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GDPR and Data Protection - Part Three

42035340031_aef68f75bf_z #GDPR [Image by Jon Worth]

Roger Matthews further examines the EU’s forthcoming General Data Protection Regulations and its potential impact on dental practices. Have you drawn up your privacy notice yet? Are you up to speed on how you can lawfully process the data you hold on patients?

roger matthews

In the first two articles in this series (part 1 and part 2) I’ve taken a look at how the new Data Protection Bill – incorporating the EU’s General Data Protection Regulation (GDPR) - is coming along. I’ve highlighted the importance of preparing by taking a good look at all the personal data you currently hold in the practice (a Data Audit). Where does it come from? With whom do you share it (or might disclose it to)? How long will you keep it? Do this as a practice team, because ultimately everyone is responsible for good Data Protection.

The Data Protection Bill is still working its way through the parliamentary system and further amendments are still possible, although unlikely to impact dentistry. We will continue to watch this progress closely and to update Simplyhealth Professionals practices as we move towards the implementation date of 25th May 2018.

Fees

I gave some clues as to future Data Protection fees payable by Data Controllers last month, and now we have a clearer idea, although still subject to Parliamentary approval. As predicted there are three ‘tiers’, but some careful thinking may be needed to know which one you fall into.

Firstly, if you do not do any electronic processing (at all – that includes computers, tablets, smartphones, CCTV or any form of digital equipment) – and that’s pretty unlikely I would say in 2018, or if you only use a computer for the purposes of staff employment, PAYE, business administration, and payment processing (i.e. only basic personal details) it might appear you are technically exempt from paying a fee. But, the ICO has stated that any personal data processed for the purposes of ‘healthcare administration’ you will still have to pay. (See The Data Protection Fee – A guide for Controllers at ico.org.uk)

If you have a small practice, with 10 or fewer staff (every part-timer counts as ‘one’ and that includes the cleaner, gardener, and self-employed associates, hygienists etc), and if your annual turnover is less than £632,000 then you are in Tier 1. The fee will be £40, or if you pay by direct debit, then £35. Yippee, no increase! You will get a reminder when your current registration runs out, and an opportunity to set up the direct debit then.

(A little complication: if you have an NHS contract, then you are regarded as a ‘Public Authority’ in respect of processing and fees from that contract only. Public Authorities are exempt from the turnover threshold above, so if your NHS contract turnover is more than £632,000, then you are rated only according to your sGDPRtaff numbers. So a very big NHS contract but low private fee income might keep you in Tier 1.)

Larger practices, who do not fall within the above criteria, will pay a Tier 2 fee of £60 (again presumably with a direct debit discount of £5). This covers Data Controllers with 250 or fewer staff and a turnover of less than £36 million. Large Corporates may need to do some calculating, but otherwise this Tier will cover just about every other large-ish practice or small chain.

Tier 3, at £2,900 annually, is probably not an issue for dentists!

If you are currently registered (‘notified’) with the ICO – as you almost certainly are – there is no need to take any action until you receive your reminder to renew after 25 May 2018.

Your fee level will, in most cases, be accurately anticipated by the ICO but you should check to make sure it is correct and either call or e-mail them if not. It seems likely that if your renewal date is shortly after the implementation of the new law, there will be significant delays in getting changes made, but so long as you can show you took all reasonable steps then this should not disadvantage you.

Remember that Associates will only need to register – as now – if they act as Data Controllers in their own right (see the ICO’s Information Governance in Dental Practices, September 2015).

Action Stations!

Between now and 25th May, practices will need to:

  • Complete their data audit (as above, if not already done)
  • Check where back-ups are stored (ask your software provider/s)
  • Consider how to present Privacy Notices to patients (see more below)
  • Consider revising their Data Protection and Information Security policies
  • Update their Cookie policy if they have a website
  • Carry out and document a Legitimate Interest Assessment
  • Draw up a Data Breach policy and procedure (if not already done)
  • Appoint a Data Protection Officer

Whew!

Helping Member dentists

To help with preparation, Simplyhealth Professionals will be publishing further guidance for members on all the above, including templates for the necessary policies and assessments. However, in every case, it will be necessary to consider how these templates should be adapted for your own particular circumstances and practice.

This information will be published on the web portal for member dentists to access and it is hoped that all the necessary policies will be in place by the end of March. However, the new law is still Parliamentary ”work in progress”, so you should keep aware of any updates in monthly newsletters and e-mails.

Although ICO has said they will take a “proportionate” approach to enforcement in the early days of the new legislation, we cannot be sure the healthcare regulators (or NHS Commissioners) will take a similarly sympathetic approach. So preparedness is necessary!

A Lawful Basis

As noted when writing about Privacy Notices in previous articles, a Data Controller can only process data under the new legislation if they have a Lawful Basis to do so. Sounds reasonable, and GDPR gives six options to choose from.

Consent sounds like a good idea and as dentists we are well versed in this topic. However, remember that consent can be withdrawn at any time, and whilst you might simply and rightly stop treating a patient who decides, for whatever reason, to exercise this ‘right’ it would make life difficult for all concerned.

Necessary to fulfil a contract would apply in the case of self-employed staff members, such as associates, hygienists and so forth, so is appropriate for those cases.

Necessary for a Public Task is actually appropriate for all processing to do with NHS Contracts, since if you have one, you are regarded as a ‘public authority’ and are carrying out processing as required by legislation. So that ticks off the NHS patients and their care.

Legitimate Interests of the Controller is really the catch-all that would be appropriate for most of your private patients’ care and treatment. A ‘legitimate interest’ is really any self-evident need that an organisation has in order to function, and where a ‘data subject’ (patient) would ‘reasonably anticipate’ that such processing is necessary, provided it does not undermine any of their rights.

In order to use Legitimate Interests as your Lawful Basis, the legislation requires that you complete a Legitimate Interests Assessment (LIA). This is not too difficult provided you follow the detail of the law: firstly do you need the information? Secondly is there any alternative? Thirdly can you balance your need against the patients’ rights? And finally what actions do you take to ensure the security and confidentiality of the data? There will be a template for an LIA provided on the member dashboard during March.

Why the fuss about ‘Lawful Basis’? The legislation requires that your full Privacy Statement, freely accessible to all those persons whose data you process, specifies clearly what this basis is. On a website this must be clearly signposted (not buried in the small print), and in the practice its availability can be pointed out within a brief statement given verbally or, I would suggest, added to medical history forms and updates.

Finally…

A few odds and ends.

If your practice software provider stores or backs up your data, you should have a fully documented contract showing where the data is kept, and if it is overseas (especially if outside the European Economic Area) does it conform to GDPR requirements?

If you use patient data for marketing purposes, and also if you routinely contact patients by e-mail or text message, you will need to have specific marketing consents for these activities. Again, simple messages about forthcoming appointments can be consented with specific ‘opt-in’ boxes to be ticked and signed for. The medical history form is a good place for this too. ‘Opt-outs’ or other non-explicit methods will no longer be acceptable.

Do you need a Data Protection Officer? If you have an NHS contract (however small) the answer is “yes” as you are considered a ‘public authority’. However, authoritative guidance (from an EU Working Party) states that although ‘large scale’ processing of ‘special’ (e.g. health) data, such as by a hospital, does require the appointment of a DPO, processing of patient records by ‘an individual physician in practice’ does not. You may however feel that it is worth appointing one anyway: note that their identity will be shown in a public register held by the ICO. They are not ‘responsible’ for compliance (that remains with the Data Controller), but may be a source of expertise and advice, and may, if desired, be an external appointment.

Check your website cookie policy and make sure it is compliant (a template is on the way!)

Finally, make sure everyone in the team is aware of the changes coming up, of their increased responsibilities around data security (no more passwords on Post-It notes!), data breaches, and confidentiality, and review your training at regular intervals!

Part 1 of this blog

Part 2 of this blog

Errata - Postscript by Roger Matthews

A quick note before you read through my blogs on GDPR (or if you’re reading them again). The complexities of this new legislation (and the amendments taking place at the eleventh hour in Parliament) mean that my commentary has been “on the hoof” so to speak and based on available knowledge at the time of writing (starting last December). So there are a few points I now need to clarify and correct.


In Part 1 ‘GDPR - The New Millennium Bug?’ I mention specific consent from patients for processing data. It’s now clear that this is a bad basis to use since patients can withdraw consent. I correct it in Blogs 2 and 3. Oh, and the new law will be the Data Protection Act 2018 (not 2017).

In Part 2 'GDPR - Privacy Notices and Consent' I refer to patient consent possibly being needed for referrals. This arose from some EU commentaries on GDPR (The Section 29 Working Party if you must know) whose advice was rather vague. I now think that this is unnecessary by virtue of exemptions in the Act. I also got the new ICO fees wrong – but those were the ones she was suggesting to the Government at the time… plus ça change…

Finally in Part 3 'GDPR and Data Protection', written as recently as March, we have again been overtaken by events. It seems the ICO will ‘assume’ everyone is in Tier 3 for fees, so unless you want (or need) to pay £2,900 a year, make sure you correct her when your renewal notice comes around (on the anniversary of your current notification fee). The Report stage of the Data Protection Bill happened on Wednesday 9th May when there was a whopping 138 amendments to be considered. One of those of particular note was an amendment to exempt primary care providers with NHS contracts from appointing a Data Protection Officer. Sadly for NHS providers, the Government rejected this amendment.


The Bill now returns to the House of Lords for the final stages.

Roger Matthews

 

GDPUK thanks SimplyHealth Professionals and Roger Matthews for their permission to reproduce these three blog articles.

Image credit - Jon Worth under CC licence - not modified.

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GDPR – Part Two. Privacy Notices and Consent

part-2 Part of GDPR blog by Roger Matthews

Roger Matthews further examines the EU’s forthcoming General Data Protection Regulations and its potential impact on dental practices. Have you drawn up your privacy notice yet? Are you up to speed on how you can lawfully process the data you hold on patients?

 

roger matthews

Hopefully you’re reading this after digesting the first part of this GDPR blog. If so, then even more hopefully, you will by now have done a “data audit” as recommended by the Information Commissioner’s Office (ICO).

You haven’t? Then you should: it won’t take too long. Work out all the personal data you hold: on patients, staff and contractors (Associates etc.), where do you get it from? And with whom do you share it? If you export data to a third party (a laboratory, patient referrals or cloud storage for your Patient Management Software maybe), do they have good data security (can they describe it or have a policy you can see?) and where is it stored or backed up? In particular is cloud storage in the EEA or in another country?

When you’ve completed your audit, the next thing is to consider “why” you hold the data – the “purpose of processing”. For the vast majority of practices, this is blindingly obvious – to you at least! You process patient data in order to provide safe and effective dental healthcare, you process staff data for employment law purposes, and you process contractor data to maintain effective financial and performance records. Simples!

A few practices may undertake forms of marketing which go beyond those simple purposes. They may buy in mailing lists to attract new patients, or may offer additional services to existing patients. If you undertake direct marketing in this way, you should look at the advice given by ICO (Google: ’ICO direct marketing’).

One of the relatively few (for dental practices anyway) major changes that the General Data Protection Regulations (GDPR) will introduce is that ‘data subjects’ (i.e. living individuals) whose data you will hold, store, process and ultimately delete, must be given prior notice about the data you hold, the reason/s you hold it, who you disclose it to and what their rights under the new Data Protection regime will be. This is called a Privacy Notice.

If that sounds like a complicated document, it is! At least in the sense that it needs to be drawn up carefully. It must not read like a complicated document, since you must, by law, be transparent and clear in your communication.

The ICO helpfully suggests that you do not need to spell out the full details of your Privacy Notice when patients (or staff, or contractors) first engage with you, but you must signpost it to them so that they can easily find it. That’s easy on a website (“click here for further details”), but perhaps a little more difficult when patients telephone or present in person.

You could, for instance have a short Privacy Notice at reception, or on a practice information leaflet, and either display a full version on the premises or laminate one that is available for patients to read. However you do it, a Privacy Notice is a must!

Again, you can read about Privacy Notices on the ICO website, and/or you can sign up (for free) to www.dpnetwork.org.uk which is an open access website for small businesses and charities. They have good legal opinions backing them.

Now let’s have a closer look at “consent”. Don’t confuse this with the professional and dento-legal term: in this case, it is defined as one of six ways in which you can lawfully process personal data. I have seen it rumoured that you will need to have explicit, clear and unambiguous consent from every patient/employee/contractor before you can even access the personal data you already hold! Whilst possible (maybe), that’s a very big ask.

Fortunately, the GDPR allows other ways for organisations to lawfully process data. One of these is the “legitimate interest” test. Essentially, this means that if the data subject would reasonably expect you to collect, hold, etc., their data for, effectively, self-evident purposes, and you only collect and process data for such essential purposes, and you are not contravening or infringing their rights to privacy in the process, then that’s OK.

Well, it’s sort of OK!! It is recommended that in order to validate your choice of “legitimate interest” as a lawful basis for processing, you should carry out a Legitimate Interest Assessment (LIA). This would set out firstly, what those essential interests are; secondly,  identify the necessity for processing the data; thirdly, to balance the needs of the organisation against the rights of the data subject; and finally, what actions will be taken to ensure that processing is not excessive or invasive. 

Again, the ICO and DPNetwork have excellent advice on how to carry out an LIA and it’s strongly recommended that you do this before relying on this basis. But it does avoid the need for a blanket consent exercise.

All that having been said, it remains true under the new legislation that health-related data about an individual is regarded as more sensitive (“special” in GDPR-speak). Thus article 9 of the GDPR states that processing health-related data (and other categories, similar to the existing UK Data Protection law) is prohibited, unless one of a number of exceptions apply. One of these is ‘…medical diagnosis, the provision of health or social care or treatment …pursuant to contract with a health professional’. So again, that seems OK, but… the EU Working Party looking at consent still hasn’t produced its final guidance and in its final draft it gives an example which suggests that explicit consent is required, for instance, when transferring a patient’s health data to a referral practitioner or specialist.

So for caution’s sake, when getting updated medical histories, having patients sign treatment plans, or submitting treatment claims, it is probably advisable to get patients to clearly indicate that they consent to the use of data as in your Privacy Notice (which should be available to them to read if they wish). And refreshing that consent (e.g. at medical history updates) is a good idea too. The use of pre-ticked boxes, inaction or silence on the part of a data subject can no longer be relied on, either.

It’s anticipated that generic templates will be available for Privacy Notices, LIAs and other key components of the new Data Protection legislation in the coming months, but it’s a good idea to have some drafts in your mind now to stay ahead of the game.

In the third and final part of this GDPR blog, we’ll look at Data Security, dealing with Subject Access Requests and complaints, and an update on how the new Data Protection Act is going through Parliament.

PS: Annual Registration Fees with the ICO

Parliament hasn’t yet approved a new fee-scale for registering with the Information Commissioner after the new Data Protection Act becomes law in May 2018. But the ICO’s draft guidance to the Government has suggested a three-tier approach. Very small, or new dental practices which process fewer than 10,000 personal records will be Tier One with a fee “up to £55”; but those with larger patient bases will fall into Tier Two: “up to £80”. It’s likely that existing annual notifications will be valid until their expiry date. Watch this space!

Part 1 of this blog https://www.gdpuk.com/blogs/entry/2123-gdpr-the-new-millennium-bug

Part 3 of this blog https://www.gdpuk.com/blogs/entry/2125-gdpr-and-data-protection-part-three

 

Errata - Postscript by Roger Matthews

A quick note before you read through my blogs on GDPR (or if you’re reading them again). The complexities of this new legislation (and the amendments taking place at the eleventh hour in Parliament) mean that my commentary has been “on the hoof” so to speak and based on available knowledge at the time of writing (starting last December). So there are a few points I now need to clarify and correct.


In Part 1 ‘GDPR - The New Millennium Bug?’ I mention specific consent from patients for processing data. It’s now clear that this is a bad basis to use since patients can withdraw consent. I correct it in Blogs 2 and 3. Oh, and the new law will be the Data Protection Act 2018 (not 2017).

In Part 2 'GDPR - Privacy Notices and Consent' I refer to patient consent possibly being needed for referrals. This arose from some EU commentaries on GDPR (The Section 29 Working Party if you must know) whose advice was rather vague.  I now think that this is unnecessary by virtue of exemptions in the Act. I also got the new ICO fees wrong – but those were the ones she was suggesting to the Government at the time… plus ça change…

Finally in Part 3 'GDPR and Data Protection', written as recently as March, we have again been overtaken by events. It seems the ICO will ‘assume’ everyone is in Tier 3 for fees, so unless you want (or need) to pay £2,900 a year, make sure you correct her when your renewal notice comes around (on the anniversary of your current notification fee). The Report stage of the Data Protection Bill happened on Wednesday 9th May when there was a whopping 138 amendments to be considered. One of those of particular note was an amendment to exempt primary care providers with NHS contracts from appointing a Data Protection Officer. Sadly for NHS providers, the Government rejected this amendment.  


The Bill now returns to the House of Lords for the final stages.

Roger Matthews

 

 

GDPUK Thanks SimplyHealth Professionals and Roger Matthews for their permission to reproduce these three blog articles.

 

 

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GDPR - the new 'Millennium bug'?

gdpr

roger matthews

Roger Matthews looks at the significance to you of the EU’s forthcoming General Data Protection Regulations.

If it hasn't already happened to you, it will! Over the next few months you'll be approached with numerous offers to guide you (for a fee) through the 'demanding processes' of compliance with the EU's General Data Protection Regulations (GDPR).

"Aargh," you may say, as you read the doom-sayers' predictions of harsh fines and imprisonment (or both), here comes yet more compliance pressure on my overworked dental team!

However, you should be reassured by the Information Commissioner's statement that anyone (or any organisation that complies with the existing Data Protection law, is already well on the way to achieving compliance with the new requirements.

New Data Protection Act from 25th May

GDPR was issued by the EU in May 2016, giving all member states two years to comply. It's provisions will apply in the UK from 25th May this year. However, each country has some freedom to amend a few details and the UK Government has also decided to 'tidy up' and 'tighten up' on the existing law, the Data Protection Act 1998.

so, on 25th May there will be a new Data Protection Act 2018. This will encompass the GDPR requirements and the draft legislation is currently lumbering through Parliament. The

House of Lords has been debating it since October and it probably won't get the Royal Assent until sometime around Easter.

While we don't absolutely know what the final version will look like, we do know most of it, given that much of the discussion will not really be relevant to dentistry in particular, or primary healthcare in general.

12 step guide

The Information Commissioner's Officer (ICO) has already issued a '12 step guide' to the GDPR which is a useful start to check your current status. As a responsible practice you'll already be registered ('notified') with the ICO (don't be fooled by the earlier news that GDPR will abolish notification or annual fees!) Plus, you'll have a Data Protection Policy and an Information Security Policy (Information Governance compliance too, if you're an NHS contract-holder).

It is worth checking some things at this early stage, however. Do you obtain 'specific and explicit' consent from your patients to store their data? Do you have a privacy notice that tells patients (and prospective patients, for instance on your practice website) exactly what data you hold and who you share it with?

Data flows

It may seem simply - you keep their personal details and health records and because you know all about professional confidentiality, you

keep it all to yourselves. But what about your IT system? Is it backed-up in-house? Is it held in ‘the Cloud’? And if so, where exactly? Do you send patient information to any third

parties, such as insurance companies or Simplyhealth Professionals, for instance? You can be certain that Simplyhealth has rigorous security, but do others? Do you? Is any data taken home or stored on USB sticks or personal computers? It’s worth thinking it through and conducting an audit to look at all the data inflows and outflows.

When you know exactly where all your patient and staff data comes from and where it goes, you can rest assured that you’ll have ticked off one important stage in preparing for the 25th May deadline.

Read Part 2 of this blog

Read Part 3 of this blog

Errata - Postscript by Roger Matthews

A quick note before you read through my blogs on GDPR (or if you’re reading them again). The complexities of this new legislation (and the amendments taking place at the eleventh hour in Parliament) mean that my commentary has been “on the hoof” so to speak and based on available knowledge at the time of writing (starting last December). So there are a few points I now need to clarify and correct.


In Part 1 ‘GDPR - The New Millennium Bug?’ I mention specific consent from patients for processing data. It’s now clear that this is a bad basis to use since patients can withdraw consent. I correct it in Blogs 2 and 3. Oh, and the new law will be the Data Protection Act 2018 (not 2017).

In Part 2 'GDPR - Privacy Notices and Consent' I refer to patient consent possibly being needed for referrals. This arose from some EU commentaries on GDPR (The Section 29 Working Party if you must know) whose advice was rather vague. I now think that this is unnecessary by virtue of exemptions in the Act. I also got the new ICO fees wrong – but those were the ones she was suggesting to the Government at the time… plus ça change…

Finally in Part 3 'GDPR and Data Protection', written as recently as March, we have again been overtaken by events. It seems the ICO will ‘assume’ everyone is in Tier 3 for fees, so unless you want (or need) to pay £2,900 a year, make sure you correct her when your renewal notice comes around (on the anniversary of your current notification fee). The Report stage of the Data Protection Bill happened on Wednesday 9th May when there was a whopping 138 amendments to be considered. One of those of particular note was an amendment to exempt primary care providers with NHS contracts from appointing a Data Protection Officer. Sadly for NHS providers, the Government rejected this amendment.


The Bill now returns to the House of Lords for the final stages.

Roger Matthews


GDPUK Thanks SimplyHealth Professionals and Roger Matthews for their permission to reproduce these three blog articles.

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MAY
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Dental Royalty

Dental Royalty

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MAY
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Key issues discussed at roundtable event

ADG-Healthcar_20180504-145946_1 Healthcare Markets Intelligence

 

In partnership with LaingBuisson, the Association of Dental Groups (ADG) recently hosted a roundtable event to discuss current challenges facing dentistry and identify possible solutions that might help to ensure the long-term sustainability of NHS dentistry.

Chaired by former Deputy Chief Dental Officer at the Department of Health Sue Gregory OBE, and attended by a number of principal figures in the profession, the roundtable addressed a number of key issues that are threatening to undermine the delivery of dental care.

Education and training, regional variations in the supply of dentists, dwindling numbers of EU dentists, and the greater demand for skills mix in the dental practice were among the topics discussed. As the stakeholders identified at the roundtable, changes will be required in a number of areas to get to grips with the problems that lie ahead – including greater involvement from the government and NHS commissioners.

The roundtable was a huge step forward for dentistry, bringing together most of the key organisations for the discussion, but there is still a lot of work to be done. The Association of Dental Groups will therefore continue to work closely with key stakeholders from the profession as well as senior government and NHS figures moving ahead.

