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JUL
18
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It's Dreadfully Confusing

jigsaw_472 It's Dreadfully Confusing

I'm sure I'll take you with pleasure!" the Queen said. "Two pence a week, and jam every other day."

"Well, I don't want any to-day, at any rate."

"You couldn't have it if you did want it," the Queen said. "The rule is, jam to-morrow and jam yesterday – but never jam to-day."

"I don't understand you," said Alice. "It's dreadfully confusing!

 

Poor Alice, life had seemed much simpler when she graduated BDS, two years ago. A sunny summer passed living on her parents’ credit card visiting her friends from university. But the confusion had already started.

Alice was qualified and fully GDC registered so could work privately. She must wait 8 weeks until September to start her FD job post. She kept hearing about the shortage of NHS dentists but this was the “system”.

Her FD year went well, learning new skills with a supportive trainer, and then she failed to get either of the associate jobs in “mixed” practices for which she had been interviewed. The successful candidates were people who called themselves “Cosmetic Dentists” with portfolios of perfect photographs of composite restorations and who boasted about how many Invisalign cases they had done.

Soon, she was back living at home to start her first “proper” job; working in Mr Jackson’s practice where she had done her work experience from school. Mr Jackson didn’t own it any more and it wasn’t quite the same, being part of the “GleamDent” chain where everyone wore identical, shapeless “scrubs”. It didn’t seem as friendly as she remembered.

Her interview had been OK, although they didn’t seem keen on her charity work and hobbies nor did she didn’t get to meet any of the other dentists. The practice manager, “Queenie” as everyone called her, seemed a bit brusque and insisted on her signing her employee contract before she left the building, although she was sure they had told her on her FD course days that wasn’t best practice. Queenie said that was what GleamDent did and it was a standard “BDA” contract, so it should be OK.

The confusion continued. When she was eventually paid, four weeks after the month end, she hadn’t earned as much as expected. There were so many deductions! Laboratory work she understood, but laundry bills for those awful scrubs? She had made a couple of private crowns for an old friend using a different impression material, so she must pay 100% of the material cost as it was a “non-standard” GleamDent product. Hadn’t she read the employee manual listing what was acceptable and what was optional? Well no, she hadn’t because it wasn’t available.

CPD provision and certification was available in-house, at a cost. £100 for someone from GleamDent HQ to recite Prof Welbury’s child safeguarding manual, seemed a bit steep.

She did at least have a GleamDent online mentor and coach. He worked at a practice 150 miles away had seemed encouraging when they first met via Skype, “the first five years are the worst!” he had joked, she presumed it was a joke. She hadn’t been told that she would have to pay him too.

Alice had been a diligent student and enjoyed statistics but “practice KPIs” were a mystery all of their own. She received daily, weekly, monthly and quarterly reports, which usually arrived in the early hours of the morning. Queenie expected her to have read and understood them by the time of the next team morning huddle, or “The naming and shaming session” as the other associates called it.

Whatever the KPIs said, Alice felt as if nothing could improve. She couldn’t grasp why patient’s late cancellation of hygienist appointments could be her fault or why she was then expected to make a contribution to the hygienist’s wages.

Twelve months later and the promised “loads of private patients” was rarely more than a trickle of challenging full denture cases. Alice was the last to arrive and got the highest needs NHS patients, she had trouble making her UDA targets and was now facing subsidising any practice clawback. “Your problem”, said Queenie during one of her little “pep-talks,” is that you care too much. You spend too long with the patients; the chatting and consent should be done by “TCO Jackie”, the treatment coordinator. “You must learn how to become a more effective operator, you’ll never be a success unless you cut corners. How do you think Dr King, (the founder of GleamDent) made his money?”

Alice remembered a line from her FD Information Handbook, warning about social media blurring the boundary between public and professional life. She hadn’t realised that there could be a similar blurring between ethical and less ethical behaviour.

It all seemed dreadfully confusing.

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© Alun Rees, 2019

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JUL
15
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Just Say No - You Can Refuse

Just say no - refuse!

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JUL
08
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Can we fix it?

Can we fix it?

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JUL
04
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Community Water Fluoridation – Campaigning With Fortitude

Description goes here

If you check out the word fortitude you get a sense of the characteristics necessary to campaign on Public Health. Resilience, endurance, perseverance, patience, tenacity, resolve, determination, grit and pluck. I wish we’d looked this up in 2012 when we started all of this – we may have decided to duck the challenge. We didn’t, and now we know why fortitude is essential, necessary, imperative, obligatory paramount, courage over a long period, plucky………

 

Back to 2012 then - let’s fire up the De Lorean although for the petrol heads it’s a metaphorical one as we know they stopped making them in 1983 which coincidentally was the same year that McColl v Strathclyde set a 201 day record for any legal case in Scotland over you guessed it Community Water Fluoridation. Manchester City win their first league title in 44 years, the Olympics come to London, Bruce Springsteen releases Land of Hope and Dreams and Hull LDC wake up.

Hull LDC met at the Ionians Rugby Club back then and that evening we meant business. Ionians were known for their love of democracy, philosophy the arts and pleasure. We were more in to treating our patients and staying healthy and solvent as NHS Practitioners but we did enjoy a beer. That night we were fed up as usual. Fed up with the tsunami of decay and the human consequences, the pain, the extractions the relentless tide of poor dental health. We were all very committed to prevention. We were all very committed to our patients and to the community of Hull. But we felt powerless and we knew we needed change. Hull has very poor oral health and is one of the most deprived areas in England. We understand the social health gradient now, but we were embedded in it in 2012 (as we still are) and we finally decided to do something. This isn’t surprising. People from Hull have a track record of standing up. In 1642 Hull refused the King entry to the City even though he turned up personally, endured a long siege militarily outnumbered by 2:1 and finally saw off the threat. That definitely takes pluck, grit, and fortitude.

Over a pint of bitter and a sandwich we voted to try and drive a Fluoridation agenda. We would start with a letter to the BDJ and publish an e – petition. So we did, convinced in our own minds that by the next AGM we would have cracked it.

We even developed a QR code link to the e- petition on the Petition Parliament site. Like a deluded punter down the bookies – we couldn’t lose could we?

Inertia

The BDJ printed the letter and we waited for the e-petition to take off, soar,go viral. But it didn’t and in October six months after our rallying call for something to happen, it closed on 315 signatures.

Petition

So in October 2012 it seemed like Hull LDC were standing at the Fluoridation barricades alone or at least there were only 315 of us. Then the phone rang in Reception and my Nurse whispered in my ear – “there’s a Prof on the phone who wants to speak to you about your letter in the Journal.” I finished my fifth extraction on a child that morning and took the call.

 

To be continued...

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© CWF Network, 2019.

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JUN
28
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Domiciliaries

Domiciliaries

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© @DentistGoneBadd, GDPUK Ltd, 2019.

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JUN
24
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Interviews

Interviews

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JUN
19
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Dentistry’s Existential Crisis

crisis-in-progress-sign Beware - Crisis in Progress.

The phrase “Existential Crisis” has been used a lot recently. In an individual it is defined as, “a moment at which one questions if their life has meaning, purpose or value”. Often it occurs at a point of depression or negative speculations on ones purpose in life.

Extrapolate that to a country and you have UK 2019 where political leaders in both government and opposition seem to have lost their perspective on many things, not least the word beginning “Brex”.

Dentistry like much of healthcare, is no exception. There are many dentists examining themselves and their motivations, trying to make sense of the direction they thought they were heading and the reality. Are these individuals really symptoms of a far bigger crisis or crossroads within the profession? And is it limited to the UK?

Examine the traditional career pathway. Dental student, FD, perhaps a little hospital work then an associateship or three, find a place that suits you and either buy into a partnership or buy a practice of your own. The financial pressures of ownership led to a focus on the reality of running a tight ship making the years of relative sufficiency and comfortable associateship feel like a dream. It all seems so simple.

With hindsight 2006 was a far greater watershed than we could have imagined. Fixed contracts have brought associates to the verge of employed status. Scarcity of contracts has led to massive inflation of their value. Most agree that the contract remains bad for everyone involved excepting those who hold the purse strings and make the rules. Yet there are no shortage of takers.

Looking at it from more than a decade and a half, the one outstanding thing was the independence of practitioners. Even those who chose to be “career” associates (including those who worked part time with family commitments) had stability with their own contracts and patients. The DoH write the rules, they wanted control and they have taken it.

Add to the mix the onus on universities to produce graduates to work in the NHS as opposed to being safe to provide care under any arrangement. The change in emphasis appears small, but is significant.

The fall out from Shipman has brought about a broad brush approach to the need for compliance, adding yet another contribution to the erosion of morale. The Care Quality Commission was never suited to Dentistry and remains a poor fit. Yet the tank trundles ever onward, distracting and crushing dental teams under its tracks.

There has been a growth of larger practices and the pervasive influence of corporates, some, not all, with a culture of command and control management which puts the investors’ interests above those of the patients and workforce. New graduates, taken in by piecrust promises and unable to find other posts are discovering that there is no line on a spreadsheet for empathy and care.

The commoditisation of orthodontics, led by the Align corporation, far from increasing individual skills is leading to an A.I. world. How many  steps away are we from photographs taken with an app on an iPhone transmitted to a central hub for diagnosis, treatment planning and subsequent appliance delivery direct to the consumer. Why bother with those pesky dentists with their expectations and sense of entitlement?

Diagnosis of disease will be done more accurately using computers, treatments that can’t be carried out by robots will be performed by Dental Therapists. The headlong rush to being “Dental Beauticians” opens the market to many. Just because something has always been safe and controlled doesn’t mean that it will remain so. Remember coal, steel and newspaper typesetters.

In their book “The Future of the Professions”, Richard and Daniel Susskind predict the decline of today's professions and introduces the people and systems that will replace them. In an internet-enhanced society, we will neither need nor want doctors, teachers, accountants, architects, the clergy, consultants, lawyers, and many others, to work as they did in the 20th century.

The authors challenge the 'grand bargain' - the arrangement that grants various monopolies to today's professionals. They argue that our current professions are antiquated, opaque and no longer affordable, and that the expertise of their best is enjoyed only by a few.

Perhaps we should all embrace Dentistry’s Existential Crisis and plan for our futures.

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© Alun Rees, GDPUK Ltd, 2019

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JUN
17
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Dental School

Dental School

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JUN
10
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Keeping Mum

Keeping Mum

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JUN
06
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Talking Dental Marketing - How to utilise ONGOING marketing

part-4-twitte_20190606-104237_1 Email marketing works!

In the last blog post we talked about ensuring that your website had some form of longevity. One of the biggest problems of a website is you spend so much time and effort attracting visitors to the site yet when they visit the simply bounce and leave again, off to go back to doing whatever it was they were doing before.

To get the most out of digital marketing we really need to work to ensure that your website has ongoing marketability, even if people don't visit the website any longer!

Sounds strange… So how do we do that?

Let me introduce you to gentle e-mail marketing. If we can collect someone's e-mail address whilst they are on your website, whilst they are a hot prospect and interested in your services then we can continue to communicate with them after they leave your website.

I can almost hear you groan, “e-mail marketing is spam”, I can hear you saying.

Wait one moment – here’s an example…

If you do the National Lottery online you will know that if you win something then they send you an e-mail.

Every Saturday I'm avidly checking my phone waiting for that e-mail notification that I'm a lottery winner… I've occasionally received an e-mail which tells me I need to log into my account and check, my heart is racing as I visit their website to find out I've won an almighty £25!

This example shows the e-mails per se are not spam, it is the CONTENT of that e-mail that makes it spam, some e-mails (like ones from the National Lottery) we are eager to receive and waiting to turn up. How great would it be if you had a prospective patient anticipating the next e-mail from you?

Let me show you how.

The trick is to turn marketing backward, rather than ask “what can I get out of this prospect?”, ask the question “what can I give this person for free that will build trust and reduce risk?”

The answer is generic dental health advice and information.

If you create a free guide, place it on your website on relevant pages and allow people to download the guide for FREE but in exchange for an e-mail address you can help to demonstrate you care about the readers of your site at the same time as collecting their e-mail address. You can then follow them up with a gentle series of e-mails which continues to build a relationship and answer their dental questions.

Here's an example.

On your dental implants page create a free guide entitled “Everything you need to know about replacing missing teeth.” In your guide you can talk about

  • dental implants
  • dental bridges
  • dentures
  • not doing anything at all and the consequences of not doing anything at all on the adjacent and opposing teeth, retention of surrounding bone and possible consequences of restoring at a later date with a compromised bone quantity and/or tooth position.

We can then follow-up that free guide with a gentle series of e-mails which looks at:

  1. How comfortable is it to replace missing teeth? (Notice we don't talk about pain or discomfort rather, how comfortable we can make it)
  2. How much does it cost to replace missing teeth? Here's your opportunity to talk about the various different options.
  3. Where else to go to find out more about replacing missing teeth? Direct them to various dental implant company websites and other useful resources.
  4. How many dental implants might they need? this is a great opportunity to talk about different options and how you can help.
  5. What's the process for replacing missing teeth? This is where you can talk about planning stages, diagnostics and allow the patient to understand more about the process.

I could go on, but you get the picture…

As you can see, each e-mail is simply answering various patients concerns, each e-mail may not be entirely relevant to that person depending upon what their particular question is, but because we've written a series of e-mails we can be assured that at least one e-mail is going to be absolutely applicable to that person.

Now, we don't send all of these e-mails out in one go. We want to make sure they look natural and don't clog up someone's inbox.

The best sequence to send these e-mails out is based upon the Fibonacci series of numbers and the golden proportion, exactly the same formula you would use to calculate the width of centrals, laterals, and canines when doing cosmetic dentistry. This sequence of numbers is a beautiful sequence which appears often in nature and looks extremely natural.

So send your e-mails out with the following number of days between each e-mail 0, 1, 1, 2, 3, 5, 8, 13, 21, 34, 55 etc continuously add the previous 2 numbers to give you the 3rd number and then continue to repeat this process will give you the full Fibonacci series of numbers.

As you can see the e-mails get further and further apart as the prospect gets further down the e-mail series. I get a HIGH open rate of 70-100% using this system, so I know it works.

In each of the e-mails resist the urge to sell, sell, sell, rather handout your useful free and relevant advice to build trust and lower risk and at the same time give the patient a simple way to move into the next stage of the process, typically this may be a discounted dental health check or free consultation.

Make sure your e-mails have a button which is clickable that drives the person to this consultation. Again, this should not simply be phoning you, this should be a free consultation which is claimed by downloading a voucher from the website, this voucher then means that this marketing is then trackable when people come in to the practice but also if you have a voucher downloaded from the website means that we are again collecting people's e-mail addresses rather than simply suggesting they phone us which they probably won't remember to do the next day!

If you are then really clever you can use e-mail automation to drop people into additional campaigns, for example, let's say they click the free consultation button in one of the follow-up e-mails but do not take action, we can have an intelligent e-mail system recognises this and then drops them into an additional campaign letting them know the advantages of a free consultation, how gentle you will be, how much you will listen to their concerns and how easy it is to book.

All of these e-mails should be run from an e-mail management system, I recommend Aweber which starts at $19 per month (a highly affordable option) if you repeat this process with straightening crooked teeth, dental health, cosmetic dentistry and facial rejuvenation you will have built a robust marketing strategy which works off of your website 24-hours a day, 7 days a week never sleeping.

What you will find is that your return on investment from the website goes up enormously, no longer are people visiting your site and bouncing off again, they are now interacting with your site, we are collecting their e-mail address and we are using your website as simply the starting point in building a relationship with your prospective new patient.

Everything gentle.

Everything with the patient at the centre and not you.

If you treat e-mail like this, as a way to help people you will find e-mail can be one of THE best ways to maximise the benefits of digital marketing.

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© Mark Oborn, 2019

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JUN
05
0

GDPR for Dentists: A Year On.

46740628114_50802077af_z-1 GDPR: One year on.

25th May 2018 is a date etched in the memories of all dentists and practice managers; the date when the General Data Protection Regulations, and the Data Protection Act 2018, came into force. A little like the millennium bug, the furore surrounding this data protection revolution was immense. Was this just another layer of regulation for an already over regulated profession, or a fundamental change in the way that we treat personal data?

12 months on we look at the effect of the regulations and whether dental practices have got to grips with the changes and how the Information Commissioner’s office has been dealing with data breaches. 

The General Data Protection Act, a brief history.

The GDPR and the Data Protection Act 2018 came into force on the 25th May 2018. The regulations were intended to provide Europe wide rules to protect individuals with regard to the processing of their personal data, and to regulate the movement of European citizen’s personal data across the world.  The regulations included:

  • · Enhanced rights of individuals
  • · Increased transparency
  • · More accountability when record keeping
  • · Changes to the legal basis upon which data can be processed
  • · Introduced the new role of the Data Protection Officer
  • · Significantly increased the sanctions in the event of a breach.

In practical terms the changes saw dental practices having to thoroughly overhaul the way in which they managed their patients’ data, adopting a much cohesive and considered approach to handling the personal data of their patients.

But has GDPR made a practical difference?

What do the statistics tell us?

The ICO data shows that between January 2014 and December 2016 Healthcare Organisations accounted for 43% of all reported data breaches to the ICO. In 2017 there were 2877 reported breaches, 1062 were from healthcare, 37%. The main types of breaches related to loss or theft of paperwork and data being sent to the wrong person by email or letter.

For the first “Post-GDPR” quarter, April to July 2018, healthcare data breaches accounted for 677 of 3146 reported breaches; just 21.5%. In the second quarter, August 2018 to November 2018 healthcare breaches accounted for 619 of 4056 reported breaches; just 15%.  However, whilst the percentages may be going down, the overall number of breaches complained of has gone up significantly for all areas, including healthcare.

