.

‘May I ask what is in the cage, Professor?’

‘You may, Mr. Hellyer – it’s a monkey of the species Macaca Irus.’

‘Really?’.

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MAR
21
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Eyes Wide Shut

Eyes Wide Shut

There can be very few dentists who turn patients away because the challenge is too big. Even if they can’t complete treatment themselves, they’ll at least point the patient in the right direction.

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14
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The GDC, winning hearts and minds their own way.

The GDC, winning hearts and minds their own way.

Amongst the many salaries that your GDC registration fee helps to fund is that of Daniel Knight. He has the title of Stakeholder Engagement Manager, where he leads on student and new registrant engagement.

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COVID-19 – when the rubber hits the tooth

Positive tests

I have a friend who is a proper scientist. You know the type, PhD after their name, and understands all the stats stuff like Cronbach’s alpha, Spearman’s r and the Wilcoxon Rank Sum test. Their area of research was water quality and they spent 3 years gathering data from the outfall from sewage works. Three years collecting dirty water samples and theirs is the prefix of doctor and the suffix PhD.

Collecting waste water has become a bit of a trend during the Covid pandemic. The BBC reported that fragments of the virus’ genetic material can be identified from sewage, even when there are only asymptomatic cases in the area. Identification is not easy because of other contaminants but clusters of infection may then be identified before symptomatic cases appear and preventive strategies targeted earlier than would otherwise be possible.

And if the virus is shed from one end of the gastro-intestinal tract, then it’s almost certainly at the other end too. We know that the virus gets up your nose and gathers round your tonsils. Never in the field of public health, has so much sneezing and gagging gone on in the bathrooms of this country as we test, test, test, desperately hoping for that single pink line to appear on the test kit. But what about that fluid that dentists spend their time fighting against? What about saliva?

Lateral Flow tests

There have been multiple research papers published in the past months, about the link between saliva and Covid, many fast tracked for dissemination in the fight against the disease. A recent study from the US confirmed that the virus was present in the saliva of both asymptomatic and pre-symptomatic patients. A quite specific review suggests that as saliva is easy to collect and saves the need for swabs-on-sticks-up-the-nose, which are uncomfortable and pose a risk of bleeding in some cases, then saliva testing for evidence of the presence of COVID-19 might be a more acceptable test mechanism. The review found that passively collected saliva had a high sensitivity rate to detect Covid in asymptomatic and mildly symptomatic patients when compared to naso-pharyngeal swabs. Passive collection – drooling, basically – means there is no contamination of the saliva from coughing or nasal discharge.

So there’s Covid in spit – who knew? All those prevention strategies for aerosol generating procedures must have been worth it.  But as the Government appears to remove all restrictions to normal life, how long before all those restrictions on dentistry are removed? Abandoned to the whims and fancies of the asymptomatic, untested – ‘it costs money, guv’ – maskless patient. Do we assume everyone is Covid positive, just as the basis of universal precautions is that everyone carries HIV or Hepatitis C? Back to normal then, with current screening depending largely on questions regarding symptoms and test results.

When carriers of Covid can be asymptomatic and there’s no longer testing freely available, questions about symptoms and test results appear to have limited use. There may be a future for a simple saliva test, to check what precautions are necessary before treating any patient. But I suspect that would be considered discriminatory and ethically unacceptable.

What then can be added to the standard procedures to help prevent spread of Covid? A pre-operative mouthrinse reduces the viral load in saliva for between 15 and 45 minutes. Maybe a 30 second swish of Chlorhexidene or hydrogen peroxide will become the norm for everyone.

Rubber dam is of course another weapon in the armoury of the dentist to reduce contaminated aerosols in the surgery Those of us of a certain age will recall the enthusiasm of Keith Marshall’s ‘Dam it, its easy’ courses. There’s surely an opportunity here for an entrepreneurial educator to set up some hands-on dam refresher courses.

And since condom sales fell by 40% during lockdown, there may be some good opportunities for sponsorship from manufacturers as they seek alternative outlets for their rubber. Presumably there will be fewer contaminants in the wastewater, too.

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The Endgame

Throughout the 30 years of my career there have been peaks and troughs regarding the NHS dental system. Actually, the peaks (to me at least) have really only been less deep troughs, but I’m sure you will understand what I’m saying. Most of time the profession has seemed to just get on with it and accept what the various contracts have offered, and learnt to work within them (or around them in the case of a minority). What has always happened when we end up in one of the troughs though has been for dental practices to largely and stoically maintain their NHS commitment, despite the pips being squeezed that bit more firmly each time. There have always been a few practices who have moved out of the NHS to private, but the majority have stayed put.

I have my own reasons for considering why practitioners don’t opt out of the NHS and I think it boils down to the following (in no order of importance). There are likely to be other reasons that I haven’t considered so apologies If I have omitted any alternative reasons an individual may have who is reading this.

Fear of the Unknown

Fear of not having enough patients/work

Concern that there will be a proportion of the populous that cant afford private fees

An underlying need to satisfy their own socialist tendencies

Lack of confidence in their own abilities

Fear of loss of the NHS Pension

Too late in their career.

I can’t take each one of these points and discuss them as this would take too long and bore everyone senseless. However, these are the reasons I had for not taking the leap sooner in my career. Everything I felt would go wrong (for the dentists) with this contract has done, and pretty much in the way that many of us predicted right at the beginning.

It is also clear that there are those who have been able to make the NHS work very well for them (usually in a financial manner), but I am not going there in this blog.

It is very apparent though at the moment that there has never been such an uprising of dissent from the profession post Covid, and there is an increased sound of the rattling of a profession’s collective sabres toward the powers that be. I’m informed the private plan providers are gearing up to deal with an ever increasing number of practitioners who are nearer to making the jump to private dentistry than ever before. It seems that the support that was given to practitioners throughout Covid that was initially seen as generous, has now come with the sort of interest payments a government will always put on its help.

For those of us that made the jump a while ago, I can honestly say the grass is not only greener on this side, but the park-keeper isn’t some jobsworth who has no clue and enforces ever more draconian and financially difficult rules when you stray onto the grass. Actually its not really grass anymore, but a dustblown patch of earth, but it has deteriorated over so long those playing on it don’t actually notice anymore.

However, for the first time in long time, I think the profession is more united in its outlook than it has been. Whilst there is still the obvious fear of the unknown, more NHS practitioners are realising that they are unable to shore up a completely broken system and longer. They are hopefully also realising that it isn’t their fault that they haven’t got the resources (both financial and mental) to care for patients but the responsibility of the State to fund this, not them.

I’ve given up trying to count how many times a new contract has been proposed, piloted and then prototyped before being seen as unacceptable to the DHSC. More dentists must be realising that the only thing that will be acceptable to the powers in Whitehall will be the entire population being treated for less than the current NHS budget. The current crisis is showing that this is patently impossible despite the best efforts of the profession, and I suspect that FINALLY there will be a tipping point in the profession that will lead to a mass exodus of caring practitioners leaving the NHS.