 

For more information please visit http://www.dentalgroups.co.uk/dentists/HealthcareMarkets_May_2018_ADG_Roundtable.pdf

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GDPR reviewed by @DentistGoneBadd

GDPR in Dentistry

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Corporate Bullying

By Chris Tapper

 

One working day in April 2018, precisely at 4.50pm, ten minutes before the unseemly scramble by the dentists to get out the door to avoid the dry-retching of the nurse’s as they clean the filters out, I was presented with a sheet of paper.

A nurse delivered the A4 sheet with a flourish and the warning that our corporate practice manager required my signature before five, since she was going away for a few days.

A space had been left for me to make my mark and I noticed all my colleagues had already signed the sheet, with that day’s date. My colleagues had all apparently attested to the fact that they had completed in-house training in needlestick injuries, they had all read the practice policy on needlestick injuries, and they had then participated in a ‘facilitated practice discussion’ about needlestick injuries. The top of the sheet stated that all the training and accompanying requirements had to be completed by the end of January 2015.

I certainly hadn’t completed the in-house training in question personally and definitely hadn’t noticed a facilitated practice discussion, unless I missed it because I was engrossed in Facebook at the time, doing a fun quiz on ‘is your line manager a homicidal psychopath?’ (My answers were probably of great value to Cambridge Analytica and the ‘Leave’ campaign).

More interestingly, three of my colleagues hadn’t even been employed by the corporate around the date mentioned and I figured that two of them couldn’t possibly have done the training since they are new trainees, though they MAY have read the policy during induction. One of them admitted they had only signed the policy sheet “To avoid a lot of hassle.”

I dismissed the nurse with an “I can’t sign it since I haven’t done the training,” to be met a few minutes later by a text from the head nurse with a link to a video on, presumably, needlestick injuries.

The upshot was that I actually went online and found the subject on the website of a training organization I occasionally use, and produced a CPD certificate before six and signed the form anyway.

Yup, I wimped out rather than be met with the ‘I’ve Been Bagging Angry Wasps Into A Sack With My Bare Hands Face’ of my corporate practice manager.

Of course, the nub of the above was that someone in management (I don’t know at what level) had fouled up and had realised that CQC requirements had not been met. In order to meet requirements, staff had been browbeaten into fraudulently signing a statement that would give the authorities the impression the company was complying with regulations.


And the reason I have outlined the above?

 

Corporate Bullying

 

At this time of year, independent dental providers are bidding for contracts against the corporates and increasingly, they are being undercut by the latter, who use their low wage, high trainee workforce ratio and dubious interpretation of NHS regulations to undercut independent practices.

Corporate Bullying


NHS commissioners are desperate people. They need to secure services at the lowest possible rate and the corporates present them with exactly what they need to satisfy the number-crunchers at the Department of Health - high numbers at low prices. To quote from a popular 70’s sitcom, “Never Mind The Quality, Feel The Width.”

It’s a subtle form of bullying, but it’s bullying nonetheless. The Independent practices cannot possibly hope to compete on an equal footing with companies that run their practices on trainee nurses and (largely) EU dentists willing to work for £8 to £9 per UDA until Brexit is put into effect.

It’s the equivalent of being elbowed in the face by the school thug as he pushed into the lunch queue.

I have worked for a corporate for over five years after selling my own practice, and during that time we have had a huge turnover of nursing staff. As nurses qualify, they leave within months for the independent sector - not once has a qualified nurse been replaced with a qualified nurse. The company just takes on another trainee, and often the £9-per-UDA associate finds him/herself providing the in-surgery training.

The playing field is definitely not level. Low quality materials, poorly maintained equipment and restrictions on which laboratories can be used all contribute to the ‘Poundstretcher’ mentality. At one point last year, we had absolutely no x-ray facilities while head office sourced the cheapest scanner possible.

Unfortunately the commissioning Area NHS Teams are either oblivious to what is happening in the corporates, or are turning a blind eye. And by no means is my corporate the worst offender - I’ve seen worse with my own eyes. As corporates go, mine is considered to be one of the ‘good guys.’

So what is to be done? Your guess is as good as, although I would LOVE to see widespread and coordinated unannounced CQC inspections nationwide at 9.00am. Or else a mass walkout of the Nash by the independents? The corporates definitely wouldn’t cope - few of them hit their contracts annually anyway.

As for me, I’m off to Poundland.

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Self-employed status of dentists; is the gig finally up for associates?

HMRC has written to dental associates HMRC has written to dental associates

On the 20th April 2017 HMRC updated their ‘Internal Status Manual’ regarding the employment status of dentists. This made clear that where dentists are practicing as associates in premises owned and run by another dentist and are subject to a BDA or DPA approved associate contract, and the terms are followed, then the associates income will be assessed under ‘trading income rules’ and not as an employed income. In short, associates are self-employed and as such will be liable for Class 2/4 National Insurance, not Class 1 National Insurance. Despite changes bought into effect by the NHS General Dental Services Contract, which changed the way that dentists were paid, allowing for less fluctuation in income, HMRC were of the view that as long as associates continued to pay their share of laboratory fees and follow the terms of their associate agreements, then they will remain self-employed.

So what has changed?

Over the last 6 months there have been a number of landmark legal cases before the UK courts. Laura Pearce of JFH Law wrote in June last year that the tide was turning for dental associates following the Court of Appeal decisions in the cases of Pimlico Plumbers and City Sprint, which were hot on the heels of the earlier decision in the Uber in October 2016.

These cases all revolve around the ‘gig’ economy, where companies have traditionally relied upon casual or flexible labourers, who get paid for the work they do, rather than a weekly or monthly agreed salary. These people are often categorised as independent contractors, but the legally reality can be very different.

The Court of Appeal has ruled that despite the fact that the individual’s contracts defined them as self-employed, and certainly in the case of the Pimlico Plumber, they had benefitted financially from the arrangement for many years, they were in fact ‘workers’ not ‘self-employed contractors’. This means that they are entitled to the national living wage, holiday pay and statutory sick pay and the right to pension auto enrolment.

One of the key definers for whether an individual is a worker or self-employed is whether they have an unfettered right to send a substitute. If a dental associate is obliged to undertake the work personally, and can only send a substitute in the event that they are unavailable (for example when they are unwell or on maternity leave), or the right to send a substitute is dependent upon the consent of the practice owner, then it is highly likely that they will be defined as a worker by the employment tribunals. Pimlico Plumbers have appealed the judgement to the Supreme Court and judgement is currently reserved.

However, could an associate dentist go further and argue that they are an employee; thus obtaining all of the benefits of employment, including the right not to be unfairly dismissed? As no associate dentist has yet challenged the status quo within the Employment Tribunal it is not possible to answer this categorically. It will depend on the nature of the working relationship, the mutuality of the obligation between the parties; i.e. is the dentists obliged to offer work to the associate? Is the work done within fixed hours at a price fixed by the Principal? Finally, is the associate obliged to undertake that work themselves? If the answer is yes to all of these questions, the dentist could well be an employee.

What does this mean for tax purposes?

To date, if an individual is defined as a worker by the Employment Tribunal, that has not automatically affected their status as ‘self-employed’ for the purposes of paying their taxes. Indeed there have even been circumstances where the Tribunal has determined that an individual is employed for employment law circumstances, but self-employed for tax purposes. As such a ‘worker’ and an ‘employee’ can be exempt from PAYE and pay Class 2/4 NI contributions.

In 2017, HMRC had clearly taken the view that regardless of the personal nature of the services offered by dentists, they were content to allow them to continue as self-employed. However, the indications are that this is likely to change in the not too distant future. There is little benefit to HMRC under the current arrangement, and they are likely to see a change in associate dentist’s status as an opportunity to increase NI contribution and tax revenues. Furthermore, with the Government’s current focus on shifting responsibility of pension provision away from the state onto third party employers, it is likely that the writing is now on the wall for many associates self-employed status.

This has major implications for practice owners. Whilst any change in status for the purposes of HMRC is unlikely to be retrospective, bearing in mind their current guidance, this may open the floodgates for claims from associates against their principals before the Employment Tribunal. With the tax benefits of self-employed status gone, associates may think it’s worth arguing that they have been workers or employees for years. They can then claim back unpaid holiday since the commencement of their employment and demand enrolment in workplace pension schemes.

If you are concerned about your employment status or want to discuss the content of this dental bulletin contact Julia on This email address is being protected from spambots. You need JavaScript enabled to view it. or call us on 0207 388 1658.

Julia Furley, Barrister and Partner

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Robots in Dentistry by @DentistGoneBadd

Robots in Dentistry

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Dental School Prospectus

Dental School Prospectus

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Easy Pickings – UK Dentistry And Dental Litigators

By Chris Tapper

 

Six years ago, I attended a two-day residential course. It was a CPD course I hasten to add, not the usual anger management or ‘appropriate behaviour in the workplace’ type of thing I used to have to attend before they found the right tablets for me.

Anyway, it was very interesting, although I freely admit I never put a single thing I learned into practice – mainly because the dental corporate I work for wouldn’t shell out for the equipment I needed unless I could produce a business plan that proved I could earn them at least a tenner for every quid they invested. But that is by the by.

On the evening of the first day (a Friday if I recall correctly), the ten participants plus the lecturer and two representatives of the sponsoring company, enjoyed a meal in the hotel where the course was being held. After a very pleasant starter and main course, I moved to where a gaggle of four youthful dentists were sitting and enquired as to where they were in terms of their careers. It transpired that all four had graduated from the same Northern dental school and had all been qualified roughly two years. They were all general dental practitioners and had all taken up associateships in NHS practices.

As the most experienced dentist on the course – actually, why mince words, the oldest – I was interested to see if the youngsters were enjoying their chosen profession so far. I think I was trying to vicariously re-establish myself with my early enthusiasm for dentistry.

I posed, what I felt, was a fairly innocuous question to the group:

 

"How’s it going?"

 

One female dentist confessed that she cried every night when she arrived home from work, and sometimes did it during surgery sessions. One of the males said he was so anxious about work that he threw up most mornings and that brushing the lingual aspects of his teeth was impossible, while the other female said she had trouble sleeping and had been put on antidepressants six months earlier.

Perhaps the most troubling response was from the other male, who confessed that he had on a number of occasions, thought of ‘ending it,’ having realised that he had made a dreadful mistake in going into dentistry, and couldn’t see any way out. My concern for him diminished a little when I saw that he had an incredibly healthy appetite, demolishing his own rhubarb crumble and a female colleague’s lemon sorbet in less than three minutes.

When I questioned them more closely, the reason for their universal despair was not down to the pursuit of ridiculous UDA targets or the student debts they were saddled with, but the fear of dental litigation.

All four were constantly worried that they would see their careers end either in a GDC meeting, or more likely, through the bad publicity and financial ruin brought about as a result of a civil action facilitated by a dental litigation firm. They felt that the chances of those events happening to them were high, since one of their fellow students had already found himself in the middle of litigation as a result of an NHS root-filling having not worked.

Now that was six years ago, and I would argue that since then, the UK dental profession has slipped into a febrile anxiety that I have never previously witnessed in the 30 years or so that I have been working in dentistry.

Never have I seen dental colleagues (and even strangers) so jaded and so preoccupied with fears of dental complaints and ‘the dreaded letter’ from a certain Northern dental litigation firm.

I will freely accept that I have no scientific evidence for my observations and that my views are based purely on the empirical, but I personally know of no dentist who has not recently entertained thoughts that a patient might ‘turn legal’ if the wind blows the wrong way.

Over the past 18 months, I have been offering support to a close young colleague, being pursued by an extremely aggressive young solicitor (she IS young, I looked her up) who is alleging ‘negligence’ after her client developed dry socket after a routine extraction of an upper first molar. Rightly or wrongly, my colleague decided she did not want to consult her defence organisation and so I have been (rightly or wrongly) equally aggressive in demanding expert witness or consultant reports in support of their absurd claim. So far, the solicitor has failed to provide any evidence of negligence or give any reason why an expert assessor’s report has not been provided. All I know is, it has been fun ‘having a go’ back, but it to me illustrates a sad fact – nobody in the UK-based dental profession is safe from opportunistic punts from patients who want to make a quick quid from the no-win-no-fee mob.

A few months ago, a solicitor I know told me that during a local meeting of his legal colleagues, a speaker said that a lucrative and growing new source of business was dental litigation and that it was “something to think about” since the clampdown on spurious ‘whiplash’ claims and ‘Benidorm Belly’ – where package holiday tourists claim compensation for stomach upsets caused by dubious calamari and fries - had resulted in less opportunity for successful claims.

Being a Dentist

 

Recent experience has taught me that dental litigators are a tenacious and avaricious species and are unlikely to give up easily on an area of medical law that they consider to be easy pickings. Certainly, according to my legal friend, lawyers see it as a much easier area to be successful in than medical litigation.

Soon, the cost of dental defence subscriptions will be prohibitive to viable practice, and the profession, once all our European colleagues go back home, will find itself unable to cope with patient demand. What is the answer? Your guess is as good as mine.

Until then, I am going to have a rhubarb crumble and some sorbet.

 

 

 

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Carestream Dental Announces New UK Sales Manager

Carestream-Mark-Garner

Carestream Dental is delighted to announce that Mark Garner is its new national sales manager, based in the UK.

Mark has over 20 years of experience working in the dental industry having previously managed large sales teams at other companies. Based in Leicester, he brings with him a wealth of dental knowledge and business leadership experience, with a strong focus on meeting and exceeding standards.

Carestream Dental is committed to delivering an exceptional standard of customer service to every dental practice it works with. Building a highly experienced and skilled sales team is part of this, ensuring all its customers receive the information, advice and support they need.

 

For more information please contact Carestream Dental on

0800 169 9692 or visit www.carestreamdental.co.uk

For all the latest news and updates, follow us on Twitter @CarestreamDentl and Facebook

 

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Dental Tales from the Mall online

Dental Tales from the Mall Online

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King v Sash Windows; could a bill for 20 years back dated holiday pay land on your desk?

King v Sash Windows; could a bill for 20 years back dated holiday pay land on your desk?

On 29th November 2017, the European Court of Justice (ECJ) handed down its decision in the case of King v Sash Windows. It is another case in a long line on holiday pay and has opened the flood gates for workers to claim unpaid holiday dating back 20 years.

Why is this relevant to dental practices?

At present most associates are working under a self-employed contract and as such will not be paid holiday pay. However, there is a risk, especially for those associates employed by a dental corporate, that in fact the reality is that associates are workers and therefore entitled to holiday pay.

Mr King’s case does not change the legal test for establishing who might be a worker. However, prior to this case, it was thought that workers could only claim up to two years back dated holiday pay. This meant the risk to dental practices if an associate was wrongly classified was fairly limited.

Now a dental practice is at risk of having to pay anyone found to be a worker unpaid holiday from the start of their contract or from 1998, when the Working Time Regulations came into effect, if the contract began before then.

Definition of a Worker

Before looking at this case in any detail, it is important to understand what the definition of a worker is. This is another area of employment law that has had a number of high profile cases in recent years. In essence the test is as follows:

  1. Must the person personally provide the service or can they send a substitute?

            Most associate contracts contain a right to send a substitute. However, if the right is fettered this 

            could result in the associate being found to be a worker.

 

  1. Is the company obliged to provide work and is the person obliged to accept it?

           If you have an NHS contract, you need to ensure that the associate meets their UDA targets. This 

           therefore could infer into the contract a mutuality of obligation. 

 

  1. Was the status of the ‘employer’ under the contract that of a customer?

            No; the customer is the patient. The associate is providing their services for your customers.

Facts

Mr King was a self-employed window salesman. He began working for Sash Windows in 1998 and was paid on a commission only basis. He never asked for holiday pay and he never received it. On average Mr King took fewer holidays each year than a worker is entitled to. Just before his 65th birthday Mr King’s contract was terminated on the platform of Victoria Station due to his age.

Mr King pursued various claims including unfair dismissal and age discrimination. Here we will just deal with his holiday pay claims, of which there were three, namely:

  1. Claim 1 = holiday pay due on termination of employment, namely in the final year;
  2. Claim 2 = holiday pay due in respect of days off taken but not paid for;
  3. Claim 3 = holiday pay due for any days he did not take from the annual leave entitlement.

The employment tribunal found Mr King to be a worker and all three holiday claims were successful. He was awarded £27,257.96 in total for this element of the claim.

The case was appealed and there were cross appeals in relation to various aspects of the findings. The issue in relation to the holiday pay claim was ultimately referred by the Court of Appeal to the European Court of Justice. 

Holiday Pay Claim; Legal Arguments

Firstly, the only holiday pay claim subject to appeal was in respect of claim 3 – holiday pay due for any days not taken from the annual leave entitlement.

Sash Windows’ main argument was the ‘use it or lose it’ principal, which in essence states if a worker does not use his annual leave entitlement in the applicable holiday year he will lose it entirely. This is because there is no automatic right to carry holiday entitlement from one leave year to the next. They also suggested that a worker would have ‘double recovery’ if they received pay for holidays that they in fact worked and were paid for.

Mr King argued there were circumstances beyond his control that meant he could not take the annual leave and so it should roll over. In this case it was argued that the circumstances beyond his control were his employer’s intentional failure to pay him holiday pay.

Decision

The Working Time Directive was enacted to ensure the health and safety of workers; to allow employees sufficient time away from work to ‘recharge’.  Therefore workers should not be deterred from taking their annual leave entitlement. Given this underlying principle the ECJ found that:

An employer who does not allow a worker to exercise his right to paid annual leave must bear the consequences.

Therefore whilst there may be double recovery, that is a risk the employer takes in not granting a worker his paid annual leave.  The ECJ felt it was for the employer to correctly categorise staff and ensure they are given their employment rights, as workers are in a weaker bargaining position.

The case has been referred back to the domestic courts for a final decision. However, the Court of Appeal will no doubt follow the ECJ’s decision.

This means that an associate can continue to claim they are self-employed and then on termination seek to argue they were in fact a worker and claim back dated holiday pay. There would be no down-side for the associate, as employment tribunal fees have been abolished and there is no costs regime. Also as the test for employment status is different for HMRC and the tribunal, a retrospective change of status would have no bearing on this. The risk is therefore all on the dental practice.

Further, the definition of a worker under the Working Time Directive is wider than the UK law, which an associate may be able to rely on when pursuing their claim.

Practical Tips

First and foremost, make sure you correctly categorise your workforce from the outset and provide a contract that reflects the true basis of the relationship. Whilst this means front loading time and costs, it is likely to save you a hefty legal bill later down the line.

This decision only affects the 4 weeks annual leave granted by the Working Time Directive. Not the additional bank holidays given by UK legislation. Consider amending your contracts to state that UK bank holidays will be deemed to be taken last. You would not need to add this to associate contracts, but if it is in your employment contracts you will be able to rely on this as evidence should a claim be pursued against you.

When buying a practice do your due diligence on the workforce. Make sure the old practice is complying with the Working Time Regulations. Ensure the sale agreement contains indemnities in case staff have been wrongly categorised. Consider implementing your own contracts that are genuinely self-employed, time limits for presenting a claim against you would then start running from the date of the sale.

When selling a practice be careful what warranties you give to the buyer. You would not want to be liable for the entire claim, especially if the new practice has also continued with a contract that was not genuinely self-employed.

If you need advice or assistance in relation to employment status and protecting your position, please contact Laura Pearce on 020 7388 1658 or email her at This email address is being protected from spambots. You need JavaScript enabled to view it..

Laura Pearce

Senior Solicitor

 

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What will it actually take?

What will it actually take?

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.

 

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Help me with end of year spending.....

Help me with end of year spending.....

 

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....

The thread is still ongoing but we think it demonstrates the way our users use the site. They take advice from each other and peer reviews are therefore important. 
 
We are pleased buying decisions are formed via the forum, this shows the importance of opinions from peers and how we believe GDPUK is used to form decisions before making purchases.
 
The forum is now approaching nearly 270,000 posts, from just over 23,600 threads, so similar discussions to the one we have highlighted are taking place every day.
 
As you can see from the infograph below some of the items discussed are big purchases. Digital products are obviously the products that are at the top of “wish lists” but some affordable items also on the infograph. We hope you find the info and thread interesting and certainly extremely positive to see a buying thread with so many opinions and knowledge. 
 
 
 
 
 
 
Thanks for reading, we hope you have found the infograph and thread on the forum useful.
 
 
 
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I think I’ll go and eat worms

I think I’ll go and eat worms

“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.

 

 

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David Chong Kwan

Right on my mood today

You are not wrong. Nils desperandum. https://www.youtube.com/watch?v=XdFkTk3BThA... Read More
Wednesday, 28 February 2018 10:24
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Does TUPE spell trouble for NHS dental contracts?

Does TUPE spell trouble for NHS dental contracts?

The NHS are currently in the process of putting out to tender a number of specialist NHS dental contracts, including orthodontics. The NHS are advising practices who intend to re-tender or bid for the first time to seek advice in relation to TUPE (Transfer of Undertakings (Protection of Employment) before they do so. But why?

TUPE applies where an economic entity transfers from one business to another. This can be a whole business or part of one. It applies in a number of  situations, not just when a dentist is  buying or selling their practice. It can also apply when a business takes services back in-house or outsources services.

The Transfer of Undertaking Regulations, or TUPE for short, offers enhanced protection for employees who transfer from one business to another. It is an extremely complex and confusing piece of legislation. 

In this article we  set out the key principles to help dentists better understand when a TUPE situation may arise during the NHS tendering process and what their responsibilities are. 

What is TUPE?

TUPE requires a business that is buying another business to take on any employees connected with that business.

It applies in three situations:

1. Where one business buys the whole or part of another business;

2. Where a business decides to take services back in-house, for example they use an IT contractor but wish to start undertaking the services themselves;

3. Where a business decides to outsource a service, for example it tenders for cleaners to undertake the office cleaning or it re-tenders that contract.

Whilst it is obvious TUPE will apply when you buy a practice, the question of whether TUPE applies when you tender for an NHS contract is more complicated. The NHS is a business which is outsourcing its services. A move from one provider to another would normally come under point 3 above. On the face of it therefore TUPE would apply.

Business Entity

In order for TUPE to apply the business that is being sold must be an ‘economic entity’. This means:

– It is an economic entity with assets, employees, goodwill etc that is operating as a business;

– There is a transfer of that economic entity; and

– The economic entity retains its identity after the transfer.

Again when you buy a practice it will retain its economic identity as you are buying all the goodwill and assets of that business.

However, how does this apply to a tender for an NHS contract?