Does this mean that all the changes implemented by dental practices have been a failure?  No, one reason for the significant increase in reported breaches is the general public’s greater understanding of their data protection rights. The message that your data is owned by you as an individual, and therefore should be controlled by you, is finally getting through. People are much more alive to the dangers of sharing their data freely, and know their rights. The ICO is now in the public lexicon and people know how to complain.

What the statistics do show is that there is still a great deal of room for improvement in our data processing systems and the training that we provide to team members.

What have the ICO been doing over the last year?

The short answer is, working very hard. The regulators have had to deal with the biggest changes to data protection laws in a generation, and are now coping with a significantly higher number of complaints. But along the way they have managed to catch a few of the major offenders.

In October 2018 the ICO issued the maximum fine possible (under the old regime) to Facebook for failing to protect its users’ personal information. The investigation found that between 2007 and 2014 Facebook processed the personal information of its users unfairly, by allowing application developers access to their information without sufficiently clear and informed consent, and allowing access even if users had not downloaded the app, but were simply ‘friends’ with people who had. Facebook failed to check the way in which app developers were using its platform. One developer harvested the data of over 87 million people worldwide.

In November 2018 the ICO fined Uber £385,000, again under the old regime, for data breaches that occurred between October and November 2016. A series of data security flaws allowed the personal data of around 2.7 million UK Uber customers to be accessed and downloaded by hackers. The records of almost 82,000 drivers were also stolen. Uber made matters much worse by failing to tell their customers or their drivers about the breach for over a year.

Whilst these fines may have had little impact on either of these multi-national companies, under the new regime the ICO can impose fines of €20 million or 4% of the company’s global turnover, whichever is higher. To put this into perspective, Facebook’s annual revenue for 2018 is reported as being $55.8 billion.

And whilst the ICO has not yet concluded any large scale investigations under the new regime, in January 2019 the French equivalent, the CNIL, fined Google €50 million for its lack of transparency and information regarding the processes it uses when processing data and the failure to provide data retention information. Furthermore, Google had not obtained valid consent, as users were not sufficiently informed, nor was the consent obtained specific or unambiguous. Google had continued to use pre-ticked boxes in certain circumstances, which drew particular criticism.

The Future

In reality, the 25th May 2018 was the start not the end of GDPR preparation. Practices must ensure that they are fully compliant and can evidence compliance in the event of a breach. Records of processing activity, privacy policies and notices must be reviewed and updated where appropriate. Staff must continue to be alive to the risk of breaches. Systems must be put in place to ensure that the risk of data breaches is reduced.

GDPR Training

On 24th July 2019 JFH Law will be holding a one day seminar on GDPR for dentists. This course will look at GDPR a year on, setting out any updates since implementation and providing practical tips to ensure your practice is compliant with data protection laws. To register your interest please email This email address is being protected from spambots. You need JavaScript enabled to view it..

Julia Furley, Barrister

Image credit - Linda Hudson under CC licence - not modified.

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JUN
05
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Dealing with complaints - a barrister's view

Justice_b Dealing with dental complaints

Although dentists may feel under attack a lot of the time, the risk of litigation is actually (relatively) low. Complaints can often be dealt with through excellent communication skills and a willingness to listen and respond sensitively to the concerns raised by the patient. Unfortunately, it is not always possible to resolve disputes or complaints by patients internally. This can be the result of a number of factors, from the dental practice’s internal complaints procedure, lack of staff training to patient demographic. If all reasonable attempts to resolve the complaint internally have been exhausted, then dentists should be signposting other, objective complaints handling services. This not only assists the parties in moving forward from sometimes intransigent positions, it avoids patients turning immediately to lawyer for advice on resolution.

Complaints about NHS treatment

Every NHS practice must have a copy of the NHS complaints policy and must provide it to a patient if a complaint has been made regarding NHS treatment provided. Patients should also be advised that help is available to them via the NHS Complaints Advocacy Service. Bear in mind, patients are not obliged to complain directly to a practice first, the patient can go straight to the NHS; although following the internal complaints procedure should be strongly encouraged, and patients should always be provided with access to a clear and comprehensive internal complaints procedure. A complaint to the NHS will be made directly to NHS England and must include the patient’s contact details, a clear description of what is being complained about, the name of the service being complained about and all relevant correspondence. The patient will be asked to give their consent to the practice being contacted regarding the complaint.

Complaints must be made within 12 months of the date on which the subject matter of the complaint occurred, or 12 months after the date that the subject matter of the complaint came to the notice of the complainant. Complaints are acknowledged within 3 days of receipt. However, the NHS has a 40 working day target to investigate (this can be extended where appropriate). Investigation A case officer will be appointed and will obtain the relevant information about the case and make sure that it is accurately recorded. The process of the investigation itself is reasonably flexible, and the case officer will take necessary steps to properly investigate the complaint. They will prepare an investigatory report and thereafter send a formal response to the patient. During the investigation the practice may wish to consider both mediation and obtaining a second opinion if appropriate. The response will contain: An explanation as to how the complaint has been considered. Conclusions and an apology if appropriate. An explanation as to why the decision has been reached. Whether the complaint is upheld (in part or in full). What remedial actions are being recommended. Confirmation from the dental practice that action has or will be taken. A response regarding “lessons learnt” if appropriate. Contact details of the ombudsman. If the patient remains dissatisfied with the way in which the complaint has been dealt with, then they can ask the Parliamentary and Health Service Ombudsman to review the case. The dentist should cooperate fully throughout this procedure; however unmeritorious a complaint may be. The case officer can decide to report matters to the GDC if they feel it necessary to do so. Keeping an open and positive approach to the investigation will limit the risk of further complaints being made.

Dental Complaints Service

The dental complaints service (DCS) is intended to provide a similar complaints service as that provided by NHS England. The GDC funds the service, its staff members are employed by them and it is accountable to the GDC Council. However, investigations are run independently of the GDC. That being said if the DCS do become aware of any issues regarding a practitioners behaviour or competency, then they will (like the NHS) refer the matter to the GDC fitness to practice team.

Again, complaints must be made within 12 months of treatment taking place or 12 months of the patient becoming aware of the issue. Initially patients are referred back to the practice to attempt to resolve matters internally. If this is not possible, then a complaints officer will be appointed and work with both sides to try and reach a resolution. If a resolution is not possible, then the matter is referred to the DCS panel; the final stage of the complaints process. The panel consists of two lay members and a dental professional. Both the patient and the dentist will be invited to attend a meeting. The parties will have an opportunity to put their side of the complaint, and to work towards reaching an amicable resolution. If no agreement is reached, then the panel will make a recommendation.

Feedback from users of the DCS is generally good. The last annual review of the service was in 2014, but this showed of the 1068 cases considered, 95% of patients who provided feedback were satisfied with the recommendations offered, compared with 64% of dentists. Whilst this may reflect a tendency by the organisation to prefer the accounts of patients, it may also reflect a willingness of dental professionals to refund dental fees as a business decision, as opposed to admission of liability, once the DCS gets involved.

This type of resolution, whilst frustrating, can be a much quicker and cheaper option than defending a clinical negligence claim.

If you have are concerned about an ongoing patient complaint contact our lawyers on This email address is being protected from spambots. You need JavaScript enabled to view it.

Julia Furley, Barrister

"Justice"by mag3737 is licensed under CC BY-NC-SA 2.0

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JUN
03
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DIY Dentistry

DIY Dentistry home cures

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© @DentistGoneBadd, GDPUK ltd, 2019

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20
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Mental Health in Dentistry - my story

Mental Health in Dentistry

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The best irrigant is Empathy

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Time Gentleman, Please

Time Gentleman, Please.

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Dental Nurses - the Good, the Bad & the Giggly

Dental nurses - the Good, the Bad & the Giggly

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Dental Corporates and their Responsibilities

corps_square Dental Corporates and their responsibilities

I might start off by actually saying the title of this blog is probably one of the most Oxymoronic I’ve ever thought of, but then that would probably give away the content and the thread of what follows.

However, I don’t really care if it does give away what follows; because I’m sure that many of my readers will understand just where I am coming from and why there needs to be something done about the environment we currently have in UK dentistry.

No-one can deny that corporate dentistry generally is becoming bigger and bigger as the years pass. I can remember the original clamour back in the mid 1990’s to buy the original corporate ‘shell companies’ that were legally able to provide dentistry under the 1921 re-organisation of the profession. I’m not sure anyone who was in practice in those times could have then foreseen the huge growth of the corporate, but the real change came when all practices were allowed to incorporate (as an aside, does any one else think it’s funny how the Dentists Act 1984 allowed this but still can’t work out how to take a monthly direct debit from us instead of an annual payment, but I digress…..). What is true however is that there is a significant amount of dentistry now provided under the auspices of corporate dental companies, of which some of them are quite large players. I will say here; this blog is not about any specific company; I am sure there will be some out there who have good stories to tell. However, there is no doubt that in some corporates in some places and some practices there is a culture that is not good, not healthy, and downright nasty.

Those of you on Facebook may well also be members of the ‘Mental Dental’ page. This is a hugely important page that has become an important outlet for its members to vent their concerns about a multitude of issues affecting them. By simple extrapolation, many of the issues floated here are likely to not just be unique to the original (often anonymous for good reasons) poster, but relevant to other professionals finding themselves in similar positions.

A good many of the posts on this page (and indeed on most dental specific social media groups) seem to revolve around issues that associates are having with their corporates. Whilst I am the first one to consider that there are always two sides to every story, there is also a common theme to nearly all the threads posted. Note that I didn’t actually say “Corporate Employers’ at this stage; but more of this later.

It is apparent that even if you take into account that not all the stories are likely to be entirely balanced, there are a significant amount of associates who are having problems with the working environment of the corporates. From faulty equipment not getting repaired, running out of materials, a lack of clinical freedom in referring, to outright bullying, the same themes come up over and over again. This can’t just be put down to only having one side of the story surely? The fact that these threads appear so often, from so many different contributors shows that there has to be something more behind the threads.

Some of the more concerning posts often involve bullying of associates. From target driven issues, to ‘you make waves and we’ll report you to the GDC’, this seems to often be driven by management teams within the corporate environment. There is NO place for bullying in any environment, and the fact that some people feel that it is acceptable to disguise this as performance management doesn’t make it in any way acceptable.

But how has this environment come about? I’m pretty sure the dental registrants at board level haven’t issued dictats to their managers condoning the bullying of their teams? However, the need to make money for the shareholders means that these directors have to ensure the business is profitable (although there’s another oxymoron – the profitable corporate..) and the ideas discussed at board level eventually filter down to the teams regionally and locally,

This is where the problem lies in my opinion. When the board comes up with an idea, it is down to those below it to implement this, and the board is not necessarily aware of the fine details in how this is done; just how that it needs to be done. It is down to the teams on the ground to implement that desires of the board. How they therefore go about this is part of the problem. With management teams that are often not fellow dentists (or even registrants on occasion), there can be a lack of understanding of how the profession truly works. Yes, these people can be given training in the dental industry, but they may not have the same ethical and moral compass, or even the need to be registered by the GDC, and therefore do NOT know what it means to be a real professional.

When you hear stories of associates raising concerns to management about slack appointment books causing them to not meet their UDA target, to then be shown edited data showing the books are now full, and threatening them with a counter concern about clinical treatment (that the managers know full well can result in a GDC case and a livelihood threatening result), then you have to consider that the whole structure of corporate dentistry needs re-addressing rapidly. This threat has been real, this is not hypothetical, nor fictional.

Now I’m fairly sure most of the REGISTRANT directors of the corporates are very ethical and still have the moral compass that is needed; but they don’t seem to be getting the message down to their teams very well. Whether this is because they are not being heard above the voices of the non-professionals who have no regulator to fear, or whether the management structure is so poor that the message is not getting through I don’t really care. What is certain however is that a good many of these registrant directors seem to be unable, unwilling, or unprepared to step in to deal with the problems that we hear about, otherwise we would stop hearing of them almost on a weekly basis.

Have these directors forgotten they can be held vicariously responsible for negligent acts and omissions? They seem to rely on the self employed status of associates in order to deny all knowledge of the problem. However, it is becoming more and more apparent that the associates who work in these organisations are less and less likely to be seen as truly self employed as a result of various court cases (Pimlico plumbers, UBER, to name but 2), and it is about time that they took their corporate responsibility a lot more seriously than they appear to. I’m sure a few minds would be somewhat more focused on their ultimate responsibilities if a few of them were found to be vicariously liable for a few clinical issues, or taken to an industrial tribunal by a disgruntled associate (which if you believe the stories on social media might not be a small number).

They cannot hide behind the excuses that they don’t know what is going on. There is enough spoken about in the profession about corporate issues that this is about as believable as saying they aren’t aware Elvis is dead. Whenever there is a problem posted on the various groups, I always recommend that the highest level clinical director be notified, rather than the middle management (which is often the source of the problem) in order to ensure the problem lands at the door of a registrant rather than a (sometimes over-promoted) manager. Recruitment seems to rely on the fact that younger registrants often have ludicrous debts to pay, and therefore will end up working for these organisations as they appear to have little other choice.

corp responsibility

Registrant directors need to step up and take the responsibility for the mismanagement and bullying that appears to be a problem in their organisations, and deal with it decisively. If this costs money and time then so be it; but if it does it may well show some of corporates for the shallow and non-profitable businesses that they really are. Alternatively, if they don’t act, it’ll show the profession that these people might not have the integrity, ethics, and morals that are required to be members of our profession.

But if the latter is the case, then the GDC should be told. They should ensure that the need to act in the best interests of the patient is drummed into all those registrants who sit on the boards of the corporates. There should be no hiding behind the corporate structure of these businesses and claiming ignorance of the problem. When the majority of the entire profession seems to be aware of the magnitude of problems with some corporates, then the directors cannot feign ignorance.

The elephant (so big its actually more likely a Mammoth) in the room however is that if these directors were to be removed by the GDC, the remaining non-registrant directors would no longer be able to continue the practice of dentistry and the corporate would no longer be able to function under GDC rules. What this would do for the provision of NHS dentistry would be potentially shattering, with the loss of these businesses. Additionally, is there anyone reading this in any doubt that some corporates would seek to protect their viability by cutting loose the registrant directors and replacing them at the first sign of the GDC taking an interest in them? That would really show the profession just where the priorities of some of these companies lie.

Perhaps this is why there is no appetite to deal with the problem decisively, and instead this will continue to be a problem for years to come, with neither the Registrant Directors OR the GDC taking any form of corporate responsibility for the problems that seem to be within this area of the industry.

 

Image credit - Maria Eklind under CC licence - modified.

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Radiographs

Radiographs

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The Lost Art of Complete Denture Making

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Talking dental marketing - How to make your website more effective

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If you have a dental practice website then you want it to work, otherwise it's a completely wasted resource!

For a website to work, in my opinion you need to have 2 primary functions in place.

  1. Traffic optimisation.
  2. Conversion optimisation.

Without either of the above the website becomes ineffective.

If you had wonderful traffic optimisation and 100,000 visitors to the website per month yet only had a 0.001% conversion rate then you would only have 1 new patient per month. This scenario is highly unlikely to give you a good return on investment on your website.

Equally, if you had wonderful conversion optimisation with a 100% conversion rate yet only had 1 visitor per month then you would still only have 1 new patient per month. This scenario is equally highly unlikely to give you a good return on investment from your website.

You ALWAYS need traffic and conversion optimisation working hand in hand. If you work with a search engine optimisation company and all they do is get more traffic to your website then, in my opinion, this is completely worthless unless conversion optimisation is also worked on.

In my experience I have found that a dental website needs to be performing in the following areas:

Each of these five key areas provides an excellent way to audit your own website, so open your website now and compare your site with these performance areas.

Findability.

This is pure search engine optimisation and includes (but is not limited to) the following areas:

Website title, description & headers - these should accurately reflect the content of each page. Every single page on your website should have a different title, description and headers.

Image alternate tags - these describe images for people with visual impairment, Google is able to read the description and may give a slight boost your website if the descriptions are relevant.

Text - Google is (currently ) unable to read text on images. For the moment at least we need to ensure that we have excellent and expansive content on your website which uses a range of keywords and phrases that people type into Google. If Google isn't able to understand what your website is about and/or it is not relevant to what people are actually looking for then Google will not send traffic to your site.

Inbound links (votes) - if your website is good then people will talk about it, Google knows if people are talking about your website online because it will notice the links back to your site. The more of these links you have then the higher you will rank in the search results.

Link authority - but it’s not only about volume of these links. If you manage to get a quote about your dental practice and a link back from the BBC website then this link would have MASSIVE authority. With this one single link you would almost certainly see a huge improvement in your search engine results

Internal linking - Google is able to crawl around your website following all of the links. If you have orphaned pages (pages with no links) then this is an indication to Google that this page is not important, think about it, if you had a really important page on your website such as the dental implants page then you would obviously link to it from multiple other places within the site! If your dental implants page is an orphan, with no links from anywhere else then you are indicating to Google that your implants page is not very important… And Google may choose not to rank it very highly.

External linking - good quality links out from your website to high quality sources can help your website be seen by Google as a useful resource. Example, let's say you're talking about dental implants and want to communicate more about bone grafting, linking to a good quality bone grafting information website could help the way Google sees your site is a useful resource.

Usability

Good usability helps both the user and your search engine optimisation, Google ranks some usability factors quite highly.

Video -having videos on your website enables patients which like to see visual moving images and/or listen to audio engage with your site more. Particularly patient stories and testimonials.