At the moment, there seems to be a distinct lack of concrete offerings from DHSC as to what a new contract will contain, but only the most deluded of us would suggest it’ll be better funded for less onerous working conditions. Cynically, one would say (yet again) that this is exactly what the powers that be want, but they have to make the dentists go private of their own accord so as to avoid the government getting the bad press. I somewhat cynically think the DHSC are paying lip service to the profession by making a show of negotiating with the BDA, but in reality using successive low level civil servants on a fast track to somewhere much more important to their careers in order to practice their techniques and to see if they toe the line. I actually asked on one recent webinar with the DHSC negotiator what time his mum was going to call him in for tea…..

I think the profession has to now consider it is at the point where both sides are not really going to agree. The profession can no longer work under this pressure and provide what it is contractually obliged to do; and the government will not increase funding to the degree that is needed to improve the service and access. I think it will need such a complete rethink of how dentistry works in this country that I cant even begin to suggest an option other than a core service. However this course service would have to be funded at the current level, which we all know isn’t going to happen, as core service will be a further excuse to cut the budget rather than fund dentists appropriately for the business risks they take and the skills they have.

We should take heart that the profession now has the upper hand, but if only it chooses to realise. There are not enough of us and to increase the numbers would take years and years (and look how that has ended up with overseas dentists returning home and the GDC not able to sort out the ORE). We are still the only people who can provide the service we do, and its time for use to remember this and embrace it fully. We have to remember we are only human and cannot care for every single person at our own expense. We have to also look after our own mental health and well-being so that we can properly concentrate on delivering the high standard of care we were trained to do, and not what a system is forcing us into.

It’s time to play the endgame and win.

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No Time To Talk - The GDC and GDPs

Lord Toby Harris

For far too long, relations between dentists and their regulator have been fraught, to say the least.

This may be a situation that in practice suits the GDC very well, but appearances matter. In November last year, the General Dental Council [GDC] revealed the results of some research that it had commissioned. The aim was to ascertain dental professionals’ views on the GDC. It would be very reassuring for GDC leaders to be able to demonstrate that criticism of the regulator comes from a small and unrepresentative section of the profession. The results did not fit that narrative, indeed the GDC, experiencing a moment of insight, commented that the findings “don’t make comfortable reading.”

As reported on GDPUK at the time, negative perceptions of the GDC had actually risen from a bad 45% in 2018, to a worse 58% in 2020. To add to an already grim picture, responses also showed that over time, an increasing number of respondents felt that the GDC was actually getting worse. The finding that “students were more likely than dental professionals to associate positive words with the GDC”, could be said to offer evidence that the more dental teams came into contact with the GDC, the less they liked it.

By the GDC’s standards a veritable charm offensive followed, with Chief Executive Ian Brack and Executive Director Stefan Czerniawski explaining how they would be working to improve matters. It was announced that the recently installed Chair, Lord Harris, was starting his term by meeting key stakeholders. With the vast majority of UK dental care delivered in general practice by general practitioners and their teams, an outsider might expect that this would be reflected in some of this activity.

Since taking over from Bill Moyes, Lord Harris has written four blogs for the GDC which have been sent with its periodic emails and are also available on its website. In his first blog there was indeed reference to meeting some of those key stakeholders. He had met the English CDO, as well as the BDA, BADN and SBDN and been at the launch of the College of General Dentistry. He went on to express the view that “professional regulation is a privilege”.

By the time of his next blog Lord Harris had met the CQC and HCPC (Health and Care Professions Council) and was looking forward to meeting COPDEND and the Dental Schools Council to discuss education. He added that his belief that we should see (presumably the GDC’s) regulation as a benefit, had been reinforced.

The third blog announced a programme between January and April of meeting students and trainees which would be an “opportunity to hear from students in the early stages of their dentistry careers.” There was also a section about the benefits of regulating the whole dental team. He added that he would “continue to meet representatives of the dental professions in the next few months”

The beginning of February saw publication of the fourth blog. Lord Harris had now met with Healthwatch, and rightly pointed out that “understanding the views of patients and the public is critically important”. “However” he added, “the GDC also wants to engage with people at the start of their career in dentistry”.  They had met nearly 400 students and trainees, representing dentists, hygienists, and therapists, and were “finding them helpful to build understanding of our role and hear from members of the future dental team”.

GDP’s are trained to be observant, so readers will have spotted by now that in relation to the amount of care delivered, they barely register on Lord Harris’s radar. There was also a focus on those younger team members who the GDC’s own survey had revealed, were the group with a less poor opinion of the GDC.

Following publication of Lord Harris’s fourth blog, GDPUK contacted the GDC’s communications team with an enquiry about the Chair's meetings with GDPs and related groups. To provide some context, emails to the Department of Health and NHS England on the day of the 50 million dental funding were all answered within a couple of hours. If a respondent was unable to help they suggested a suitable colleague. It did not take long to get an answer that specifically dealt with each section of our request. GDPUK also asked the BDA about meetings with Lord Harris. A comprehensive reply came within 90 minutes.

With absolutely no response from the GDC, a follow up email was sent the next day. With the same result. After 3 emails sent on separate working days, and not even an acknowledgement, a colleague who has had similar difficulties provided an alternative contact to the one on the GDC’s website. Finally, a response confirming that our emails had been received came within a couple of hours, and not long after this, another GDC official provided their response to our enquiry. The Chair would appear to have had a busy diary which will continue over the coming weeks with many meetings. The most GDP related one to add to those in his blogs would appear to be the Association of Dental Groups (ADG). Scheduled were meetings with professional bodies including hygienists, therapists, dental technicians and dentists as well as indemnifiers.

To be fair to the GDC, when a subsequent enquiry was sent, it was responded to the following day.

GDP’s may be left wondering whether following last years uncomfortable feedback, the GDC’s chosen approach to them is one of engagement, or quarantine.

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Keith Hayes

Experiencing a moment of insig...

The GDC don't like to be put under the spotlight, it is an uncomfortable place to be, especially when there could be quite a lot o... Read More
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Tony Jacobs

Posted on LinkedIn

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05
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When a win isn’t actually a win

There have recently been many worried rumblings in the profession amongst principals about the issue of vicarious liability and non-delegable duties of care  concerning their associates after the case of Rattan (Rattan V Hughes [2021] EWHC 2032 QB). In this particular case it was found that a principal who hadn’t actually treated a patient was still liable for the negligent treatment by dental associates. 

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It’s not all black and white

Black & White

 

Last night (03/02/2022) on Dragon’s Den (BBC1 8.00pm), an entrepreneur walked away with an investment of £50,000 in her company selling cosmetic dental products – charcoal toothpaste, bamboo handled toothbrushes and home whitening kits. The company, SmileTime, is generating over £1m in sales annually online, and probably more after last night’s TV exposure.

The evidence of the efficacy of charcoal based oral products appears to be lacking. A recent paper in the BDJ stated ‘Charcoal-based dentifrices, in the absence of supporting scientific evidence, may be considered to be a fashionable, marketing 'gimmick' based on folklore.’ SmileTime’s website, however, claims that their tooth whitening kit (using ‘advanced active whitening ingredient called PAP that whitens and brightens your teeth without any pain or sensitivity’) is ‘scientifically proven to whiten and brighten teeth after a few uses as shown in the clinical trial study by the Journal of Applied Oral Science.’