Unfortunately this is not an easy question to answer. It will very much depend on whether patients are transferring from the old practice to the new one. A group of NHS patients that moves with the NHS contract could be seen as an economic entity. Any employee who provides treatment to those patients for the majority of their time at work would therefore transfer with the contract. This could mean the nurses and support in a specialist practice that loses its NHS contract will be TUPE transferred to the practice that has won the contract.

Remember TUPE applies to employees only; not workers or those who are self-employed.

Enhanced Protection

Any employee automatically transfers from one business to another and their existing contract survives. In effect the new employer is stepping into the shoes of the old employer. There are very few rights that do not transfer, such as occupational pension schemes. Otherwise all other rights and liabilities will transfer. There are also very limited circumstances in which you can amend an employee’s contractual terms.

You will also need to inform and consult any employees who are affected by the transfer. This duty is on both the old and new employer.

In addition you cannot dismiss an employee as a result of the transfer unless you can show an Economical, Technical or Organisational (ETO) reason for doing so. For example, if you are a practice that wins a new NHS contract and has to take on new employees but you have sufficient employees for the work you tendered for, you may have an economical reason for dismissal, namely redundancy.

Due Diligence

If you are taking on employees from another business you need to make sure you do your due diligence. You will need to obtain information about those employees, including whether they have any outstanding grievance or disciplinary matters. As set out above, any liabilities pass to you and if you are not aware of an outstanding grievance you could have a claim issued against you.

You also need to ensure you have a well drafted transfer agreement, so that if the above were to happen, you will be indemnified by the old employer in respect of any claim issued against you.

That is a lot to think about!

TUPE is a complex area of law with many nuances. If you have any concerns about whether it applies, take legal advice and get proper agreements drawn up to protect you. The consequences of getting it wrong can be high.

If you need advice or assistance on TUPE, please contact Laura Pearce on 020 7388 1658 or email her at This email address is being protected from spambots. You need JavaScript enabled to view it..

If you find this article interesting, please like, comment and share it!

Laura Pearce, Senior Solicitor

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The Tale of a Dental Tyrant by @DentistGoneBadd

Safe air and fury

  4248 Hits
4248 Hits
JAN
28
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Professional Suicide

Professional Suicide

There have been many episodes I’m sure we all know about where a colleague has done something that has been their eventual professional downfall. Examples like the well publicised cases of Joyce Trail and Desmond D’Mello are a demonstration of how a professional has destroyed their own career and reputation through their actions, whether it be an illegal act, or a dangerous one.

But none is more worrying then the Case of Bawa-Garba. I am sure you are all aware of this, but if not, very briefly this involved a junior paediatrician being charged and found guilty of gross negligence manslaughter due to the tragic death of one of her patients whilst under her care. However, what is unusual about this sentence is that it was not only a very short one, but also suspended; something that very rarely happens in a case like this. As is then the usual route of action, the doctor was referred to the GMC for the associated disciplinary hearing that comes with a conviction. The tribunal found that her fitness to practice was impaired, but allowed her to stay on the register. However, the GMC appealed this decision, and she was subsequently struck off by the High Court last week. Interestingly, an interim orders committee of the GMC suspended the doctor initially, which was overturned on appeal by the high court who ruled that even a serious criminal charge did not always mean that suspension was necessary or appropriate to protect the public.

As someone with a conviction for manslaughter, then one could always argue that a professional actually should not be allowed to practice their art on the public again, but there is case law that supports the more subjective approach that was taken in this case initially. But this case (without going into even more detail) is as much, if not more, of an indictment of the systematic failings of leadership and organisation inherent in the environment Dr Bawa-Garba was working in. That the tribunal found no impairment was significant, as the doctor had engaged in insight, and had placed her reflections on the tragic event on her e-portfolio.

And that is the problem.

By honestly reflecting on the events and committing them to the permanent record of her E-Portfolio, this allowed the GMC to use this reflection against Dr Bawa-Garba, and subsequently was part of the case that was successful against her. In effect, by complying with the requirements of the GMC, she has committed professional suicide by recording her reflections as required. It is fine to record ones reflections to show insight, but to then have them used against you is surely unfair. You would have to trust the regulator implicitly when committing your reflections to a permanent record, and the actions taken by the GMC will have served to destroy any trust that our medical colleagues would have had in their regulator. Given that the GMC has always seemed to be to be a more considered and pragmatic regulator than the GDC of late, then once can only wonder just what manner of jeopardy we will have to place ourselves under as a result of this ruling.

In one fell swoop, the GMC have removed the chance for professionals to show they have learnt from their mistakes and develop in a no (or low) blame environment (as indeed occurs in the aviation industry) and installed a culture of fear that I think even the GDC at its worst a couple of years ago would have struggled to create so effectively. However, with the new GDC rules on CPD and reflective analysis requirements that we now have, is there anyone amongst you that thinks that the same couldn’t possibly happen to dentists? Once a regulator has set a precedent, it is likely that they will all act in the same manner.

I suspect the GMC realise there will be a problem with personal reflection now, and given the release of a blog by the GMC on this issue at the weekend, this might be seen to confirm it. The amount of internet noise coming from the medical profession over this matter is significantly higher than anything we have been able to generate, and as a result one must hope that there is a higher likelihood of something significant developing over the next few weeks and months as a result of this case, something which hopefully will roll down to the GDC as well. Even Jeremy Hunt has raised concerns about this case and its unintended consequences.

Once cannot forget the tragedy of the death of a child in the case, but there has to be consideration of the bigger picture of how a ruling such as this will now probably affect the analysis of mistakes in healthcare that are needed to protect the public.  Furthermore, unless the use of reflective writing is somehow protected, the use against us of our own insightful learning could be our eventual downfall.

 

Image credit - James Cridland  under CC licence -  modified.

  6199 Hits
Recent Comments
Stephen Henderson

Correction

Simon, it’s important to note that MPTS (GMC Fitness to Practise Panel) found the doctor’s fitness to practise to be impaired. Th... Read More
Monday, 29 January 2018 09:13
Simon Thackeray

Correction

Thanks for pointing at our Stephen. However it still doesn’t alter the fact that our reflections may well be used against us. In... Read More
Monday, 29 January 2018 09:31
Simon Thackeray

Typo

Thanks for pointing that out Stephen (it should read!)
Monday, 29 January 2018 09:32
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JAN
28
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Enhanced CPD by @DentistGoneBadd

Enhanced CPD

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3518 Hits
JAN
22
1

Child Caries

Child Caries

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Recent comment in this post
Marian Greally

Loving your humour!

...sometimes there is a very fine line between laughing and crying or perhaps you could cry with laughter? Brush-Baby is a prov... Read More
Monday, 29 January 2018 10:15
3839 Hits
JAN
15
0

EU Payment Services Directive now in force in the UK

EU Payment Services Directive now in force in the UK

 

All businesses are now banned from charging ANY fees for credit or debit card payments. The ruling came into force on Saturday 13th January.

The new rules, which have now been made into the law as of Saturday, will mean all surcharges are banned when businesses process card payments.

So there will be no charges for paying by debit or credit card, including American Express and linked ways of paying such as PayPal or Apple Pay.

As an example, when booking flights, you will no longer be charged extra for paying via credit card. Below are a few examples of charges. (from Money Saving Expert)

It is estimated that surcharging cost Brits £166 million in 2015.

  • Driver and Vehicle Licensing Agency (DVLA) - £2.50 credit card fee on all transactions
  • Council tax - 2.5% credit card fee for Ealing Council
  • Flights - Flybe charges 3% on credit card and PayPal transactions
  • Packaged holidays - Thomas Cook has a 2% credit card fee
  • Paid-for TV - Sky charges a 30p/mth fee on recurring credit card payments

The rules will apply to any UK company which is selling to UK consumers.

Switch and save
Change payment provider today and save up to 60%

The reason this is being mentioned in a blog on GDPUK is……

One because of our offer for members, where we can save dental practice money on their card payment fees, which are obviously different area when compared to the new law above but still relevant.

Secondly, businesses often charge these extra charges as listed above (especially smaller businesses such as dental practices) because of the fees the business was paying the merchant supplying the card service and they were passing on the charge to the consumer.

So therefore checking your card machine rate is more important than ever. 

One of way of helping small business owners reduce these costs is by checking your rate. Card payment services can be very costly to dental practices and other small businesses. By comparing your rate, you can reduce your monthly bills by up to 60%. That could mean an annual saving of several thousands of pounds.

 

Find out more info here via GDPUK Services. Just fill out the form at the bottom of the page and within a few days you can be making savings. Just Switch and Save!

This offer is primarily for dental practices but we can also look at other businesses that take card payments on a daily basis and see how we can help reduce your costs. Just enquire via the form on the GDPUK Services page.

Further info about the EU Payment Services Directive here.

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1430 Hits
JAN
15
1

Is your dental practice ready for GDPR?

Is your dental practice ready for GDPR?

What is the GDPR?

The GDPR is a new set of rules which will apply to all organisations that collect or retain personal identifiable data from any European individual. The idea behind it is to standardise data privacy laws and mechanisms across industries, and to ensure that fundamental rights of individuals are protected in today’s increasingly data-driven digital economy.

6 Things you need to know now

It is extremely important that everyone in your dental practice is made aware of the rules surrounding the new data regulation. Preparing for the GDPR will require changes in the practice’s culture, which you should start to plan in advance of the May 2018 deadline. Keeping everyone informed will ensure that your practice follows the proper procedure, and the GDPR is handled with the utmost care.

Here are 6 steps that will help your practice prepare for the changes today.

1. Article 7 GDPR – Consent

Under the new regulation, dental practices will be required to keep a record of how and when the patient gives consent to store and use their personal data. Consent will need to be clear and distinguishable from other matters and provided in an intelligible and easily accessible form, using clear and plain language. Consent cannot be inferred from silence or inactivity of the user.

Further requests for consent will need to be separate from other terms of engagement. In practical terms this means you will need to clearly explain to your patients what you are intending to do with their personal data.

It must be borne in mind that consent once given can be revoked, and it must be made equally easy to withdraw consent given.

The GDPR also introduces a requirement for parental consent. Where services are offered directly to a child, practices will need parental consent to process the data of under 16s.

To do list:

– Identify the categories of personal data processed within your practice.

– Consider the legal basis applicable to the processing of personal data within your practice, and make sure these grounds will still be complied with the GDPR.

– Where consent is relied on, check that it will be: freely given, specific, informed, and unambiguous.

– Consider introducing processes to promptly honour any withdrawals of consent.

– Make sure you keep a record of consents given to demonstrate compliance.

2. Articles 12-15 GDPR – Privacy notice

Aside from the need to obtain consent, your practice will be under an obligation to ensure that the processing of data is fair and lawful. Also, appropriate information must be given to your patients as to how their data is to be used. This is normally done in the form of a privacy notice. The GDPR has a mandatory list of the information which must be given to patients where data is obtained directly or indirectly from them. You will be expected to explain to your patients what data relating to them will be collected, how it will be used, the purposes for which it will be used and how their data may be shared.

To do list:

– Get to know your data. Consider what information is being collected, who is collecting it, how and why it is being collected.

– Consider how the information obtained will be used and who will it be shared with.

– Consider what possible effect the information obtained could have on the patients concerned.

– Consider building a data catalogue (if you haven’t got one in place) and drafting a meaningful privacy notice.

3. Article 30 GDPR – Records of Processing Activities

There will be a significant change to records of processing activities. The GDPR does not distinguish between internal and external records anymore. Dental practices will now require only one kind of record: an on-demand internal record. A practice will be required to maintain records of the entire practice’s processing activities internally. Moreover, these will need to be available to supervisory authorities upon request.

To do list:

– Consider implementing measures to prepare records of your practice’s processing activities.

– Consider introducing a full compliance program for your practice incorporating features such as regular audits, HR policy reviews, and training.

4. Articles 37-39 GDPR – Data Protection Officer

You will be required to appoint a Data Protection Officer (DPO) if the dental practice is:

– A public authority (except for courts acting in their judicial capacity) (Art. 37(1)(a));

– Carrying out systematic monitoring of individuals on a large scale (Art.37(1)(b)); or

– Carrying out processing of special categories of data or data relating to criminal convictions and offences on a large scale (Art.37(1)(c)).

 

Dentists providing NHS care will be regarded as public authorities. Thus, even a small NHS practice will require a DPO. It is anticipated that the Clinical Commissioning Groups (CCGs) will be providing Data Protection Officers in primary care settings.

If you don’t want to recruit, it will be possible to appoint a single DPO to act for a group of practices, provided that a DPO is easily accessible from each establishment. Alternatively, you can contract the services out.

For those organisations to whom the requirements do not apply, they may still choose to appoint a DPO.

To do list:

– Assess whether your practice is obliged to appoint a DPO.

– Consider who will be your DPO.

– Consider whether your practice should appoint an internal or external DPO.

– Compile information on data processing activities within the practice.

– Ensure that those to whom you have designated responsibility, their duties do not lead to a conflict of interests of their own role.

5. Article 20 GDPR – Data Portability

The rights of individuals under GDPR are the same as those under the Data Protection Act 1998 with a significant enhancement of the right to data portability. Under the GDPR, patients will have the right to receive the personal data which they have previously provided in a ‘commonly used and machine readable format’, and have the right to transmit that data to another controller. This information will need to be provided free of charge, thus removing the previous £50 subject access fee for dental records. This will apply only to data processed by automatic means, and not to paper files.

To do list:

– Consider whether the technical capabilities of your practice will comply with data portability requests.

– Make your patients aware of their right to data portability. Does your company send out e-bulletins and/or newsletters? Let your subscribers know by including a short paragraph at the end of the article.

6. Article 84 GDPR – Penalties

Any practice in breach of GDPR can be fined up to 4% of annual global turnover (not profit) or €20 million – whichever is greater. This fine can be imposed for the most serious infringements, for example for not having sufficient customer consent to process data. The practice can also be fined 2% for not having their records in order, or for not notifying the supervising authority and data subject about a breach, or not conducting impact assessment. In the case of a breach, practices will be required to report the breach to relevant authorities within 72 hours. The practice will be obliged to give full details of the breach and offer proposals for mitigating its effects.

What next?

You should be preparing for the new requirements that will affect your practice. Considering the above steps in the context of your practice is the very first step you can take in order to prepare for the upcoming legal changes. Do not assume that you will be able to claim innocence through ignorance of the rules – the whole point of the GDPR is to keep your company better protected and able to deal with breaches in security. If preparation is approached in the right way, your practice will be well-prepared in time for the regulation coming into force, and your business will be secured for years to come.

We will be running a workshop on 22nd February aimed at dental practices to help them prepare for the new GDPR requirements.

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Recent comment in this post
Paul Carpenter

Really CCG be Data Protection ...

The local CCG cannot be the Data Protection Officer as the duties of the Data Protection Officer on [url]https://ico.org.uk/for-or... Read More
Friday, 02 February 2018 12:48
5696 Hits
JAN
14
0

Horrorscope 2018

Dental horrorscope 2018

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4693 Hits
JAN
08
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Learn the Lingo

Learn the Lingo

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4193 Hits
JAN
08
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7 Easy ways to save money and time in your dental practice in 2018

7 Easy ways to save money and time in your dental practice in 2018

 

Save money and time in your dental practice in 2018 by Jonny Jacobs

One of the aims we have always looked to achieve at GDPUK is saving money or producing special offers from our advertisers and partners for our 11,000 members. Running and operating a dental practice (or any business) can be extremely expensive and time consuming. Not all expenses or direct debits, will get checked every month because they aren’t always the first priority but often expenses can go out of our control.

Below is a short guide we have produced that looks at some ways you can save money and time in your dental practice in 2018.

**Disclaimer** A few of the money and time saving suggestions, are services that are offered by GDPUK via third parties. These services are available elsewhere but the suppliers we have mentioned have produced excellent savings for our members and provide a service that they have been extremely happy with. Only our opinion!

 

Insurance

Dental Practices need all sorts of insurance. Insurance is always worth shopping around for when you consider the amount of cover a dental practice needs on a regular basis.

There are a number of insurances that a dental practice may choose to buy such as dental practice insurance, dental locum insurance, pressure vessel inspection, keyman protection insurance. All the policies are worth comparing the market, with a number of companies specialising in this area such as All Med Pro, Lloyd & Whyte and MIAB.

 

Dental Supplies

Over the years on the GDPUK Forum, our members have found that it is worth doing a price audit on their top 20-30 supplies in the practice based on volume per month and it can be found that with a bit of shopping around of dental suppliers, you can make some considerable savings for the practice. Obviously, credibility, reliability and efficiency of the suppliers also need to be taken into account for important supplies but some considerable savings can be made. This is certainly worth auditing a couple of times a year.

 

Credit Card Fees

We’re always looking to help you reduce costs without compromising the quality of your patient care. That’s why we’re working with nexpay to ensure the fees you pay on credit card processing are extremely competitive and save your dental practice money. Just contact us by the link below, nexpay will review your existing account and undertake a full market comparison. They will then produce a report that shows you the potential new tariff savings. Some GDPUK members are saving thousands of pounds a year on card processing fees.

You still provide the same service to your patients but save on the processing fees, which over a calendar year can often be quite a saving! Find out more here.


Water

Water is used a lot in an average dental practice. On 1 April 2017, businesses were given the freedom to choose which water supplier to buy their water and wastewater services. This means there are loads of dental practices that will be paying over the odds for their water supply, certainly worth a quick shop or call around. Companies like utilitywise and openwater will offer a comparison service and advice on what is a good offer. Once again a great opportunity to reduce costs in the new year.

 

Energy

GDPUK.com has teamed up with a leading independent business energy brokerage who is constantly striving to source the best products and most competitive market rates for businesses. With a vast array of suppliers and products available to the business market, quite often businesses are left without clear guidelines as to which is the best deal. Our broker can offer a comprehensive panel of suppliers who are vying for your business. For more information, please follow this link - https://www.gdpuk.com/energy Other similar type services are also available.

 

CQC and Regulation

Compliance is changing faster and faster. From the CQC Fundamental Standards in 2015, to the GDC standards in 2014 to changes in employment law, health and safety, sharps regulations and a whole lot more. Because the volume of compliance and regulation in a practice can seem to be overwhelming, it can be difficult for a dental practice owner or practice manager to keep on top of it all.

Services such as icomply and rightpath4, help to tell you what to do and keep you updated on the latest changes and legislation. This can help to save the practice a lot of time, stress and misunderstanding. It does help having everything in one place.

Right Path 4 who have always been great supporters of GDPUK have a special offer on for members of GDPUK. All future updates to the Right Path 4 system are included in this monthly fee. Further information here on how they can help you in your practice.

 

Software Systems

Although not necessarily saving you money in the short term, dental practice software systems certainly make your practice streamlined and more efficient for all members of the team.

You can save a lot of time in your practice by going paperless. One of these paperless systems is offered by iSmile, who offer your very own branded Patient Portal, where you can give your patients the ability to fill in medical history forms on their desktops, tablets and mobile devices prior to their appointment. iSmile can automatically email medical history forms to your patients, which are filled out securely online and then transmitted back to iSmile and stored within the patient's file, significantly reducing workload and paperwork at the dental practice reception.

Further information on this subject can be found via the GDPUK Forum:- Going Paperless.

 

We hope you found this guide to saving money and time in your dental practice extremely useful and it has got you thinking about areas that could be improved in your business.

Thanks for reading.

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DEC
30
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Follow the ARF Money by @DentistGoneBadd

Follow the ARF Money

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4540 Hits
DEC
17
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The TRUE Dental meaning of Christmas by @DentistGoneBadd

The TRUE Dental meaning of Christmas

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5055 Hits
DEC
12
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It’s official; dentists are stressed out

It’s official; dentists are stressed out

It has long been recognised that dentistry is a stressful profession. It has long appeared in the list of “top ten” most stressful jobs, along with teaching, prison officer and working in the emergency services. But now it is official; the British Dental Association has conducted research into stress levels in the profession. They have found that a shocking 39 per cent of community dentists surveyed and almost half of GDPs reported high levels of stress. This is compared to an average of around 15 per cent for all British workers. 

High levels of stress can have a very negative impact on the running of any dental practice. Ensuring staff are happy and relatively stress free, will lead to better productivity and higher morale in your workforce. However, there are additional pitfalls to ignoring staff stress levels as work related stress can lead to a claim being issued against the practice for damages. 

Managing work place stress

The BDA’s Evidence to the Review Body on Doctors’ and Dentists’ Remuneration for 2017/18  found that 51% of the dental profession would not recommend a career in dentistry. The same report found that both practice owners and associates considered their morale to be ‘low’ or ‘very low’ at 29 per cent and 32 per cent respectively.

In response the BDA is undertaking research on dentists’ well-being at work and why they experience ‘burnout’, but this does not help you tackle the problem in your practice now.

What is Stress?

According to the Government stress is a reaction to a person’s circumstances and surroundings. It is not an illness of itself but often causes other illnesses. Its effects are shown in a number of different ways, both physical and mental. For example, lack of concentration, sleeplessness, low mood, susceptibility to colds/flu, skin irritations, the list goes on.

It is important to remember that there is a difference between pressure and stress. Pressure at work can be healthy, as can some level of stress. However, too much pressure can cause stress to become harmful to health and employees will react differently to the pressures they face.

What duty does a practice principal owe to their workforce?

Employers have a common law duty to take reasonable care of the health and safety of their employees. If an employer breaches that duty, and that breach causes the employee a personal injury, the employee can bring a claim for damages.

A personal injury can include stress. However, the injury must be a medically recognisable psychiatric injury. Therefore, not all cases of work related stress will give rise to a claim for damages.

In order to succeed in such a claim, an employee will need to prove the following:

1.      That the employer breached the duty of care;

2.      That the breach caused the employee injury;

3.      That the injury was foreseeable.

It should be noted that whilst we have used the phrase ‘employee’ above, the protection will extend to workers and could even extend to a self-employed associate, if they can show that they are owed a duty of care by the practice.

Easton v B&Q [2015]

Hatton v Sutherland is the leading case in personal injury claims relating to stress at work. The court re-visited the test in Easton v B&Q and also gave some practical advice in dealing with such cases.

Mr Easton was a manager at a B&Q store. Prior to this he had worked as a manager for 10 years at a large supermarket chain. Mr Easton alleged that as a result of B&Q’s breaches of the duty of care he had suffered work related stress. Mr Easton further claimed that the way his return to work was handled, following a period of stress related ill health, caused a relapse of his condition.

There was no dispute from B&Q that Mr Easton had suffered a psychiatric illness. The issue in this case was whether the injury was foreseeable.