Calls to action - in marketing terms this is telling someone what you want someone to do from your website, every single page should have a very specific action that you want the patient to do… This could be download a guide, request a free consultation, book an appointment, send you a message or phone you.

General enquiry - you should have an ability for a patient to make a general enquiry, this should be separate from the request an appointment form.

Request an appointment - you should have a specific request an appointment form which potential patients can complete requesting an appointment at the ideal day and time, this should then drop into an automated e-mail marketing system which follows up automatically.

Flow through the website - your website should flow smoothly and guide patients, try to think big and then narrow your thinking down, for example:

Straightening crooked teeth (the problem) > Invisalign (the solution) > Invisalign cost (potential questions about the solution)

As we granulate the problem down into solutions and questions you can have separate pages on the website, this means patients can be guided through from their general problem through to potential solutions and then answer the questions about those solutions.

Shareability.

Put quite simply social media is word-of-mouth marketing on steroids. Your website should have a simple facility (usually a button to click) which encourages patients to share the page they are on with their friends on social media… It sounds simple but can work really well to get your website shared.

Effectiveness.

Is your website focused around trying to sell treatments or help patients? A website that is dedicated around selling will be focused on YOU… A website which is dedicated around helping patients will be focused on the user. The latter will be considerably more effective.

Social proof - social proof is the technical marketing name for testimonials and reviews, you should be collecting these on Google and Facebook and then displaying a selection on your website. Testimonial videos can also be used to enhance this.

Longevity.

One of the things we want to do is to get your website working over the long-term for EACH user. Most websites only work whilst the visitor is on the site, the best websites manage to capture visitor details whilst the visitor is on the site, if we do this then we can continue to communicate with that person over the long-term. This means your website doesn't just work for the minute or so that each visitor is on, if you can capture their details then you can drop them into an automated and extremely gentle relationship building marketing system.

In the next blog posts in this series we are going to look exclusively at this gentle relationship building marketing system, we will look at how to use it on your website, how to automate it and how to ensure your website works 24/7, never sleeping, never tiring and continually providing new patients for the practice… Until then.

2018-10-19_09.33.53_3-2.jpg

 

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Raindrops keep falling...

Raindrops keep falling on my head.

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Mark A Speight

You're not wrong

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50 ways to offend a patient

50 ways to offend a patient

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Dental Records – who is entitled to access them?

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Dental practices often receive requests to access dental records from people other than the patient.

One of the most common questions we are asked at JFH Law is whether a dental practice is obliged to disclose notes to officials, such as the police or social services. It is understandably hard to refuse to disclose patient notes to a police officer during the course of a missing person or criminal investigation. However, it is important to remember that data protection laws prevail and real consideration must be given to when and why notes are being disclosed.

Whilst GDPR is at the forefront of everyone’s minds right now, a practice also needs to consider professional duties of confidentiality, the common law duty to disclosure in the public interests and the rules contained within the Access to Health Records Act (1990).

In this article we clear up the confusion over who actually does has the right to access a patient’s records and in what circumstances, and how dental practices should respond to these requests?

Living Patient’s Records

If you receive a request from an external body, such as the police or social services, in respect of a living patient’s records, you must consider this carefully before disclosing anything. There is no automatic right to access, not even for the police.

Unless there is a specific court order for disclosure, you will need to consider whether the disclosure would be justified in the ‘public interest’. An example might be if either the patient or someone else was at risk of serious and imminent harm if the notes are not disclosed. You should try to seek informed consent first, but if this is not possible weigh up what is being requested against why it is needed to decide whether disclosure would be justified. Either way, make a clear record of why you have reached the decision you have reached, and why you believe it would be in the public interest to disclose any notes if you chose to do so.

GDPR would also apply in this situation. You could potentially rely on ‘protecting vital interests’ as the lawful basis for disclosing notes. However, this can only be relied on if you need to process personal data in order to protect someone’s life and they are not capable of giving consent. There are very few circumstances that this could be said to be the case for dental records.

If another dentist or health care professional requests the notes, then you will need to satisfy yourself that the patient has consented to disclosure to this third party, in accordance with GDPR and your professional duties of confidentiality. There is no such thing as “off the record” as such it is not lawful to send non-anonymised case records to other practitioners or specialists without the consent of the patient.

If the patient asks you for the records, whether in writing or verbally, but requests they be sent to another dentist then you must comply with this also. The only caveat is if you are concerned that the patient does not understand what the implications of the disclosure might be; you should explain what will be disclosed and check the patient is still happy to consent.

Deceased Patient’s Records

The duty of confidentiality extends beyond the death of a patient. This must be borne in mind when deciding if access to the records will be granted to anyone else. Ultimately, if the patient explicitly states whilst alive that they do not want their records disclosed on death, then this wish must be adhered to.  

The Access to Health Records Act (1990) allows access to records to two defined categories, namely:

  1. The patient’s personal representative, namely the executor of the will or administrator of the estate;
  2. Any person who may have a claim arising out of the patient’s death.

You do not need to provide access to all of the dental records when requested by the above, only information that is relevant to any claim being pursued. This may require you to obtain from the requester more information as to why the request is being made so you can determine what information should be provided.

You may also receive a request to access the notes of a deceased patient from a coroner (or procurator fiscal in Scotland). As they have a legal obligation placed on them to investigate the death, you must provide them with access to the records.

You may also be asked by the police to provide certain information to help identify a body. In these circumstances disclosure would be justified as being in the public interests.

Remember GDPR applies only to living data subjects and so would not be relevant here.

Practical Tips

Whenever you receive a request you should:

  • Make sure you understand what is being requested and why;
  • Satisfy yourself that the person making the requests, is who they say they are;
  • Train staff to ensure they understand GDPR and patient confidentiality and can identify when a request for information is being made;
  • Don’t be bullied by officials, who claim to have a right to access, but are unable to identify the lawful basis for disclosure;
  • Where applicable try to seek the patient’s consent to the disclosure first;
  • Always consider the wishes of the patient, whether living or deceased;
  • Make a clear note on the file of any decisions made and why.

If you have any questions about the content of this article please feel free to email Laura Pearce on This email address is being protected from spambots. You need JavaScript enabled to view it. or telephone 0207 388 1658.

Laura Pearce

Senior Solicitor

 

Image by vjohns1580 from Pixabay

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Talking dental marketing - a complete system

twitter-1 Mark Oborn-dental-marketing-trackers-hunters-explorers

In the last blog post we looked at the meaning of dental marketing, how (in my opinion) it should change in dentistry and focus entirely on the patient. I talked about flipping the focus of our marketing to not be about what we can sell as a practice or be about the treatments we want to do, rather, it should be about solving patients problems in an engaging and relationship building way. The natural result of that is that people are attracted to us.

In this post I'm going to begin looking at some of the more specific ways that we can make that happen, future posts are then going to look at each of these individual ways that we can build relationships with patients.

When we look at digital dental marketing is useful to break down into 2 primary areas:

  1. Traffic optimisation to a dental practice website, this typically includes:
    • search engine optimisation
      • On-site search optimisation using words and phrases
      • offsite search optimisation with articles linked back to your website which Google sees as votes
    • paid advertising (PPC)
    • social media marketing
    • e-mail marketing via permission-based list building on your own website
  2. Conversion optimisation to get more of those website visitors converting into patients, this typically includes:
    • calls to action and wording on the website
    • things for prospects to do, typically these are downloadableguides which are handed out in exchange for an e-mail address
    • e-mail marketing
    • social media campaigns

Now that you've broken down digital marketing into very specific areas you can begin to understand more about whether you can do this yourself, who could do it in your practice or what you may need to outsource.

In general, I recommend 3 marketing strands:

  1. your website
  2. e-mail marketing
  3. social media marketing

Each of these should work in unison, as a system, referring patients backwards and forwards to the correct pace at the correct time in order to answer their dental problems and subsequently to gently attract them into your practice.

No single strand is more or less important than the other.

This is typically how I might approach this.

Patients that engage with you in some way via your website or social media stream  may not be ready to book an appointment straightaway, They may be:

  • TRACKERS : They know exactly which treatment they wish to buy and are using your website to check the price, availability and your service.
  • HUNTER: They don't have a specific treatment in mind yet but they do know what type of treatment they are looking for e.g. orthodontics, they probably have a few more features in mind. They are using your website to compare alternative options.
  • EXPLORER: They don't have a particular treatment in mind yet but they may have a particular objective e.g. straighten crooked teeth. They may even be looking on behalf of someone else.

oborn blog 2

 

We therefore need to provide things for each of these people to do, in order that they can feel as though they have taken action whilst on your site (at the same time we get to collect their information!)

For the respective categories this should be:

  1. HUNTERS or EXPLORERS: Free guides and downloads for patients wishing to solve a dental problem.
  2. TRACKERS or HUNTERS: An incentive to request an appointment, this could be a free consultation, refund of initial assessment or explicit promotion of your new patient health check. This will help to convince patients if they are wavering about requesting an appointment.
  3. TRACKERS: A request an appointment facility.

As you can see, explorers are not going to book an appointment yet, so what are you going to do to ensure you don’t lose them at this early stage in their decision?

We are using social media to drive people to your website, your website to collect their details, e-mail marketing to answer their questions which then sends auto responses (assuming we have permission) to drive them to make an appointment if appropriate.

Most of this is automated and all of it will work 365 days of the year, 24 hours per day. Never sleeping!

My opinion is that if you don't use all of these mechanisms, all of them working today as a cohesive system then your digital marketing will be less effective and you will be able to help fewer patients.

In the next article going to go through marketing on your website specifically, looking more at hunters, trackers and explorers and how you can get your site to be more effective.

Until next time…

 

Mark Oborn

 

 

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Who gave Voldemort the apex locator?

Who gave Voldemort the apex locator?

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Teamwork

Teamwork

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Julie Deverick

Good read...

Thanks, a change in culture is difficult but can be achieved if we have the support you have obviously shown. The BSDHT/BADT respo... Read More
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Let's Talk Dental Marketing

Relationship marketing

Let's talk dental marketing.

Actually, let's not!

That word “marketing” often has negative connotations.

  • Trying to get someone to buy something they don't want
  • Annoying people with multiple adverts
  • Spammy e-mails
  • and from the point of view of the patient, trying to be sold treatments just to make you more money! (Yes, that's what lots of people think)

This old school way of marketing is what is known as a push strategy. You have your marketing message and the treatments/products you wish to ‘sell’ (I hate that word in health care), you then push that message out to the maximum number of people in the hope that someone, somewhere sees your message, identifies with it and buys whatever it is you are selling.

It's a strategy often used in transactional marketing, we simply want someone to engage in a single transaction, part with their money, take the goods, go away and not come back again… Is that something you really want to do in a dental practice?

Let's flip this completely on its head. Let's look at this from the point of view of relationship marketing. [1]

Relationship marketing often uses a pull strategy instead of the classic push strategy.

A pull strategy involves allowing prospects (new patients) to pull the relevant information towards them at a time that is right for them. It's about handing over control, they control what they see, when they see it and what happens next [2]

Rather than try to force our message on these people, we simply generate a range of content which answers various dental problems, we put that content in various places on the Internet (think your website, e-mail marketing, social media, YouTube) marketing is then simply driving people towards this relevant content which helps them solve a dental problem.

Here's the thing…

Stop thinking about treatments, services and products.

Start thinking about the problems that those treatments solve.

  • I want to replace missing teeth.
  • I want to have straighter teeth.
  • I want to overcome my dental anxiety.
  • I want to look and feel good whilst being able to eat more efficiently.

These are the concerns that patients have, NEVER has a patient woke up one morning and decided out of the blue that they want to have dental implants, what they will do, is wake up one morning and think that they wish to solve their problem of missing teeth, they then go on a search to find out the best way to do this… This search (hopefully for you) ends with them deciding to have dental implants in your practice.

And by the way, by the time you get to the end of this series of blog posts you will see how this search absolutely can end up with them coming to see you in your practice.

If we begin focusing on solving patients’ problems (pull strategy) rather than trying to sell treatments (push strategy) we turn marketing into a relationship building mechanism whereby we genuinely help people with their dental health, and isn't that what dentistry is all about?

In the next blog post I'm going to go through some definitive techniques that you can use in order to implement your new relationship building marketing strategy. I will show you how you can attract new patients in an ethical, friendly, kind and gentle way which builds trust [3] and reduces risk.

Something which pushing your messages on people absolutely does not do!

Until next time…

[1] Gummeson E. (2002), Total Relationship Marketing, (2nd edition), Oxford, Butterworth Heinemann
[2] Urban, G L. (2005), Customer Advocacy: a New Area Marketing?, Journal of Public Policy and Marketing May 2005
[3] Bibb, S. and Kourdi, J. (2004) Trust Matters, Hampshire UK, Palgrave Macmillian.

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The Adventures of Dr. Den

The Adventures of Dr. Den

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At first I was afraid, I was Petrified...

at first I was scared, I was petrified

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Life after GDC

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Guess Who?

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Referral Letters

Writing Referrals by

Writing referral letters

The Definitive Guide To

Writing Referral Letters

By

@DentistGoneBadd

 

 

Basic Referral Writing

Let’s start with the essentials. Referral letters should contain the basics; name, sex (if any – I don’t like to ask really), date of birth and reason for returning….oh sorry, that’s sending a parcel back to Amazon. Long gone are the days of “Please see and treat,” so try and give the specialist you are referring to, a bit of a clue as to the reason for your referral. Throw in a couple of vague differential diagnoses if you can, just to demonstrate you aren’t completely gormless, with proper medical terms like ‘epidermolysis bullosa’ or ‘squishy lump.’ It’s probably best not to refer a patient just because you don’t like the look of them, tempting though it is.

Writing referral letters

Choice of Specialist

If you are worried about a lump, it’s best to send to a consultant lumpologist. But beware, some specialisms do cross over and consultants can get a bit elbowy and will fight over interesting lesions. I once witnessed a near fist-fight between an oral medic and an oral surgery registrar – both convinced they could write a paper about it. Every time, make sure you are referring to the most appropriate department. One department will treat a lesion with a spray and ineffective mouthwash, while another will cut it out and put an implant in its place.

 

Oral Surgery Referrals

Oral surgery referrals are probably the most common type made. It’s not quite clear why this should be. Fewer dentists get into trouble over oral surgery than perio neglect or root-treatments. I think that oral surgery is probably all a bit too gooey for a lot of dentals and the anticipation of complications is overthought. Because oral surgery departments are absolutely swamped, you have to make a convincing case. Warfarin patients are no longer a bar to treatment in practice, so throw in ‘difficult access’ and ‘a history of difficult extractions’ for good measure. ‘Proximity to the antrum’ doesn’t often wash. Since many oral surgery departments insist on you supplying a supporting radiograph, they can justifiably throw out the referral and tell you where to stick your jpeg when they realise it’s a lower molar you are talking about.

Writing referral letters

Orthodontic Referrals

These are probably a little more clear-cut, if you completely ignore IOTN, which I did. I doubt very much if it’s done now, but the acronym ‘FLK’ (Funny Looking Kid) in the margins of the old paper files, acted as a reminder to refer to the orthodontist once the overcrowding started to hurt your aesthetic sensibilities. I find FLK’s generally DO get orthodontic treatment, so providing they are reasonably competent with toothbrushing, and generally look as if they’re using the hairy end, send that referral. Again, don’t just ask to ‘see and treat’. Throw in ‘well-motivated,’ ‘optimal oral hygiene’ and ‘very stroppy mother’ to emphasise the need for action. Chuck in a couple of measurements if you can, and try and crowbar in a stab at a ‘division’ to show to the orthodontist you’ve given it some careful consideration.

Writing referral letters

Periodontal Referrals

This type of referral is usually done in panic five minutes after you have just unexpectedly lost a BPE probe down a previously scoring ‘1,’ so do try and keep the panic out of your letter. Make it sound like you’ve been closely monitoring things for a considerable period of time and really emphasise that when you first saw the patient, most of the damage was already done. ‘Despite my oral hygiene instruction’ also shows that you have been caring, but don’t get too down about having to refer and being condemned by the periodontist. The specialist will probably only see the patient for twenty minutes max anyway, and will never see them again, immediately throwing the patient into the ‘Pit of Hygienists.’

Writing referral letters

Endodontic Referrals

Endodontic referrals are becoming incredibly popular and you are highly unlikely to get one rejected, since they are often made to private specialists. Don’t bother trying to refer to your local dental hospital. The sun will have died well before your patient gets to the top of the list. Besides, dental hospital endodontists are exceptionally picky about what they treat. My local dental hospital won’t treat any tooth beyond a first molar. They aren’t that clear why, though I suspect it’s because trying to get to a seven is a bit ‘too fiddly.’ Failure in endodontics is a growing area of litigation and if you are an NHS dentist in particular, don’t risk ANY root-treatment – refer. You can throw a lot of information into your referral letter – sclerosis, unusual anatomy or “There’s a prominent squiddly-do on my radiograph” – but it doesn’t matter. These are endodontists. They have to pay for swanky microscopes and German Sportwagen. They’ll accept anything.

magnification

 

Implant Referrals

See Endodontic Referrals. Patients think they are the same thing anyway.

 

Prosthetics Referrals

Tricky. Prosthetics specialists are a dying species. Their natural habitat in the 60’s and 70’s was gummy, but since forestation with teeth, the need for them has diminished. The few prosthetists left, tend to pack together at dental schools, desperately attempting to procure close relationships with implantologists, borne out of their innate instinct to survive. Having said all that, I have had more referrals rejected by prosthetics specialists than any other type. To be absolutely honest with you, whatever you say in your referral to a denture specialist, they’ll write back with “We would recommend extending the flanges and see no reason why this cannot be carried out in practice. Now leave me alone. I need to bury my nuts for the winter.” Good luck.