So let’s look at this evidence for their tooth whitening kits. The study was published in 2017 and carried out by a team at Witten/Herdecke University in Germany. The active materials under test were a non-hydrogen peroxide bleaching agent phthalimido peroxy caproic acid (PAP) and calcium lactate gluconate (a remineralisation agent), available as an over the counter (OTC) product called iWhite. iWhite is a brand sold by Sylphar, who supported the quoted research project with funding for the materials and compensation for the participants. A disclaimer states, however, that ‘the company was not involved in the study design, the data collection and analysis, the decision to publish or the preparation of the manuscript.’

iWhite is intended as a self applied bleaching gel, using trays provided in the kits. After some explanation of the legalities of the use of hydrogen peroxide as a dental bleaching agent, the authors introduce PAP and calcium lactate gluconate (as a remineralising agent) as a novel OTC bleaching agent. For the research, they recruited 40 participants (the paper doesn’t say how they were recruited) and randomly divided them into an active group and a placebo group. The active group received application of iWhite and the placebo group received iWhite but with the active ingredient removed.

All participants were examined, confirmed as disease free and had no teeth lighter than VITA Lumin shade A2. Using the shade guide (numbered 1-16), the blinded examiner recorded tooth colour at baseline, immediately after gel application and 24 hours later, under similar light conditions (not defined). The middle one third of each upper and lower anterior tooth was used to select the shade and an average score was produced for each participant. All participants were supervised during application of the gel by the researcher.

According to their results, the mean shade score fell significantly (i.e. whiter) by about 2 points for the active group immediately after application and after 24 hours. There was no significant change in the placebo group. That’s the scientific evidence.

But there’s a few anomalies. Forty one percent of individual teeth showed no shade change. This means the gel is not as effective as it might be or, even under supervision, was unequally distributed in the one-size fits-all trays. The product is sold to be used unsupervised at home. The discussion states that the examiner found no mucosal irritations immediately after application nor 24 hours later. However, the results section states that the examiner found 5 subjects with gingival irritation in the study group and 3 in the placebo group after application. At baseline, hypersensitivity was measured by blowing air on the teeth. After 24 hours, hypersensitivity was measured by asking the subject. Even with that ambiguous method, hypersensitivity was recorded in 4 subjects. There’s no description of how the ambient light was controlled, surely important in discussing anything to do with shade and colour. The authors state that ‘the colour stability after bleaching has been largely confined to weeks or months’ – but they didn’t measure that.

On the whole, it’s all a bit wishy washy. One examiner? Why not 2 for a much stronger conclusion? Only one application? That’s because ‘the products may cause irreversible damage if used on a long-term basis.’

And I’m not convinced by the stats. A shade guide is basically a stack porcelain or acrylic teeth, named subjectively for convenience A1 to D4. You could name them white, whitey, whiter, whitest, yellow, yellowy, yellower etc etc. By ascribing numbers 1-16 doesn’t make them numbers. They are still simply labels. And just as you can’t create an average of white, whitey, etc, you can’t create a mean or average of these number labels. The mean is therefore meaningless which undermines the validity of the whole paper. But I’m happy to see if greater statistical minds come along to correct me!

Even if I’m wrong on that, the study certainly doesn’t show that the product ‘whitens and brightens your teeth without any pain or sensitivity’ as claimed on the website. The study does not show that ‘PAP formulas have been scientifically proven to whiten and brighten teeth after a few uses as shown in the clinical trial’ as claimed on the website. The study does not show that ‘results will last anywhere between 2 weeks and 3 months,’ as claimed on the website.

I can find no other in vivo research of the use of PAP as a bleaching agent, although a recent in vitro study found non-peroxide mouthwashes had minimal bleaching effect.

I guess the jury is still out.

But, as they say on Dragon’s Den, I’m afraid I’m definitely out.

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24
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The puzzle of TMD

The puzzle of TMD

There have been a few common phrases around recently that would not have been heard some years ago.

‘You’re on mute!’ in the first year of lockdown and ‘Have you had your jab yet?’ in 2021.

This year it is ‘Have you heard about Wordle?’

Wordle for those who have yet to discover it, is a web-based word game, with a 5x6 grid of boxes. Participants enter a five-letter word into the top line and are then informed, by the highlighting the relevant letters, whether the choices are either in the correct place for the word to be guessed (green) or present in that word but in the wrong place (a shade of sickly khaki). Using that information, the process is repeated on the descending lines until either the correct word is found or the 6th guess is incorrect. A new game is set each day.

Diagnosing tempero-mandibular joint disorder (TMD) strikes me as similar to playing Wordle, but without ever getting to line 6 with the correct answer. All responses to questions are about as helpful as those squares of sickly khaki.

‘Does it hurt when you open your mouth?’

‘Sometimes’

‘Does it click when you open wide?’

‘Oh yes, listen …… and it drives my partner mad at meal times.’

‘Do you grind your teeth in your sleep?’

‘Oh yes, and it drives my partner mad to 2 in the morning.’

‘Do you clench your teeth at all?’

‘Occasionally, when my partner’s mad at me.’

‘Do you get headaches?’

‘Well, my partner and I aren’t getting on too well at the moment, so yeah, I guess I do.’

‘Have you had any knocks to the head recently?’

‘Look, I said we’re not getting on too well but its not as bad as all that!’

 

And so it goes on, checking for tenderness to palpation and whether the occlusion looks OK and writing ‘TMD?’ in the notes and offering generic advice about self-care, all of which is available on the NHS website, such as don’t chew pen tops, eat soft food, take some analgesics and if it doesn’t get better, see you GP, who might refer you to a dentist (who might make you a soft bite guard).

According to a recent paper in the Journal of the American Dental Association (JADA), dentists in the USA offer similar advice. One hundred and eighty five dentists were recruited to record details of a sequence of patients attending with TMD. They recruited 1,901 subjects who fulfilled their criteria for entry to the study. Almost half of these had had painful TMD for at least 3 years and diagnoses included combinations of myalgia, arthralgia and headache. A quarter had only muscle pain and 10% only joint pain.

Treatments offered were mostly non-invasive and reversible:

  • Avoid oral habits
  • Relax your jaw muscles
  • Apply heat or ice
  • Eat a soft diet
  • Avoid chewing gum
  • Keep your teeth apart
  • Chew food on both sides
  • Reduce caffeine intake

Three quarters of dentists in the study recommended an intra oral appliance of some sort and two thirds recommended referral to ‘allied care providers.’

And there’s the rub. To whom does one refer? Who are the allies in the management of TMD? Outside of a large conurbation with a dental hospital, I suspect most end up with the local maxillo-facial surgeon. But how often is surgery required? Orthopaedics, maybe – that speciality which diagnoses and treats ‘a wide range of conditions of the musculoskeletal system, (including) bones and joints and their associated structures that enable movement - ligaments, tendons, muscles and nerves?’ I’m not sure their interest stretches superior the hyoid and anterior to the atlas and axis. Oral medicine? Physiotherapy? Osteopathy? Aromatherapy?

It is perhaps not surprising that a further paper in JADA found that TMD is linked with other chronic conditions such as chronic back pain, myofacial syndrome, chronic stomach pains, migraine, irritable bowel syndrome, fibromyalgia and depression. They conclude that their review ‘supports the idea that clinicians, including dentists, treating patients who had received diagnoses of TMD should be attentive to the presence of signs and symptoms of other chronic pain conditions that could require collaborative care across medical specialities (for example, neurology, rheumatology and psychiatry.’