The key findings of the court were as follows:

1. Lack of promotion

The court recognised that Mr Easton’s condition affected his perception of the events that had taken place. However, the court found Mr Easton had persuaded himself that a promotion was in line and this could not therefore be a breach of duty. The court commented that employees should try to look at events objectively.

Tip: employers who can show they have acted fairly and in line with any policies are unlikely to be in breach of the duty of care. If an employee has taken exception to a decision you have made, try sitting them down and clarifying why it is needed, rather than saying ‘I am the boss, my decision is final’.

2. Removal of night time staff

The court found that the effects of this were not as dramatic as Mr Easton made out and that Mr Easton failed to make any complaints about this to his employer at the time.

Tip: An employer cannot be expected to foresee an injury if it is not aware of the concerns the employee has to begin with. However, if a member of staff raises any complaints with you, you should take them seriously and deal with them accordingly, even if that means explaining to the employee why their concerns are invalid.

 3. Rejection of a grievance

Although not in fact argued by Mr Easton, the Court took the opportunity to clarify that when an employer rejects a grievance, as long as a proper procedure was followed, this cannot be a breach of duty simply because the employee does not feel justice has been served.

Tip: this is often an issue for employers. Employees not agreeing with a grievance outcome and feeling they have been dealt an injustice. However, as long as you have properly investigated the issues and provided a reasoned response to the same, it is unlikely you will be criticised.

4. No knowledge of stress

The court found that B&Q had no knowledge that Mr Easton was suffering from stress. The court took into account Mr Easton’s previous role as manager for a large supermarket chain and concluded that he was therefore capable of doing the role. In the absence of Mr Easton informing B&Q of his concerns, B&Q were not on notice of any issues.

Tip: An employer is entitled to take what his employee tells him at face value, unless there is good reason to think to the contrary. Therefore unless an employee reports to you they are feeling stressed, you do not need to take action. However, if they do you should take heed and ensure you have dealt with any concerns the employee raises.

Conclusion

Whilst work related stress should be taken seriously, employees need to show that the employer did know, or should have known, that their actions would cause an injury (the foreseeability test) in order to succeed in a claim. Most claims fail on this basis, as it is a high threshold.  A common misunderstanding by employees when arguing a claim for personal injury is that simply because they have suffered from work related stress, that the employer must be liable.

Irrespective of this, as an employer you will want to ensure your staff are as happy and stress free as possible. There are a number of ways you can do this:

1.       Appraisal process;

2.       Having an ‘open door’ culture so employees feel safe talking to you;

3.       Undertaking staff meetings so staff feel part of the practice;

4.       Ensuring changes to procedures are properly explained before they are implemented, to help staff understand the reasons for them.

Also remember that whilst an employee may not have a stress at work claim, they may be able to bring claims for disability discrimination or harassment, unfair or constrictive dismissal or breaches of health and safety requirements.

If you have queries regarding the content of this article please contact Laura Pearce, Senior Solicitor, on 020 7388 1658 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it.

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3569 Hits
DEC
11
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CQC Latest Policies - In Pictures

CQC Policies in pictures

  5543 Hits
5543 Hits
DEC
08
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3 for 2 offer for advertising on GDPUK in 2018

3 for 2 offer for advertising on GDPUK in 2018
 
 
Want to reach dentists in the UK?
 
Want to increase exposure of a new product or service?
 
Want to move away from traditional advertising and instead utilise digital advertising?
 
If the answer is yes to any (or all) of those questions ..... then you have found the perfect offer to facilitate those needs
 
We are running an offer.
 
We are aware it's not manic Monday or black Friday but we have taken a risk and put a special offer out anyway.
 
Contrary to a lot of advice found on social media, these offers work incredibly well for GDPUK.
 
In fact one of these offers, actually produced one of our most loyal clients over the last few years and it has helped us build up a brilliant working relationship with that particular business.
 
So today we are offering a 3 for 2 offer for booking advertising on GDPUK in 2018.
 
Book advertising in Jan and Feb 2018 and get a third month of advertising absolutely free.
 
 
 
Leaderboard Banner - appears at the top of all Jan & Feb 2018 plus an extra month - £1650 + vat
 
Forum Banner - Appears on forum pages on left hand side - £990 + vat
 
Front page Banner - Appears on front page and blog page - £990 + vat
 
Email Banner - Appears on daily digest email in 2 spots - £780 + vat
 
 
*All advertising includes opportunity to post special offers / PR to our products update page, this gets shared on social media.
 
**For £150 + vat for the 3 months booked, your banner can also appear on our mobile app in the 3 months you book above. Please ask for further details. 
 
If you would like further information about these offers or would like to receive further information about GDPUK. This email address is being protected from spambots. You need JavaScript enabled to view it.
 
 
 
 
  705 Hits
705 Hits
DEC
07
0

Amazon Threat to the Supply Chain?

Amazon Threat to the Supply Chain?
 
A slightly US focused story but yesterday (6th December) an interesting report was released by Morgan Stanley.
 
The report by Morgan Stanley says Amazon isn't gunning for pharmacies or medical devices just yet. Instead, it's turning its attention to the dental supply business.
 
Should the traditional dental supply businesses (such as Henry Schein) be worried? 
 
Probably not just yet but I do believe that Amazon Business will be a force in the next ten years, supplying consumables, stationery, office supplies, food etc for all businesses both big and small. (not just dental)
 
How will this work?
If we take a dental practice as an example. The person who does the purchasing for the practice will have an amazon business account (many already do) and will start to buy dental consumables and even equipment on the amazon site. It will be convenient, familiar and reliable. This is definitely something to watch over the coming months / years in the US first and the UK won't be far behind.
 
Read more here.
 
Further Info on Amazon Business UK
  941 Hits
941 Hits
DEC
06
0

Cult Fiction

Cult Fiction

We’re all members of a cult. Whether we like it or not, since mankind first appeared on earth, there has been a need for the majority of humans to flock together in some form or another. Whether it was for protection by strength of numbers, or to increase the genetic variety of a group, the formation of cults, tribes or groups has always been something that the human race has experienced.

I’m not talking here about race-related groupings of human, because that is something far more fundamental. That is all about the genetics that make you part of one race or another, and there is precious little you can actually do about the genes you were born with.

What I’m thinking about here is the tribal nature that makes you support one football team over another, or a different political party to someone else. Religion may also be part of this, but I am going to steer well clear of that for obvious reasons. However what is apparent is that most of these tribes and cults  are based on the shared values and belief structures that the members of the cult have.

“Where is he going with this blog?” I can hear you all thinking. This is not one of my normal types of observational commentary on the state of dentistry where I’m having a go at some (dis)organisation or system in dentistry.

Or is it?

Because it actually is exactly the same as usual in that I’m pointing out something that I believe is fundamentally inherent to the problems that we are experiencing in the profession at the moment.

Cults and tribes are collections of people who flock together under one belief structure. The profession of dentistry is such a tribe. We all share the same skill set fundamentally, and are working together to provide the same goal of health for our patients.

But within a tribe are often sub-tribes and cults. These are the things that seem to me to be dividing the profession in more ways than one and can often cause problems. When we look internally we see the infighting between some of the orthodontists and those providing GDP orthodontics. You can guarantee a lengthy ‘discussion’; when some of the more evangelical on both sides come out to discuss their views on this subject. The same is true of the two cults of private and NHS dentistry.

It is actually possible to be a member of different cults at the same time, and cross over seamlessly from one to another depending on the situation. You might find yourself agreeing with someone from another cult one minute, and then vehemently arguing the next.

When your strongly held values and belief structure is in disagreement with someone else’s equally strongly held views then conflict is almost inevitable. Only the control of the emotional aspects of these differences is what prevents the breakdown of the relationship between these two sides. Some people are able to control it more than others and agree to disagree, but many others are not.

Dentistry is absolutely full of cults.

More so than I think it has ever been before. I personally think the rise of social media and the ease with which one like-minded individual can find others who are from the came cult has been at least partially to blame.

The problems arise when the cults cause not only infighting in the profession, but also are responsible for the perception of the profession to the public (who I’ll just take as one big tribe at the moment).

Within the profession we have the cult of the Key Opinion Leader, some of whom seem to have opinions based on their parallel membership of the financially motivated cult, and who can pay them the most. Then we have the Celebrity dentist cult, often admitting to no personal or clinical failings and who may have sprung from anonymity in record time, with fawning acolytes who can see no fault in their heros. Given the following of some of these two groups, I’m actually waiting to read in the BDA news that 600 cult members have all drunk copious quantities of Hypo in a mass attempt to align their teeth. Ok, maybe that’s a bit far, but what will usually happen is the acolytes will be the ones who get left in the lurch either with the GDC or with a load of obsolete materials when the Guru-esque leader moves onto the next best thing since the last best thing.

There is the huge cult of the NHS dentist, who can often see no way out of the cult, but stay because they are also members of the ‘I’m alright Jack, my pension’s great’ cult or the ‘We cant go private where we are’ cult. There is also the sinister ‘Gamers’ cult, where you’re a member but don’t admit to it, either because you don’t want to, or because you don’t realise you are.

I could go on and on with this but I think I’ve made my point.

I’ve probably managed to alienate a huge chunk of my readers now with those analogies (perhaps it would have been more sensible writing a blog on the various religions after all !) because I’m sure you now will find yourself both agreeing and disagreeing with me and become annoyed at me in some way.

The point I’m making is that the values and beliefs that we have developed place us firmly in pigeonholes and groups in such a way that someone else can make an observation that can start a conflict if you don’t like it. I’ve done precisely that in the previous paragraphs.

But the above is all a myth based on your belief structure, which can be changed if you really want it to. Do you want to be a member of the cult of materialistic egotistical, self-promoters? Fine, do that, but then don’t be shocked when others take issue with that.

Until we have the unification of the profession behind one overriding cult then we will always be divided. Since these cults are nothing to do with our genetics but only down to our beliefs, it is all an entirely fictional situation that causes the problem; a brainwashing due to our desire to hold onto our beliefs and opinions.

We need to not become a profession against itself especially as we have enough external factors affecting us already. Unity and a sense of purpose is more important now that it ever has been.

 

 

Image credit - Legominifig under CC licence - not modified.

 

 

 

 

 

 

 

 

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Notes - Post It?

Notes - post it?

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We Did Not Sign Up For This

We Did Not Sign Up For This

I thought I'd share this latest opinion piece by a young dentist in the latest BDJ, entitled:
"Defensive dentistry and the young dentist- this isn't what we signed up for."

Read it here 

 




So what are THE main problems here in Dentistry in England worst of all, but relevant to all the UK too?

My shortlist would be:

1. An impossible UDA NHS contract that publicly promises unlimited care for needs, in a very limited system

2. Onerous regulation using the slide-rule of 'perfection' instead of 'seriously below' reasonable standards.

3. An increasing Claim/Blame culture that takes little or no SELF responsibility for prevention or resolution in the first place. It's like they are given an 'exemption' ticket and thus can claim/blame/complain with impunity, even when fraudulent.

4. A CLAIMS culture driven by some enhanced-fees Lawyers selfishly, resulting in the UK having the worst reputation in the World for FALSE or exaggerated claims, just to get free easy money, from car whiplash claims to holiday insurance etc.

5. Some very Poor Expert witnesses who seem to readily use a yardstick of perfection, without the experience or TRUE NEUTRALITY to act in the public interest first, regardless of WHO engaged/paid them and not applying No.2 above properly.
The trouble is those prosecuting/claiming are only too happy to send MORE work to those who seem to write the worst reports - this may be SO bad that it needs a lookback exercise - if it's good enough for our dental records then why not ?

5. Some indemnity organisations feeling vulnerable because of the above and/or struggling to put up a timely/full defence, make a Corporate decision to minimise THEIR future liabilities in years to come and payout early. It's a tough call for them I know, but many now want to see more pushback and earlier payouts may be just pouring petrol on the fire and thus encouraging more claims, fishing and efforts to get more payouts. It's like a feeding frenzie and that's bad for all.

6. Due to pressures and cuts from the DH and HEE on the undergraduate curriculums, clinical teaching is downrated and research and other targets get all the qudos/funding, so our Undergraduates are getting less clinical exposure, training and preparation for the 'real' world = more like walking into a Gladiator ring and surviving the first few years, but with early scars already from the above. Increasingly even after FT/VT not all are surviving those first few years after qualifying and already experiencing GDC, Lawyers letters, Complaints, Compromises from systems and Corporate limitations and high stress etc - certainly not looking forward to a happy Career!

7. Our Profession - yes we must take some of the blame, but currently we are taking ALL OF THE BLAME whilst Society is overlooking or even encouraging further the above 5 aspects for short-term gain and anyway those Dentists have it easy so let's see them suffer, right ?!? 

So at what stage do we reach breaking point - at what point do we say enough is enough and start acting together in Unity.???

UNLESS we start making it someone else's problem, this will continue and in 10 years when our Profession is decimated and dental care is so defensive it's do nothing or refer for extractions, the population suffers greatly.

Read that article again in the BDJ - our young graduates are rightly saying, this is NOT what I signed up for .

Tony Kilcoyne.

 

 

Image credit - hierher under CC licence modified

 
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4414 Hits
NOV
26
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12 Days by @DentistGoneBadd

The twelve days of Practice

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5580 Hits
NOV
19
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Perceptions

Dental Perceptions

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5164 Hits
NOV
13
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Wash your hands of responsibility

Wash your hands of responsibility

No one can deny that modern technology has been a revelation in recent years. The use of it to improve diagnostic yields in radiography, to allow mainstream imaging in practice of aspects of dental tissues that we couldn’t previously visualise the same way  can only benefit our patients. Computerisation of dental notes and management systems, (whilst restricted in the choice of manufacturers) have probably improved the efficiency of most dental practices far beyond that of the old paper systems. Digital marketing tools, online presence through websites and blogs, and social media are all here to stay, and have driven the profile of the profession upwards. All in all, I think most of us would agree, technology has been largely a good thing for the profession

But one thing that I am REALLY struggling with that has come about as a result of this type of technology is the increase in Referral Portals for NHS referrals. On the face of it is would seem to be a streamlining of the process needed to refer into secondary care, and reduce the costs and problems with paper referrals. Entering the data via a computer linked to the patient database and directly into the referral systems would seem on the face of it far more efficient that writing a letter and posting it.

So why do I have an issue with it? This sort of advanced technology is right up my street normally. However, because of the way these systems seem to be implemented, I can see potential problems for registrants falling foul of the GDC Standards when they are forced to use them. The GDC standards that I personally think relate to this type of system are :

 

Standard 1.7 – Put patients interests first before your own or those of any colleague, business or ORGANISATION – these systems tend to be imposed unilateral decisions that don’t seem to have any guarantee that they are better for the patient (or indeed tested fully).

Standard 4.2.6 - If a patient allows you to share information about them, you should ensure that anyone you share it with understands that it is confidential – How does a faceless system with no identification of who receives the data comply with this standard?

Standard 6.3 – Delegate and refer appropriately and effectively. However, someone else often choses where the patient goes and who they see, with the clinician often having no idea of the degree of expertise that clinician actually has. Referrals are even rejected if often irrelevant (but required) tickboxes are not filled in.

Standard 6.1.5 – You must ensure that all patients are fully informed of the names and roles of the dental professionals involved in their care - How does a portal allow us to do this? Do we give all our patients Bill Gates’ name as its done on a PC?

Standard 6.3.1 - You can delegate the responsibility for a task but not the accountability. This means that, although you can ask someone to carry out a task for you, you could still be held accountable if something goes wrong. You should only delegate or refer to another member of the team if you are confident that they have been trained and are both competent and indemnified to do what you are asking.

For me this is the big problem. This alone is where the entire concept falls down unless we are indemnified for the errors of the system. What if this is a life changing referral such as a tumour? You are going to be ultimately responsible as you have to make the referral, and you can guarantee the powers that be who thought it was a good idea to impose the portal will NOT indemnify you against the failure of the referral in some way, nor will the GDC.  If the referral is rejected because of some missing tickbox that is largely irrelevant to the immediate urgency but required because some software engineer hasn’t allowed any flexibility in implementation then I personally cant see how this should ever be the responsibility of the clinician. The fact I might for example omit the patients GP because I’m more interested in the speed of the referral is a pedantic bureaucratic issue and not one of patient care.

I can’t comprehend how we as a profession have allowed this type of loss of control of patient care to creep into our referral systems. I am fairly sure there are practices that are on referral pathways that our patients will be allocated to that many of us would not be happy for them being treated in. Part of being a professional means that you take on the ultimate responsibility for the care of a patient, and the GDC standards means that includes ensuring they are referred to an appropriate colleague. Unless every single one of these referrals is triaged by a clinician then there will be mistakes made. And this pre-assumes the system actually works like it should…..

I have had the misfortune recently of being forced onto a pilot in my local area of just one of these systems. Due to the obviously more knowledgeable people in charge of procurement in my area, they foisted a system onto practitioners without actually discussing anything with them first. To say I experienced problems was an understatement, and I know many others did too (despite the LAT saying the response to their questionnaires about it was overwhelmingly favourable – presumably because the portal lost as many bad responses as it did referrals). To be quite honest, I would have been better served learning how to send smoke signal referrals rather than use the system that was imposed. I did some research into the actual system and found that it had been dropped by at least one area as it was unsatisfactory, and another region have accepted that the same system isn’t good, but it’s the best they’ve seen. Hardly a glowing endorsement is it?

For example, in the 2 months I used it, we experienced a plethora of problems. I don’t think it is particularly useful to have to spend over TWO HOURS trying to upload a Periapical radiograph, knowing that if it wasn’t sent the referral would have been rejected. This was a compressed file of just 103kb. I don’t think it is particularly helpful to have half the tick boxes missing for medical histories, or dropdowns that you can’t fill in because they are incorrectly populated. A spell check that allows only the incorrect spelling of a drug is also pretty useless. It’s not useful that the system doesn’t tell you if the referral has gone correctly, or instead forever been lost in the ether of the internet. It’s not professional to have no idea who you have just referred the patient to or who is going to read the information. Not particularly useful if your patient who doesn’t have an email address (like many of my elderly patients) can’t even be referred at all as the system refuses to accept the referral without their email address. It also falls foul of my data security policy of allowing an unknown (to me) commercial third party installing software onto my system (which is massively firewalled both by hardware and software – which would appear to more than can be said for the NHS system if the recent Cryptolocker problem is anything to go by).

But having the system obviously ticks another box for those who confuse boxticking with patient care. By having a system that once again means all the responsibility still lies with the registrant even though they have no control of it is highly convenient for the powers that be. They get to have a load of committee meetings about the procurement, knowing full well that if and when it fails, and if and when patients suffer from it, it will be the clinicians who will get the blame for it. Having a system imposed from above without actually making sure it works is nothing new: lets face it the NHS hardly have a great track record in getting IT infrastructure correct out do they? Heaven help us if our friends at Capita get involved with implementing one of these systems; patients will probably end up with an 18 month wait instead of an 18 week wait. Still, at least losing patients in the system will make the waiting lists look good for the managers and they can get their bonuses for being so successful…..

So unless we get some form of indemnification from those who perpetually get to wash their hands of responsibility, I can’t see how we can use these portals and still adhere to our required standards. Please correct me if I’m wrong.

 

Image by Benjamin White

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Paul Carpenter

Nice Idea shame about the impl...

Pretty much spot on about the problems. Standard large organisation this would be a good idea and every department adds its 'woul... Read More
Thursday, 16 November 2017 10:28
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NOV
13
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Dental Karma

Dental Karma

Continue reading
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3445 Hits
NOV
10
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GDPUK Latest News and Blogs - w/c 06-11

GDPUK Latest News and Blogs - w/c 06-11

 

Below you will find some of the top news and blogs posted on GDPUK, week commencing 6th November.

 

1. At LMC Conference, doctors will vote on GPs leaving the NHS https://www.gdpuk.com/news/latest-news/2771-gps-to-vote-on-leaving-nhs

2. BDIA takes initiative towards Brexit https://www.gdpuk.com/news/latest-news/2776-bdia-leads-initiative-on-brexit

3 .MPs debate child oral health https://www.gdpuk.com/news/latest-news/2778-mps-debate-child-oral-health

4. @DentistGoneBadd posts a serious blog https://www.gdpuk.com/news/bloggers/entry/2037-dentistry-is-not-immune-from-harbouring-sexual-abuse-we-must-be-vigilant-too

5. Portsmouth graduate wins student of the year award https://www.gdpuk.com/news/latest-news/2780-portsmouth-graduate-wins-student-of-the-year-award

6. Coca-Cola ‘threatened to cut investment’ over sugar tax https://www.gdpuk.com/news/latest-news/2779-coca-cola-threatened-to-cut-investment-over-sugar-tax

7. Enough is enough: BDA demolish case for ARF levels https://www.gdpuk.com/news/latest-news/2770-enough-is-enough-bda-demolish-case-for-arf-levels

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NOV
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Dentistry Is Not Immune From Harbouring Sexual Abuse. We Must Be Vigilant Too.

Dentistry Is Not Immune From Harbouring Sexual Abuse. We Must Be Vigilant Too.

As a Brit, I was both ashamed and proud of the revelations coming out of Westminster this week - ashamed that a small number of our elected representatives could act in such a grubby and misogynistic manner, but also proud of the way that the whole decades-long business is being exposed and acted on in an open way, even if it has been fuelled and inspired by our free press.  There was something typically British and admirable in Sir Michael Fallon’s quick decision to resign from his post as defence minister, as opposed to my disdain for the USA’s Orang-Utan in Chief who has a considerable number of accusations of sexual assault outstanding against him and is a self-confessed and unashamed “pussy-grabber.”

It’s become obvious from the ubiquity of the ‘metoo’ hashtag (#metoo) 

this week, that few walks of work life are free from sexual innuendo, threats and frank abuse and I have been wondering at what point the medical and dental professions will stand accused of similar behaviour either in the present or the past.  What follows, has bothered me for years. There was nothing I could do about it at the time, and nothing I can do about it now, but I felt it was time to at least illuminate the fact that dentistry is not immune from the abuse of women.

I trained in the eighties in a fairly well-known dental school. There was a reasonably affable relationship between the students and lecturers – there were some lecturers who were frankly, evil bastards and there were some who treated you as sentient adults and although you wouldn’t go out for a pint with them, you would say “Good morning” to them in a corridor without ducking into the nearest toilet facility.