Writing referral letters

Community Clinic/Paediatric Referrals

This is where you send all of your ‘challenging’ patients, or those that take an hour to do an enamel-only incisal edge composite on. Terms you should include in your letter are ‘wriggly,’ ‘anxious,’ ‘fearful,’ ‘phobic’ and ‘gagger,’ though be careful you don’t end up making it sound like a Facebook advert for happy hour at the local S&M Club. Make it absolutely clear that this patient needs sedation. Forget about suggesting GA. The clinicians at these emporia don’t stop talking about the risk of death from the time the patient enters the place having found it after previously mistakenly walking into the adjacent STD Clinic. If your local clinics have their own referral forms and it gives you the option to have the patient back if they refuse sedation, tick ‘NO!!!’

Writing referral letters

Restorative Specialist Referrals

 

Quite a few restorative specialists lurk in dental schools, but despite this, they try not to have anything to do with teeth. There is only one important, indeed, CRITICAL sentence you need to include in your referral letter, and that is: “I am ALREADY monitoring the diet and wear.”

 

Oral Medicine Department Referrals

 

You will normally refer to the oral medicine specialists as a means of backing up your diagnosis, which is almost certainly, atypical facial pain/burning mouth syndrome. Often, you would save a lot of time by giving a nightguard or benzydamine hydrochloride rather than wasting your time on a referral letter.

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Integration of the messaging services - Facebook's big idea

messenger_chat_20190126-130337_1 Say hello to your friendly chatbot

In the news today is a story about Facebook planning or already on the way to creating a single underlying service, that integrates the Messenger, WhatsApp and Instagram message services that so many of us use.

It will mean that a Messenger user will be able to send messages to an Insta user or Whatsapp user, of whom they don’t have other personal or contact details.

This integration, whilst retaining the apps of each separate branded platform, may be the source of some friction during 2018, when the Instagram founders, Mike Krieger and Kevin Systrom unexpectedly left Facebook. They were followed by the Whatsapp founders, Brian Acton and Jan Koum, all for largely unspecified reason, like “playing more Frisbee”.

There will be other advantages for users, as well as the reasons I give below, and one will be the addition of end to end encryption of messages as standard. This will mean neither Facebook itself, nor others, can read what is being sent. Some feel the integration will be a further reason to move away from these services, as they doubt the altruism of Facebook in all of this. Whatsapp users don’t give away too much of their personal data to use that messaging service. However, Facebook users have given an ongoing dump of their personal data to the company in exchange for the service for many years. I think there will be a long debate on what people are willing to share across the platforms. One thing is for sure, billions of people will be more wary of what they share with the data giants.

There is one another basic motivation. Whatsapp has about 1.5 billion active users each month, yet it generates very little revenue for Facebook. Instagram has 1 billion monthly users, this business has very valuable advertising revenue. There must be an undisclosed masterplan behind this move, which must raise revenues.

Here are two possible [speculative] reasons this might all be going on:

Firstly, business would like to message people using these systems. Messenger presently allows automation of some interactions of business with their customers. Invoices and receipts can be sent this way, and some organisations have chatbots working successfully already.

Here is an example from my personal phone – an airport car park chatbot.

chatbot

It’s not too hard to see that message could be sent by email, or to Whatsapp, but the improvement is the interaction with the chatbot – ask it for directions, or the confirmation, and the result is instant. Humans might chat and smile, but the chatbot simply responds with the answer you want, instantly.

This sort of interaction will allow companies to compete to provide super efficient customer services we cannot yet imagine. Of course the reach can therefore be worldwide, and would not bar the present users of the other services.

Whatsapp already has a platform to allow for customer services direct, BBC news uses Whatsapp for news images and remote crowd sourced news gathering, the uses of these services is gathering momentum daily.

Secondly, email is failing for personal communications. Randomised spam emails are a nuisance, as well as needing to be filtered daily. People use email for business use, but so much personal comms traffic is now via the various messaging apps, on our smartphones.

Putting it very simply, people read these massages when their phones buzzes or vibrates, somehow emails are easier to ignore, or delete later. This is a further factor which will drive businesses to communicate and provide services in this way.

On the other hand, we can expect spammers will find a way through these systems, but no doubt there will be privacy settings in place, and instant long term blocking. Apparently, the email marketing industry is already turning over more than $100 billion.

Any company, individual or spammer can guess, buy or steal your email address, then send you those unsolicited messages. But if these three services I have described above are integrated, the ecosystem created, with verified contacts, the resulting service could take over from email, possibly consigning email to the dustbin of technology history.

The rules must be that users would opt in to receiving messages from business, so we would only receive messages from the people and business that we know, interact with, and possibly have an account with already.

Life without spam email? You never know. . .

messengerchat

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Fake Dental News by @DentistGoneBadd

Fake Dental News by @DentistGoneBadd

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Pointless?

Pointless

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The GDC

The GDC's financial situation

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Modern Professional Betrayals - The Screenshotters

betrayal Betrayal by screenshot

I thought that I would mark my return to writing this blog by broaching a subject that has been annoying me (and I’m sure many others) more and more recently.

We have to accept that there are people who walk amongst us every day who are maybe not as deserving of our trust as they should be. It is inevitable that we will experience them both personally and professionally, and that they may not have the same understanding of ethics and morality as we do, and not have the same belief and value structures as we do. It is not necessarily an overt thing that can be observed in an individual, and as such, this trait has been utilised successfully (often by governments, corrupt or otherwise) throughout the years, especially at times of war and public unrest.

These are people who will betray you.

I refer mainly to the events of WW2 and the Cold War as being probably the most obvious known times of the incidence of betrayal. In both of these world events, people often found their lives and that of their families changed irrevocably by the actions of people they worked with or whom they lived amongst.

Such a culture of fear had been generated by the leadership of these countries that once normal people would revert to acting for their own protection, or to inveigle themselves with the regime in order to further themselves, by reporting neighbours, colleagues and even friends to the ‘authorities’. It came to the point that no-one could trust anyone, even members of their own families, for fear of saying or doing the wrong thing leading to extreme and often fatal outcomes. This sort of behaviour will always be present in society to some degree or another, so we should not necessarily find it unusual.

However, the reason I mention the above scenarios is because there is a sinister and similar thing occurring in dentistry today, which is acting to damage the profession hugely. It is creating an environment of distrust, a climate of fear, and preventing free speech and the raising of legitimate concerns about working conditions in dentistry.

I refer to the increasing use of what can only be termed as snitching. We all remember at school the odious type of person who had no qualms whatsoever dropping fellow schoolmates into trouble by running off to a teacher, usually trying to become some form of favoured individual. It’s the same as when you can’t fight your own battles and stand up for yourself and expect mummy or daddy to do it for you. The same thing is becoming much more of an issue in dentistry.

Some of it seems to be taking the form of the use of the ‘Screenshot’; when comments or opinions that appear on social media or the web are photographed and then used to report an individual to the GDC, or even to an employer. The use of anonymity seems to be no protection; I know of a situation that has been posted recently where a screenshot has been reported to a corporate as the anonymous poster revealed enough details for others to determine exactly which corporate was being talked about. This resulted in a potentially serious issue for the anonymous poster, when all they were doing was trying to draw attention to obvious issues (given the theme of many posts about corporates there appears to be very little smoke without fire).

I also know of a colleague who made some comments under his/her own name, only to have these screenshot by apparently someone well known in dentistry report them to the GDC for said comments, just because of a previous disagreement and some bad blood between them. Thankfully the GDC just issued a stock type of warning about social media to our colleague; but had it gone further it would have been interesting for the complainant as they would no longer have been anonymous, and we might have found out who it was.

So it seems that the GDC is now seen as a mechanism for some professionals to get revenge on one another by anonymously reporting one another. There are many satires that abound (on social media of course!) of associates being effectively threatened with being reported to the GDC when they have a disagreement with principals/corporate management, especially if they have departed under less than amicable terms with one another.

Isn’t that the same as blackmail? ‘Keep you mouth shut/do as you’re told/we’ll keep a high retainer or tell the GDC your dentistry isn’t great’? I’m sorry, but I fail to believe it is anything but blackmail. If a professional relationship has deteriorated to the point where people can no longer work together that is one thing: but to then threaten to report each other to our regulator is something I find reprehensible and without honour.

I am also aware of other cases where dentists are only too happy to push their colleagues ‘under a bus’ when they see dentistry that is perhaps a little suboptimal. In many of these cases there is a financial incentive to the first dentist to get the second dentist to pay for the work that a patient might not be able to afford. They then advise the patient to report the dentist to the GDC and/or take legal action. The first dentist seems to forget however their actions can misfire on them, as it is highly unlikely they are of such clinical prowess that they never do any suboptimal work themselves.

Now I’m absolutely not saying that we turn a blind eye to obvious problems that need to be reported to the authorities, and especially where there is a legitimate reason to suspect patient harm is occurring. This is where we DO have to take professional responsibility to our profession to report a colleague ourselves, but not get a patient to do it for us.

But reporting someone to corporate management because a valid concern is being raised and not listened to, and then someone just asking the advice of a hive mind? Using a social media policy as a mechanism to prevent free speech?

Having spies on social media is no different to not to being able trust your neighbours in the Cold War Soviet Union to not tell the KGB.

It certainly appears that the upper echelons of some corporate dental companies has little or no idea about what is actually going on at the tooth-face or if they do they just ignore it – which is probably worse), and they seem to forget fellow professionals will want to discuss with their colleagues these types of situations so that they don’t feel isolated, bullied, or even warn others off working in these places. It appears this lack of insight, coupled with unapproachable and inaccessible high level management leads to frustrations that are then exposed on social media. Personally I have no problem with this as it draws the profession’s attention to things that should be exposed if we are to retain our professional integrity and standing.

But to then use a social media policy to effectively gag a person reminds me of the saying ‘the beatings will continue until morale improves’….

The same is true of those who screenshot and report to the GDC. Freedom of speech is still supposedly a right in this country, and whilst it is one that can have consequences if legal and moral boundaries are crossed, it is still the right of an individual to express themselves. In years gone by, many things would be said at dental gatherings and the pub hat might well have been contentious but said in the heat of the moment; however I don’t remember people standing around with recording devices or making shorthand notes to then use against somebody. It is however now so easy with modern technology to take a screenshot and send it merrily on its way to the GDC and watch the as the drama unfolds from a distance. When this is used as a form of revenge against a colleague for a business dispute or some form of personal disagreement, then it can only be described as the lowest of the low, especially given the draconian manner with which our regulator polices our profession.

And what about those dentists who advise that patients report their previous dentist to the GDC/Solicitors for less than the true professional reason of patient safety? Those who do it because they feel they are somehow superior and have never made a mistake themselves? There could be a multitude of reasons for such behaviour, including financial ones (and not those of the patient I hasten to add).

Have they themselves never tried their best with a patient only to realise they are quite possibly the most challenging and difficult patient ever who consistently misses appointments, and considered this might be a reason? If there is a real patient safety issue then they are obliged themselves to inform the GDC as this is part of our professional responsibility to one another in keeping the public’s faith in us. The fact they get the patient to do it must somehow make them feel they have absolved themselves of the guilt of dropping a fellow professional in it if their reasons are not completely pure and without bias.

I have to reiterate that I am not suggesting a closing of our professional ranks so that problems are never reported; what I am actually saying is that there are some in our profession who cannot and should not be trusted these days because of their own motives and that depresses me.

I sincerely believe these people do not have the same values as the majority of the profession, and are likely to be entirely self-centred and self-absorbed individuals with little insight or no into their own failings. We can only hope that karma eventually serves them a suitable outcome, and they too then find themselves hoist by their own petard at some point in the future. The French at the end of WW2 had a fairly direct way of dealing with collaborators and informants, so history does tend to suggest what goes around comes around for these people.


They are one of the reasons there is a climate of fear where the GDC is concerned, and the GDC will happily use these turncoats to justify the persecution of the profession, as it gives them the legitimacy to say we can’t be trusted to regulate ourselves.

They are one of the reasons that indemnity costs are increasing; because they sow the seed in the patients mind there is money to be made to correct their dental issues. They seem to forget they too are human and can also err… but then they would need insight to realise that, and to understand the GDC is not there to replace dealing with a matter face to face professionally.

They are the reason I sometimes feel ashamed to be a member of this once proud profession.

They are Pariahs.

[ And I bet someone screenshots this article :)   ]

 

Image credit - Dimitry B  under CC licence - modified.

 

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Stevan Milson

McCarthysm and Pogroms UK

I really have to agree with you Simon and you are very brave to voice your words. When I came back to the UK in 1998 I have never ... Read More
Wednesday, 02 January 2019 18:47
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Health check success for Boundaries for Life and Simplyhealth Professionals

Lords-mascot The Boundaries4Life team at Lords with mascot.

 

Boundaries for Life and sponsors, Simplyhealth Professionals, are celebrating their most successful season of health checks this summer, helped by the introduction of new diagnostic software.

Founded in 2010 by Dr Chet Trivedy, a dual-qualified dentist and doctor, Boundaries for Life offers free health checks at major cricket fixtures throughout the UK. Made possible through a team of volunteer health professionals, spectators and ground staff are checked for signs and risks of health issues, including mouth cancer, blood pressure, diabetes, cholesterol, heart age, and obesity.

Commenting on this year’s success, which ran between April and September at high profile cricket venues including Lord’s, Edgbaston, Old Trafford and the Ageas Bowl to name a few, Chet Trivedy said: “It’s been a fantastic year with the team conducting over 250 checks and raising awareness of good general health and oral health with a huge audience.

“It was a particularly exciting season, as this was the first year that we conducted heart age checks in addition to our regular checks. This provides users with an opportunity to know how old their heart is medically, compared to their actual age. Many people were shocked that their heart was a lot older than they thought it was. As we were using a software system to calculate the heart ages - provided by Health Diagnostics - every user had the opportunity to understand how they could reduce their heart age. This was not possible in previous years as the health checks were not automated.” 

As well as a detailed medical check from a health care professional, users also benefit from a mouth cancer check from a dentist – many of whom were volunteers from Simplyhealth Professionals’ network of member dentists. At the end of the checks, each user is given a five-page health report and access to an online interactive dashboard.

Henry Clover, Chief Dental Officer at Simplyhealth Professionals, said: “Supporting Boundaries for Life is a great opportunity to champion The screening tent full, all seats taken.a very important cause, as well as to highlight Simplyhealth’s approach to preventive wellbeing. We’re delighted and very grateful that many of our member dentists volunteered their valuable time to assist with mouth cancer checks.

“The health checks offer the chance to identify people who might be at risk of future health problems at an early stage, particularly those who might not be regularly visiting a dentist or GP. Importantly, the health checks help users to understand the links between general and oral health. It encourages them to reassess lifestyle choices such as alcohol consumption, smoking and diet, which could potentially contribute to issues such as mouth cancer, diabetes, and high blood pressure.”

Not only does Boundaries for Life provide the means to help users to understand their current and future health, the initiative also has the additional benefit of collating valuable insights into the nation’s health. Data insights discovered that 34% of users were obese, 42% had a raised BMI, and 70% had a waist measurement that is considered to be medium or high risk for diabetes. Shockingly, almost half of users (48%) were at an increased risk of developing diabetes according to the Diabetes UK risk scoring system. Furthermore, one in four users had raised blood pressure, and 40% had raised cholesterol.

As a result of their health check, nearly 50 users were referred to see a GP, dentist or other health professional for further advice or treatment - potentially saving lives.

“We’re proud to have helped so many people, but these figures highlight that there is still a lot of work to do,” says Chet. “We’re keen to keep building on our success and provide an ever-broader range of checks at next season’s cricket fixtures. The checks are only possible due to our fantastic team of volunteers, including Simplyhealth Professionals member dentists. They have all promised to do more next year and that is the best endorsement we can get.”

For more information, visit http://boundariesforlife.co.uk/

About Simplyhealth

For 145 years we’ve been helping people to make the most of life through better everyday health.  In 2017 Simplyhealth and Denplan united under one Simplyhealth brand and today we’re proud to be the UK’s leading provider of health cash plans, Denplan dental payment plans and animal health plans.

We help over three million people in the UK access the health and care products, services and support that they need, when they need them and at a price they can afford.

  • 1m health cash plan customers
  • 1.5m patients with a Denplan payment plan
  • 6,500 member dentists
  • 1,900 member vets
  • 1m animals covered
  • 11,000 corporate clients

We’re proud to donate 10% of our pre-tax profits to health-related charitable activities every year, and this amounted to over £1 million in 2017. Our Simplyhealth Great Run Series partnership raised an additional £42.6 million for charity.

Simplyhealth is a trading name of Simplyhealth Access, which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

Dental

Simplyhealth Professionals is the UK’s leading dental payment plan specialist with more than 6,500 member dentists nationwide caring for approximately 1.7 million patients registered to a Denplan product.

Simplyhealth Professionals provides the following range of leading Denplan dental payment plans under the Denplan name:

  • Denplan Care: all routine and restorative care + worldwide dental injury and dental emergency cover
  • Denplan Essentials: routine care only + worldwide dental injury and dental emergency cover
  • Denplan for Children: routine and other agreed care + worldwide dental injury and dental emergency cover
  • Denplan Membership: registered with the dentist + worldwide dental injury and dental emergency cover
  • Denplan Hygiene: A dental payment plan without dental insurance for all types of practice from NHS, mixed and private to support patients commit to a consistent hygiene programme.
  • Denplan Emergency Insurance: worldwide dental injury and dental emergency cover only

Simplyhealth Professionals also provide a wide range of professional services for its member dentists and their practice teams, including the Denplan Quality Programme and Denplan Excel Accreditation Programme. Plus regulatory advice, business and marketing consultancy services and networking opportunities.

