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Posted by on in DentistGoneBadd

Dental litigation - fighting back

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©DentistGoneBadd, GDPUK Ltd, 2018
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Posted by on in Simon Thackeray

Once again the new patient charges have been announced for the NHS, and once again they have gone up far more than the amount dentists will get for their UDA’s. The third consecutive inflation-busting rise in patient charges means that an ever increasing number of dentists will find themselves as unpaid tax collectors for the government, with the added pleasure of having to continue to practice in a hostile environment where the threat of litigation and GDC involvement is ever present.

So what will it actually take for dentists to wake up and smell the coffee? Patients are paying an increasing amount for their care, and as they do so, direct their annoyance as ever to the dentists. Its unlikely that they will understand or accept the explanation given that the charges are in effect a taxation, as they are too closely linked to the provision of a service.

Why do many of the dental practices seem to forget that they are in truth independent contractors within the NHS, and as such only have to refuse to contract to the NHS in order to retake a degree of control of their own future once again? It can’t be that working within an NHS contract is too easy; we increasingly hear of the demands on the practitioner’s time to fulfil the contract requirements. This time of year is full of comments on social media about the increased flurry of activity in order to hit the UDA’s targets once again or suffer claw-back.

By raising the patient charges, the government is contributing less and less each year to the cost of dental provision. The population of the UK isn’t reducing, and the cost of providing dentistry isn’t either. But for less and less contribution the government is still dictating the terms of the contract, and dentists continue to accept it.

Will it actually take the government to raise the patient charge to £30 for an exam (whilst still paying £25 for the UDA) for dentists to realise that they would be better off just charging the patient £30 and sticking two fingers up at the government? Or is it the NHS pension that people are holding out for? Or the continued chance to pay an associate £10 per UDA when they are really getting £30?

Practice owners (and particularly the bigger practices and corporates) definitely have the whip hand here. I can remember the times when associates were few and far between. It appears that the reverse is now true in many areas of the UK (particularly in metropolitan areas), which allows the principal to reduce the unit price of a UDA paid to an associate. An increase in patient charges will likely bring a drop in the number of patients visiting practices, and in one fell stroke this will reduce the PCR, and reduce the chances of the UDA targets being met, and therefore a claw-back occurring. I know of many associates that are made liable for the gross amount of any claw-back due to their individual underperformance (rather than the net amount they have been paid per UDA). Add this to the NHS pension of the principal that is effectively enhanced by paying a smaller percentage of the UDA value, this hardly puts the principal under any immediate pressure to withdraw from the NHS system they are still aligned with. However, I suggest that it is now causing a much greater ‘Us and Them’ situation with associates than ever before.

So why is it ok to make money out of the associates and not charge the patients a decent amount for their care? Whilst a business has a duty to its shareholders and owners to keep its costs low, with the introduction of the minimum wage this means they don’t tend to be propping up their bottom line by charging their staff for the privilege. They tend to charge their customers for it with the increase in the charge for the product.

Unless you happen to be in a fixed price system…so the only way money can be made (let’s forget upselling to patients using the NHS as a way to get them in the practice for now) is by reducing the costs of the workforce and investment in the business. However the government expect more and more for less and less (look at the next round of orthodontic commissioning that is going on) and it becomes impossible to square the circle unless someone actually pays for it. That certainly isn’t going to be the government.

Given that some patients will not be able to afford the hike in charges does not mean that many others would not pay for a decent service if they had to. Surely having fewer patients (but of the sort that don’t sue and complain) that are being charged a fair amount for the service provided, with no third party dictating targets has to be better for the stress levels of both dentists and patients under their care?

Will it take associates to actually walk away from the profession and retrain? With the current environment of stress due to the GDC, threat of litigation, and the real time reduction in associate income, then this has never been more possible than it is now. And that will lead to a reverse in the associate market again, especially if the (currently unknown) effect of Brexit results in European dentists returning to their home countries – and who wouldn’t if it meant avoiding the GDC and Litigation!

So what will it take for the profession to see the light? That we need to realise the government would still wish to control us if they only contributed £1 in every £100 charged and only then will we react? Or do we need to remember that everyone who owns a practice is a private practitioner already and they should just tell the government:

‘No More’.


Image credit - Pascal under CC licence - not modified.


©Simon Thackeray, GDPUK Ltd, 2018
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Posted by on in Digital Dentistry


Below you will find an infograph we have created from a recent thread on GDPUK which was titled - help me with end of year spending....