Some lecturers (and yes, it IS males) however, had a closer than affable relationship with female students and it is one that I need to focus on.  This married lecturer was a reader in restorative dentistry and was a phantom head instructor.  He always seemed to have a pally relationship with the female students and before long it was rumoured that he was having an extra-marital affair with a young student in the year below me.  The affair became quite open within the dental school and he would often turn up at finals nights and exam celebration nights at Med Club.  I didn’t follow that closely, the ins and outs of the relationship, but since it was so well-known, I assume that the dental school authorities turned a blind eye to it since the female hadn’t protested.

A few months after I qualified and left the dental school, friends of mine who were still at the dental school separately told me that the lecturer and been frequently ‘bothering’ a new and attractive dental student in a sexual manner, to the point where the young woman went to the head of the restorative department to report it. 

She was later called to the Professor of the department where she found herself confronted by the Prof and the lecturer in question with the threat that if she were to take her complaint any further, they would ensure that she would fail finals.

I was told a few months later, that the young woman managed to find herself  a place at another university and transferred.  She apparently took her complaint no further.

I believe the head of the department is long retired (or hopefully dead), but the lecturer in question has risen to the heights, is nationally known, and is in active charge of students.

I didn’t know the victim, or even if she would have wanted to have taken this incident further.  The fact that I didn’t?  I am ashamed. 

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Don Gibson

Abuse

Wow. Unbelievable. I noticed an attempted close relationship between one of our female students and one of the prosthetic techni... Read More
Monday, 13 November 2017 19:08
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OCT
30
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Personal Development Plan by @DentistGoneBadd

Personal Developent Plan

  5382 Hits
5382 Hits
OCT
26
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What makes a successful banner ad?

What makes a successful banner ad?

 

 

A few basic things are always needed in a banner ad to ultimately give you an excellent click through rate. (CTR) We have collected our experiences and thoughts together to produce a short blog on what makes a successful banner advert.

 

A clear call to action (CTA), has to make sense for your product or service. Such as “Shop Now”, “Learn More” etc. A call to action always has to be included.

Secondly the banner ad can be compared to the billboard in the street, the consumer has a split second to decide if they are interested in the product or service. So you need to decide what you want the consumer to see and take away in those few seconds you have to grab attention to your product or service. This can be a catchy headline, an aspirational image or a hybrid of the two!

Basic animation is also always recommended. Animated GIF is therefore recommended over a static image. Keep it simple and to the point, telling a story rarely works. But the advantage of the animated GIF is that you can put together a  series of frames then combine them in such an order that will eventually form some sort of animation and attract attention.

A theme I always go back to when talking to customers is the landing page. The clickthrough needs to land on a landing page that delivers what the banner ad promises. So that when you do secure the click from the consumer, you make sure they get the information the consumer desires. So basically you need to ensure you promote a product or service and not a website / homepage!

This blog - http://www.boxofads.com/blog/always-fine-tune-your-landing-page/ sums up the value of a landing page quite nicely. While designing a campaign think about it as a whole, an ad makes the first impression, and a landing page is a continuation of this impression.

We also recommend that our clients don’t just have one version of the their banner ad. We always say to test the colours, the CTA or the headline and see what works in line with the branding of your business. The software we use (DFP) can handle more than one ad in the space you book, so it's always worth testing a few banners and seeing what performs best. The same can also be said of landing pages as well.

Thanks for reading, hope this short guide to what makes a successful banner is useful.

 
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999 Hits
OCT
24
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2017 GDPUK Conference: 17th November - Book Today

2017 GDPUK Conference: 17th November - Book Today
 
There is still time to book for the GDPUK Annual Conference in less than four weeks at Hotel Football in Manchester. We have been able to hold the price at the early rate of £140 plus VAT.
 
Book your ticket now by clicking Join at www.gdpuk.com/conference
 
Our keynote, and non dentist speaker, is Tom Cheesewright, applied futurist - just one of the people to help you think outside the normal box.Catherine Rutland on GDP's role as the gatekeeper, Simon Thackeray on Expert witnesses, Neil Taylor, on being a dentist and a barrister, Prof Kevin O'Brien giving views on short term ortho and Dr Laura Gartshore on revascularisation of non vital teeth.
 
 
Please book the day off, Friday 17th November, and treat yourself to a relaxing day, with speakers who are looking at things differently, as we do on the GDPUK forum, meet like minded colleagues, enjoy good food and a dose of brain stimulation.
 
We have a musical session too, before and after lunch, something else to look forward too from an unusual, refreshing dental day out. We look forward to you joining us on the 17th and help to celebrate 20 years of GDPUK. 
 
Click Join - at www.gdpuk.com/conference only £174 for a full day, 6 hours of CPD and meeting like minded colleagues.
 
We look forward to seeing you all on the 17th.
 
 
Tony Jacobs
 
ps - read some of the glowing reviews from those who attended the 2016 Conference here. 
  1616 Hits
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OCT
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Dental Body Language

Dental Body Language

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5780 Hits
OCT
10
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Fraud

Description goes Fraud - don`t be caught red handed.

  5045 Hits
5045 Hits
OCT
05
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What is stopping your landing page converting sales leads?

When running a marketing campaign we are told that landing pages are an extremely important part of the sales journey. This is still a true statement and something we always make clear to all our clients.

In this blog, I want to look at what happens when once you have a landing page created but it still isn’t converting in the way you desire, what mistakes are being made with the page and where could it be improved? I have identified a few reasons why the page may not be performing as you hope...

Social Proof

Reviews and testimonials are incredibly important. Reviews or testimonials will act as social media proof, so when a customer is looking to purchase, they will often look to others for cues concerning whether to make the purchase or not. So making the excellent reviews or testimonials prominent is certainly a good start to improving your landing page.

Being Clear?

Is your landing page actually clear enough? Have you explained what your business offers and how it is unique? Your landing page should always contain a clear description of what your company actually offers! The copy needs to be clear and not overly full of jargon and too many words.

Too Much Text!

Remember you only have 5 seconds to convince the person clicking on the site. This means the landing page must be focused on one single objective, which is clicking on your call to action (CTA). As I said before it needs to stay clear and direct. Not too much text but enough to get the message across. Focus on the benefit: this is what you will get by clicking here.

What is your USP?  

It is vitally important that you have a very clear and exciting USP. An exciting Unique Selling Proposition leads to people clicking on the CTA because they want to know more. Explaining your USP can work well either using a bullet list or a short, informative video, that gets the message across and leads to the results you desire.

Too many details.

If on your landing page you present a form in which you want your potential clients to share their details, make sure you ask only for the information that is really essential. If you want to send the prospective client a white paper about selling their dental practice, you only need a name and an email address. Focus on getting the essential details and achieving the result of someone engaging with your business.

Always be testing.

The only way to know that the content is persuasive, the video or images work and how successful the form is, you have to keep testing and tweaking the page. On a an optimised landing page, every aspect, should be tested to ensure you’re using the right option to maximize your conversion rate.

Thanks for reading and we hope you have picked up a few pointers to improve one of the most important sales funnels in a modern business.

 

  1280 Hits
1280 Hits
OCT
02
2

Social Media isn’t the Real World

Social Media isn’t the Real World

No one can have missed the inexorable rise in the use of social media for virtually every kind of interaction we experience in the modern world. From a few users 10 years ago there would appear to be now virtually every corner of the globe unaffected by it (except for maybe some long lost Amazonian tribes – lucky them).

Dentistry has not been slow to embrace this revolution, and as a mechanism of disseminating information world wide, sharing new techniques, and even asking advice about a case, then it there is no doubt that is it hugely helpful. Accessing social media though our smartphones is perhaps the most common application of this media, and it is thought that phones are now become part of the way in which we experience life, and how we form our memories. Certainly, creating a virtual scrapbook on our social media persona that shares with other people is something that will help you look back on events perhaps differently to how you did in the past.

But I worry that some people don’t understand the dangers of social media enough. I’ve written about this before on this blog, and the majority of what I said then holds true now. But there now seem to be some people who take the whole social media thing to be a benchmark by which they should measure their own lives against. There is a relatively new Facebook group called ‘Mental Dental’ which was set up to help dentists with some of the challenging mental health issues that can occur in our profession. Personally as someone who has suffered mental health issues in the past, I think it’s a pretty crass title, but the ethos of the group is actually a pretty good one. Whilst much of the time it might be seen as a moaning forum, there are some quite worrying threads that appear from time to time, and it may be that having this type of forum is beneficial to those wanting to ask advice, or just offload anonymously.

However, one of the recent threads that drew my attention was a post about how a practitioner felt he or she was so unsuccessful when compared to all the other dentists who were posting their personal and professional successes all over social media. This concern was so great in this practitioners mind that they were considering leaving the profession because of it. There has always been a degree of ‘Keeping up with the Jones’s’ in all aspects of our lives, and until one becomes satisfied with themselves as a person, there might always be a tendency to search for success via the medium of materialistic gains. However, what struck me in this case was what appears to be the sheer despair this person was feeling, and all as a result of what some people post on social media.

Social media to this person had become the real world, and the posts of amazing composites, perfect implants, and then fast cars, and exotic holidays was seen as the absolute reality of other peoples lives. The superficiality of such posts is obvious to many, but not to others who may already be suffering from a change in their perception of the world due to the mental health issues that appear to be quite common in our profession. It might not be so easy to ignore these sorts of posts when someone is feeling depressed by the profession, and the damage that this can then do could potentially be quite serious.

There seems to be a lack of humility generally on social media that is behind these types of posts. Whilst it is everyone’s right to post what they want and when they want, certainly the ‘Look at Me aren’t I great’, or the so-called ‘Humble brag’ type of posts sometimes serve only to sometimes make other people feel negatively toward the poster, or more worryingly, negative towards themselves. There is no background to a social media post usually, so the context is completely lost. Does the poster EVER have a bad day? Do they Ever have things go wrong in Clinic? Have they ever worried about their Health/Finances etc.? Given the tone of many of the posts we see, the answer to all the above appears to be no.

It’s important then to keep in mind all that happens on social media is NOT necessarily true, and that we should look more deeply into posts like this. It is vitally important that we should all keep in touch with the real world around us.

Social media is here to stay, but it needs taking with a large pinch of salt at times.

  4421 Hits
Recent Comments
Richard Charon

Social Media isn’t the Real Wo...

Hi Simon, Probably a timely reminder to us all and yet... you have touched on an interesting aspect that certainly affected me fo... Read More
Wednesday, 04 October 2017 11:52
Arthur Cooper

Social media can sometimes be ...

Simon. While there is a lot of truth in what you say, that is only a very small part of what gdpuk represents. We have all learnt ... Read More
Wednesday, 01 November 2017 19:35
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CPR Training by @DentistGoneBadd

Hoe to survive CPR Training

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Can a practice principal really be liable for an associate dentist's criminal behaviour?

Can a practice principal really be liable for an associate dentist's criminal behaviour?

The question posed to the court was whether an employer can be vicariously liable for sexual assaults perpetrated by an independent doctor?

Between 1968 and 1984 Dr Bates was engaged by Barclays Bank to carry out medical examinations on potential and existing employees of the bank. Barclays at that time were undergoing a positive drive to recruit women into the bank and as a result a number of the individuals assessed by Dr Bates were women, some as young as 16.

Accusations against Dr Bates

The employees would go to Dr Bates’ home, where he had created a purpose-built treatment room. He would see the patients on their own with no chaperone present. They were required to undress to their underwear. The allegations against him included inappropriate breast examinations and digital vaginal or anal contact. Following the examination, Dr Bates would send a pro-forma document setting out the details of the examination to the bank. If the report was satisfactory the individual would be offered employment.

Dr Bates died in 2009, however in 2013 a police investigation was carried out which concluded that had he been alive, there would have been sufficient evidence against him to warrant a criminal prosecution.

Barclays’ vicarious liability

In 2016, 126 claimants sought damages against Barclays Bank in relation to the sexual assaults they had suffered. They claimed that the bank utilised the services of Dr Bates in the role of medical examiner in order to satisfy themselves that the person was fit to work for the bank and to confirm that they would be suitable for the life assurance policies in place.

In July 2017, the Hon Mrs Justice Davies ruled that, yes, the bank was vicariously liable for the actions of its self-employed contractor. The reasons she gave were as follows:

A two-stage test must be considered to determine whether or not a vicarious liability exists:

  1. Is the relevant relationship one of employment or “akin to employment”?
  2. If so, was the tort sufficiently closely connected with that employment or quasi employment?

When is a relationship “akin to employment”?

When the following criteria are satisfied:

– The employer is more likely to have the means to compensate the victim than the employee and can be expected to have insured against that liability;

– The tort (act) will have been committed as a result of activity being taken by the employee on behalf of the employer;

– The employee’s activity is likely to be part of the business activity of the employer;

– The employer, by employing the employee to carry on the activity will have created the risk of the tort committed by the employee;

– The employee will, to a greater or lesser degree, have been under the control of the employer.

 

The bank argued that Dr Bates was an independent contractor, and that he bore personal liability for the acts. Had the claim been made much earlier his personal estate would have been able to settle the claims.

 

However, to determine whether the relationship was “akin to employment” the judge applied the five criteria set out above:

– The judge concluded that whilst Dr Bates would have had indemnity insurance, that insurance would not have covered him for cases of sexual assault; his estate was distributed many years earlier.

– Employment was conditional upon the bank being satisfied on the basis of the medical examinations that the applicant was medically suitable for service. Dr Bates was the chosen doctor of the bank and he used their stationery.

– The purpose of the examination was to enable the bank to be satisfied that a potential member of staff would, health wise, be an effective member of the workforce. This was an intrinsic part of the business activity of the bank.

– The bank directed the employee where to go and gave no freedom of choice. They directed the doctor to undergo an examination, including a chest measurement! Many of the claimants, who were as young as 15 and 16 saw the doctor alone in his room and were asked to remove their clothing. The judge concluded that the bank created the risk of the tort (sexual assault) taking place.

– The fact that Dr Bates organised his own diary and carried out other medical activities did not negate the argument that he was under the control of the bank at the relevant time. The fact that the assessment took place at his home rather than the bank made no difference to this conclusion.

 

Tort closely connected with the employment

When considering stage 2, she concluded that the sexual assaults occurred during the course of a medical examination which the bank required the applicants to undertake for the purposes of securing employment. Dr Bates was trusted to do the work and placed him in a position to deal with the employees. This gave him the opportunity to abuse his position. The abuse was inextricably interwoven with the carrying out of his duties.

Would a practice principal be vicariously liable for the tortious acts of their Associates?

In short, the answer is yes. Whilst many associate dentists prefer to maintain their self-employed status for tax purposes (the Tooth Counsel has blogged on worker v self employed status on a number of occasions) the relationship that they have with the practice is almost entirely “akin to employment”. It is now common practice for associate dentists to appear to members of the public to be an integral part of their dental practice, bookings are made and diaries organised by the practice, patients and referring dentists are introduced to the associate via the practice, uniforms are often worn and the practice systems and stationery utilised. If an associate dentist commits an actionable tort against a patient or other member of staff whilst engaged by the practice, then the practice itself would be liable.

Whilst the principal of the “independent contractor defence” remains intact, this judgement sees the court extending the scope of vicarious liability significantly. Whilst the facts of the above case are extremely unlikely to arise in today’s society, particularly in a dental setting where nurses are present at all times when a dentist is seeing a patient, it is a valuable lesson to reinforce the view that the employers should not be complacent about the potential for poor behaviour by their independent contractors and the liability that may follow.

If you have any questions about this blog, or require advice and assistance in relation to your liabilities within the work place please feel free to email Julia Furley on This email address is being protected from spambots. You need JavaScript enabled to view it., or call us on 020 7388 1658.

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Stephen Henderson

Unusual circumstances

Great summary of a curious case. The claimants came after the bank because it has deep pockets and the doctor is dead and his affa... Read More
Tuesday, 03 October 2017 07:22
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Dental Software by @DentistGoneBadd

Dental Software

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Why don’t dentists work privately?

Why don’t dentists work privately?

This piece is not aimed at those people who work in salaried posts without a choice of materials, staff, equipment or patients. I believe they do great work in spite of the system. It is focussed on the self employed, those who have made the choice to hitch their wagon to the NHS and who now frequently find themselves with a dilemma of conscience.

The National Health Service, once “the envy of the world” is effectively broken. Starved of investment and degraded by political interference the morale of staff from cleaners to consultants is at an all time low.

The budget cannot stretch to include high quality dentistry so we have the ideal political option, control the fees, tax the recipients and squeeze the providers.

For more than five decades dentistry and dentists were perceived as the awkward squad and outsiders because they retained their independence and dealt with cash. After fifty five years the unthinkable happened, they were effectively neutralised, hobbled and brought firmly into the NHS tent. Limited contracts placed a cap on earnings. The new contract brought a system that measured activity but did not reward it and has ground down the nearly universal entrepreneurial spirit that had existed. No matter how hard you work you will never earn any more from practicing NHS dentistry only by profiting from other’s labours.

These controlled contracts have had their value eroded by inflation, post crash austerity and three successive governments determined to break another profession. Yet, counter-intuitively, the price paid for the exchange of contracts has increased out of all proportion.

Dentists complain, with justification, that their clinical freedom has been undermined, there is no reward for prevention and the fees paid are still linked to random measures taken a dozen years ago.

So why do dentists put up with it? Behind closed doors everyone  agrees that it is difficult, if not impossible, to maintain standards in the face of increasing bureaucracy, the imposition of disproportionate compliance and the threat of big brother GDC. Yet if a dentist dares to say to a patient that they cannot carry out a treatment to a satisfactory standard on the NHS and they could do it better if they charged a fee that is proportionate to the time, skill and materials required they can be pilloried for bringing the profession into disrepute.

The NHS is the elephant in the room of far too many discussions.

As a “retired” dentist (i.e. no longer on the register) and, running the risk of never being asked to be an after dinner speaker at a GDC bunfight (their loss, I’m quite a good turn), I’ll say it. In many cases if you want the full range of choices, materials, techniques and options of treatment to ensure that someone can deliver their best for you then you will have to pay that someone to treat you privately.

If you want dental care without the clinician needing to compromise, then you have to pay and not have the relationship controlled by a third party.

In my own practice I reduced my reliance on NHS funding in 1993 in the wake of a 7% gross fee cut, I had large borrowings but was fed up of being told how I should treat my patients, I wanted something that was better for them and better for me.

For much of the past 40 plus years NHS dentistry has avoided looking itself in the eyes, owning up and speaking the truth. The hamster wheel rotated ever faster until it became so compromised and patched up that it eventually ran out of spares and ground to a halt.

The majority of people seem to believe that the current situation is unsustainable and it cannot carry on much longer. Don’t think that the people who issue the contracts are going to change anything. They hold the cards, they are the ones who say jump and unfortunately a great many dentists default response is, “how high?”.

To return to the original question, why don’t dentists work privately?

In my experience the reasons fall into two main over lapping categories, fear and comfort.

Fear.

There’s a fear of failure, they think that their patients will not pay them, they fear that the patients will all run away to the practice down the road. They fear that they will not make any money, they quote anecdotes of people who have tried to leave and gone broke.

They are frightened they do not have the skills to perform dentistry to the best of their ability. That’s valid in the short term only, ask anyone who has escaped and they will tell you it takes several years to fully escape from the “make do and mend / just enough is good enough” approach encouraged and fostered by the stifling NHS contract.

Scratch the surface of a lot of these excuses and there often emerges problems with self esteem. They worry that they will be rejected, their patients will effectively say “We don’t love you any more”. They think that they are just not good enough human beings. 

What I also see are people who have skills which are not valued by their paymasters, presuming that they will not be valued by their patients, they say, “They don’t want good dentistry”. This is one small step away from, “they don’t care about themselves, why should I care for them?”

Comfort.

“People will often not make changes until the pain of not making a change exceeds that of making the change.”

The so-called comfort zone has to become pretty uncomfortable to force many to leave it. There is a line on the Pink Floyd track “Time” which runs, “Hanging on in quiet desperation, it’s the English way” for English substitute NHS.

The head in the sand is easier, the hope that Mick Armstrong, Sara Hurley et al will deliver a change, the nirvana contract. Then we will all return to the “golden age” of UK dentistry which you never actually experienced but older people have told you about. Wake up, it’s Jeremy Hunt who has got control and he doesn’t care about you.

There’s the money, let’s not forget, in spite of falling incomes for associates it seems that principals are surviving. With every year they are that little bit closer to claiming the NHS pension, but with every year of added stress they are less likely to enjoy a full life with the pension.

We must also consider the increased value of the practice, the market has peaked and the corporates are growing shy. It would only take a small government bill to remove the exclusivity of the contract and bang goes the bubble.

Final comfort excuse, “I support the NHS”. Really? Really??

I will often ask wavering clients to ask themselves, “Is this what you signed up for? Is this what you saw yourself doing when you left university? Is this what you want to be doing in 10/20/30 years time?”

 

If the answer to any of these questions is “No” then the next ask is, “When are you going to change?”.

 

So - why don’t dentists work privately?

 

 

 

 

 

 

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Breaking the News

Breaking the News

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GDPUK is 20 years old.

GDPUK is 20 years old.

 

Today is the 20th anniversary of the first posts by four members of GDPUK, by email.


Yes, that is how we started, unbelievably before Google and Facebook!

I do love telling this story, and I'd like to share it with you. I was online from 1996, in those days it was dial up with those nostalgic modem sounds. The web was much more simple in 1997, and I taught myself, as many of you did, how to write a web page, rudimentary html, including how to upload it and make it display. I was interested in email communication, and before the ease of modern social media, email lists were the best method, using an internet protocol older than the WWW.

I was a member of an American dental group, IDF, which is still going, but it was very US centred, not particularly useful for a UK dentist. In April 1997, I got the idea of founding a mailing list for UK dentists, and thought about how to get a group together. The BDJ was the way forward.

So, I wrote a letter on my word processor software, posted to BDJ that month and carried on with work and my family. This was the pace of life only 20 years ago. Then in June, [only 8 weeks later :) ] I received a postcard [!!] from the editor of BDJ, saying yes, we will publish your letter. So, in the second August magazine, my letter was published, three colleagues replied, and we got started in the September. Here is the Medline link to that letter .... https://www.ncbi.nlm.nih.gov/pubmed/9293127

 

I must have the hard copy somewhere, ready for the GDPUK museum!!

We are celebrating the anniversary of GDPUK with our Conference in November. Early bird discounts available here https://www.gdpuk.com/conference/ I am looking forward to an interesting and unique day in Manchester - meeting colleagues old and new... all are welcome.

Looking forward to a celebratory drink with you all at the end of that day… cheers.

Thanks for reading and helping GDPUK grow for 20 years.