Dentist enquiries telephone: 0800 169 9962.

For patient enquiries telephone: 0800 401 402   

www.simplyhealth.co.uk

www.simplyhealthprofessionals.co.uk

 

more sporting events in the future, dependent on their team and their funding.  

Links:

http://boundariesforlife.co.uk/

Twitter @Boundaries4Life https://twitter.com/boundaries4life

Twitter @SHP_Dentists https://twitter.com/shp_dentists

Lancashire Foundation http://foundation.lancashirecricket.co.uk

Healthy Stadia http://healthystadia.eu/  - Enabling sports clubs to influence health and behaviour.

news article http://healthystadia.eu/boundaries-for-life-fixtures-2018/

Blood biochemistry tests https://www.bhr.co.uk/  - small machines which run rapid tests of blood biochemistry.

What is HbA1c? https://www.diabetes.co.uk/what-is-hba1c.html

GDPUK article https://www.gdpuk.com/blogs/entry/2133-knocking-mouth-cancer-for-six-simplyhealth-professionals-announce-boundaries-for-life-sponsorship

 Panoramic view of the Old Trafford ground, Copyright Tony Jacobs 2018.

 

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How the GDC struck a Dentist off by mistake

You Couldn’t Make It Up

(How The General Dental Council Fouled Up – BIG TIME)

By

@DentistGoneBadd

Anyone who read my blog of a couple of weeks ago, which attempted to satirise the General Dental Council’s recent online opinion survey, will probably not be surprised by the alacrity with which I have jumped on the opportunity to outline the following episode, which beset an unfortunate general dental practitioner a few days ago.

The following events are true. The main action took place on Friday 12th October, 2018. The names of the “very professional” GDC employees have been withheld and the name of the protagonist has been changed. With a deferential nod of acknowledgement of the recent Royal Wedding, I will call the protagonist, who is very well known to me, Eugenie. I thank her profusely for granting me permission to relate her sorry tale to you. 

Eugenie is a GDP currently working in general dental practice in a dental corporate. Her precise location she would like to also keep secret, but she describes it as ‘Moderately gentile, Middle Earth.’

Eugenie has been an NHS dental surgeon for 30 years and after a career as a full-time GDP, she decided earlier this year, to take early retirement and “escape the nightmare of NHS corporate dentistry.”

Eugenie being ‘exceptionally anally retentive’ (her words), she put in the appropriate pensions paperwork to the NHS Business Services Authority, informed her employer of her intentions and also the local NHS Area Team.

The latter irritated her somewhat, since she received communications twice from the Area Team, asking her if she was taking ‘24 hour retirement’ – her Area Team being unable to fully comprehend and understand the phrase “taking full retirement.” The Area Team also asked twice if she could confirm she had told her ‘employers’ of her intentions – the Area Team also failing to remember the concept of self-employed associates.

Being mindful that the GDC had taken over £900 quid off her earlier in the year for 12 months of exquisitely executed administrative services, Eugenie wanted to get her money’s worth and decided to retire on December 31st, 2018. Remember that date, it is important. That date was disseminated to all those that needed to know at the business end of dentistry, and she decided as a conscientious i-dotting and t-crossing individual, she would also inform the GDC of her desire to be removed from the General Dental Register on……come on, I told you to remember the date…yes, correct, the 31st December.

Ten days or so after submitting her letter, the GDC sent a form back to her via email, for ticking and signing and posting. Eugenie was surprised to find that she didn’t have the final say as to whether she could remove her name from the Dental Register. It was up to the GDC to decide if she had a valid reason to leave and the letter advised her that she would be informed of the GDC’s decision on whether to remove her name, in due course. Eugenie speculated that this was possibly to prevent someone in a spot of forthcoming bother, from removing his or her name before the GDC had the opportunity to strike them off themselves.

On the form, Eugenie was adamant that she made it clear she was removing her name due to retirement AND noted on the form, her desire for that procedure to be carried on after….come on…..anyone….31st December, 2018.

Skip forward to last Friday, 12th October. Eugenie was on an ‘early’ and by 9.45am had seen a bridge prep, a filling and two examination patients. It was the custom at the corporate practice Eugenie works at, for reception staff to hand letters to dentists at lunchtime, or earlier if the letter looked like it needed early attention. On Friday, the head receptionist handed Eugenie an unopened letter marked ‘General Dental Council.’ Eugenie nearly tossed it behind the computer monitor for later perusal, suspecting it was a letter confirming her removal at the end of the year. But something, fortunately, made her open it, because it was a letter from a ‘Registration Operations Officer, dated 10th October informing Eugenie that she had been removed from the Dental Register as from 9th October – TWO DAYS EARLIER. This mean that Eugenie had not only worked illegally as a dentist that day, but since the previous Tuesday. In other words, she had been, without her knowledge, breaking the law for four days, with, presumably, invalidated dental indemnity insurance.

She was chilled to the bone when she looked at the GDC register online and found she definitely wasn’t registered.

The practice manager was called. Eugenie and the manager agreed that she had to stop work immediately and her day was cancelled. The next patient, sitting patiently outside her surgery was fortunately very nice about the fact that she had wasted a forty mile round-trip, and happily rebooked.

An understandably irritated Eugenie then rang the GDC and spoke to a ‘very nice lady’ who eventually told her that on neither Eugenie’s letter or returned form, had she informed the GDC of her retirement date. After Eugenie’s protestations that she knew she had put the date on both pieces of correspondence and following the GDC representatives’ ‘consultations with colleagues,’ the GDC lady apologised for the ‘mix up’ – she had apparently been ‘looking at another person’s letter’ when she had given the previous statement that there was no date on Eugenie’s correspondence. The GDC lady said that a member of the Registrations Team would ring her back.

After one hour, at 10.45am, there was no call and Eugenie rang again, this time speaking to an equally pleasant GDC worker. She couldn’t apparently raise the Registrations Team and so Eugenie left her with the chilling message “I’ll be back.”

At 11.45am, still no joy, but this time the original person Eugenie had spoken to, answered the phone. She said the Registrations team were at that very moment looking into the matter and would definitely be in touch in the afternoon. By this time, Eugenie had decided not to leave the practice until the GDC had telephoned on her mobile, not wanting to be caught out having to take a call in the car. She said she spent the whole morning whining to colleagues and swearing a lot, as well as threatening the Registrations people by email with ‘action’ if she was not reinstated immediately.

Around midday, a sheepish, very polite gentleman from the Registrations team telephoned Eugenie and apologised profusely for the mix-up and reassured her that she would be reinstated immediately and that her name would reappear on the register online, after midnight.  

What confused Eugenie was that this particular Registrations officer gave her a totally different explanation as to why the mix-up had happened. The first GDC worker said that the wrong registrant’s application had been accessed initially, while this Registrations man was saying that while Eugenie’s first letter to the GDC clearly stated the date of deregistration had been seen and noted, a second registrations officer had processed the GDC form without seeing the original letter and that form did not state the date. To Eugenie’s recall, she did date the form, the need for the date being critically important.

On having an early finish on Friday, Eugenie fired off an email and recorded delivery letter to the GDC, asking for a scanned or hard copy of her returned form – a form they still had in their possession and had apparently accessed on Friday. This letter was mainly to check and reassure herself that she wasn’t actually going insane, so sure was she that she had put the date carefully on the form, which the GDC were adamant she hadn’t.

Eugenie checked online on Saturday morning and found that her name was back on the Dental Register.

So all’s well….or is it?

One of the primary roles of the General Dental Council is to, (to quote the recent survey):

“Maintain(s) a register of dentists and dental care professionals, and check they meet requirements.”

I dunno, but I would have THOUGHT that if there was any ambiguity with regard to a dental professional’s intended removal, they would have double-checked with the practitioner. The GDC had responded to the original request for removal by sending the form to Eugenie, so surely that correspondence could have been looked at? After all, it is the most final act in a dental professional’s working life.

The other question regards the first GDC worker’s statement that she had been looking at another registrant’s letter! What???? Another letter on Eugenie’s file belonged to another registrant? I mean, GDPR and all that, surely???

I REALLY hope you all took the opportunity to fill in that survey, and if you did, you give them Hell when they start the telephone survey.

Happy retirement, Eugenie xxx

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Dr. Andy Bates

Rejected by the Survey

I'd have liked to give my views - But the the first question " Are you *Male * Female * Prefer not to say" I responded "Prefer not... Read More
Tuesday, 16 October 2018 09:58
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GDC Survey: by @DentistGoneBadd

The GDC Survey

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Periodontology in practice simplified by @DentistGoneBadd

PERIODONTOLOGY IN GENERAL DENTAL PRACTICE

PERIODONTOLOGY IN GENERAL DENTAL PRACTICE

A New, Simplified Classification System For General Dental Practitioners

By

@DentistGoneBadd

 

Introduction

We present here, the results of a thirty-five minute workshop on new periodontal classifications compiled by the only few General Dental Practitioner’s we could find that were even remotely interested in gums and jawbone. This is the first time GDP’s have been bothered to categorise (or take notice of) gum conditions and we feel it will be a more useful day-to-day guide than those new classifications issued recently by the American Academy of Periodontology and the European Federation of Periodontology. The workshop was carried out during a Curry Club Thursday at the Salisbury Wetherspoon’s.

Methodology

Brian wrote everything down on a beer mat because the screen on his iPhone stopped working after his ios12 update went pear-shaped. We wrote down everything we could think of regarding perio, without Googling it, not that Brian could anyway.

Classifications

GINGIVAL TISSUES

  1. 1. Perfick

The patient has no inflammation, deposits or staining. This has nothing to do with you or your ‘diligent’ care. Either the patient has been to another practice, or is just extremely lucky. Treatment – NHS – none required.   Private – One to two sessions with the hygienist.

  1. 2. Bit Gammy – But Not Worth Getting The Scaler Out

The patient has a little bit of plaque or stain that is forgivable bearing in mind the goofiness she presents with and having to control the three kids that are currently all trying to make a human pyramid on the nurse’s chair. Teeny bit of bleeding when you bodged it with the BPE probe, but no calculus. Treatment – NHS – MAYBE a polish. OH advice – “You’re missing a bit – get an electric.” Private – Two to three sessions with the hygienist.

 

Gum tissue by DGBadd

 

  1. 3. Quite Gammy

The patient has dirty-filthy-muk-muk everywhere as usual – I say everywhere, it’s mainly on the lower linguals of three to three (there MAY be other stuff but you didn’t look anywhere else). Some crowding is hindering OH, but the patient doesn’t really make an effort. Neither do you really. Treatment – NHS – get the blunt hand scaler out. No air scale since the phantom of the practice has bent all the inserts (how DOES that happen?) Private – Three monthly scales. This proves to the GDC disciplinary panel that you were providing continuing care.

  1. 4. Incredibly Gammy

Even YOU can’t ignore the dirty-filthy-muk-muk between the 6’s and you are too scared to push the BPE probe in too far in case you hit a ‘3’ and end up having to do a full perio chart (even if you COULD find a perio probe). Treatment – NHS – See what you claimed previously and see if you can get a Band 2 perio out of it. Order an air scaler and hide it so it doesn’t get either nicked, bent, or boils the water as it passes through. Private – This pays the hygienist nurse’s wages for six months.

  1. 5. Acutely Gammy

Punched out interproximal gingivae, necrotic look, breath that would stop a charging rhinoceros in its tracks at 100 metres. This is the first time you have asked if the patient smokes or is under stress. Treatment – NHS – Metronidazole and smoking cessation advice – SORTED! Private – The patient doesn’t return after the Flagyl.

Gum tissue acute by DGBadd

  1. 6. Pregnancy Gammy

You can breath a sigh of relief. It’s not you, it’s hormones.   Treatment – NHS – A quick prophylaxis. Private – You can’t, she’s exempt. It doesn’t seem right.

  1. 7. “Brushed Too Hard This Morning”

This does not exist. Occurs because the patient uses a brush like a Brillo Pad and doesn’t try and get in between the teeth. This is YOUR fault.

Gum tissue hard brush by DGBadd

PERIODONTAL TISSUES

  1. 1. Bone Loss, But Patient Knows About It

You have inherited this patient from another practice or a colleague, so breathe a sigh of relief. Pre-existing bone loss, but patient is on top of OH. Treatment - NHS – Give the patient a pat on the back. Private – Two-monthly scales with the hygienist under local.

  1. 2. Bone Loss, But You Didn’t Know About It

As you are flicking around the lower incisors with a blunt sickle, you notice the lower right one is a bit wobby. You sneakily apply a little bit of lateral force with the scaler to all the teeth and discover ALL are a bit wobbly. Treatment – NHS - As you were, but in the notes, emphasise that you reinforced the need for interdental OH and daily TePe use. Private – Refer to the hygienist and on the prescription note “Hygiene has slipped a bit.”

Gum tissue splint by DGBadd

  1. 3. Bone Loss, You Knew About It And Splinted It

Your pathetic broken splint is cutting into the patient’s tongue. Treatment – NHS – You casually mention the phenomenon known as ‘Immediate Dentures’ and hope the patient doesn’t listen to local commercial radio and catches an advert for dental litigation lawyers. Private – Not appropriate. The hygienist is a stickler and might report ‘concerns’ to the authorities.

  1. 4. Terminal Bone Loss

You check how long you have treated the patient and then check your dental indemnity subscriptions are up-to-date. Treatment – NHS – Ask lots of questions about gum disease in the patient’s parents and plant the seed that the condition is inherited. Private – If the patient asks if they need to see the hygienist, either say you haven’t got one, or price the patient out of it. You really don’t trust that hygienist. Her eyes are too close together.

  1. 5. Chronic Periodontitis

Also known as ‘chronic’ periodontitis. Has been there forever and you haven’t really addressed it. Treatment - NHS - Pull yourself together and do something about it before you retire. Private - NOOO! You keep checking the hygienist’s scrubs pockets for digital voice recorders.

  1. 6. Acute Periodontitis

Also known as Peri Peri Periodontitis. You diagnose that a bit of Nando’s chicken has got stuck and irritated the gum. Treatment – NHS – Pull the bit of chicken out (preferably with your eyes closed – Ewww Ewww Ewww) and claim Acute Mucosal. Private – Squeeze in with the hygienist and get them to pull the chicken out. Charge £60.00.

  

PERI-IMPLANTITIS

  1. 1. Also known as “What the Hell? I didn’t know that was even possible.” Treatment – NHS – Arrange the following words in order: Touch Barge Pole Don’t A With. Private – Refer back to the implantologist.
  1. 2. Advanced peri-implantitis. Same reaction. Treatment – See above, but TWICE as fast.
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Dr Bawa-Garba and protecting public confidence

DB-72-a Dr Bawa-Garba and protecting public confidence

On 13th August 2018 the Court of Appeal handed down its decision in the case of Dr Bawa-Garba v the General Medical Council. The GMC had successfully appealed against the decision of the original Medical Practitioners Tribunal not to erase Dr Bawa-Garba, but to suspend her from practicing for 12 months. The Court of Appeal upheld the original sanction, ruling that erasure was not appropriate in this tragic case.

Dr Bawa-Garba was convicted by a jury before the criminal courts of gross negligence manslaughter, for behaviour which the trial judge felt was so serious that it should be marked by a sentence of imprisonment, albeit suspended. Yet neither the MPT nor the Court of Appeal felt it necessary to erase her from the register. This left many wondering what would it take for public confidence in the profession to be damaged, if not gross negligence manslaughter?

Background

On 18th February 2011 Dr Bawa-Garba was on duty at the Leicester Royal Infirmary Hospital. She had just returned from a period of maternity leave and had completed two shifts back to back.

Jack Adcock, a 6 year old boy, was admitted to the hospital at 10.15am that morning. When he attended he was unresponsive and limp. Jack presented with dehydration caused by vomiting and diarrhoea, his breathing was shallow and his lips slightly blue. Jack had a history of illnesses. He had been diagnosed with Downs Syndrome from birth. He also had a hole in his heart that required surgery. He was taking enalapril which meant he was more susceptible to coughs and colds.

Dr Bawa-Garba was the most senior junior doctor on duty and Jack was under her care for the next 8-9 hours. Dr Bawa-Garba was assisted by a nurse, Isabel Amaro and the ward sister, Theresa Taylor.

Jack was originally diagnosed as having gastro-enteritis and dehydration. After an x-ray it was determined that Jack in fact had pneumonia and was treated with anti-biotics. As a result of this not being picked up immediately, Jack’s body went into septic shock which caused his heart to fail. Despite attempts to resuscitate him, he died at 9.20pm. There was also a mistaken belief, perpetuated by Dr Bawa-Garba, that Jack had a ‘do not resuscitate’ in place, which hindered his care.

Criminal Proceedings

Initially Dr Bawa-Garba was informed that the Crown Prosecution Service would not prosecute. However, following the inquest into Jack’s death in 2013, the CPS reviewed its decision and in December 2014 she was informed she would be charged. Ms Amaro and Ms Taylor were also charged.

During this time Dr Bawa-Garba remained employed at the hospital.

At the hearing the prosecution advanced a number of failures by Dr Bawa-Garba, which it said led to her being grossly negligent. Dr Bawa-Garba’s defence was that Jack’s death was as a result of hospital computer failures, lack of staff and failures by others.

The trial judge directed the jury that the prosecution had to show that what Dr Bawa-Garba did was ‘truly exceptionally bad.’