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Posted by on in DentistGoneBadd

And the Oscar goes to...

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©DentistGoneBadd, GDPUK Ltd, 2018
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Posted by on in Alun Rees

“Nobody loves us, everyday hates us, think I’ll go and eat worms. “

Sometimes listening to discussions between dentists at my speaking events, or reading the opinions voiced online at various forums I have to wonder about the dental mind-set. There seems to be a dominant attitude that if there’s a way of seeing the worst in things they will.

It is understandable for dentists to feel unloved, let’s face it we’re hardly the most popular of professions. Very few others, even in medicine, routinely carry out potentially painful procedures in such a sensitive area with the patient supine and their airway exposed - rubber dam or not.

Dentistry can be an irritant both physically and financially; nobody leaps out of bed in the morning saying, “Excellent! Dentist today! I do hope they find something challenging to test their ability so I can lie there for an hour or two and then pay for the privilege.”

No wonder that more and more dentists choose to spend as much time as they can on such minimally invasive treatments as whitening and “short term orthodontics”. No drills, no needles and a result that the patient can see is a definite improvement, what’s not to like?

Perhaps social media has made things worse. Reading some of the “I’m more miserable than you, my life is worse than yours” Facebook postings recently has made me wonder if previous generations were more resilient or perhaps were better prepared for a lifetime of dealing with, “I hate these places” as a new patient’s open gambit.

In the pre-internet days the only place for dentists to share their misery was the local post-grad or BDA meetings. There the young bucks (yes, usually male) boasted about their gross whilst their more senior colleagues complained about anything and everything from the new practice down the road (unless the principal was present) to the price of alginate.

I recently I asked a group at a meeting to share what advice they would give to young dentists. Top of the list were “emigrate", “go part time” and “don’t be afraid to leave". This does point to a pretty low state of morale.

Everybody else thinks they know about Dentistry. Politicians, medics and now venture capitalists all believe that there are simple ways to “sort out dentistry”. The result is usually a few corners cut that are perceived as unnecessary by bean counters. So far few, if any, have succeeded in improving clinical care.

Add to the mix the dramatic reduction of dentists who have “skin in the game”. By this I mean the fall in partners and owners from 45% to 17% in general practice. This drift is taking us towards a situation where, in NHS practice anyway, associates are one court case away from being classed as employees. It also has a knock on effect on morale. If you have little or no say in the way your (work)life is being run and you feel like a cog in a machine then it does make it hard to feel valued.

I do wonder if the profession does enough to help itself.

As individuals dentists are often insular and divided, unlike medics we are not taught to be part of a bigger team, and are unable to see the greater good. Writing in “The Advance of the Dental Profession - A Centenary History of the British Dental Association”, N.David Richards noted that in the mid-nineteenth century there was a large group of “dentists” who attracted patients by blatant advertising. He also stated that, “at that time the vast majority of dental surgeons practised exclusively for their own individual and financial interests”.

One hundred and seventy years on I see some similarities. The dramatic increase in marketing and the insularity of many dentists come to mind. The rise in dentist-initiated referrals to the GDC says little good about those involved.

The profession has been played by government over the past dozen years where limited contracts have seen practices willing to join in a race to the bottom by undercutting their colleagues. There is little unity it seems except in complaining. The mantra of non-BDA members is “what has the BDA ever done for me?” Sadly there are too few willing (or able) to join in and serve, rather waiting on the sidelines for the benefits for which the members pay. The BDA has many faults and, by virtue of the inherent conservatism of its membership, tends to serve the late majority rather than be led by the early adopters.

Dentistry is a profession that is full of intelligent, flexible and adaptable people who are skilled at carrying out procedures that influence patients’ quality of life. They work well to deadlines and can make instant decisions (usually correctly).

In her research in the 1980s Helen Finch concluded that the majority of people don’t like dentists as a profession but do like their own dentist. Instead of running scared of those who tell us that the sky has fallen in, we ought to embrace the respect that has been hard gained and exploit it. No, the GDC, CQC won’t do it, the DoH won’t do it, the BDA tries but can’t do it, the only people who can do it are individual dentists and their teams. It’s time that all dentists celebrated what they do, shared the fact that they are far more than the hackneyed drill & fill merchants and started to actively convert their patients one by one to the benefit of good dental health.

If not decide how you want to eat your worms.



©Alun Rees, GDPUK Ltd, 2018
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