The temporomandibular joint is the Cinderella of all joints, falling between the specialities which may be able to help. Since 1892, it has clearly failed to be recognised as part of the ‘anatomical arrangements of the human body.’ Yet 80% of dentists report treating up 3 patients a month with TMD.

TMD therefore is not uncommon and these papers show that its diagnosis and treatment is a complex, multi-disciplinary exercise and not one to be passed down like the rows of a Wordle puzzle, eliciting sickly khaki responses in the hope of finding a successful result of 5 green squares.

Paul Hellyer BDS MSc

The puzzle of TMD

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2928 Hits
DEC
27
0

NEARLY As Bad As 2020 – DentistGoneBadd's Review Of 2021

2021 Round-up

You thought 2020 was bad? Well, 2021 wasn’t THAT far behind.

 

 

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5947 Hits
DEC
20
0

Ditch The Spreadsheet: Your Modern Day Practice Acceleration Strategy For Tracking And Managing Prospective Patients.

 

We need to talk about how dental practices manage their enquiries. Unfortunately all too often they are not treated with the attention and nurturing they deserve. 

Let me explain what I mean by that in 4 simple steps…

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1181 Hits
DEC
20
0

The Impatient Patient: New Patient Generation In The Goldfish Attention Span Era.

Over the past 20 years, I’ve been working within the UK  and American Dental Industry to support dental practices growth through a number of different engagement and marketing strategies. However, over the last couple of years, I’ve noticed that something has drastically changed.  Suddenly getting new, high-value patients has become increasingly difficult, expensive and confusing. So what’s happened?

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1643 Hits
NOV
22
0

Where have all the associates gone?

abstract-landscape-by-kevin-dooley Some truths for NHS dental commissioners

A personal opinion, by Michael Watson.

Where I live, on the borders of Essex and Suffolk, has gone from a quiet rural community where dentists just got on with the job of treating their patients to the centre of a movement, Toothless in Suffolk, which aims to go nationwide as Toothless in England.

Two of their aims are to have an NHS dentist for everyone and reforms to the NHS dental contract that will encourage dentists to provide NHS treatments. Both of these will require more associates, who to put it simply are not there.

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4096 Hits
NOV
08
0

GDPUK asks, Should the BDA step back from Toothless Suffolk?

Throughout 2021, the British Dental Association [BDA] has been at the forefront of moves to tell politicians of the challenges facing dental services across the whole of the UK. It joined with Healthwatch England in calling on the Chancellor to provide vital funding for the recovery and rebuild of services, a move backed by 40 cross-party MPs.

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2384 Hits
OCT
29
1

Should dental practitioners brace for a surge in professional negligence claims?

Should dental practitioners brace for a surge in professional negligence claims?

David Hallsworth, a solicitor at BLM specialising in healthcare claims, discusses a potential surge in future dental claims as a result of thousands of children missing crucial check-ups during the pandemic.

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Recent comment in this post
Richard Bannister

Comment

Practitioners were limited by NHS orders.... therefore is it not the NHS that is 'negligent' for not providing some sort of cover?... Read More
Friday, 05 November 2021 08:48
2648 Hits
AUG
08
0

Public benefits from a GDC Lay Chairperson?

GDC-chair-clinical GDC Chair - Registrant or not?
 

I have seen the soft campaigning in the form of opinion pieces and social media posts by dentists active in various positions in the British Dental Association (BDA) in the weeks and months before the General Dental Council (GDC) announced their new Chair to replace Dr William Moyes who is due to step down soon. The question that forms the title of this piece was running in my mind.

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4255 Hits
JUN
23
2

Bring Back The RDO, Buzz Aldrin

Bring Back The RDO, Buzz Aldrin

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Recent Comments
David Chong Kwan

DROs

We still have RDO's in Scotland. Unfathomably now called DROs. I reckon them looking at big cases is not so fruitful. For my point... Read More
Saturday, 10 July 2021 08:29
Ivan Simmonds

DROs

I qualified in 1967. Back then we had DROs which origionally stood for Dental Reference Officers. Some "Items of Service" within t... Read More
Wednesday, 04 August 2021 22:42
6086 Hits
JUN
21
0

What Model Works?

nick-fewings-C2zhShTnl5I-unsplas_20210621-114222_1 Here, There, Everywhere
 

Once upon a time, as all the stories, good, and bad, start, a dental surgeon would have a chair of some sort in his (almost always his) south facing sitting room and ply his trade. George Bernard Shaw in the 1897 play “You never can tell” describes such a set up in the home of Dr Valentine, a “half crown” dentist. The half crown refers to the standard treatment fee, not his clinical technique.

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3905 Hits
JUN
07
0

Come On GDC - Be A Hero!

Come On GDC - Be A Hero!

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4471 Hits
MAY
24
0

How I Started To Learn To Love Humans Again

How I Started To Learn To Love Humans Again

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3764 Hits
MAY
20
0

Raisin Awareness on Social Media

Raisin Awareness on Social Media
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  3390 Hits
3390 Hits
MAY
10
0

Don’t Be A Rat – Have A Quiet Word

Don’t Be A Rat – Have A Quiet Word

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5058 Hits
APR
26
0

Backup - Protecting all of your data

Backup - Protecting all of your data

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2356 Hits
APR
26
0

Sorry Is The Hardest Word

Professionalism Means Never Having To Say You’re Sorry

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3718 Hits
APR
11
0

What is the GDC's Line of Duty?

What is the GDC's Line of Duty?

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4644 Hits
APR
05
0

Raisin Awareness

Raisin Awareness

For the last 18 months I have been campaigning to get the government to change the policy to stop giving out dried fruit as part of the School Fruit & Vegetable Scheme.

GDPUK news was one of the first places to publish details about Raisin Awareness.

Following on from Marcus Rashford's incredible #EndChildFoodPoverty campaign, Sustain are lobbying for the School Fruit and Vegetable Service to be extended to include Key Stage 2 pupils so that it will reach all primary school children.


Campaigners celebrate reinstatement of school fruit and veg - Sustain Web

School snacks

 

Public Health Minister Jo Churchill said to journalists that the School Fruit and Vegetable Scheme will resume as normal in Autumn when all children return to school. While we wait for official confirmation, this is not the end of the campaign for more fruit and veg in schools. The scheme should be expanded to all children in primary school and improved to include higher standard British produce.

www.sustainweb.org


Now that Sustain are calling for the expansion, I am asking the dental bodies to add their voices, and suggest that together we can approach the called-for extension as an opportunity to raise dental concerns and make this positive change at the same time. I'm hoping that we can use this to eliminate the dried fruit, if and when the scheme expands.

Sustain are delighted to get dental bodies involved, and have agreed to rewrite the calls to action to include dropping dried fruit from the SFVS scheme, and I have drafted a new version with Nigel Carter. We will also be detailing this in a joint letter to DHSC & Department of Education.
Many dental organisations including BDA, BSPD, OHF, BADN, BSDHT & BADT have offered their support.

In my correspondence with Jo Churchill at DHSC I was informed that their stumbling block is delivery logistics (the reason they say that they cannot swap from dried fruit).