On 4th November 2015 Dr Bawa-Garba was convicted of gross negligence manslaughter. Ms Amaro was convicted of the same offence.

On 14th December 2015 Dr Bawa-Garba was sentenced to two year’s imprisonment, suspended for two years. She was ordered to pay £25,000 in legal costs. The remarks of the judge when sentencing were ‘there was a limit to how far these issues could be explored in the trial, but there may be some force in the comment that yours was a responsibility that was shared with others’.

Fitness to Practice Proceedings

Under Fitness to Practice Rules a certificate of conviction is conclusive evidence of the offence committed and cannot be challenged. The role therefore of the Medical Practitioners Tribunal is to determine if fitness to practice is impaired and if so what sanction to apply.

On 20th February 2017 a hearing was convened to assess whether Dr Bawa-Garba’s fitness to practice was impaired. Dr Bawa-Garba did not give evidence at that hearing. On 22nd February 2017 the Medical Practitioners Tribunal held that Dr-Bawa-Garba’s fitness to practice was impaired. It found that she ‘fell far below the standards expected of a competent doctor’ at her level and that the conduct had brought the profession into disrepute. However, it went on to say that the clinical failures, although serious, were capable of being remedied and had been addressed.

On 12th June 2017 the same panel reconvened to consider sanction. Again Dr Bawa-Garba did not give evidence; the panel commented ‘the Tribunal was unable to conclude that you had complete insight into your action as it did not hear from you directly’. On 13th June 2017 it issued its decision to suspend Dr Bawa-Garba immediately for 12 months, subject to review. The panel confirmed that it had to bear in mind that the sanctions were not to be punitive but to protect patients and the public interest. The Medical Practitioners Tribunal weighed up the following factors:

Mitigation factors Aggravating Factors
Unblemished record Failures were numerous
Good Character prior to the event Failures continued over a period of hours
Remained employed by the trust until conviction A failure to re-assess Jack
No concerns raised regarding her clinical competency Jack was a vulnerable patient given his age and disability
Length of time since offence Expressed condolences but did not apologise
Covering CAU, emergency department and the ward  
Systematic failures identified by the Trust in its independent report of the incident  
No evidence actions were deliberate or reckless  

The Medical Practitioners Tribunal said ‘whilst your actions fell far short of the standards expected and were a causative factor in the early death of Patient A, they took place in the context of wider failings.’

The GMC appealed the decision. The High Court overturned the Medical Practitioners Tribunal decision and replaced it with a sanction of erasure. In essence the judge felt that the panel had not taken into account the true force of the jury’s finding of ‘truly exceptionally bad’ behaviour on the part of Dr Bawa-Garba.

Dr Bawa-Garba appealed. Her grounds of appeal were that the court had erred:

  1. By applying a presumption that a conviction of manslaughter by gross negligence should lead to erasure save in exceptional circumstances;
  2. By failing to appreciate the distinct roles of the jury in a criminal trial and the Medical Practitioners Tribunal;
  3. By unlawfully substituting its own judgment on the basis a suspension was not sufficient to maintain public confidence;
  4. In concluding the Medical Practitioners Tribunal was precluded from taking into account evidence of systematic failures;
  5. By reaching an irrational conclusion; no reasonable court could have concluded erasure was the only sanction.

The Court of Appeal confirmed that

The task of the jury was to decide on the guilt or absence of guilt of Dr Bawa-Garba having regard to her past conduct. The task of the Tribunal, looking to the future, was to decide what sanction would most appropriately meet the statutory objective of protecting the public pursuant to the over-arching objectives… to protect, promote and maintain the health and safety and well-being of the public.

As a result of this finding, the Court of Appeal held it was wrong of the court to presume a conviction of manslaughter should lead to erasure save in exceptional circumstances and to preclude evidence of systematic failures within the hospital at the time of the incident.

The Court of Appeal overturned the court’s decision and re-issued the 12 month suspension as the appropriate sanction in this case.

Conclusion

Having read the judgment it is clear Dr Bawa-Garba was well regarded amongst her peers; indeed a fund set up by junior doctors raised over £200,000 to go towards her legal fees. The incident itself  was deemed a one-off incident; a lapse in clinical judgment in an otherwise unblemished history. She had taken remedial action in respect of any issues. There were also failures on the part of others and the hospital itself.

If the public had all of this information, it would no doubt agree Dr Bawa-Garba’s sanction was fair.

If you need any advice or assistance in relation to fitness to practice proceedings, 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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Simpler Times

Simpler Times

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Only Dentistry Can Save the Earth

Carbon Footprint

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It’s the Tortoise and the Hare all over again…

It’s the Tortoise and the Hare all over again…

Boota Singh Ubhi, Principal of Birmingham Periodontal & Implant Centre (BPI Dental), Specialist Periodontist and implant dentist, shares a long-term referral case that highlights some important lessons.

The patient was initially referred to us for full arch reconstruction with guided surgery in 2006. She presented with failing upper bridgework, which was partially implant-retained. There were multiple problems including failed apicoectomies, fractured roots, and the two anterior implants were failing as well (Figures 1-3).

 Figure 1   Patient presents (Mobile)

 

Figure 2   Pre treatment right lateral (Mobile) (2)

Figure 3   Pre treatment left lateral (Mobile)

The treatment options discussed with the patient were to either do nothing for as long as possible or to replace all existing restorations and implants. As the patient was keen to find a solution sooner rather than later, she chose the latter option.

A full clinical assessment was conducted with radiographs (Figures 4-5) and photographs. The only good tooth remaining was the upper right canine, but other than that the natural upper dentition had a hopeless prognosis and was unrestorable. A very large lesion was detected on the UL5, the UL3 was 

apicoectomised and both the anterior implants were positioned very poorly, which had affected the smile aesthetics with a midline shift to the left. These implants had been placed about 13 years previously, so they featured very old designs. 

 

 Figure 4   Pre treatment radiograph (Mobile)   Figure 5   Pre treatment X ray showing upper arch (Mobile) 

 

Initial treatment and surgical planning 

The treatment process was explained to the patient and informed consent obtained to proceed. The existing implants were removed (Figure 6), as were the few remaining natural teeth. As poor bone quantity had been identified in the assessment radiographs, bone augmentation was indicated if we were to place new implants with a good level of primary stability. The procedure was performed at this time around the implant site to preserve the sockets and in the upper left quadrant. This was left to heal for about six months, during which time the patient was provided with a removable temporary denture.

After this healing time period, the patient returned to the practice for a follow-up CT scan and wax-up, which was used for the guided planning process of the implant placement. The ideal implant positioning, angulation, length and width were determined using Simplant software.

 Figure 6   Implants removed (Mobile)   Figure 7   Mid crestal and midline removing incisions (Mobile)

 

Surgical treatment

On the day of surgery, mid-crestal and midline reliving incisions were made (Figure 7) and a full thickness mucosal flap was retracted back. A bone-supported guide was used (Figure 8) to place six Astra Tech dental implants (Figure 9), which at that time enabled the guided planning process with Simplant software. The flap was closed and sutured (Figure 10). Six multi-unit abutments were then placed (Figure 11) in preparation for the new screw-retained bridge. The post-operative X-ray demonstrated good positioning of the implants, which were all parallel to each other (Figure 12). The bridgework was fabricated (porcelain fused to Cresco gold framework), once again utilising compatible products. Due to the effective angulation of the implants, there was no need to angle the screw channels and we achieved a very passive fit for the bridgework. In this time, two implants were placed in the LL5 and LL6 areas, which were restored with two splintered crowns (Figure 13). The lower right bridgework was left alone despite the distal cantilever, as it was causing no problems at all.

Figure 7   Mid crestal and midline removing incisions (Mobile)    Figure 8   Bone supported guide (Mobile)
Figure 9   Implants placed (Mobile)   Figure 10   Flap closed (Mobile)
 Figure 11   Multi unit abutments palced (Mobile)   Figure 12   Post operative X ray shows parallel positioning of implants (Mobile)
 Figure 13   Lower implants placed and restored (Mobile)    
     

Several try-ins of the upper bridge were conducted with the patient in order to achieve the right aesthetics. Once the patient was happy, she went on her way.

Review

After about a year – during which time the patient saw her routine dental team for check-ups and general care – she returned to our practice for her annual clinical review, involving X-rays and full six-point pocket charts on every tooth and implant. The restorations still looked great (Figures 14-17) and the patient reported no issues.

Figure 14   One year review smile (Mobile)    Figure 15   One year review intraoral (Mobile) 
     
 Figure 16   One year review right lateral (Mobile)    Figure 17   One year review left lateral (Mobile)
Images show the result at one year review.

 

The patient continued to frequent her routine practice to ensure on-going maintenance of the dental implants and restorations and to help optimise her oral health. She also had access to our dental hygienist at BPI Dental on a yearly basis to support this maintenance programme. Around 10 years after we performed the surgical treatment, we were lucky enough to see the patient again and, as shown in the photos, the restorations still looked great (Figures 18-20). There had been very little soft tissue change and the aesthetics were fantastic, so the patient was still delighted with the final outcome.

Figure 18   Periapical radiograph 10 years later (Mobile)
 
   Figure 19   10 year review (Mobile)
 Figure 20   10 year review intraoral (Mobile)    
Images show the result at ten year review.

 

Discussion

This case highlights a few important aspects worthy of note. First, we don’t always need to rush treatment – this case required treatment over several months and the final outcome was highly appreciated by the patient. Secondly, dental implants placed in the right positions will facilitate long-term soft tissue and hard tissue stability for durable outcomes.

As in all dental implant cases, the presented case emphasised the importance of excellent maintenance by the patient – only by attending on-going review appointments and adhering to strict hygiene routines at home can patients enjoy long-lasting results. Finally, this case demonstrates the superior aesthetics of porcelain both in the short- and long-term – I don’t think it can really be bettered and therefore it would remain my gold standard restoration material wherever possible.

For more information on the referral service available from BPI Dental, visit www.bpidental.co.uk, call 0121 427 3210 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

Author biography:

Boota graduated in 1992 and later gained an MSc in Periodontology from Liverpool University. He became a lecturer at the University and passed his Membership in Restorative Dentistry form the Royal College of Surgeons of England in 2000 to become a registered Specialist in Periodontology. Since then, Boota has lectured at universities and educational events in the field of periodontics, dental implantology and bone / soft tissue augmentation, running his own implant training programme for colleagues as well. He is also an active member of the British Society of Periodontology, the Association of Dental Implantology and the American Academy of Periodontology.

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Presh Mulay

Beautiful

Beautiful work!!
Saturday, 08 September 2018 08:33
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Pump up the Volume by @DentistGoneBadd

Pump up the Volume, a plea to the Chief Dental Officer (England) by @DentistGoneBadd

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GDC Watch - Conflicts of Interests - Part Two

VH_blog_cover_0818 Keeping an eye on the GDC by Victoria Holden.

My next concern relates to conflicts of interests and, again, I have raised these with the GDC and I remain concerned hence I am ‘going public’. 

Having been taken to task myself by Counsel once over an issue of a conflict of interest during a Fitness to Practise hearing, I fully appreciate that expert witnesses and FtP panel members must be, or at least be seen to be, ‘whiter than white’.  That is, of course, subject to the phrase not being in anyway offensive to any sectors of society as it certainly isn’t intended to be, or otherwise inappropriately bringing the profession into disrepute, in which case I mean ‘holier than thou’.  Or do I? Truthfully I’m not sure what I can and can’t say these days.

The GDC also seem to grasp the impact that conflict of interests may have on the disciplinary processes, as they have a document titled ‘Managing Interests Policy for Council members and Associates’. In this document it says:

VH blog 1

VH blog 2

VH blog 3

So it all sounds like, on paper at least, the GDC takes the issue of conflicts of interests very seriously indeed.   And it is with reference to conflicts of interests and the Pate case that I am writing this blog.

There has already been plenty written on the GDC v Pate case elsewhere.  On Dentistry online their 4 most popular links refer to the proverbial ‘FtP case of the year’. 

VH blog 4

At the time I started writing Mr Hill was winning with over 9,000 views.  Coming up fast at the back with a late article on the subject was Mr Anis with a tidy 4000 views of his re-iteration of the points Mr Hill makes, but it feels with more insistent tone that negative Islamic comment equates to hate speech.   Mr Rees and Mr Watson also give opinions on the subject and there are some excellent arguments made in all these pieces, including within the comments.

Much is made of the fact that the Met Police said that no crime had been committed by Mr Pate and that this means nothing in terms of FtP.  Actually, I would have to concur.  But the problem is that the Chief Constable of the Met did not simply say ‘no crime committed here, everyone move on’.  What he appears to have said as I read it, is that what was said wasn’t that bad.  The police letter, which is not mentioned in the determination, but I shall add it here for transparency, says:

VH blog 5

 

Interesting. Controversial views, and at times unpleasant to the majority, but certainly not criminal, offensive or even religiously offensive says the Chief Constable of the Met.  And, there are well-known individuals saying the same things.  Not an entirely helpful letter for the GDC’s case, which presumably explains why it is not referred to the determination.  The transcript does refer to the letter, but these are not publically available and only available to the parties directly involved in the proceedings.  Well, correction; they are available to the public, at a cost of approximately £250 per hearing day as I found out recently from an FOI. 

Anyway, I am side-tracking.  Back to the conflicts issue.  Further to the complaint, and the Met letter, the hearing progressed with an unrepresented Mr Pate, as non-clinical issues fell outside of his defence indemnifiers remit as it has been reported. Having read the transcript, the need for representation at these hearings is clear.  Many of the arguments and points Mr Pate put forwards would have been better made, and no doubt have carried more weight if made by Counsel. ‘Stories of the Law’ by the Secret Barrister who explains how self-representing people frustrate the hell out of everyone else in any kind of legal or quasi-legal hearing.  So the GDC got a great opportunity to make the point that registrants should tone it down, or better still, completely shut up on social media by securing a four-month suspension of Mr Pate. 

Chair of the FtP panel, Mr Adair Richards was soon after noted to have listed the General Dental Council as a previous client when tweeting about his new training and consultancy company website earlier in the year:

 

 VH blog 6    VH blog 7

 

Indeed, the GDC are right in their warnings that social media can be hazardous. 

Unfortunately, the level of trust in our regulator appears to be so low that registrants are now at the point of scrutinising the background and motives of associated individuals. Here, it appears that we have an FtP panel member who has been paid by the GDC to provide training and consultancy to the GDC.  A Freedom of Information request was submitted to request Mr Richards declaration of conflicts and other information about his previous business relationship with the GDC, of which nothing was apparently declared.

I was told that Mr Richards ‘made an error’ on his website, and as if by magic, one week later the website had been altered to remove the GDC from the previous list of clients.  I’ll be honest, and say I am not sure that I buy this is an ‘error’.  FtP panel members go through rigorous testing of their critical thinking skills.  They are not unintelligent people.  To make an error implies that Mr Richards either misunderstood that his role on the FtP panel was somehow an extension of his consultancy services, or perhaps that he was completely unaware that the website copywriter had listed the GDC as a client.  The other possibility that crosses my mind is that it could have been a ‘deliberate error’, made with the intention to mislead potential future clients into thinking the company had trained or consulted with the GDC.  Either way, it does not look good.   The Managing Interests Policy document tells me that these are the possible interests, of which I pick at the very least a ‘perception of a conflict’:

VH blog 8

As a result of this error/lie on the website, which seems to have been swept under a rug in Wimpole Street, I also perceive that Mr Richards could be in breach of the Nolan Principles listed in appendix 2:

VH blog 9

VH blog 10

I think it is great that Mr Hill came online to explain why the GDC took the Pate case so seriously, and highlighting why protecting public confidence in the profession is so important.

However, I can’t help thinking that the large number of dissenting registrants would be more respectful of the Pate hearing outcome were it not for the issues that I have exposed here and in my previous blogs.  It is not just the registrants that are responsible for public confidence: the GDC also have a major role to play.  If registrants do not have confidence in the regulator and those associated with them to act professionally and properly this can only lead to damaged public confidence at the end of the day. 

Next time, I will be looking at Prejudicial Interests, and delving a bit further into the Pate case.

In the meantime, if you have been affected by any of the issues raised in my blogs, do not worry.  You could waste 15 minutes of your life that you will never get back by sharing feedback about our regulator with the Professional Standards Authority here.

 

 Image credit - Best Picko ; under CC licence - modified.

For Part One of this blog - click here.

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© Victoria Holden, GDPUK Ltd, 2018.

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The New Health Secretary by @DentistGoneBadd

The new health secretary

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An open letter to Mr Brack of the GDC

typewriter Image by rakka_pl

Dear Mr Brack,

I have previously been a harsh critic of the GDC, especially in the days of the previous registrar. Indeed, I wrote many blogs that were well received by the profession. With the departure of the previous registrar, there was an opportunity for the GDC to begin to repair the damage it had done to the profession by the draconian and inefficient manner in which it had been led.

There appeared to be a time when the new team seemed to be developing a far more appropriate attitude to regulation, and I therefore felt it appropriate to perhaps watch the situation without commenting further. It was disappointing when Jonathan Green left, although I did feel that with you at the head of the Organisation (for indeed it is NOT a business but a QUANGO I think you will find) then there would be a continuation of the bridge building that was sorely needed.

However, whilst there seem to have been some minor improvements, fundamentally there seems to be no real change in the way the GDC wishes to be perceived by the profession and how it executes its statutory duty. Under the aegis of protecting the public, it is actually doing more to negatively affect the public it serves to protect by continuing to prosecute its role in a draconian and often arrogant manner. There is still huge a lack of insight into the damage it is doing to the morale and the well being of its registrants; damage that can be squarely blamed on the actions of the GDC itself.

