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

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 7^th 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.

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.

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!

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.

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

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.

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

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.

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.

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.

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

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

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

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.’

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.

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.

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

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.

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.

Your NHS dentistry and oral health update

19 July 2022 (Issue 50)

An update from Sara Hurley and Ali Sparke

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.

On 16^th 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 27^th 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

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?  

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. 

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?’.

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.

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.

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?

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.

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.

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.

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. 

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 6^th 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

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

 

 

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…

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?

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.

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.

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.

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.

Since I retired a couple of years-or-so ago, I’ve had many dentistry-related dreams/nightmares. Many of these dreams find me suddenly planted back in a surgery somewhere, working on difficult patients with tricky clinical needs.

It seems odd at my age, writing the words ‘Dental Hero,’ but Simon was one of them, even though he was only a handful of years older than me. Simon was my first ever dental boss, and he ran two practices, one in the Cotswolds and a newly acquired practice in a large Worcestershire town.

These days, if I get any phone call on my mobile from a number I don’t recognise, I reflexly activate the speakerphone and start the voice recorder up on my watch.I used to get quite tense and angry when I received these calls. At my own practice a few years ago, we fell victim to a scam operated by UK-based scammers. We didn’t lose much money, but that was just by pure luck.

Two years ago, a bit like anything the General Dental Council does lately, our oil-fuelled central heating boiler was condemned. It was old and tired, was wasting money and was basically unsafe – yes, am still talking about the boiler, but, you know, there are parallels there.

Backup is without doubt the most important element of your IT Infrastructure, without a robust backup process in place in your practice your patient data is at risk, and if you lose your patient data, your whole practice is at risk – 60% of businesses that lose their data close within 6 months

I was fifteen and I was on my first ‘date.’ We were in the Grove Cinema, Winson Green, Birmingham. For some stupid reason, which looking back was actually probably reasonably refined psychological reasoning for a 15-year-old lad playing to what he thought might appeal to girls, I had decided to take Jackie (‘twas not her name) to see ‘Love Story,’ the saccharin-drenched blockbuster of that particular year.

So, it’s been a heavy few days for the General Dental Council, clinging desperately on to its reputation as a law-abiding health regulator, while being dragged into a murky, treacherous quicksand, by its own past misdemeanours. The following isn’t a full list of the GDC’s antics, by any means.

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

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

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.

Last week, the NHS made a plea to victims of abuse to contact the health service for support. The call came after it was shown that calls to support lines had almost halved since the lockdowns started. It was suggested that because domestic abusers were also at home more, there was less opportunity for victims to seek help.