I am currently arranging local vegetable delivery to my village primary school (on those 6 raisin days a year) with the hope of reproducing nationally - to overcome this. I am planning to use the Sustain network of local vegetable growers and sellers to provide the national supply web needed, whilst getting dental practices to link up to primary schools to initially pay for this veg and also long-term to input Oral Health Education.

I know that this can be overcome if we are determined.

I wonder if you, the GDPUK community, would also consider supporting this as a collective and as individuals?

There will be a number of ways you can get involved - look out for specific details of what and how in a series of articles coming out in the dental press, and I will also keep you updated with this blog.

If we can’t change it from the top down, let’s do it from the ground up.

Jo Dawson

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2235 Hits
MAR
29
0

Christmas Was February

christmas_February Christmas Was February

Christmas Was February

As a committed Labour Party member it is quite something to be impressed by a Conservative Party Minister and Secretary of State for Health, but I have to say this is precisely the case. The recently published proposals on fluoridation represent a clear intention to act. There’s a lot of talk around reducing inequalities and levelling up but precious little action. This is different, it’s a clear intention to support communities and improve oral health and preventing the consequences of poor health, pain, sleepless nights, extractions, poor self-esteem.

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2779 Hits
MAR
29
0

Don’t Leave Yourself Vulnerable

Don’t Leave Yourself Vulnerable

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3259 Hits
MAR
20
0

Get off that seat and put up your feet!

writing_hobby Writing is my hobby

What do you do when you are not treating teeth? Get off that seat and put up your feet!

OK, that’s a poor example of poetry, it is not even poetry but merely a poor attempt at some rhyming to a beat-ish! 

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2436 Hits
MAR
15
0

My Dental Disasters

My Dental Disasters

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3560 Hits
MAR
01
2

Mental Health In Dentistry

But Seriously - Mental Health In Dentistry

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Recent Comments
Stevan Milson

What an honest and riveting es...

I am 2 days into semi retirement and can certainly identify. So very well written. Bravo.
Tuesday, 02 March 2021 18:14
Ian M Redfearn

Brilliant

A sincere thanks for your honesty and insight.
Friday, 05 March 2021 10:22
6016 Hits
FEB
22
0

How can you tell a good dentist?

Sig_20210222-190251_1 Sign of a _good_ dentist
 

There is always a risk in asking the question “How can you tell a good dentist?” Some people reading it will take offence, others may feel threatened, a few will read and conclude half way through that there is no point in continuing. Hopefully there will be the persistent ones who will take some time to ponder the question and even come up with an answer or two, if you do please feel free to share.

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3556 Hits
FEB
15
0

Dental Secrets I Never Knew

Dental Secrets I never knew

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4316 Hits
FEB
13
0

Get Political!

ballot_box_get_political Get Political to make changes happen.
 

It is now (February 2021) almost a year since dental practices were first told to stop face to face appointments as part of the response to the COVID19 pandemic during the first UK wide lockdown in March 2020. I clearly recall the Prime Minister’s address to the nation on 23rd March, a day when I should have been in India with my father to celebrate as he turned 80 years old.

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2707 Hits
FEB
08
1

Goodbye Lansley - Ministers to take control of NHS

Lansley_Big_Ben_2021 Goodbye Lansley - Ministers to retake control of NHS

Last Friday (Feb 5) Health Policy Insight published[i] the draft of the Government's forthcoming White Paper on Health, which was reviewed extensively in the media over the weekend. The main news in it for dentistry was that the paper included proposals to hand over control of water fluoridation to the health secretary and away from local councils. The move was widely welcomed in the profession especially by the CWF network (@network_cwf), the national organisation of dentists supporting water fluoridation.

Andrew (now Lord) Lansley’s 2012 reforms, when he was health secretary, handed control of the measure to local councils, which led, in October 2014, to a decision by Southampton City Council to scrap plans to fluoridate its water. This followed a vigorous campaign by ‘Hampshire Against Fluoridation’ and tentative plans to introduce the measure in other areas such as the North West of England and Hull were quietly dropped. Speaking in the January 14 Commons debate on dental services during Covid-19, health minister Jo Churchill said she was ‘extremely sympathetic’ towards the measure, so we may expect its revival perhaps.

In his report[ii], the late Professor Jimmy Steele said the first priority of any NHS system should be ‘a strong, co-ordinated public health system’, something that has not been possible with it being devolved to individual local councils,

The Lansley approach, which was controversial in the Conservative/LibDem coalition, was to take power away from ministers and put it in the hands of administrators. NHS England was given ‘power without responsibility’ to quote Stanley Baldwin’s description of the press in the inter-war years[iii].  But Ministers were still held accountable to Parliament for the NHS; ‘responsibility without power, the worst of all worlds’ as then Home Secretary David Blunkett, described it in 2002.[iv]

Without going into any detail, the document says there will be ‘enhanced powers of direction for government’ to ensure that ‘those overseeing the health system’ are held to account. For dentistry this could mean that the focus moves from NHS England’s obsession with delivering UDAs to MPs’ demand that anyone who wants to see an NHS dentist can do so - a shift from activity to access.

Secondly the Lansley approach was to promote competition within the service, hence the over-long process of commissioning new services, typically a year or more and, arguably, the botched orthodontic recommissioning exercise.

The pandemic showed, though the commissioning of urgent dental care practices, that the NHS can move rapidly when circumstances demand and so it should be in the future.

In responding to the January 14 debate, health minister, Jo Churchill said that ‘a transformation in dentistry is necessary.’ She continued: “There is a huge opportunity to deliver a greater range of health advice monitoring and support, using dentists and their teams.”

The demise of the Lansley system could give her the opportunity to achieve this.

 _____________________________________

[i] http://www.healthpolicyinsight.com/?q=node%2F1699

[ii] NHS dental services in England: An independent review led by Professor Jimmy Steele, June 2009

[iii] ‘power without responsibility – the prerogative of the harlot throughout the ages’, Stanley Baldwin speech on newspaper proprietors March 17, 1931

[iv] Speech by home secretary, David Blunkett to Labour local government and women’s conference Cardiff, February 2002

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Recent comment in this post
Tony Smith

video explanation?

I thought my video explained it quite well. https://vimeo.com/502805336 ... Read More
Monday, 08 February 2021 19:49
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FEB
08
0

A COVID stimulated wake-up call for dental prevention

Perio_COVID A wake up for dental prevention, COVID is worse for patients with periodontal disease.

We are all (well most of us!) now actively involved in prevention and risk assessment. 

We stay at home, keep our distance, wash our hands and wear masks.  We know some people are at higher risk of serious complications and death from COVID than others, so we shield the elderly and those who are clinically vulnerable, and we require our medics, dentists and care workers to wear PPE and engage in comprehensive disinfection routines to protect them and their patients from the close contact they have to have in their essential work.  Our vaccination programmes have initially been targeted at those who, by nature of their inherent risks or lifestyle risk factors, are in most danger. 

It is the coming of age of risk assessment and prevention, a time when the public accept that the inconveniences of doing the right thing are essential to ensure a better future.

I strongly believe that NHS dentistry post-COVID will take on this challenge: the one that says prevention comes first, and to prevent you must first to know your susceptibility and what you personally can do to protect your health.  Treatment is a fix, not a cure and whilst essential to get patients out of pain, should not be the focus of a modern health service.  Advanced restorative treatment on an unhealthy periodontium should not be paid for out of the public purse. 