Because when a profession is so scared of its very shadow that it can no longer function as it is supposed to, then the ONLY thing that will happen is harm to the public. That these professionals are so scared of virtually every treatment they do, every comment they make (including ones like this), and every action they take is a sad indictment of the way that the GDC is systematically destroying the very profession it regulates.

By retaining the ARF at the same level again, with yet another different reason than before, is symptomatic of the disdain and the contempt with which the profession perceive the GDC have for them. The profession are happy to be regulated, but by a fair, just, and right touch regulator. The continued heavy touch that the GDC continues to use cannot continue if the profession is to survive to be allowed to serve its patients as there will come a tipping point where we will no longer be willing to accept the duress of just turning up to work. If we placed a colleague under this type of stress in our workplace then WE would rightly fear being reported to our regulator.

We are human beings who set ourselves out to care for other human beings. There is no higher privilege than to care for another. However, we make mistakes, we are fallible. You are the same as us, a fellow of the Human race.

We rarely do things wrong deliberately, but we shouldn’t live in fear that the next thing we do both privately or in our jobs could end our careers and destroy our lives.

Please think of the damage that is being done to our profession by this apparent continued lack of insight displayed by the GDC.

Kind Regards,

Simon Thackeray

 

Image credit - Rakka_pl under CC licence - not modified.

 

 

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© Simon Thackeray, 2018.

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GDC Watch: Bringing the profession into disrepute - Part One.

Lookout_GDC_Watch_July_18 Lookout: Image by Dave Bleasdale

The GDC have recently being taking a stance over professional conduct and particularly in regard to social media.   The Standards say that we must not publically criticise colleagues unless this is done as part of raising a concern.  I should like to make it clear at the outset of this blog that what follows is part of me raising concerns.  Concerns that I feel are not being taken seriously enough, and some not even acknowledged as being concerning at all.   This blog is in 2-parts.  Part 1 will look at ‘bringing the profession into disrepute’ in the context of social media.  It is perhaps timely in view of Mr Hill’s recent effort of justification over the need to suspend retired dentist Mr Pate under the pretext of ‘protecting the public’.   Part 2 will look at my concerns over conflicts of interests.  Both will, as usual, look at this in terms of recent events and cases. 

So my part 1 concern relates to a fellow dentist who is a Clinical Advisor providing early advice reports to the GDC and the material posted on the public stream of their Facebook page.  Our regulator tells us that we must not post material on public media that may undermine public confidence or bring the profession into disrepute.   On this public-facing social media page, there is a joke about a sexual act, several slang references to parts of male anatomy and masturbation, a profile picture that is potentially racially-offensive (depending on the generation of the particular panel that might be selected by the GDC), but the finest one has to be the picture which blames patients for their gum disease and tooth decay because they are “*insertslangformasturbators*’’.  Yet this Clinical Advisor, wrote in an early advice report for the GDC that a dentist who communicated with a patient using Facebook Messenger, was unprofessional for doing so. This would be funny apart for the stress that the registrant was put under as a result of it being included in their initial allegations which contributed to the case being forwarded for a full hearing. There will be more of this to come in another blog.   

I emailed the current Director of Fitness to Practise to ask him what he thought about the content on this Clinical Advisor’s Facebook profile page, and whether he felt it was appropriate for someone affiliated with the GDC.   The GDC ought to know how their Clinical Advisor was behaving whilst giving potentially life-changing advice about other registrants’ professional conduct.  Perhaps my tip-off might assist them in getting their own house in order after a run of bad hearing outcomes for them and at a time when the mood of the profession is resembling that at the time of the ARF debacle.  At the time I had started to draft this blog I had not received any reply, and suspected that the GDC’s email filters might have kicked my email with its supporting attachments of profanities straight into their Spam Folder. I have now received my reply, so I will come back to that later.

On this particular issue of ‘unprofessional’ social media comments, 2 registrants recently received letters from the GDC reminding them of their need to uphold standards when using social media.  They had both used an inappropriate word, albeit on a single occasion, on a Facebook thread and a helpful colleague had very kindly pointed this out to the GDC without raising their concerns with the group moderators or the registrants themselves.  The digital evidence suggests that the anonymous informant was another registrant. In terms of the naughty word used, it was quoted ‘verbatim and in italics’ in the GDC letter.   If the GDC think that word is inappropriate they ought not visit the Dr Rant page and see their ‘affectionate’ nicknames for Jeremy Hunt which are used on an almost daily basis.  The GMC don’t seem to concerned however, but perhaps doctors do not refer each other to their regulator over spats and spite instigated on social media platforms.

Anyway, I felt pretty strongly that this particular display of conduct on social media referred to above really should not go unquestioned, all things being considered.  

 

The Standards apply to all and this Clinical Advisor who is a fellow dentist, is held to the same standards as us all.  No-one should believe that they sit above us mere-registrants, somehow ‘protected’ by a relationship with the GDC.  A colleague has a four-month suspension for alleged religiously-offensive statements made visible only to other dental registrants, yet I found his comments less offensive that this advisor’s silly, misogynistic and sexist posts. Also, someone with the infantile mentality that is publically displayed arguably unfit to assess whether any other registrants’ behaviour is professional, surely.

Whilst waiting for my email to be replied, rather hilariously, another registrant got a letter from the GDC courtesy of another anonymous informant reminding them of their professional obligations, and advising them to take action so they too could be better behaved in the future.  However, the letter gave no information on what was posted that caused offense or deserved some kind of GDC-referral retaliation.  An SAR sent the GDC may well clear that one up in time. 

Taking screenshots from Facebook and using them to make complaints to the GDC is a rather petty way to retaliate against another dental registrant in my opinion.  Those doing it really need to take a long hard look at themselves, especially if they are in the subset of registrants whinging about our high ARF.

As it happens, the GDC Annual Accounts and Report show that by 2018, 9-10% of incoming GDC complaints (as per my little infographic below) currently arise from other registrants.  This is a record year.  Well done registrants!!  Keep this rate of progress up and in a few years we might actually beat the patients. 

Table 1 GDC Watch July 18

So actually, never mind the GDC: we also need to get our own house in order here.  Please can we all stop being so childish? If you don’t like what’s on Facebook, get off social media, leave the groups that aren’t to your taste or contain people you don’t like, block people who wind you up, or if what’s being said is about you is that bad, spend your own money on legal proceedings rather than wasting all our money artificially inflating the ARF telling tales by the use of screenshots.  Still, it’s nice to see that the GDC has healthy reserves of £20 million against a back drop of a decreasing number of incoming complaints.  Maybe this is in preparation for the day we achieve a level of 100% of complaints arising from all the back-stabbing and bickering going on between ourselves. 

This is the problem with the ‘duty to report concerns’:

LEGITIMATE CONCERNS REPORTED TO THE GDC OFTEN END UP IN ONE OR MORE REFERRALS IN THE OPPOSITE DIRECTION.

This is the sheer reality of the dire situation that faces us.  The minute you act on a professional duty to raise concerns with the regulator, you are at risk that ‘concerns’ will be raised about you, and there will be GDC referrals all round.

But back to my email:  I did get a reply regarding my Clinical Advisor issue.  I was advised that I should use the online form to report the matter to the Initial Assessment Team.  

It looks as though we are not the only group happy to throw dentists under the bus, which is always nice to know. 

 

Image credit - Dave Bleasdale under CC licence -  modified.

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Copyright

© Victoria Holden, GDPUK Ltd, 2018.

Recent Comments
Mike Wanless

GDC Watch

Thanks Vicky Very interesting and thought provoking blog. Is it possible to look at your dissertation, or if not could you be temp... Read More
Wednesday, 11 July 2018 07:38
Victoria Holden

Response to Mike Wanless

Hello Mike, Many thanks for your comments. I have messaged you via GDPUK. I am not sure if the complaints about social media sp... Read More
Wednesday, 11 July 2018 20:57
Mike Wanless

Thanks

It would be difficult to establish a trend in terms of numbers, but I think that on reflection I am probably more interested in te... Read More
Wednesday, 11 July 2018 21:22
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JUL
03
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Pimlico Plumbers case; a spanner in the works for self-employment?

db69_1 Employed or self -employed?

On 13th June 2018 the Supreme Court, the highest court in the UK, gave its long awaited judgment in the Pimlico Plumbers case.

Mr Smith was a self-employed plumber who had been dismissed after six years of service. He claimed he was a worker and therefore entitled to certain rights such as holiday pay.  The court found in his favour despite Mr Smith being registered as self-employed and benefiting from this status. He claimed tax relief on a home office and had his wife on the payroll of his company.

Sound familiar? Many associates are labelled as self-employed and benefit from this status for tax purposes. However, could they challenge their status in the employment tribunal and also benefit from basic employment rights?

In recent years the courts have been awash with cases in respect of worker status. With the rise of the gig economy, companies are taking advantage of those who want a more flexible way to work by offering ‘self-employed’ contracts. But is this being done at the expense of basic employment rights?

It is often the most vulnerable that are affected by the imbalance of power in such relationships. A prime example of this is in relation to a case involving a City Sprint courier. The courier took the firm to the employment tribunal claiming they were a worker and won. However, instead of changing all contracts to worker status the firm changed the contracts 'to simplify the language in these, further clarifying the rights and flexibilities available to self-employed couriers who provide their services to us'. It should be noted that in order to enforce worker rights, a claimant will need to issue a claim at the tribunal. This can involve time and money, which many in lower paid jobs do not have.

There has been a further case in the employment tribunal against Hermes, in which their couriers have also been found to be workers. Tim Roache, GMB general secretary, said: “This is yet another ruling that shows the gig economy for what it is – old fashioned exploitation under a shiny new facade. Bosses can’t just pick and choose which laws to obey"

Pimlico Plumbers Decision

Turning now to the case in hand, however, in which Mr Smith was paid highly for the work he completed, he was also able to add a 20% mark up on materials which he got for discount via the company, and he had a great deal of flexibility in his role. Is this really a vulnerable individual being taken advantage of?

Either way the Supreme Court has determined that Mr Smith was a worker and as such should benefit from the rights associated with this. As a result of another recent decision on worker status that we reported on, his claim for holiday pay could now date back to the start of his employment.

The two main issues for the court to determine were whether Mr Smith had to perform the services personally and whether Pimlico was Mr Smith’s client or customer.

Personal Service

If a person has to personally perform the services under the contract it is likely that they will be deemed a worker. Here the court looked at Mr Smith’s right to send a substitute to determine if he had to personally perform the services.

The employment tribunal held that whilst Mr Smith could send a substitute for any reason such as illness, holiday or other reason, he could only send another Pimlico plumber. This was seen as akin to employees swapping shifts. As a result of this limitation the Supreme Court held Mr Smith had to personally perform the services.

In assicoate contracts, there will often be a right to send a locum. However, is this right fettered? Does the Practice get the final say as to who can undertake the locum role? Or do they merely require a minimum qualification, DBS check and performer number? This could have a bearing on whether the associate is a worker or self-employed. 

Business Undertaking

The court looked at whether Mr Smith was an independent contractor not in a relationship of subordination with the person who receives the services.

Pimlico tried to argue that they were the client of Mr Smith and he was a business in his own right. They relied on his tax return, which put his annual gross profit at £131,000, costs of materials around £53,000 and his net pre-tax profit at £48,000. The court disagreed with this for the following reasons:

  • Pimlico’s tight control of Mr Smith, including Mr Smith wearing branded clothing, driving a branded van and carrying an ID card;
  • Mr Smith’s obligations to follow administrative instructions from the control room;
  • The fact Pimlico placed a tracking device on Mr Smith’s van;
  • The severe terms as to when and how much Mr Smith would be paid (he was paid 50% of the fees paid by the customer) meant he was not economically independent.

As such the Supreme Court found that Mr Smith was not truly independent as there was an element of subordination.

Whilst many associates have clinical freedom and would not be required to wear a uniform, they do have to follow Practice policies and Practices decide the fees to be charged and when payment will be made. 

Conclusion

This case does not suddenly change the status of self-employed associates. As stated above, someone needs to challenge their status in order to be afforded the necessary employment rights; until then the status quo will continue. Even then, simply because one associate does challenge their status this will not automatically affect other associates are affected. It must be borne in mind that dental practices come in many shapes and sizes. 

However, this case is a warning for those that employ self-employed contractors of any nature. Now is the time to review contracts and ensure they are truly self-employed. If they are not, you need to take steps to protect your position as the risk to you is much greater.

If you have any questions about this article or need a contract reviewing, please feel free to contact Laura Pearce on This email address is being protected from spambots. You need JavaScript enabled to view it..

Laura Pearce

Senior Solicitor

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Boundaries For Life - oral health checks at cricket grounds

IMG_0405 Branding on the gazebo where the screening is based

Boundaries for Life was founded in 2010 to provide free health checks to fans or staff at sports grounds at major matches, engaging with people who may otherwise not encounter professional medical and dental advice.

Sponsored by SimplyHealth Professionals, they hope to help even one person prevent illness, using simple health checks followed by a little more sophisticated follow up which I will detail further.

I had the pleasure of visiting Chet Trivedy and his team at the Old Trafford One Day International between England and Australia, the series that England won 5-0, on Sunday June 24th. All the team there were volunteers, and the presence of their tent was helped by The Lancashire Cricket Foundation and Healthy Stadia.Helping even one personn  change the course of their future health was the aim.

Chet is the founder and clinical lead of Boundaries for Life. He is dual qualified as a dentist and medic, with an interest in emergency medicine and maxillo-facial emergencies. In addition to his clinical work, he is an Academic Clinical Lecturer in Emergency Medicine at Warwick Medical School.

Chet said: “Given that men in their 30’s and 40’s are particularly poor at presenting early symptoms of diseases to their GP, and with limitations on access to dental services, the availability of free health and dental checks in the relaxed atmosphere of a sporting event is a valuable resource in the early detection of symptoms associated with chronic diseases. We are particularly pleased to be offering fans a ‘heart age’ test for the first time in 2018, and explaining why it’s important to know blood pressure and cholesterol numbers.”

The screening tent full, all seats taken.

 

Amongst the health checks made in the small branded gazebo    

  • height
  • weight
  • waist size,
  • body mass index
  • blood pressure
  • cholesterol levels and ratios
  • heart age assessment
  • diabetes - will check the HbA1c with blood testing run by xxxxxx

Each person is given a login to review their health results online, with a secret question and answer to safeguard future logins. The subject will then get an email follow up in several months to nudge them to follow the recommendations made during the short check at the cricket ground. The Biochemistry tests and team members who do this from minute blood samples are provided by BHR Pharmaceuticals of Nuneaton.

He set up these screening events after founding the Boundaries for Life organisation, then amazingly Chet suffered a stroke, he briefly lost his vision then found he was diabetic but thankfully has returned to good health. Ironically, as a dual qualified dentist and doctor, he hadn't had his own checks!

BFL is really proud to have helped over 3500 people have these health checks over the last eight years, with your help more can be seen in the future.

An appeal to dental readers of this blog – Boundaries for Life is seeking further dental volunteers for the oral health screening at future cricket matches. The schedule of matches is planned, but the number of dental colleagues volunteering is small. On the day I was there, one colleague was working the whole day and getting more volunteers shares the load. The ones who are off duty can watch the top class cricket!  The more the merrier, it becomes a win-win-win.

To volunteer please use our contact page https://www.gdpuk.com/more/contact-us and GDPUK will pass on your details. I might join you, four colleagues, we can do checks for 2 hours, watch cricket for 6 hours!

Simply Health Professionals, using their network or practice contacts are also seeking dentists to volunteer to do the oral health screening. On Sunday, one family was helping their father, with daughters measuring height, weight and measuring waists! Chet reminds us it’s all worth it - if one helps the health of one person.

Boundaries For Life also seek further sponsors, and hope to cover even more sporting events in the future, dependent on their team and their funding.  

Links:

http://boundariesforlife.co.uk/

Twitter @Boundaries4Life https://twitter.com/boundaries4life

Twitter @SHP_Dentists https://twitter.com/shp_dentists

Lancashire Foundation http://foundation.lancashirecricket.co.uk

Healthy Stadia http://healthystadia.eu/  - Enabling sports clubs to influence health and behaviour.

news article http://healthystadia.eu/boundaries-for-life-fixtures-2018/

Blood biochemistry tests https://www.bhr.co.uk/  - small machines which run rapid tests of blood biochemistry.

What is HbA1c? https://www.diabetes.co.uk/what-is-hba1c.html

GDPUK article https://www.gdpuk.com/blogs/entry/2133-knocking-mouth-cancer-for-six-simplyhealth-professionals-announce-boundaries-for-life-sponsorship

 

Panoramic view of the Old Trafford ground, Copyright Tony Jacobs 2018.

 

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Increased Dental Litigation

Increased Dental Litigation

(Is It ALL Down To Patient/Lawyer Greed?)

By DentistGoneBadd

“This theory which belongs to me is as follows. Ahem. Ahem. This is how it goes. Ahem. The next thing that I am about to say is my theory. Ahem. Ready?”

Anne Elk (1973) Monty Python’s Flying Circus


It was a glorious September afternoon in 1966. The sun was streaming through gleaming windows. England had won the World Cup, and I had just moved to an exciting and brand new senior school. The classroom had spanking new desks with inkwells, filled with free ink you could draw up into your refillable Parker fountain pen. All was well with the world.