 

Tony

 
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Switch and save

Switch and save

Change payment provider today and save up to 60%

GDPUK are always looking to help you reduce costs without compromising the quality of your patient care. That’s why we’re delighted to announce a new partnership with nexpay.
 
Who are nexpay?
 
Nexpay is a leading UK based payment consultancy and management company, officially licensed by Visa and MasterCard for the provision of card payment services.
 
Why nexpay?
 
Card payment services can be very costly to dental practices. Nexpay can reduce your monthly bills by up to 60%. That could mean an annual saving of several thousands of pounds.
 
GDPUK and nexpay - partners in payment
 
We’re so committed to helping practices like yours that we’ve established a joint mission with nexpay. Our ambition is to save members of the site over £1M in card processing fees. And we’ve already started.
 
Putting our money where our mouth is
 
406 dental, run by GDPUK founder Tony Jacobs has been the first to make the switch saving a massive £2,526.96 over a new contract term.
 
Tony said “We always want to save without compromising on service. After a full market comparison, nexpay offered extremely competitive rates, which ensured that 406 dental had no hesitation in switching.”
 
Who could benefit from this price comparison?
 
Dental practice owners, dental practice managers, dental corporates and any business owners who take card payments.
 
How it works
 
 
2) nexpay will review your existing account, undertake a full market comparison and produce a report that shows you the potential new tariff savings.
 
3) Simply decide if you’d like to start saving on your payment services.
 
Proactive merchant management
 
Nexpay has dedicated people who are passionate about payments and security. Just like GDPUK they work proactively to provide you with the best possible service. Together, we will review your account on a monthly basis to make sure you are receiving the best rates.
 
You’ll then receive personalised reports that outline your savings and have access to in depth reporting confirming how your account continues to benefit. Please click to read more on the GDPUK website, where you can fill in all your details via a contact form. Click here for further informationWe’re so excited to be able to announce nexpay as a partner. We believe that, together, we can benefit the whole GDPUK community.
 
Thanks for reading and supporting GDPUK. 
Jonny
 
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Complete Dentures for Dummys by @DentistGoneBadd

Complete Dentures by @DentistGoneBadd

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More Danger than Prosecco? by @DentistGoneBadd

Prosecco

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Being a Dental Nurse for Dummys

Being a Dental Nurse for Dummys

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The Tipping Point

The Tipping Point

It has been a little while since I last wrote this blog. Various things have taken over as they tend to do in life, and the blog unfortunately was something that seemed to never quite get done. However, I’ve now found myself back in the writing frame of mind, and I still seem to have opinions that some will agree with and no doubt others will disagree with, so here we go with some more ramblings of a Yorkshireman.

I have still been keenly observing what has been going on with regards to the profession over the last few months, and there still seem to be the same old problems surfaces that always have. I shall be writing about all of these issues in the near future.

The GDC seems to still be a problem to many, and personally whilst it seems to be to have become more aware of its previous problems, I don’t think it can truly move on whilst the current chair is still at the helm. It is time for a registrant to be in charge again, and for Dr Moyes to be moved to some other Quango where he can’t oversee damage to the morale of an entire profession.

Social media is also still a hot topic, and the GDC have now issued a case study on this. Some of the profession are obviously of the opinion that social media is the real world, and seemingly lack the ability to see it in its true context. There is a lack of humility in the profession where social media is concerned, and huge damage can occur to people when they believe that all they see on their iPhone is the unadulterated truth. It isn’t.

The lack of a new NHS contract, or anything really concrete is also concerning. However, I have a fairly simple view on this. We must be deluded as a profession if we think for one moment that there is suddenly going to be a fantastic new contract that will give the patients and us everything we ask for. I will guarantee that any new contract will primarily be worded to the benefit of the DoH so that the dentists can be held responsible for whatever goes wrong with it.

I’ll write more on these subjects in the coming weeks. But for this blog I though I would concentrate on something that has seemed to be brewing for quite a time, and might actually be reaching a tipping point.

 

Indemnity.

Now, I can remember when my indemnity was about £1200 a year, and didn’t particularly change by much annually. But now, as a principal dentist working full time, it is £5800. This increase is over the period of about 10 years. We have seen an increase in both the activity of the GDC and especially negligence solicitors in this time, which it is claimed to account for the increase in our costs.

Indemnity is a little bit like car insurance in that you hope you will never need it, but it is a necessary evil to have. With the costs of legal representation being what they are, and the increase in the amount of cases being brought, it is not really surprising that costs rise year on year.

But how do we know how these costs are calculated individually? If you are a young driver with a fast car (which you will no doubt be flaunting on Facebook!) then you are likely to be a higher risk than an older person in a more sedate family saloon. This doesn’t necessarily translate to your dental indemnity though. It seems that the longer you are in the profession, the more likelihood you are to be sued and thus have higher premiums. Perhaps the reason for this is that when these practitioners retire, often the patients are found to have large amounts of remedial dentistry to be done. This may be the case, and I am aware of some dentists who have built up a good practice on rectifying this type of problem, especially when they perhaps encourage the patient to take some form of action against the previous dentist.

I’m not saying a wrong shouldn’t be corrected in that situation, but there do seem to be some dentists who are quite happy to throw colleagues under the bus in order to ensure they get the benefit of the patient charges to rectify the problems. Perhaps ‘There but for the grace of god go I’ would be an apt phrase to remind those considering this course of action. In addition, they will also find that their indemnity is going to increase also when this happens.

Because that’s how this kind of indemnity really works; the current members are paying for the claims that are currently being made and are going to be made in the future. In much the same way as the state pension works.  We can’t have an indemnity company suddenly have empty coffers, so they have a duty to ensure they assess the needs of the society to actively have the funds to cover their expenses. All of this is paid for by the membership.

However, this is where I spot a problem. There are some dentists who for what ever reason have higher indemnity costs. Whilst it always seems unclear why this is (as there is no apparent transparency in the fee structure when applied to an individual member), it is not unreasonable to consider that there might be an increased risk identified by the indemnifier. So they are basically saying there may be claims likely to be made against this person in the future. I have no problem with that in principle, but the issue comes when this person then leaves the society because the costs of indemnity have risen so high it is fundamentally unaffordable for them to keep paying.

What happens then? The costs of these future claims will be potentially met by the rest of the members who are maybe NOT doing the same sort of high risk dentistry as the member who has left. One can argue that this is a socially responsible and indeed professional manner in which a wronged patient can claim recompense. The problem occurs when there are more of the lower risk members paying for the expenses of the higher risk. Add into this situation that the societies offer ‘discretionary cover’, meaning that your claim only has the right to be considered by the society (and not actually guaranteed to be supported), then some people feel that they are paying an increasing amount of money for less than guaranteed and continued support in their time of need.

It seems to me that many of the members of the traditional membership societies are becoming increasingly worried about the inexorable rise in costs, and the discretionary nature of the support offered. I am aware of much conversation about the pros and cons of moving between the societies, and I’m also aware of the increase in membership of the Insurance based companies as a result of the concerns about this. One of the advantages of insurance based cover is the presence of a written contract, and the ability to make a complaint to the Insurance Ombudsman, which doesn’t exist with the discretionary membership. In addition, the insurance companies are also heavily regulated by the likes of the Financial Services Authority; the traditional indemnifiers however seem to have no regulator at all. The counter to this argument is that with discretionary cover the traditional indemnifiers can cover those who are not indeed members at the time of a claim, and for the benefit of the profession. I can recall this publically happening at some point in the past, and if I am not mistaken it was a human rights issue that became clarified as a result. However, just how many times has the discretionary cover been used in that manner, and not just to refuse cover?

The way I see it, we will reach a tipping point if something is not done soon to clarify more robustly the stance of the traditional indemnifiers, especially where their discretionary powers are concerned. I want to know that I have the support of the indemnifier in assisting me in my time of need, and not that at some point they decide to pull the plug due to a disagreement or just because it is easier and cheaper to settle (despite it being morally, ethically, and clinically wrong to do so). Does writing a blog of this nature give them grounds to refuse cover? Your guess is as good as mine since there is no real published criteria to know where you actually stand.

I can see there becoming a tipping point at some time in the future where all the good clients of the protection societies are no longer willing to put up with the uncertainty and the lack of transparency about the decisions made about any individuals’ costs and especially the discretionary element of support. These clients will leave, and since it is a requirement to have appropriate indemnity, there will be no shortage of new style companies happy to disrupt the market place and offer an alternative.

For example, what if the indemnifier needed a million pounds to cover its expenses and it had 10,000 clients? The cost per client is obviously £100 per client. But what if this indemnifier then starts to haemorrhage clients until it only has 1000? The cost per client is then £1000. These remaining clients are not necessarily going to be the high risk ones either, as it’s probably the case that those higher risk clients will have changed society much sooner in order to keep their costs down.

This is probably a gross oversimplification, and I’d actually welcome someone putting me right over this, especially from any of the defence societies. However, fundamentally what I see is an ever increasing demand on the resources of these societies, with a potentially decreasing number of members footing the bill, and those members not actually knowing if they will be fully supported by the society due to the discretionary nature of the membership. This is a prime situation for a tipping point to occur that changes significantly the whole model this operates under. This might be practitioners leaving, or it might be a re-evaluation of the business model to take things into account. However it is not something that can remain the unchanged as it appears to me unsustainable in the long term.

Before anyone says this couldn’t happen as the societies are so big and have so many customers, all I have to remind you of is Kodak not identifying the digital camera revolution, Encyclopaedia Britannica not recognising the  threat of the internet, and finally the inexorable rise of Uber in its disruption of how we utilise taxis.

All indemnifiers are also reliant on the need for legal cases to continue. By this I mean there is a symbiotic relationship between the defence and prosecution of dental cases, as without one side the other cant really exist the in the same way. Once a case is begun, then costs accumulate on both sides, and the legal profession feeds from this accordingly. These adversarial sides become dependent on one another, and in particular the defence side of negligence does not necessarily work under a no-win, no-fee basis in my experience and gets paid regardless of winning or losing (by our indemnifiers). Cynically, one would say it is therefore in the financial interests of those in the legal profession to have the current highly litigious situation in dentistry to continue, because there appears to be no shortage of work for them. The practice of dentistry becomes the raison d’etre for the existence of both the societies and those legal firms feeding it until we do something to stop it.

There may be protests from the indemnifiers of the tome of this blog; certainly I have taken no account of some of the truly awful issues that result in harm befalling patients by some practitioners. I am definitely of the opinion that we as a profession most certainly still need to put our house in order, and there is probably no room within it for some of the practices that some of our colleagues routinely feel are acceptable. However, unless you are part of the solution, then you are actually part of the problem, and I feel that there should be much more clarity evident in the world of indemnity, so that the profession can practice with the confidence that our patients need us to have when caring from them.

Otherwise, what’s the point in us continuing to serve our patients? That may well create a further tipping point…..of no one in the profession left to care.

Image credit - Guiseppe Milo under CC licence - not modified.

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Dental Confidence Survey by @DentistGoneBadd

Dental Confidence Survey

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Is the GDC supertanker turning? by Keith Hayes

Is the GDC supertanker turning? by Keith Hayes

Last Monday 14th August 2017, I had another meeting with Jonathan Green (Head of FtP) and Matthew Hill (Head of GDC Strategy). 
It was a no holds barred meeting and I was free to ask any questions. I wasn't locked in dungeons under 37 Wimpole Street at any point! 
Here is the agenda of the 90-minute meeting, along with the GDC answers in blue. 

It raises some important considerations about what we need to do as a Profession. I think we need to think about the answers and discuss a strategy for the Profession. 

Continue reading
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Crowns for Dummys

Crowns for Dummys

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6 Top Tips for dealing with difficult patients

6 Top Tips for dealing with difficult patients

At some point during your professional career you will no doubt have been faced with an unpleasant patient; you may have been unlucky enough to come across a few. However, in what circumstances can you refuse to treat them?

Alternatively, what if a patient refuses to be treated by you or someone in your practice? What if the reasons for such a request are or could be discriminatory?

At a time when instances of every day discrimination and sexism are rife in all walks of life, it is not hard to see why some dentists and doctors feel like they are walking on egg shells. This week BBC Radio 4 Today Show presenter John Humphrys, asked the tennis player Johanna Konta a series of questions regarding her origin, culminating in, ‘So, what are you?’; questioning whether she was truly British. Johanna Konta has represented Great Britain at the Olympics and the Fed Cup. She has been a UK citizen for almost half her life. Chancellor Philip Hammond, has been criticised for allegedly saying driving a train is so easy 'even a woman can do it'. We’ve even seen uproar over the “sex” of a fictional character with two hearts.

But is there ever a situation where someone’s nationality or sex can affect their ability to perform their role? 

Refusing to treat a patient

With so much regulation in place and a fear of patient complaints being escalated to the GDC, you may feel as if patients hold all the power. However, there are situations when you are entitled to refuse to treat a patient. Below are 6 legitimate reasons for refusing to provide treatment:

1.   When a patient questions your clinical judgment. If a patient questions your clinical judgment or expresses a lack of confidence in your abilities, we would recommend you stop treatment immediately. At this point explain to the patient that it is important they have confidence in you as their treating physician and that to carry on treating them would be unethical. Try not to take this personally, and certainly avoid arguing the toss with the patient; this could result in a complaint against you. Everyone has different views and personalities and whilst you and the patient may clash, there will no doubt be another dentist who gels with the patient.

2.   When there has been an ‘act of God’ If a dentist is hospitalised or suspended, or there is an emergency, such as a flood in your practice, it will be impossible for you treat the patient at that time. Keep the patient updated and make alternative arrangements where possible, otherwise the patient may go elsewhere.

3.   When a patient fails to pay a bill or continuously misses appointments If a patient fails to pay bills or continuously misses appointments, then you should give them a warning that this conduct will not be accepted and future similar conduct will result in them being removed from the Practice. Put information on your website regarding the circumstances in which treatment may be withdrawn.

4.   When there is a conflict of interest. Whilst, this is unlikely to arise that often in a dental practice, there may be circumstances, for example where a patient is pursuing a claim against your colleague, where it would not be appropriate for you to treat. If the patient comes to you and you know about the claim, there could be a perceived conflict and it would be better not to treat the patient at all. However, if you are part way through treatment, you should highlight to the patient that you are aware of a potential conflict and let the patient decide whether they wish for you to continue treatment.

5.   When a patient is violent or abusive If a patient is violent, or even threatens violence, to you or any of your staff, depending on how serious this is you may wish to call the police. In terms of treating the patient in the future, you should assess the situation and why the matter escalated. For example, was it honest misunderstanding that has got out of control, or has the patient been violent for no reason? Do you think the patient can be managed in the future without putting your staff members at risk. The more serious the incident the more justification you will have for refusing treatment. Write to the patient and confirm that you will no longer be treating them and, if you are an NHS practice, contact the NHS Commissioning Board.

6.   When a patient has complained. You should avoid the temptation to refuse treatment in these circumstances as it could result in a further complaint. However, if the complaint is about your clinical treatment or is shown to be entirely unjustified or malicious you can follow the process in point 1 above.

Patient’s freedom of choice

Generally speaking, a patient has the right to choose which dentist provides them with treatment, just as you are entitled to choose who supplies your materials for your practice. Therefore if a patient requests a specific dentist to provide treatment you should seek to accommodate that request.

What if the request to be treated by a specific dentist is racially motivated? You have no obligation to treat a patient in those circumstances except in an emergency. Bear in mind, the patient also has to consent to treatment, and they can refuse treatment on bigotry grounds if they wish.

However, there is a grey area in all this. What if a female patient requests a female dentist on religious grounds? Or a Polish patient requests a Polish dentist as a result of not speaking English? In these circumstances, we would recommend accommodating such requests where possible, to prevent allegations of discrimination against you.

You should create a practice policy for dealing with such requests so staff know what to do and can identify when such requests might be reasonable.

If you need advice or assistance in dealing with a difficult patient, you can contact Laura Pearce on 0207 388 1658 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it..

Laura Pearce, Senior Solicitor

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Recent Comments
Chris Burton

Font

Great article Laura but terrible font!
Thursday, 10 August 2017 09:48
Laura Pearce

thanks

Thanks Chris, I am not sure what happened there. I will see if admin can resolve it.
Thursday, 10 August 2017 10:07
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Evil Genius - a guide to not being sued.

A guide to not being sued

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Diary of a Wimpy Dentist (2)

Diary of a Wimpy Dentist (2)

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Dental associates; workers or self-employed? The tide is turning.

Dental associates; workers or self-employed? The tide is turning.

Since the Central London employment tribunal handed down its decision in the Uber case on 28th October 2016, the courts have been awash with claimants seeking to gain worker status. Pimlico Plumbers and CitySprint have both had judgments against them, and claims against Deliveroo, Amazon Logistics and Hermes are all in the pipe line.

But how is this relevant to the dental profession?

Whilst associates enjoy self-employed status for tax purposes, this is an arrangement with HMRC; not the legal system. Since the Uber case it is clear the courts are cracking down on false self-employment and so dental practices need to be live to this issue.

Failing to identify a person’s status from the outset will be a costly mistake to make.

Here we take a look at the recent judgments in the Pimlico Plumbers and CitySprint cases and explain what impact they have on worker status in the dental profession.

Definition of worker

What are the benefits of being classed as a worker? Workers have rights such as the national living wage, holiday pay, statutory sick pay and the right to pension auto enrolment, whilst still retaining the flexibility of a self-employed person.

The courts will ask three questions to determine if someone is a worker:

  1. Must the person personally provide the service or can they send a substitute?
  2. Is the company obliged to provide work and is the person obliged to accept it?
  3. Was the status of the “employer” under the contract that of a customer? 

Over the years the dental profession has changed considerably. Increased regulation has meant that practices must have more control over how their associates work. Corporates seek to have a unified model of delivering dental services under a brand name. Practices more generally need to ensure they meet targets provided by NHS contracts.

The net result has been that associates have less control over their working practices, and have more obligations placed on them. This is likely to elevate them from self-employed into the category of worker.

Recent decisions

Pimlico Plumbers – sending a substitute

At the very outset of the judgment the Court of Appeal stated, The case puts a spotlight on a business model under which operatives are intended to appear to clients of the business as working for the business, but at the same time the business itself seeks to maintain that, as between itself and its operatives, there is a legal relationship of client or customer and independent contractor rather than employer and employee or worker’. A model that should sound familiar to most dentists.

The main focus of this appeal was the Tribunal’s finding that the plumber was obliged to perform the services personally.

The primary argument put forward by Pimlico Plumbers was that the plumber in question had a right to send a substitute and as such he was not engaged to perform the services personally. However, the Tribunal’s findings on this point was that the plumber could not send anyone he wished to do the job, he had to send another Pimlico Plumber. As such there was not an unfettered right to send a substitute at will, but instead the position was more akin to a shift swap.

The Court of Appeal recognised three types of relationship:

  1. Persons employed under a contract of service (worker);
  2. Persons who are self-employed, carrying on a profession or a business undertaking on their own accord;
  3. Persons who are self-employed and provide their services as part of someone else’s business or undertaking.

It is this last category that the plumber, and also dentists, would fit into.

The Court of Appeal went on to define the requirements of personal performance and set these out as follows:

  1. An unrestricted right to send a substitute to do the work is inconsistent with an undertaking to do the work personally. This is simple to determine and pretty obvious by all accounts;
  2. A conditional right to send a substitute may or may not mean there is personal performance; it will depend on the conditions placed on that right. In other words, it will depend on nature and degree of any fetter on the right. This was broken down further into:
    1. A right to send a substitute only when the contractor cannot perform the services suggests the contract is for personal performance;
    2. A right to substitution limited only to one who is suitably qualified, is inconsistent with personal performance;
    3. Where the right to substitution is dependent on the other party’s consent suggests the contract is for personal performance.

The Court of Appeal found that as the plumber could only send another Pimlico Plumber to undertake the work, this meant he had to perform the services personally and was therefore a worker.

In a dental practice the right to substitution is often limited to the circumstances set out in a. to c. above, meaning a court is likely to find that they are engaged to perform the services personally.  However, it is important to bear in mind that this conclusion has not yet been tested by the Courts. Arguably the very nature of the provision of a medical service should be given special status on the basis that it is the patient’s needs, not the employers that must be taken into account. There are many circumstances where it would not be acceptable for a substitute to be sent, such as when a dentist is dealing with a patient with special needs.

CitySprint – controlling performance

In this case the courier had a contract that purported to be a self-employed contract. It had terms such as:

  • The Contractor agrees and warrants that he is a self-employed contractor and is neither an employee or worker;
  • The Contractor shall…provide the Services using reasonable case and skill and use his best endeavours to promote the best interests of CitySprint…the Contractor has discretion to determine the manner in which the services are performed at all times;
  • The Contractor warrants and represents that he has read and understood the Information Booklet;
  • The Contractor may at his own cost provide a substitute to perform any particular job. However, if that substitute is not a person or an entity who or which has itself already entered into a Tender Agreement with CitySprint the substitute shall be a person or entity this has the required insurance cover, knowledge, skills and ability.

Not too dissimilar from terms found in many associate contracts.

The courier accepted that if these terms were genuine then she would be self-employed. However, she asked the tribunal to look at the true relationship. It should be noted the courier had signed to confirm acceptance of the self-employed contract and had been registered as such for tax purposes.

It is well established that the Courts can look behind the contract to determine what the true relationship is between the parties. The Tribunal in this case re-iterated that the threshold for doing this is low; a firm reminder therefore that the terms of the contract should reflect the reality of the situation.

In this case the Tribunal held that there was sufficient evidence to show that the contract did not reflect the true relationship, and that the courier was in fact a worker for the following reasons:

  • The Tribunal found that the courier did not have ‘discretion to determine the manner in which the services are performed at all times’. The courier had a one day training session where she was instructed on things like how to greet the customer and what to do if someone was not home. This showed an element of control by CitySprint as to how the service was to be provided.

Whilst clinical work will naturally be at the associate’s discretion; if a practice has strict polices in place in relation to how long each patient must be seen for, what documents must be completed for each patient visit, complaints procedures the associate must abide by or even compulsory training sessions and staff meetings, this could show an element of control.

  • When looking at whether the courier had to provide the services personally, the Tribunal found that even though there was a right to send a substitute the reality was that the circumstances when she could were so small that she was in fact engaged to perform the services personally.

Associates very rarely send a substitute as patients expect to see their own dentist, and have often been recruited due to their specific skills. As stated in the judgment ‘the legal test is not whether there is a valid substitution clause but whether the claimant was contracted personally to carry out the work’.