A study has just been published from Qatar on the impact of perio disease on COVID outcomes.  Qatar has electronic health records containing medical and dental data (definitely something for the NHS to aspire to!) which facilitated the analysis of confounding factors.  To quote the press release here:

 The case control study of more than 500 patients with COVID-19 found that those with gum disease were 3.5 times more likely to be admitted to intensive care, 4.5 times more likely to need a ventilator, and almost nine times more likely to die compared to those without gum disease.

Blood markers indicating inflammation in the body were significantly higher in COVID-19 patients who had gum disease compared to those who did not, suggesting that inflammation may explain the raised complication rates.

Professor Mariano Sanz, one of the study’s authors, noted that oral bacteria in patients with periodontitis can be inhaled and infect the lungs, particularly in those using a ventilator.

“The results of the study suggest that the inflammation in the oral cavity may open the door to the coronavirus becoming more violent,” said Professor Lior Shapira, EFP president-elect. “Oral care should be part of the health recommendations to reduce the risk for severe COVID-19 outcomes.”

Causality, which is very difficult to prove, is not claimed here, and as always, whilst confounding factors have been adjusted for, those with perio disease often also have other health issues. Maybe the periodontitis is just a manifestation of a tendency to inflammation, and the COVID response simply results from that.   However, the evidence for periodontal disease raising your risk for other systemic diseases is indisputable and growing.

The crunch is this:  gum disease is the easy part to deal with: it is not invasive, expensive or harmful.  When you can stop the disease in its tracks, why risk COVID complications?  Why accept the heightened discomfort and dissatisfaction with your teeth, and the tooth loss that results from periodontitis?  Knowing that gum disease is associated with diabetes, CVD, kidney disease, dementia etc, why would the susceptible patient not choose health over bleeding?

Now is the time to talk prevention: to explain to the susceptible periodontal patient how they are more vulnerable than others in the population; to identify and share the lifestyle factors which put them personally at risk of the disease; to explain the potential impacts on their systemic health, and persuade the patient that it is up to them to take the decision to work with you to take charge of their future. 

Liz Chapple

OHI Ltd, UK provider of PreViser and DEPPA technology

www.previser.co.uk

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© Liz Chapple, GDPUK Ltd, 2021

5338 Hits
FEB
02
0

BDA Benevolent Fund – facing the challenges of Covid-19

BDA Benevolent fund logo

In this exclusive interview, Laura Hannon shares with readers how the BDA Benevolent Fund has continued to support the profession in times of unprecedented challenges.

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  4182 Hits
4182 Hits
FEB
01
0

Why Call The Ghostbusters When There’s A Nurse Around?

Why Call The Ghostbusters When There’s A Nurse Around?

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4429 Hits
FEB
01
0

Sincro™️ Syringe: An Introduction.

The SINCROTM is presented as a multi-part device

Hambley Trading Limited are looking to supply dental professionals, experienced in the delivery of local anaesthesia to patients, example prototypes of the SINCROTM system for them to examine and assess and compare with their current choice of syringe delivery device.

A questionnaire relating to the handling characteristics may be completed and returned electronically which will entitle the respondent to a FREE box of SINCROTM [50 syringes] after the device is launched into the UK dental market.


For a limited number of early respondents there is also the chance to be awarded a £25 Amazon gift voucher, so get your response in quickly.

 

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1641 Hits
JAN
18
0

Making Sense of NHS Mathematics

Making Sense of NHS Mathematics

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3981 Hits
JAN
11
0

Just A Little Scratch

Just a little scratch

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4601 Hits
JAN
08
0

Every Generation Blames The One Before

Every-Generation


That opening line from the song “The Living Years” resonates with anyone who has lost a parent, grandparent, teacher or mentor and comes to appreciate that, “we are all prisoners of what our predecessors held dear”.


One of my prepared talks (post-covid bookings are now being taken!) includes me reading a paragraph from one of the required textbooks of my undergraduate years, Immediate and Replacement Dentures. Chapter two, “The patient as a person”, has a section called “The quiet mind”, this starts with a definition of the normal patient which reads, “The normal patient is one in whom the loss of teeth follows previously satisfactory dental treatment”. When presenting, I pause and read it again emphasising loss of teeth, normal and satisfactory.


The reactions of the audience, if I am fortunate enough to have attracted one, is varied, the baby boomers nod and smile in remembrance, Generation “X" shake their heads in disapproval, Millennial (Generation “Y”) are cross and want me de-platformed, Generation “Z” need to be revived after the trauma and demand post-presentation counselling.


Not only do I believe that subdividing groups of people into “Gens” in order to predict their behaviour is akin to astrology for sociologists but it can also prove confusing and futile. There are rarely true generation gaps in a profession like Dentistry where changes are introduced slowly and incrementally. Teaching of undergraduates reflects the previous doctrines filtered through the published research, the experiences of the, as yet, unpublished opinions and the perhaps more dogmatic, heavy hands of department heads.


All this of course is filtered and influenced by that relatively new group, the educationalists, or specialists in education, whose views on the manner of teaching delivery may have a significant bearing on what, how and why knowledge is delivered by whom, where and when.
I was moved to write this piece for two reasons. The first was another in a long line of consultations from dentists who are deeply unhappy in and with their chosen profession. Almost all of them tell me that they felt they were too young, usually 14 to 16, when they made the decision to study dentistry and that their undergraduate training, whilst fine at the science of dentistry, hadn’t prepared them for the reality of life in (UK) dentistry.


My other stimulus was reading David Epstein’s book, “Range”. In it the author examines the virtue of early specialisation with many hours of deliberate training in one field compared with the value of being a generalist.


I am not sure if I have come to any definite conclusions. What I know is that I never wanted to be anything but a dentist and it took me 25 years to accept that I didn’t enjoy being a “wet-fingered”, micro-managing surgeon. With hindsight I can see that I spent too long climbing up the wrong wall, my ladder looked perfect, others were envious of my achievements and success, but it didn’t make me happy, indeed quite the opposite.


A proportion of dental graduates are not suited to the careers available to them and would walk away if they could. Unfortunately the pressure from parents and peers, not forgetting the financial implications, means that leaving is the social equivalent of not turning up for your own wedding. For many who persist this means that further down the road comes a moment where they wake up, unhappy, wondering, “is that all there is?”
Epstein quotes Winston Churchill whose words are used to encourage unhappy, unsuited people to show “grit”, “Never give in”, he said, “never, never, never, never”. What nobody tells you is that he finished the sentence by saying, “except to convictions of honour and good sense.”
What could be done? Could we go down the American route of an honours “Bachelor of Medical Science” degree followed by a three-year dental programme taking 46 weeks per year of proper work? A 21 year old is in a better position to make a career decision than a 17 year old and other pathways are available to those who are unsuited.


Would a better career path in general Dental Practice work? Perhaps a three-year post-grad programme with spells in different independent and corporate practices, NHS, specialist and private with clear transitions, supervision and significant mentoring. Some years ago there was a brave move to start an independent vocational training scheme, which foundered after the intervention of the NHS who were opposed to anything that they could not fully control.