Mrs Wojciechowski, who was also our form teacher, was beginning our first ever French language lesson. I was trying hard to concentrate and confess I missed the meaning of ‘je m’appelle,’ because Peter Hadley who was sitting next to me, was crushing and drowning wasps in his inkwell, with what I regarded as an inferior fountain pen – the sort that scratched, rather than flowed Quink luxuriantly on to the page. Another failing of his pen was that as a tool for Vespidacide, it was failing miserably, one poor creature valiantly struggling to get itself out of the inky torture chamber. Not knowing at that point that Peter Hadley was a distant relative of a notorious Birmingham crime family and was destined to become the school’s head ‘hard-knock,’ I nudged him out the way and offered the tip of my pen to the bedraggled Hymenoptera, so that it had a means of escape from an indelibly inky death.

I suddenly heard a scream that sounded like a French woman shouting ‘murderer,’ but later realised I was in fact witnessing my first ever French swear-word - ‘merde,’ to be precise. I looked up to see Mrs Wojciechowski (French-born, despite her name) bearing down on our twin desk with a wooden ruler in her hand, and quicker than one of my Maryland bridges falls off, she had whacked the back my hand with the EDGE of the ruler, with all the might that her 4ft 6in frame could muster.

This episode was not only painful and a miscarriage of justice, but humiliating to boot and for the rest of that year, Mrs Wojciechowski looked at me with a deep loathing, like I had presented my dentist with the post-crown for recementing after I had retrieved it from the bottom of the Armitage Shanks two days after swallowing it. Upon realising I was under constant surveillance by Mrs Wojciechowski, I made sure I was never near a wasp, bee or inkwell ever again in that school.

I switched to a BIC not long after.

“My theory is along the following lines. Ahem."

We all know inherently, that it is becoming more and more difficult to avoid complaints these days, bombarded as the public is, with targeted Internet adverts and radio advertising. Even looking up and typing ‘dental complaints’ in Google as research for this article, brought up a host of dental litigation firm’s adverts on my Facebook page and various online news sites I read regularly, within an hour.

I strolled into a colleague’s surgery the other day to catch the end of a radio advert by ‘THEM’ – you know, the Cheshire-based mob, enticing dental patients to use them for all their dental litigation needs. I was appalled – I never listen to radio in the surgery – I just inflict my old-bloke’s iTunes playlist – from the Bee Gees to The Eagles to Snoop Dogg on my nurses day in, day out. It’s the reason I oppose permanent nurses, it means they don’t fatigue and burn out on my repetitious Barbara Streisand and Pussy Riot.

I couldn’t believe that these litigation firms were so ‘in-your-face’ with their radio ads, but my colleague confirmed that she heard them at least a couple of times a day and she often talks loudly over them to distract the patient in the chair from memorising the phone number.

Not only are civil claims mediated by the specialist dental litigation firms rising at a seemingly exponential rate (if you don’t believe me, look at your indemnity organisation’s annual subscriptions year-on-year), but cases brought to the GDC’s Fitness to Practice (FtP) process are also rising faster than caseworkers can write ‘dishonest’ on a charge sheet even if you haven’t been charged with dishonesty. From 2010 to 2014, FtP cases rose by 110 per cent. What the rise in civil and GDC cases is now, in the four years since 2014, is difficult to ascertain, but I feel it’s not outlandish to bet that the same rate of rise is probably not far out.

Most of us will know someone who is currently experiencing a spot of bother with the NHS Area Team, the GDC, or more likely, some chancer who has been taken in by a law firm who has found their supply of whiplash clients has suddenly dried up. A colleague of mine has recently been pursued by a patient claiming damages for a dry socket. Sheesh.

But, is the increase in patient expectations, fuelled by the easy access to no-win-no fee legal services, the only reason for the large rise in dental patient complaints?

“Ahem. This theory which belongs to me, is as follows. Ahem. Ahem. This is how it goes. Ahem. The next thing that I am about to say is my theory. Ahem. Ready?”

Well, here goes.

We all know nowadays, that the most important issue surrounding litigation is the paperwork. Have you recorded the BPE? Have you recorded why you are taking radiographs? Have you recorded why you aren’t taking radiographs? That’s what we’re obsessed with – getting the paperwork right so the statistical algorithms down at the NHSBSA don’t flag us up, or so we have a nice neat piece of work to show your defence organisation when they summon you for a day long grilling at a plush lawyer’s office in Lincoln’s Inn Fields.

But the whole reason you have ended up in trouble is that the patient wasn’t happy with your treatment (or some pig of a dentist who never liked you dropped you in it, but that’s another matter).

Have we taken our eye off the ball?

<

So. I would ask the question: Have we taken our eye off the ball?

“My theory is along the following lines. All brontosauruses are thin at one end, much MUCH thicker in the middle, and then thin again at the far end. That is the theory that I have and which is mine, and what it is too.”

Before 2006 and the introduction of the UDA-based ‘new’ contract, we all had, every few weeks, a sample of completed patients pulled by the Dental Reference Service and dragged into some God-forsaken community dental clinic, to have their work checked. The Dental Reference Officer (DRO) would check that you had a) carried out what you had claimed for, and b) done it nicely and hadn’t missed anything.

Admittedly, quite a few patients didn’t attend as requested (despite the fact they had consented to do so in the small print), but as a recent graduate, I was always quite on edge knowing that my work was going to be scrutinised by dentists that I considered by be my elders and betters. Dentists had the option of attending the DRO’s examination. In the main, I chose not to go. On one occasion, I did go.

And frankly, these checks focussed the mind. I was never accused of missing perio during that time, though I was once criticised for leaving a sub-gingival ledge the size of Chiswick on the distal of an upper six. Knowing that ANY patient could be pulled in for post-op examination by a DRO meant you left nothing to chance, even if you did note it. The DRO’s rebuke over the ledge, to my FACE, was like Mrs Wojciechowski’s ruler across the back of the hand. I have been very wary of ledges ever since. They have a nasty sting. I've missed LOADS of other stuff, but ledges are at a minimum.

I have no evidence for my theory, but I do wonder if the increasing litigation, particularly with regard to periodontal problems, could be as a result of there being no, what I would call ‘proper,’ check on the work carried out by dentists. (And this is by no means confined to NHS dentists). Even when cases against dentists go forward, patients are RARELY actually examined.

Anyway. That is my theory. That is what it is. Do we need to go back to DRO checks?

I would frankly, welcome them.

Epilogue

In 1983, after I had been at dental school for a year – some ten years after leaving school, I attended a summer garden party with my wife. Across the garden, I noticed a pair of latecomers. An elderly, tall, burly, Eastern European looking man with a shock of white hair, and a petite little lady of similar vintage, hanging off his arm. I instantly recognised Mrs Wojciechowski.

Encouraged by my wife, I approached her. My former teacher clearly didn’t recognise me ( l like to think I had by that time turned into a swan), so I introduced myself as one of her former pupils.

She said three words to me (this is absolutely true) and walked away:

“Oh **** off!”

And it wasn’t in French.

Quotations from Episode 31 Monty Python's Flying Circus BBC 1973
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Dental Irritations by @DentistGoneBadd

Dental Irritants

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04
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I’m Sorry, But I Think You Need Therapy

europe

By @DentistGoneBadd


This is where I stand.

A few years ago, before David Cameron adopted the foetal position and waved the white flag to the advancing UKIPS, giving them the Brexit referendum, I was stopped by a ‘kipper’ in the high street of my adopted home city. I was asked if I wanted to forever remain ‘dominated’ by some ‘faceless European bureaucrat who would force us to consume straight bananas and live in dimly lit buildings powered by puny Dutch lightbulbs, or put the ‘Great’ back in Britain.

I answered thus:

“If I were the Prime Minister and had unlimited funds, I’d build a motorway bridge from here (the Midlands) directly to Paris.”

It was a nonsense answer – the sort that Donald Trump would have given – but I thought it got my point across. I am, and always will be, a European - a citizen of the world. I think Brexit is madness, and at a time when the world is becoming more and more fragmented, I strongly feel we need unity.

I’m Sorry, But I Think You Need Therapy

In the past couple of weeks, two of my closest dental friends – both from the EU, have indicated that they are thinking of returning to their countries of origin, having worked in UK dentistry for several years. Both were worried about the uncertainty surrounding their rights to residency – an issue still not absolutely clarified by the UK Government.

Another East European friend has recently left my corporate practice to go into independent dentistry, unable to cope with the madness of the NHS, UDA system. This has left the corporate practice critically short of clinicians and attempts to bring in either a permanent dentist or long-term locum has failed. (OK, fair enough, it IS a corporate after all). Many foreign dentists I have met have all been working for a UDA rate much lower than their home-grown counterparts and it is them in the main (it appears to me) that are prepared to work at a rate UK-born dentists would turn their noses up at.

One former corporate practice manager told me recently that she was told to offer prospective dental associates different UDA rates – foreign nationals being offered two pounds per UDA less than their UK counterparts.

Associate Shortages

I know of a number of NHS practices locally, which are currently struggling to find fully qualified associates of either UK, EU or other origin and this of course contributes to the lengthening of waiting lists and reception desk grumbling. With unattractive salaries on offer, particularly from the corporates, it is no wonder some practices are struggling to recruit. I once put myself on a few dental jobs websites and despite pleading to be taken off, am daily bombarded with all manner of associate jobs, from part-time to ‘whatever you can manage.’

Besides EU nationals going home as a result of Jacob Rees-Mogg, in 2017, a private Freedom Of Information request obtained from the General Dental Council showed that foreign dentist numbers dwindled in 2016, since nearly 40% of dentists who were found to have impairment of their fitness to practice originated from the EU or outside the UK and EU. This represented just over 3.7% of the total ‘foreign’ dentist workforce as contrasted to the 0.2% of naughty UK dentists based on 2018 registrant figures.

A search of the number of dental therapists in trouble with the GDC finds no such comparable statistics. Apart from one therapist in 2005 who was erased for performing a filling without a dentist prescription and one in 2013 who forgot to pay her Annual Retention Fee, there has been an exceptionally low rate of fitness to practice cases brought against therapists.

These days, since I work in a corporate, I meet very few therapists, but I have a very high opinion of them from personal experience. I will admit, I was forced into it because I couldn’t find an associate to move out into the sticks where my practice was located, but I employed a dental therapist in my own practice for a while a few years ago and her work was very good - providing a top-notch client service as well as taking patient appointment pressures off me. Her employment was also economically, a ‘no-brainer,’ being cheaper than employing an associate at 50% renumeration. I also trained with a mature dental therapist in the early 80’s. She flew through the dental course with ease, knocking spots of her classmates.

A Solution?

With many practices searching fruitlessly for fully-qualified post-vocational training dentists to replace fleeing dentists (for whatever reason), I wonder if we are missing a trick? Why not put these underutilised dental professionals to full use? Even the corporates haven’t caught on to this yet – presumably because they haven’t done the sums fully. Dental therapists can perform a wide range of tasks that can leave the corporate associates more time for searching for materials or stabbing the practice manager in the back. The only fly-in-the-ointment would be the stroppy associate who resents writing a prescription, but they can always be blackmailed with ‘OK. Do you want to do a radiograph audit after 5.00pm?”

In independent/NHS practice, remuneration would be a simple matter of a salary or hourly rate. In corporates, a nod to the associate’s prescription input would have to be acknowledged, so that he can get on to providing Band 3 mouthguards for someone who may have heard a vague click in their left TMJ in 1998.

Having said all that, I WILL miss my European colleagues if they do decide to go.

When I first met her, one of my EU friends was trying to pick up some British colloquialisms, mainly taught to her by her dental nurse, a girl with a mischievous sense of humour.

I arrived with my wife at the new house she was occupying with her now (British) husband. We had a lovely traditional meal from her home country, but then she apologised for the lack of furniture, and although we were perfectly comfortable at the dining table, she pointed to a couple of ample beanie’s in the lounge area and asked “Or would you prefer sitting on the douche-bags?”

David Cameron, what did you do?

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What would you suggest? asks Alun Rees

Red-man-speaking

A couple of months ago I stopped part way through a presentation and asked what words of advice the audience of dentists, of varying ages and experiences with the vast majority over 40, would give to a group of 25 - 30 year old dental graduates.

I have been mulling over their responses and the subsequent post-meeting discussions since then and sharing them whenever I can.

“Emigrate” was the first shout out. When I asked why, there were a number of answers, which set the tone for the mix of the realistic, but slightly miserabilist attitude, which can tend to dominate groups of dentists. “Because this country doesn’t appreciate dentistry, nobody values what we do, it’s better elsewhere”. This attitude harks back to my last post for GDPUK, “Nobody loves us every body hates us” and I believe that dentists should come to terms with the fact that people do like their dentist but don’t enjoy dentistry.

Next response was, “Say No”. On exploration this was the heartfelt plea to be left alone to do the very best for their patients. Constant interference from government bodies and the imposition of repeated layers of untried, untested and mostly unnecessary compliance have done little or nothing to improve the condition of patient care.

There was a feeling that dentistry had been caught napping about many of the changes and that the British Dental Association could and should have been more proactive in defence. (This was not a BDA section meeting). I teased this out a little more and the mood was that the BDA should lead, rather than react to change, that they should be the early adopters instead of worrying about the laggards.

“Go Part Time,” said an associate who shared how she had just reduced her working week to 3 days. My suggestion that all dentists especially practice owners should work no more than 4 clinical days a week (preferably less) was greeted with a certain amount of suspicion - no change there. Often I find that many dentists have such a “high maintenance” lifestyle because they can borrow highly that when they do want to consider reducing their hours they are so wedded to a treadmill of their own construction that it is hard to slow down.

The words of advice started to get more measured then and the group were clearly focussing on the target group rather than their own discomfort.

“Continue with Post Graduate training.” The awareness that in many areas therapists are replacing associates, who had not developed their skills and training beyond BDS, is leading to a growing realisation that you must bring something unique or special to the party. I do meet associates who cannot see the wall ahead of them and still believe that a few local meetings a year is all they need to stay current.

“Choose the right practice.” Said with some emotion by one dentist who shared some familiar stories of promises made and not kept by several principals with whom he had worked. The nods in the room showed that was a common experience.

“Get the balance right.” Bearing in mind that the subject of my talk was the causes and signs of burnout it was no wonder that this was in delegates’ minds. Unfortunately for too many it seems that balance is something that has to be restored in their lives after a problem or two rather than being established as a matter of course.

“Good financial advice, ASAP” This contributor was keen to encourage all young dentists to start planning for their financial future sooner rather than later. Their experience it turned out had been of needing to stay working rather than wanting to because they were not going to be as well off in retirement as they had believed.

“Look after yourself, physically and mentally.” In every group where I speak, especially about the topic mentioned above, someone comes and speaks to me at the end and shares their experiences of breakdown in some shape or form. This was no exception, except there were three of them who had not taken care and suffered from the consequences. The sometimes macho culture of (UK) dentistry can certainly take its toll with life altering consequences in some cases.

“Don’t be afraid to leave.” The world of dentistry is split into two groups it appears, those who have no idea of the value that they can to deliver to the world away from the dental chair and those who have walked away and been successful. The former camp may have self-esteem problems in my opinion and possibly never thought themselves good at dentistry in the first place. It could be that having aimed at dentistry from the age of 15 or 16 they can’t comprehend a life away from it.

“Choose your company wisely.” I thought this was particularly good advice, unfortunately the Internet is full of bad stories about “things” that have happened to dentists. If you are so inclined you can spend hours wallowing in websites, Facebook groups and bulletin boards where individuals try to out do each other with either misery or boasting about their success. All these of course are exaggerated and do little or nothing to help. If the old adage, “you are the sum of the people you spend your time with” is true, and I believe it is, then be selective and stay away from doom mongers and atmosphere hoovers who celebrate misery.

Finally came this gem:

“Don’t listen to old gits who tell you how good things used to be.” This was the view of the people who were really enjoying their lives in dentistry, who had control of their own destiny and could see opportunities in the future. They knew that there have been, and would, always be challenges and that was the way that life is. The “old gits” are the same people who moaned about the 1990 contract, the move to wearing gloves, and changing burs between patients. They were probably the ones who in their day missed vulcanite (look it up), daily “gas” sessions and the inevitability of full dentures. They were the gang who were suspicious that dental hygienists would take the bread from their mouth, believed that the relaxation of advertising was the death knell of professionalism and said that they would never get rid of their upright chairs.

There’s a lot of wisdom in dental audiences, it’s a shame it isn’t shared in dental schools.

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Recent Comments
Paul Hellyer

Shame about your last sentence

Having spent 6 years teaching undergrads in an outreach centre recently and speaking and teaching and publishing about stress in d... Read More
Thursday, 31 May 2018 12:11
Alun Rees

Thanks Paul

Thanks for taking the time to comment Paul. I frequently deal with the fallout from the consequences of stress in dentistry, my pr... Read More
Thursday, 31 May 2018 13:23
Paul Hellyer

Old gits

I think one thing which would help would be more of the old gits being willing to Mentor new graduates, after DF1. One of the com... Read More
Thursday, 31 May 2018 14:19
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Elf & Safety

Dental Elf & Safety

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More Post It Notes

More Post-it Notes

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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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Dental Royalty

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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

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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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08
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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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28
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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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© Alun Rees, GDPUK Ltd, 2018

Recent comment in this post
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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05
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The Tale of a Dental Tyrant by @DentistGoneBadd

Safe air and fury

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© DentistGoneBadd, GDPUK Ltd, 2018

5245 Hits
JAN
28
4

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.

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© Simon Thackeray, GDPUK Ltd, 2018

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
0

Enhanced CPD by @DentistGoneBadd

Enhanced CPD

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© DentistGoneBadd, GDPUK Ltd, 2018

4550 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
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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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