  • Finally, the tribunal found this was not a client/customer relationship; the courier was not in business on her own but part of the CitySprint business. They made this determination on the basis that the courier had to work when she said she would, when working they are directed as to what they will do, they have procedures to follow, and are part of the ‘family’ of couriers.

Dentists who have set hours, are told what patients they will see, follow practice procedures and are advertised on the dental practices website as part of the services the practice provides are likely to be deemed to be working as part of the practice not independently.

Conclusion

In issue 34 of our dental bulletin we set out how the Uber judgment would impact on associate contracts and these recent cases only strengthen our view that many associates legally will be defined as workers.

Of course, until an associate decides to test their status in court, the status quo is likely to remain as  many associates enjoy tax benefits of being self-employed. That being said, it is perfectly possible that whilst an individual is deemed self-employed by HMRC, they are deemed to be a worker for the purpose of their employment status; an associate may well be able to have their cake and eat it. Employers need to consider this issue very carefully; failure to do so may result in a hefty bill to pay.

That is not to say you cannot retain the self-employed relationship between you and associates. With well drafted contracts tailored to your business you can ensure that you are protected. Remember; one size does not fit all.

If you need advice on the status of anyone in your workforce or need assistance with re-drafting contracts or documents to ensure associates are truly self-employed, please contact Laura Pearce on 0207 388 1658 or email her at This email address is being protected from spambots. You need JavaScript enabled to view it..

Laura Pearce, Senior Solicitor

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Are you looking for ways to help improve your patients’ current oral care routines?

 

 

LISTERINE® Professional is now offering a variety of programmes focused on the most important topics facing dental professionals, including prevention strategies and patient communication.

  • The LISTERINE® Professional Newsletter: A once-monthly e-mail to keep you informed on how to help patients treat or prevent common oral care conditions like gingivitis and sensitivity, or how to help prevent cavities.
  • THE HABIT CHANGE CHALLENGE: An interactive learning programme to help you influence changes in patient behaviour even more effectively

By signing up for both or either programme(s) today, you will gain access to:     

                                                           

  • Clinical data that you can apply to your practice
  • Tips on how to increase patient adherence to your recommendations
  • Free LISTERINE® samples for you and your patients
  • Information on upcoming conventions and events
  • LISTERINE® product information and news

 

SIGN UP TODAY

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Promises, promises; can anyone really save the NHS?

With days to go before the UK once again goes to the polls and a large number of voters still undecided on how to cast their vote, there is still a huge amount to play for in the General Election 2017. The handling of the NHS is critical to any party’s success, so we have scrutinised the Conservative, Labour and Liberal Democrat’s offerings in the lead up to June 8th. If you don’t have the time or energy to trawl through hundreds of pages of manifesto pledges, read below for a helpful summary of NHS commitments.

The Commitments

 

The Conservative Party

 

1.       A commitment to the founding principles of the NHS; a service that meets the needs of everyone, based on clinical need not ability to pay and care should be free at the point of use.

2.       Spending will be increased by £8 billion in real terms over the next 5 years.

3.       Create a “truly seven-day healthcare service”, with GP weekend and evening appointments for all by 2019. Hospital consultants will be supervising patients every day, with weekend access to key diagnostic tests.

4.       Current 95% A&E target and 18 week elective care standard will be maintained.

5.       Prioritise during the EU negotiations that the 140,000 staff from EU countries “can carry on making their vital contribution to our health care system”, whilst continuing to invest in training medical students. Will encourage and develop new roles and create a diverse set of potential career paths for the NHS workforce.

6.       The most ambitious investment in building and technology that the NHS has ever seen, to ensure that care is delivered properly and efficiently.

7.       The NHS will become a “better employer”, strengthening the entitlement for flexible working and introducing better support services for employees.

8.       To implement the recommendations of the Accelerated Access Review to make sure that patients get drunk treatments faster, whilst ensuring value for money for the NHS.

9.       GPs will be expected to provide greater access, more innovative services and offer better facilities. A new GP Contract will be introduced.

10.   The role of the CQC will be extended to cover health related services commissioned by local authorities.

11.   10,000 mental health care professionals will be recruited. The co-ordination of mental health services with other local services will be improved.  

12.   Radical changes to social care for the elderly. Aligning the current means-testing for domiciliary care with that for residential care. The value of the family home will be taken into account, along with other assets and income when assessing the amount of funding that an individual will receive from the state. The current cap of £23,250 will be increased to £100,000. Individuals will be able to defer payments if receiving care at home in order to avoid selling their home during their lifetime.

13.   End of life care will be improved. Families who lose a baby will be offered additional bereavement support.

None of the above pledges have been costed in the published manifesto.

 

The Labour Party:

1.       A commitment of over £30 billion in extra funding over the next Parliament. Paid for through increased income tax for the highest 5% of earners and an increased tax on private medical insurance. Money will be freed up by halving the fees currently paid to management consultants.

2.       A new office for budgetary responsibility will be introduced to oversee health spending and scrutinise how it is spent. “Sustainability and transformation plans” will be halted, and a review undertaken, asking local people to contribute, considering patient need rather than available finance. A new regulator “NHS Excellence” will be introduced.

3.       Privatisation of the health service will be reversed. A legal duty will be introduced on the Secretary of State to ensure that excessive private profits are not made out of the NHS at the expense of the patient.

4.       Promise investment to give patients a modern, well-resourced service. Guaranteeing access to treatment within 18 weeks, taking a million people off the NHS waiting lists by the end of the next Parliament. Patients will be seen in A&E within 4 hours. Mixed sex wards will end.

5.       The Cancer Strategy for England will be fulfilled by 2020.

6.       Funding will be increased to GP services and cuts to pharmacies halted, and the current position reviewed.

7.       Patients will be given fast access to the most effective new drugs and treatments, and “value for money” agreements will be negotiated with pharma companies.

8.       To make the country “autism friendly”; with specialised care plans in place and access to condition management education.

9.       High quality and personalised end of life care.

10.   A commitment to completing the trial programme for PrEP, and rolling the treatment out to high risk groups to reduce HIV infection.    

11.   Free parking for patients, staff and visitors at hospitals by increasing tax on private medical care premiums.

12.   For the work force the pay cap will be scrapped, with an independent review body making the decision. Bursaries and funding for health related degrees will be scrapped (University tuition fees will be scrapped).

13.   The rights of EU nationals working in the NHS will be immediately guaranteed.

14.   The foundations for a “National Care Service for England” will be laid. Social care budgets will be increased by £8 billion. Place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care.

15.   Funding for mental health services will be ring fenced.  Out of area placements for young people will be ended by 2019. Early intervention for children and young people’s mental health services will be prioritised. Counselling services will be available in all secondary schools.

 

The Liberal Democrats:

1.       Pledge to put a penny on the pound on Income Tax to raise £6 billion in extra revenue for NHS and Social care funding. This money would be directed to key areas, including social care, primary care, mental health and public health.

2.       Commission a dedicated health and care tax following consultation.

3.       Guarantee the rights of all EU NHS and social care staff to remain in the UK.

4.       End the public sector pay freeze for NHS workers and reinstate nurse bursaries.

5.       Transforming mental health care and reducing associated waiting times to no more than 6 weeks for a therapy appointment for depression or anxiety. No young person will wait for more than two weeks for treatment when they first experience psychosis. The focus will be on young people and pregnant women/ new mothers.

6.       An end to out of area placements and improving front line services in schools and universities. Ensure LGBT and inclusive mental health services receive funding and support.

7.       Establish a cross party health and social care convention to carry out a review of the long term sustainability of the health and social care finances and workforce. Introduce a statutory independent budget monitoring agency for health and care, similar to the Office for Budget Responsibility.  

8.       Improving the integration of health and social care; ultimately creating one service with pooled budgets.

9.       Implement a cap on the cost of social care and increase the earnings limited from £100 to £150 per week for eligibility for carers’ allowance, and reduce number of care hours a week for qualification.

10.   Provide more choice of end of life care and move towards free end of life social care. Expanding the work of hospices.

11.   Promote easier access to GPs, expanding evening and weekend opening, encouraging the use of on line appointments, whilst supporting GPs to prevent practice closures.

12.   Using innovative funding to promote GP led multidisciplinary health and care hubs and ensure access to local pharmacies.

13.   Helping people stay healthy in the first place through a National Well Being strategy, including public awareness campaigns on cancer and by developing a strategy to tackle childhood obesity and a sugar tax.

14.   Introduce a minimum unit pricing for alcohol.

15.   Make PrEP for HIV prevention available on the NHS.

What will these pledges cost?

The Institute of Fiscal Studies has undertaken its own review of the funding behind each of the above pledges and state as follows;

The Conservative manifesto:  Would suggest an increase in Department of Health (DH) spending to £132 billion (in today’s prices) in 2022­–23, if the other (non-NHS) aspects of DH spending were frozen in real terms over this period. This would be an average growth in real spending of 1.2% per year between 2016–17 and 2022–23.

The Labour manifesto: promised a larger increase in health funding. Labour would increase spending relative to current government plans by £7.7 billion in 2017–18, rising to £8.4 billion (in nominal terms) by 2021-22. This could take DH spending to around £135 billion (in today’s prices) in 2021–22. This would be an average 2.0% per year real increase in spending between 2016–17 and 2021–22.

The Liberal Democrats: have pledged to increase spending on health and social care in England, Wales and Northern Ireland by approximately £6 billion each year, with £2 billion ring-fenced specifically for social care. This could imply DH spending of £131 billion (in today’s prices) in 2021-22, and average growth in spending of 1.4% per year in real terms between 2016–17 and 2021–22.

However they also conclude that the planned spending of all three parties is well below the historical 4% per year growth in health care spending per year that has been seen since 2009/10. The difference between the parties spending plans is in fact reasonably modest and as such the NHS will continue to suffer financially whoever will win the general election.

Julia Furley, Barrister, JFH Law LLP

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10,000th Daily Digest Email!

10,000th Daily Digest Email!

 

Hello all,

Today (17th May 2017) we will be delivering our 10,000th daily email digest to our GDPUK members. Something we are extremely proud of.

  • Our first daily digest was sent out in 2008 when we built the first GDPUK website (pictured above).
  • Barring one or two hiccups alomng the way.... We have sent out 3 daily digest emails a day since.
  • The emails contain the latest news from the site, plus the top forum posts of the day. This keeps our members engaged with the site and more importantly, what is happening within UK Dentistry.
  • The digest contains advertising banners from our partners, so thanks to all our loyal clients and friends over the last ten years who have made it possible to reach this milestone.
  • In that time we have had 54 different people post over 1000 times on the forum pages. All that posting helped to create the unique content of the digests. So thanks to the 54 people and the thousands of other posters who have contributed to the site.
  • Thanks also, to over 10,000 members of the dental profession who have signed up to the site since 2008.
  • The GDPUK forum continues to thrive on a daily basis. The forum has had over 22,000 threads created and nearly 256,000 replies to those threads. That is 11.5 replies to every thread created. A lot of knowledge and content contained in our forum pages :)
  • You have to be a member to view our forum and daily digests. Register for free here.

Thanks again for supporting and reading GDPUK.

 

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Listening, talking and networking:- Dentistry Show 2017

Listening, talking and networking:- Dentistry Show 2017

We enjoyed an extremely busy couple of days at the Dentistry Show on Friday and Saturday in Birmingham. This year we didn’t have a stand, so we did a lot of walking, talking and listening of course…...

A few initial thoughts and products that caught the eye:-

The Full Picture

In a room of a few thousand people, it always intrigues me the different impressions people get from the show. “Fantastic show”, “our stand has been so busy” “selling loads of gear” and then you move about 3 feet to the next stand and the reaction is totally different “waste of time”, “not as busy as last year” “this part of the room isn’t getting any footfall” so when stepping back and looking at the full picture, I reckon it is somewhere in the middle. The show was certainly busy but it is not for everyone.

Takeaway - it is not always about following the crowd. This kind of show works for some companies but not all.

Closer Still

Closer Still Media, have built an amazing business, which is demonstrated by the fact that the show attracts a huge number of exhibitors, speakers and visitors. As you will know from previous blogs, GDPUK have not always had the best experience at the Dentistry Show but we must say that it has a great spirit, atmosphere and 2 days seems a perfect amount of time.

Well done to all the Dentistry Show team and the wider Closer Still Media team which is now over 200 people strong. They obviously understand the formula to produce extremely successful events.

Internet of Things

Last year we reported on Oral-B’s move into connected toothbrushes and now Philips have followed with the Philips Sonicare DiamondClean Smart which not only is incredibly smart with its matt black handle, black brush head and charge in glass technology, it also uses connected technology to inspire and motivate patients to take better care of their oral health. I believe it will be available to consumers in the next few months. Great to see dentistry leading the way in connected devices and improving oral-health at the same time.

Good to Great

“Good to Great” is a journey to greater business prosperity for dentists, which has been underpinned in the last 12 months by the introduction of SoE’s Customer Success Programme. (Software of Excellence). The Good to Great Challenge encourages dentists to think more clearly about how they can optimise their performance and maximise revenue and provides a vehicle by which dentists can track and follow the progress of likeminded dental practices. More information available here - http://www.g2gchallenge.com/ 

Will be interesting to see how many practices get involved in this challenge and what affect it has on their practice over the 12 months.

Social

The show is great for networking which is demonstrated by the thousands of people attending and the huge queues at the Starbucks just outside hall 5! I really enjoyed this element of the show, fantastic to catch up with so many people from all areas of the profession.

A few other mentions and thoughts

  • The Simply Health juice drinks were delicious and perfect after a few beers on the Friday evening. I am sure anyone who attended the Dental Awards or the Dental Circle party also found those drinks refreshing :)
  • Prem at Quick Straight Teeth certainly caught the eye but I know this has been covered elsewhere on social media :)
  • The dental industry certainly seemed positive overall, digital is growing. Innovation isn't always the quickest in dentistry compared to other sectors but some of the options and resources available to a dentist just starting their dental practice journey are endless.
  • The 3M intraoral mobile tablet scanner is extremely clever and could be excellent for interaction with your patient. Info here.

Thanks for reading and hopefully see you at the BDA Conference in a couple of weeks. Get in touch if you would like to meet up or need some advice on the best restaurants in Manchester.

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Just say NO!

Just say NO!

Just say no.

 

I deal with more and more dentists who are close to or have reached burn out one of the causes of problems is of their own making, it’s their inability to say, “No”.

The temptation in any transaction is to say yes. In the hurly burly of the semi-organised practice where the pressures on our time are made worse by a lack of clear guidelines that facilitates people to say, “no” on our behalf we can always be under pressure to answer in the affirmative.

The NHS is constantly telling their professionals that they should be doing more, that activity is the key to everything, (hell they even called the measurement system units of dental activity) and that to turn someone away is wrong, implying that it’s also unprofessional.

Yet we know that to squeeze a quart into a pint pot leads to wastage, a mess and someone having to clean up later. Here we have one of the paradoxes of the NHS, pile high sell cheap and put in long hours but woe betide you if quality should drop.

One extreme of this is in NHS practices with large numbers of high-needs patients who are not motivated enough to attend regularly but who expect to be seen at short notice. Often it seems they expect a better service than they would get from their GMP.

Time is like land, they aren’t making any more of it so use it wisely. It can be a good servant but a hard master.

Many of us have had the pleasure and pain of starting “a book” from scratch. I did it first for somebody and then twice for myself, possibly a definition of business masochism. In those circumstances faced with an empty diary, a phone that rings sporadically, debts and a growing sense of self-doubt, the knee-jerk response to every call is to get the patient in as quickly as possible, it smacks of desperation but who cares?

By the time I did it for the third time I had learned a tip from the restaurant business and gave a “false” date of opening. When the phone rang we implied that I was booked for a fortnight ahead. Emergencies excepted, obviously. The demand levels rose and within two months I was booked a fortnight ahead.

Unfortunately that sense of urgency, of fearing failure and wanting to oblige may lead to subservience and can prevent the dental business from maturing. The result can be a manic, uncontrolled version of Dental “ER” where the appointment book is full of unprofitable sessions.

I met a colleague, Mary, at a local meeting once and asked her if she was going on holiday this year, her reply alarmed me, “Yes but I only ever take a week, if I have a fortnight there are so many patients to see with problems when I get back it’s just not worth it.” Shortly afterwards I needed to replace our receptionist for maternity leave and recruited an individual who had worked as a nurse and subsequently run reception for Mary. When her husband’s job relocated they had moved away for three months until he was promoted and re-relocated.

Within a week my appointment book was a war zone, every patient who with even the slightest problem and then summoned to be seen as soon as possible. Double booked, triple booked, lunchtimes, after closing, it was a nightmare. When I asked her what was happening to my beautifully crafted, session based and above all organised and optimised book, I was told Mary had said you had to see the patient at once, that patients were encouraged to ring whenever they wished and she would always see them, on that day.

Clearly there was a difference of philosophy and opinion, she had no hesitation in telling me that I was wrong and we agreed to part. Control was re-established and I fully understood why Mary had to take early retirement a couple of years later - burnt out by a bonfire of her own making.

Ideally the people answering the phone should only do that, but it’s not always possible or practical. They must be trained to ask the right questions and to have a manner that reassures and doesn’t alarm and that reflects your practice ethos.

Jack Welch the former CEO of GE wrote in his autobiography, “Saying no is incredibly liberating. Try it on anything and everything that is not part of your deliberately chosen work-life plan”

But it’s hard especially if you have built a system on saying yes.

The first step to change is to decide what you will and will not do. Then introduce boundaries which cannot be crossed. It’s not my place to tell you what they are in your case but common ones are working longer hours than feel comfortable, missing important family duties and giving your patients access to an “open book”.

The next is to decide when you work at your very best and concentrate on those times for your most challenging (or most rewarding) work.

Finally zone your appointment book and vary those zones from day to day through the week for flexibilty. I am not naive enough to suggest that you can avoid some early and late working but when and what must be under your control.

Delegate everything that you possibly can. Dentists should only do what only dentists can do.

I recently helped a principal who was close to breaking point, his private practice was so busy that he wasn’t able to take a holiday and was missing out on his family life. He had the tiger by the tail not daring to let go but losing the strength to hang on. It took a few hours of questions, of analysis of his business and some questioning to show that his beliefs were not really truths.

Once that was established, the tiger was slain he took a filleting knife to his schedule keeping what only he could do and delegating everything else, including some of his more straightforward implant cases. Sanity was established but more to the point he felt that he was in charge of his life rather than the other way round. He could see the choices, and was able to take them.

No is a wonderful word and might just save your health.

 

 

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Assessing Fitness to Practice: what test must the GDC satisfy?

Assessing Fitness to Practice: what test must the GDC satisfy?

There is a feeling amongst dentists on forums such as this that the GDC has become too heavy handed when dealing with alleged misconduct cases.

In March 2017 alone, of the 29 misconduct Fitness to Practice cases heard by the GDC, 9 dental professionals were suspended, 4 had conditions placed on them, 4 were erased and 2 were reprimanded. There were also 4 cases with the outcome still pending. That means of the 25 cases concluded 76% of dental professionals were found to have committed misconduct.

Compare this with the GMC figures for the same month, there were only 6 misconduct Fitness to Practice cases of which only 2 had findings of impairment made against the doctor. Considering there are more doctors than dental professionals registered to practice in the UK, the difference is significant.
 
In November 2016 the GDC introduced Case Examiners in an attempt to help streamline the Fitness to Practice process. Their role is to consider whether a referral should be made to the Practice Committee. Given this new stage is still in its infancy, we are yet to see what impact this will have on misconduct cases within the dental profession. However, it is hoped that as cases will be considered by a lay member and a dental professional, a more proactive approach will be taken at an early stage. This is the approach taken by the GMC and the low numbers of misconduct cases being referred for hearings could be a positive sign of things to come.

Unfortunately there are rarely any consequences for patients who make spurious complaints which are not upheld; however, the same cannot be said for the professional. The time, stress and expense of misconduct hearings can have a devastating effect. Many feel that their stress is exacerbated by an unsympathetic and heavy handed regulator.

If you are facing a misconduct investigation, it will no doubt be a worrying period for you.  It is important to understand from the outset what legal test the GDC will be applying. This way you can properly prepare your defence and gather evidence from an early stage. Proper presentation at the start may well ensure that the Case Examiner determines that a case should be closed at an early stage. If the case should proceed to a hearing you will be armed with the necessary knowledge to put forward the best possible defence, which in turn could help with any later appeals to the High Court.

What test does the Professional Conduct Committee (PCC) apply when assessing Fitness to Practice?

The Test

The test the PCC applies is twofold;

1.       Has misconduct taken place?

2.       Is the dentist’s fitness to practice impaired?

Whether or not misconduct has occurred will depend on the allegations raised and the evidence produced and as such this element of the test will be fact sensitive. The PCC must decide whether ‘it is more likely than not’ that the allegations took place, which unfortunately is a relatively low threshold. However, even if any of the allegations are found to be proved, case law has established that the conduct must be ‘serious’ before moving to the next stage of the test.

Tip. Is this a potential area that can be challenged? Are you able to obtain evidence or refer to previous cases that show the misconduct is not serious and therefore no further action should be taken?

When considering if a dentist’s fitness to practice is impaired, the PCC should look at the dentist’s current fitness to practice? It will not be sufficient to show historic impairment, unless the misconduct is so grave as to warrant it.

It should be noted that impairment is not assessed against any established standards of proof; it is a matter of judgment for the PCC committee. However, a failure to comply with the fundamental standards laid out in the ‘Standards for Dental Professionals’ is likely to lead to a finding of impairment.

Tip. Even if you do not accept the allegations against you, you should consider what actions you can undertake to show your fitness to practice is not impaired. For example, attending training courses, amending your policies and procedures, or being mentored/shadowing another dental professional. This should not be seen as an admission of guilt but a recognition that professionals can always seek to improve. 

The Sanctions

If impairment is found, the PCC will go on to decide which of the following sanctions to impose:

·         Reprimand;

·         Conditions;

·         Suspension;

·         Erasure.

 

In deciding what sanctions to impose, the PCC must apply the principle of proportionality by weighing the interests of the public against those of the dentist.

Tip. This is where you need to put forward your mitigating circumstances so as to reduce the sanction imposed. Also you are allowed to suggest out what sanctions should be imposed and if you are able to give the PCC well thought-out sanctions bearing in mind the allegations, this could prevent erasure or suspension.  

Stage 1 – Case Assessment

When the GDC receives a complaint, it first considers if it is the correct body to deal with it. If so, it will obtain more information from the complainant to assess whether one of the ‘Standards for Dental Professionals’ may have been breached. It is important to note that the Case Assessors do not make any findings of fact.