What we have can be inconsistent and does not help everyone. Dentistry is unsure of itself. Is it still a speciality of medicine? Does it want to truly embrace teamwork, if so exactly what model works best? Or is it straddling the divide with one foot rooted in the disease model and the other trying to run away along the road of cosmetics?


Are we failing the next generation? Will more and more unsuited young people be ground beneath the NHS wheels?


You say you just don't see it, He says it's perfect sense,
You just can't get agreement, In this present tense.

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© Alun Rees, GDPUK Ltd 2021

3287 Hits
JAN
01
0

Dental Predictions for 2021

Madam DentistGoneBadd looks to the future

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3568 Hits
DEC
28
0

2020 - How Can You Improve On that?

2020 - How can you improve on that?

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2490 Hits
DEC
14
0

The Grinch

Christmas comes but once a year, And when it comes, it brings fountains of pus.

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© @DentistGoneBadd, GDPUK Ltd 2020

3590 Hits
DEC
04
2

Are you a leader?

leadership-3331244_192_20201207-112554_1 Leadership lined up

“If you think you’re a leader and no one is following you, you’re just out for a walk.” Peter Drucker.

 

I hesitated before putting finger to keyboard on the subject of leadership. A Google search shows in excess of 2 billion results on the subject. What can I possibly add to that? The answer is to only share my take on the subject, which in spite of all the papers, videos, courses and hot air is still poorly addressed and understood.

Two years ago, in those carefree pre-Covid days, I researched, wrote and presented half a dozen talks on leadership in the hope that I might in some way help to improve things in my nano-field of influence. One of the main points that I made then is that we often look at the wrong people for examples of good leadership. Certainly the procrastination and self-interest shown by politicians and business leaders does little to stimulate recommendation or inspire imitation to those owning, running and working in small businesses.

So what is it leadership? One sidestepping answer to that is, “I’m not really sure but I know it when I see it.” In his landmark book, “Good to Great” Jim Collins expected to find the leaders of successful large companies were “those with high profiles and big personalities who became celebrities”. In reality they were often “self-effacing, quiet, reserved, even shy individuals with a paradoxical blend of personal humility and professional will”.

Dentistry and other professions used to attract large numbers of the latter but I do see growing amounts of attention seekers who appear to believe that success is directly proportional to Instagram posts and can happen almost overnight. Perhaps I am becoming jaded but the retreating tide of 2020 plus the year to come will show just who has been swimming without a suit.

Another regular way of talking about leaders is to compare and contrast them with managers and, until a decade or so ago, I was as guilty of that as the rest. Then it struck me that in the field of small and micro businesses it is impossible to be a good leader without managing; and it is equally impossible to be a manager without leading. Shoving individuals into defined silos doesn’t work, we must all wear different hats to suit circumstances. There are some, but very few, absolutes, there must be overlaps in some areas.

In my experience with successful leaders in dentistry and other small businesses I have found several characteristics that they all share to a certain extent. In many these traits are not instinctive but have been learned by experience and acceptance.

  • Pragmatism. They understand the practical consequences of situations, decisions and actions. Whilst they are aware of theory and dogma they know that flexibility is needed for success.
  • Understanding. They both understand the business they are in and that they are in business. They learn from experiences and apply and share what they have learnt.
  • Empathy. They are able to see things from the point of view of others, can rationalise that and know that there are limits.
  • Delegate but don’t abdicate. Knowing where the buck stops means that they have personal systems with checks so they can ensure nobody is allowed to feel unsupported.
  • Communicators. Their team understands where they are heading, why they are doing what they are asked to do, and how they are expected to do it.
  • Gratitude. They are grateful for the opportunities they have had, the lessons that life has taught them, and the people with whom they spend their time.
  • Constant. They know the value of constancy in those areas where it is appropriate. They support their co-workers and understand the need for stability in others. When change is necessary, they take time to ensure that all grasp the why, how and when it will happen. There is only one set of principles and they apply to everybody.
  • Don’t hide. They front up when they need to, they know everyone on their team no matter how large and there is no area of the business with which they are not familiar. They have systems to ensure they are on top of everything.
  • Share (the responsibility and rewards). Things go wrong as well as right in any size of business and their attitude is that where possible it will be shown to be a system error rather than an individual blame. That way the business will evolve to reduce mistakes.
  • Generous (with their time). They know that time invested in helping and encouraging others will be reflected in a culture of both individual and team growth.

Warren Bennis wrote in, “Becoming a Leader”, “I don’t know if leadership can be taught but I know that it can be learned”. He described “The Cauldron of Leadership” as formative events, critical struggles or serious challenges that force leaders to learn, grow and think differently about themselves. The cauldron theory is fine, but can be traumatic, and you are better off paying attention to what is happening and reflecting and considering what you have learned.

If I have managed to make you think about the boxes that you tick, or not, in your leadership roles then my work is done.

To your success.

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Recent Comments
Tony Smith

"Management is doing the thing...

Another insightful post. As a profession, many of us are aware and want to lead by example to our patients and staff. Our managem... Read More
Friday, 11 December 2020 09:57
Alun Rees

Thanks

Hi Tony Thanks for taking the time to respond. It's always good to know that someone is reading what I write. Kind Regards Alun... Read More
Friday, 11 December 2020 11:20
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Fear & Loathing in Dentistry

Fear & Loathing in Dentistry

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NOV
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Bullying – The New Pandemic?

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16
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Say After Me…I BELIEVE!

“Say After Me…I BELIEVE!”

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Surveys & Guidelines

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Dr. Badd Solves your Dental Problems

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18
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The Value of Dentistry

The Value of Dentistry

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OCT
12
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Stripped of Dental Super-Powers

Stripped of Dental Super-Powers

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OCT
05
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Returning to practice after lockdown

Back To Work (Not As Easy As You Think)

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SEP
20
1

Just imagine if the newspapers weren't interested in dental disasters

Just imagine if the newspapers weren't interested in dental disasters

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Jonathan Aspey

'kin Excellent

Not smiled/grinned this much for sometime. Thank you so much @Dentistgonebadd for lightening my mood on this dreary Sunday morning... Read More
Sunday, 04 October 2020 11:22
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Flying off for a Sunny Smile

Beach? No Time For The Beach!

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SEP
08
0

Three H’s for success and happiness.

IMAGES Humility, Hubris, Humanity.

For several years it was my honour to be the opening speaker at the annual scientific meeting of the BDA Western Counties Branch, Young Dentist Group (YDG). The challenge for me in, say, 2016 was to try to share some perspective on changes in dentistry. In 2016 it had been 43 years since I embarked on my university studies, rolling that back another 43 years would take us 1930. I wondered what someone from those interwar, great crash and depression, times could have said to me that would have had any relevance to me in my post-qualification years. Eventually I chose to major on the letter “H” and look for similarities rather than changes.

Another “H”, neurosurgeon Henry Marsh, has written one of the best medical autobiographies that I have read. In “Do No Harm: Stories of Life, Death and Brain Surgery” he writes of the cases he has treated successfully and otherwise and the lessons he has learned. He describes his mistakes both surgical and human and the frustrations of his life with an honesty and insight that I can only envy and attempt to imitate.