You will be asked to provide:

1.       Evidence of your indemnity insurance cover;

2.       Details of your current employers/anyone you are contracted to provide services to;

3.       If the complaint is about dental treatment, the patient’s medical records.

Tip. At this stage do not provide any further information than the above. Whilst it will be tempting to explain what has happened, at this stage the GDC has not set out what the allegations are against you, so you do not know what you are responding to.  Any statement given could later be used against you.

Stage 2 – Case Examiner

If the Case Assessors consider a dentist’s fitness to practice may be impaired the case is referred to the Case Examiners; the case will be considered by one lay person and one professional. At this stage you will be sent details of the specific allegations against you and it is at this stage you will be asked to respond. The Case Examiners are not making findings of fact. Their role is to consider whether there is sufficient information to make a referral to the Practice Committee.

Tip 1. If the allegations are not clear, seek clarification. If evidence is referred to, ask for copies of that evidence.

Tip 2. Whilst the Case Examiners are not determining the case, if you can show there was no misconduct, we would recommend responding fully to the allegations and providing evidence to support your assertions. However, if you think there may be a case against you on the evidence received think very carefully before making any admissions at this early stage. It may well be worth seeing the extent of the case against you before admitting any wrong doing.

Stage 3 – Hearing

Should the case progress to a hearing then you will need to fully prepare for the same bearing in mind the test set out above. Consider:

·         What evidence do you need to rebut the allegations?

·         Are you able to show the misconduct is not serious?

·         What have you done to show your fitness is not impaired?

·         Will other dentists/patients provide statements as to your character?

·         What mitigating circumstances are there?

·         What sanctions should be imposed?

Tip. If you are not happy with the GDC’s decision you have the right to appeal to the High Court within 28 days. We set out the circumstances when you can appeal in Issue 2 of our dental bulletin.

If you need advice on a current Fitness to Practice investigation or appealing a decision of the GDC, please contact Laura Pearce on 0207 388 1658 or by email at lpearce@jfhlaw.This email address is being protected from spambots. You need JavaScript enabled to view it. for advice.

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Believe

Believe

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Dental Conspiracies

Dental Conspiracies by @DentistGoneBadd

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White fillings - - for Dummys

White Fillings - Theory & Practice

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5555 Hits
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What is GDPUK?

What is GDPUK?

 

 

GDPUK.com is for dentists and dental professionals to discuss all aspects of their profession, their practice and their business, centred on the UK. Subjects dissected have been diverse, from tips on simple techniques to guidance on buying major equipment, to discussions on the various practice management software packages, and of ongoing developments in British dental politics.

Established since 1997.

Moderated in Manchester, England by Dr Tony Jacobs BDS, the Group was started in Summer 1997, and continues to grow rapidly. Tony continues to work in his family general dental practice in Manchester.

Dental News

GDPUK.com also publishes UK dental news, and has had many exclusive stories, as well as being able to publish the latest news relevant to dentistry before other dental news providers. Latest news.

Blogs

In addition GDPUK blogs, both editorial and product updates are well read throughout the dental profession and industry. Latest blogs here.

GDPUK Forum

The group now has over 10,000 members, and attracts interest and sponsorship from major companies involved in the dental trade. The forum has had over 22,000 topics created and over 254,000 replies. That is 11.5 replies for every thread created! A huge amount of content and information.

Joining the Forum

The site remains free to join for all members of the dental profession. Register here.

Advertising

Advertisers can look forward to their banners being displayed thousands of times in a verified manner, using professional banner server software, to a targeted group of UK dental professionals.

Media Pack

Revenue is generated on the site by companies in the Dental trade, advertising on the site. More information about what GDPUK can offer our advertisers, can be found in our latest media pack. Please This email address is being protected from spambots. You need JavaScript enabled to view it. for the latest media pack.

Further Information

For further information on what GDPUK can offer, please This email address is being protected from spambots. You need JavaScript enabled to view it.. Jonny will be attending both the upcoming Dentistry Show and BDA Show, get in touch if you would like to arrange to meet up.

20 Years of GDPUK

The site was established in 1997 and this year marks the 20th year anniversary of dentists talking to each other using the GDPUK medium. To mark the occasion we will be hosting a conference on Friday 17th November in Manchester. More details to follow.

 

20th Anniversary Publication.

We are currently putting together a publication that will be published in digital form in November 2017 around the time of the conference. If you would like to contribute to this please get in touch. We will also have advertising opportunities available at the conference and in the publication. For further information, please get in touch.

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Ask Auntie

Ask Auntie

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Is it time to review Vocational Training in UK dentistry?

Is it time to review Vocational Training in UK dentistry?

I was not an outstanding student. I had a very full 5 years at Newcastle but was not famed for my exam grades. Past form being no guide to a cup final I passed my finals.

This was before vocational training, whether voluntary or compulsory. Most of my year headed into general practice within days of graduation and kept their heads down for the next 35 or more years. If they were spared.

Inspired by MASH the movie and dreading being stuck in one place I spent two and a half years as an oral surgery resident, dealing with inpatients, impacted 8s, smashed faces and bleeding sockets. I learnt skills that would help me through my clinical career and life, once you have had to cope with gunshot injuries and Le Fort III fractures not much phases you. I coped with warring consultants, departmental politics and green-gowned theatricals but not with primary FDS. General practice was next and, like everyone else, it was in at the deep end and sink or swim. I bobbed about keeping my head above water, unsure what I was doing for many years.

The hospital service had made me open books, read journals and attend regular study days. There were no such expectations in practice, indeed any day long courses were frowned upon, as you “would not be earning”. The limit to my being mentored in practice was a dressing down when I missed caries, “you could have earned another £X here”.

Post Graduate Education (later CPD) was dominated by what was put on at the local PG centre with Section 63 and BDA section meetings, plus the very occasional trip to London for a day at the RCS.

To cut a long story short, one evening with Philip Greene changed my life and I realised that I had to know more about perio. That’s where my CPD proper started and much of it was beyond “approved by the NHS”.

Occlusion with Higson and the full BSOS year experience, with visiting speakers from the US opened my eyes wider. This coincided with my starting my first practice and nothing had prepared me for that! I found the people on the courses stimulating company who cared deeply for their patients, always looking for better ways to treat them. These people further opened my eyes to a philosophy of prevention. “What you need to remember, Alun, is that you don’t cure caries with a turbine” came as a shock, I was a dentist and I drilled teeth didn’t I?

BUOLD took me back into (mostly) university led teaching which was sometimes undergrad+ but led me to think about solutions. A week on the MGDS course made me remember how much I hated exams. Then came several years of tutelage and discipline of Mike Wise and eventually a spell with the Open University Business school MBA course that helped me to get to grips with my expanding and floundering business.

VT was a great idea but it came after my time. There was something to be said for my ad-hoc, buffet style of learning but I know I could have done it a lot better with a mentor. However VT / FD is facing major problems. Many good trainers have been forced out of a pile high / sell cheap system regretting the regular opportunity to pass on their skills and experiences but unable to square the commitment with the imposed system. The majority do not do it for the money, those who have done are left disappointed and their trainees disillusioned.

New graduates and young dentists face a changing world and it’s about time we looked to the future with a clean slate instead of reacting to the present. The department of health / NHS has responsibility for postgraduate training. The NHS is falling apart and has never taught dentists, dentists teach dentists. Is dental education really one of their priorities?

No other profession has such a poor career pathway. It’s not going to happen unless some enlightened and altruistic dentists make it happen. An independent VT system is an idea whose time has finally come. The last time it was mooted there was some enthusiastic support but the project was savagely crushed under the jackboots of Whitehall.

To take Covey’s axiom and start with the end in mind, what skills will a dentist require beyond 2030? How can these skills be learned? How can the very best be encouraged to deliver the very best care that they can and to properly lead skilled teams?

Here’s what I am starting to see in the switched-on practices. The principal has a set of values and standards that they share and instil in their associates. They help the associates to build a rolling personal development plan where, over a period of three years or so, they not only attend courses that will educate, enthuse and encourage them but also are able to put those new ideas and skills into practice. The idea is to provide a bedrock for their next 20 or more years and to imbue good habits. The associates earn reasonably well, possibly less than they would delivering UDAs but they work with great support staff, the pressures they will feel are the ones associated with doing a good job and they have no quotas to fill.

They routinely visit and observe specialists working and take part in routine, non-judgemental two-way appraisal / audit sessions. If they find that they want to pursue a further qualification they are encouraged. In addition they are shown the workings behind the practice so that they are able to understand how a successful dental business functions. Their communication and leadership skills are developed and enhanced.

How would it be if these Private trainees were able to rotate through say, 4 to 6 practices, over a three year period not unlike a registrar system and were expected to embark on a Masters degree during the latter part of their training?

There is an irony here in that the “corporates” would be better placed to provide such a system; there would be the opportunity to provide different practices for their trainees to work. Sadly they are mostly wedded to shareholder value, concentrating on servicing NHS commitments in an environment which does not encourage excellence - in spite of what they say.

So what’s going to scupper this?

•   Failure to ensure this is a win/win/win trainees/trainers/patients.

•   Egos.

•   Involvement of medical educationalists.

•   No long term plan.

•   No leadership.

•   Allowing the NHS within a hundred miles of this idea.

•   Not enough people with the vision to make it real.

 

Now who’s going to run with it and safeguard the future?

 

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Recent Comments
Ian Gordon

Let's rescue what we have

Alun. Excellent article. I have been involved with VT since 1990 , as a Trainer 13 time , as a VT Advisor for 7 years and now as ... Read More
Thursday, 13 April 2017 09:18
Alun Rees

Thanks

Hi Ian Thanks for taking the time to respond. I think we're in agreement about most things. The problems that you describe are par... Read More
Friday, 14 April 2017 07:13
Ian Gordon

In defence of Corporates!

Thanks Alun. You are of course right that not all Corporates/groups are the same - but from time I have spent with CEOs and CDs of... Read More
Friday, 14 April 2017 08:13
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Labelling Patients

Labelling Patients

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Julia Easton

Labels

Couldn't find these on SOE! My favourite in the days of paper notes was CPITN (complete pain in the neck)
Monday, 17 April 2017 08:41
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Final Exam MCQ by @DentistGoneBadd

Final Exam MCQ by @DentistGoneBadd

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Liar Liar

Liar Liar

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Part 10 - Digital Can Help Your Non-Digital Media Channels

Part 10 - Digital Can Help Your Non-Digital Media Channels

 

In a 2014 study commissioned by Brand Science and Microsoft, the study shows that not only does online advertising deliver excellent ROI efficiency, but it also provides extra value to your other spend in the media. Can be read here [PDF].

In basic terms the report shows that the difference in ROI is striking when a campaign has an online element against those that do not have any online element. When online advertising is added into the mix, the return on investment is much improved.

From a dental point of view, this means that when a brand sponsors an event or runs a conference for their clients, the marketing campaign needs to cover all mediums.

Over recent years, this is the way the online marketing world has evolved. Brands within dentistry have been hesitant to spend all their budget on online marketing but will often use some of their budget online, to compliment campaigns in magazines, events they are hosting or to promote attendance at an exhibition.

Businesses can see that they need coverage across all mediums, their customers are constantly using and sharing digital content and therefore digital is becoming as important as non-digital channels when looking to achieve maximum ROI on their marketing spend.

Therefore, digital is certainly important in the marketing cycle and plays a part in helping produce results from non-digital media channels. This is another reason that online marketing is here to stay. 

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Dentistry - The Thief of Time

Getting Your Timing Right

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April & May Offers on GDPUK

The dental exhibitions are approaching in May.
 
So we have put together some offers for you.
 
Reach thousands of dentists on a daily basis. Established since 1997, GDPUK has over 10,000 members, who are part of the dental profession. 
 
Publish content to the most read dental online publication in the UK. Over 22,000 threads created. Thousands of readers of our daily news and blogs. 
 
Even get content shared on our forum thread for advertisers. 
 
Banners appear on the forum, news and blogs.
 
Excellent value, you can publish more than one banner ad at a time. Ask us for more details. 
 
Limited space available on our featured email banner slot in April and May. Email arrives in your target audience's inbox, 3 times a day. Opened over 120,000 times a month.
 
For April and May 2017 we are offering buy 2 months and get an extra month free. You can choose your third month at your own discretion. Terms and Conditions Apply. Email below for further info.
 
Get in touch today for more information and pricing. This email address is being protected from spambots. You need JavaScript enabled to view it..
 
 
 
 

 

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14
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Part 9. Engagement

Part 9. Engagement

 

In Part 9 of this series, we take a look at engagement and the number of options we have to engage with potential customers. 

Online advertising lets you know a customer's exact level of engagement. You can see how many impressions and clicks an ad has and where the ad has been clicked. This again gives you the marketer, a lot more information than ever before.

Although the click to a landing page is a form of interaction and engagement, the measure of engagement is often based on other criteria and seen as a compliment or an alternative to measuring the traditional click which has been historically the first form of engagement taken into account. So this means this could be via content, ads or audience interaction.

You therefore can see what has been effective for your product or brand in achieving engagement; comments, impressions, shares, recommendations, social media, contact forms, competition entries etc

You might have circulation and readership data for a print publication, but you can’t know how much time customers spend interacting with your ad, how much time they spent on your website, if they researched more of your products, and whether that ad led to conversions. In fact, with print it is impossible to even see if someone has seen the ad in the magazine. Print advertising is often just following the old adage of “Half the money I spend on advertising is wasted; the trouble is I don't know which half.” (John Wanamaker (1838-1922) At least with online ads, you get to see how much engagement there has been.

An online presence gives you all of a whole range of valuable data and places you in a position to learn where your most engaged prospects live, work or interact. With a bit of research you can find out where your potential customers congregate, whether that is a forum, social media or a marketplace like Amazon or Ebay.

This access to data means you can start to reach people where they are most engaged and where they are genuinely interested in receiving your message.

When using social media, online ad engagement can then be used for engagement retargeting, which is now used by all major retailers and marketplace sites.

To summarise this part  of the series, online advertising has all the right skills not only to attract your potential customers but to get them properly engaged and totally involved in what product or service you are looking to offer. Online advertising opens a world or opportunity and options to get your client engaged within your story. 

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The whole tooth and nothing but the tooth - criminal investigations explained.

The whole tooth and nothing but the tooth - criminal investigations explained.

 

 

If someone makes a criminal allegation against you, whether true or false, you will be subject to a police investigation. This will no doubt be a daunting experience for you. In this article we guide you through the process and give you some important advice to help you protect your registration as a dentist.

At the police station:

It is a fallacy that only those who have done something wrong need to seek the advice of a lawyer. If you are facing criminal allegations the first thing you should do is seek legal advice from a criminal defence specialist solicitor. Good representation at an early stage will ensure your rights are protected, and can in some circumstances even prevent criminal charges being pursued. Facing a criminal allegation can be one of the most stressful events of your life, you do not need to face it alone.

The police can choose to either conduct an interview following arrest, or on a voluntary basis – commonly referred to as “caution plus three”. An interview after arrest means that you will be detained at the police station and are not at liberty to leave until the police or courts allow it. Under “caution plus three” is less draconian, and means that you are free to leave at any time as you will not be arrested. Everyone who attends for a police interview, whether, voluntary or under arrest, has the right to free and independent legal advice.

Can I choose my own solicitor?

Yes, if you are given notice of the interview it is important to research and identify an appropriately qualified lawyer.  However, if you are arrested unexpectedly and are not able to request your own lawyer, you will be offered the assistance of a “duty solicitor”. There is a duty solicitor on call at all times to provide assistance in the police station.

When you are arrested, and again at the beginning of your interview, you will be read the police caution:

“You do not have to say anything. But it may harm your defence if you do not mention when questioned something which you later rely on in Court. Anything you do say may be given in evidence.”

There may be circumstances when it is appropriate to answer “no comment” to questions being asked by the police officer. For example, where there is in fact limited evidence that you were present or have participated in a crime and the police are essentially “fishing” for incriminating information. Alternatively, if you do not feel comfortable or confident in answering all questions put to you, it is possible to provide a prepared statement setting out the terms of your defence. If this is done properly then it is unlikely a jury would be invited to draw an adverse inference as a result of your failure to answer all questions put.

Whilst legal advice and assistance is free and available to everyone in a police station, regardless of their means, you can choose to instruct a solicitor on a private paying basis, if for example you wish to have a consultation with them in advance of the interview.

It is very important that you make clear to your solicitor that you are a dentist, and that any police action against you could have serious consequences on your registration with the GDC. You must bear in mind that what you say to the police may be used in any later fitness to practice hearing. It can be a difficult balance to strike in providing information that offers a defence to a criminal allegation, but will not inadvertently leave you open to disciplinary action with the GDC. A defence of innocent incompetence to an allegation of fraud for example, may amount to a breach of the GDC Standards for the Dental Team.

If you did use the duty solicitor at the police station but were not happy with their service you are not obliged to continue to be represented by them.

Court Proceedings

Low level offending, such as common assault, shop lifting and traffic offences are all dealt with at the magistrates’ court. Your case will be heard by either 3 magistrates (lay people) or a District Judge. There is unfortunately very limited rights to anonymity before the criminal courts, and your name will appear on the court lists regardless of whether you are found guilty or not guilty.

Legal aid is available in the magistrates’ court, but it is both means and merits tested. The threshold for automatic financial eligibility is income under £12,475 per annum, as such most dentists will not be eligible for legal aid. When paying privately, it is important to bear in mind that even if you are found not guilty you will not be reimbursed for all your legal costs. Any reimbursement is at the legal aid rate, which is very low, and is dependent on you having applied for and been refused legal aid at the outset. Some insurance policies will cover criminal allegations, particularly where they are related to professional misconduct charges. It is always worth speaking to your insurers to find out what they will cover at the outset and remember you have the freedom to choose your own solicitor to represent you under such cover, you do not need to rely on the solicitors appointed by the insurers.

In the magistrates court you can be represented by either a solicitor or a barrister. It is worth considering very carefully the trial experience of the person who is going to represent you. Do not be afraid to ask what their experience is and whether they have dealt with similar cases in the past.

More serious offences are dealt with at the Crown Court. Legal aid is technically available for everyone who appears before the Crown Court, however, applicants have to make a contribution towards their legal costs of up to £900 per month, which is capped dependent upon the seriousness of the offence. For more serious offences you are likely to have the benefit of both a solicitor and an advocate representing you; this can be either a barrister or solicitor advocate.   Your solicitor should discuss their choice of advocate with you before they are instructed to ensure that you are happy with their choice of representative.

If I have been arrested but not charged with any criminal offence should I notify the GDC?

If you are arrested but not charged with any offence there is no obligation to inform the GDC. However, if you are charged, but not yet convicted, of an offence anywhere in the world, you will need to inform the GDC. Similarly, if you are given a formal ‘police caution’ (not the same as the caution above, but a warning from the police regarding behaviour following an admission of guilt), or accept a penalty notice for disorderly behaviour, then you will need to let the GDC know.

If you receive a fixed penalty notice for a driving offence or antisocial behaviour order, you will not need to inform the GDC.

When do I need to inform the GDC of criminal convictions/cautions?

Generally dental care professionals do need to inform the GDC immediately if they are convicted of a criminal offence. However, if you are registering with the GDC you do not need to inform them of a conviction if it is considered “protected”.

  • This means it is not a “listed offence” under S2A(5) of the Rehabilitation of Offenders Act 1974 (amended)
  • A custodial sentence was not imposed
  • The individual has no other convictions
  • It was received either when the individual was under 18 and at least 5 years and 6 months has passed, or it was committed when the individual was over 18 and at least 11 years has passed.
  • If you have a police caution that does not relate to a listed offence, and was given either when the individual was under 18 and at least 2 years has passed, or it was committed when the individual was over 18 and at least 6 years has passed.

If I am convicted of a criminal offence will I automatically face fitness to practice proceedings?

All criminal convictions and cautions will be referred to the GDC Fitness Practice department for consideration. The GDC will then consider whether the offence committed involved a departure from the high standards required of dental professionals and whether it impacts on their fitness to practice. Consideration will also be given to the dentist’s character and conduct since the commission of the offence. The GDC will assess the level of risk that the conviction or caution will have on protecting the public and maintaining confidence in the profession.

Do I have to declare my conviction to future employers?

Whether you need to declare your convictions to your employers will depend on whether it is considered ‘spent’. The rules are complicated and vary depending upon the type of conviction you have and the reason you are being asked to provide the information. For instance, an enhanced criminal records check is usually required for all jobs that involve working with children, so any convictions, including those that are ‘spent’, will usually have to be declared. If in doubt, ask an expert!

If you or someone you know has been contacted by the police, or faces criminal charges, call our criminal team on 020 7388 1658. Our dental experts work in conjunction with our criminal lawyers to ensure you have the best possible representation to protect both your personal, but also your professional life.

Julia Furley, Barrister

 

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5246 Hits
MAR
06
0

Part 8. Reach

Part 8. Reach

 

 

The image above greeted me this morning in an email from Google. The email read “With last week's announcement of YouTube TV, the lines between TV and online video continue to blur.”

Read more here. I thought this was perfectly linked to part 8 of the blog on Reach and how attracting interest in your product or service needs to incorporate so many different mediums to be effective. 

So according to Google, people are watching less live TV and turning to their computers, smartphones or tablets for their favorite shows, music, and to access their news.

Marketing professionals therefore need to make sure that they are staying in front of their customers and tracking their behaviour. So as all the latest stats suggest, your customers are online, so you should be too, and sooner rather than later!

Moving online gives you access to a global audience (if that is your target) and it means your ads can be working for you 24 hours a day. The options are practically limitless when it comes to your reach capabilities when you take your campaign online.

This means that your reach increases dramatically once you start the online advertising journey, as discussed previously you have a lot more control over your ads and they are building up impressions and clicks 24 hours a day, reaching unique 

Online advertising enables you to promote your products and services locally, or even worldwide. With the print media you can only reach fix number of customers limited to a certain location, but online offers you a global opportunity and certainly a larger number of options than has ever been possible before.

So with a modern marketing plan, your reach can be greater than ever before. Your online advertising plan can incorporate social media, video, blogs, plus of course specialist sites for your particular niche. Utilising all these methods of retargeting, means you can reach your target audience a number of times a month and hopefully get your message across to your desired audience.

Thanks for reading.

 

Part 7 on Affordability Here.

 
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1668 Hits
MAR
05
0

Dental Occupational Health Risks

Occupational health

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5612 Hits

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