Back to the YDG where, in my fifteen minutes in the spotlight, I attempted to describe the roles of Humility, Hubris and Humanity in success and failure. My naive younger self believed that the path to success was mostly straight with the occasional glitch of disappointment. Before Dental School I presumed that my skills would grow and develop in a largely logical and linear manner, much like building a wall with Fletton bricks. I hadn’t anticipated the possibility of quantum growth, where I would feel stuck at a level of inadequacy before suddenly acquiring, whatever it took to move up to the next level of competence.

Nor did I realise that there could be levels of competence that I would never, achieve and to which I could not even hope to aspire. Perhaps it was a good thing that I realised, early on, that my own skills and my temperament would always be limited. I could also see that there were those who were naturally, instinctively skilled, even artistic. Journeyman level is honourable enough as long as you have the humility to acknowledge and accept your own limitations and to develop your skills as far as you are able.

There are far more problems in all walks of life caused by hubris. Defined as excessive pride or self-confidence, there can be a natural tendency with new graduates to run before they can walk and pride will come before a fall. With the fall should come learning of limitations, awareness of boundaries and hopefully acknowledgement of what we don’t know.

Henry Marsh describes the “Keynote Speakers” in his subject who, “Clearly had amazing results way beyond anything that I could achieve. People for whom self doubt is never an issue and whose post-op scans never showed a trace of residual tumours.” He then talks about Hubris driving him on, the risks of over confidence and the disasters that arose. I am reminded of the Key Opinion Leaders (KOLs) associated with newer Short Term Orthodontic and other techniques who are paid by companies and make claims and encourage use of one particular system whilst trying to maintain a veneer of independence.

Finally, we reach humanity, which I defined as the quality of being kind, thoughtful, and sympathetic towards others. In our early years this can be an overwhelming urge to help everyone and to treat each case to its limits. Experience should show us our limitations but there are some who do not acknowledge they have any, or are so intent on treating cases that they put the treatment before the patient. Marsh says, “On reflection you only get good at doing the very difficult cases if you get a lot of practice but that means making a lot of mistakes at first and leaving a trail of injured patients behind you. I suspect that you have to be a bit of a psychopath to carry on or at least have a pretty thick skin. If you're a nice doctor you'll probably give up, let nature take its course and stick to the simpler cases."

Perhaps our desire should be to become good surgeons rather than great surgeons. It can be difficult to balance pressure from patients to do something, especially if you have been looking for a case to do. The enthusiasm on the Monday to find a patient who matches the technique learned on Saturday’s course has led many to regret their actions.

Knowing when to treat, and not to treat, or instead to refer is a big skill itself and requires complete detachment from, and yet total compassion for, the patient and what is ultimately in their best interest. Awareness of Humility, Hubris and Humanity may help us to sleep at night.

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07
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Dental Laboratories In Crisis

Dental Laboratories In Crisis

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GA's are GAGA

GA's are GAGA

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The Peaky GDC

The more I think about the General Dental Council, the more I think they  resemble the Peaky Blinders.

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Quirks in Dentistry

It’s Not Normal, Love

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Now Where DID I Put That Enthusiasm?

Now Where DID I Put That Enthusiasm?

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Julian Irving

Sad and angry.

I too qualified in 1984 and have had a love/hate relationship with dentistry throughout my career until I retired in 2017 because ... Read More
Tuesday, 11 August 2020 09:21
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06
1

If all the world was a swimming pool . . .

water_cropped Deep water

If all the world was a swimming pool.

I sat down to write something that would show insight or perhaps provoke a response if only to get the reader thinking about their situation and how they might improve it.

Of course I would like to impress or inspire enough for you to pick up the phone and employ my services as a coach and business mentor, but that is secondary.

This column was inspired by the behaviour of several clients. It struck me that the best metaphor was that of swimmers at a pool.

We all start unable to swim, as we know it, with poorly defined strokes and no style. Some are lucky to come from “swimming” families who visit pools routinely, or perhaps have their own pool. Others have parents who are frightened of water, have never learned to swim and avoid aquatic recreation.

We all eventually go through dental school where we are taught a version of the theory and practice of survival in the water. Depending on the school there will be an emphasis on different strokes and skills. After five years we can keep ourselves afloat doing our basic strokes - even if we still have to put the occasional foot on the bottom of the pool for security.

It’s what happens after that interests me; it depends very much on the individual, their attitude to risk, their ambition and luck.

Until VT arrived, new dental paddlers were thrown into the deep end of the pool, the wave machine turned on and, although they swallowed a lot of water, their basic stroke helped them to survive. Confidence grew, widths became lengths, a few strokes under water and duck dives.

With VT a lifeguard was assigned who checked they were still afloat and not dragging anybody under.

Many practiced in different pools until they found one that suited them, and the owner sold them a share, some wanted their own pool and built or bought it.

Some new paddlers throw themselves in not sure if it’s the deep or shallow end. water2

Fewer still climb to the highest diving board jump in and somehow survive.

Some drown.

Some swimmers become perpetual associates. They never trust the water, are frightened of getting out of their depth, they swim widths and occasionally lengths but always stay within touching distance of the poolside. They move from pool to pool dreaming of the one that is warm enough, the water is calm and they can do whatever style they wish. They want their pool owner to supply designer swimsuits and send them for advanced swimming courses that teach skills, unusable in their home pool.

The 21st century has seen a new phenomenon. The individual who inevitably has the “abs & pecs” gets up on the springboard and bounces up and down a few times with great style and noise. They attract a lot of attention, take a few photos for their Instagram feed and head off without getting their hair wet.

There are nervous types who go on expensive courses on swimming. They listen to everybody, swimmer or not about how to swim best. They read books about how to swim. They walk round the pool, put their foot in to feel the temperature. Eventually they go down the ladder and swim but never, ever go out of their depth. 

Some become NHS (National Health Swimmers). They used to enjoy swimming, they felt they had a role in life and swimming was their duty. Nobody told them was that there was a wave machine at the end of the pool, the speed of which was inexorably increasing. As fast as they swim, as hard as they work they don’t make any progress. The depth of the pool is increasing, the flippers, worn for compliance not progress, are getting heavier and make things worse, not better. They’re frightened that if they make it to the side of the pool to leave their swimsuit will have holes in embarrassing places.

water3
Who succeeds? The ones who work hard at being better swimmers, who know about all the strokes and concentrate on the one or two that gives them most happiness. They focus on being smooth swimmers, not fast, making as few ripples as possible. They understand that sometimes the pool can get uncomfortable, the water temperature goes up and down and that to be a successful swimmer you need to be fit and keep practicing.

They know that they don’t know all there is to know but they join a club and work with a coach or mentor they will be helped to improve. They talk to other good and successful swimmers and they learn how to stay afloat.

We learn in pools but we must now swim in the ocean. The riptides are dangerous the currents changing and the water deep and cold. This is no place for social swimmers. Only those who are 100% focussed on being successful swimmers will make it to the next beach.

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Keith Hayes

Waving or drowning?

Excellent posting Alun and really relevant to present times. Just wanted to say, if you aren't waving or at least managing to kee... Read More
Friday, 07 August 2020 11:02
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What Dentistry Taught Me About People

What Dentistry Taught Me About People

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Dentistry's Battle against Racism

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A simple guide to General Practice in the post-COVID-19 world

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General Dental Council - Protecting our income and sometimes the patients.

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