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All that's new in the world of dentistry
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Clawback

Clawback

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Balancing Views

Balancing Views

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Breaking Bad News

Breaking Bad News

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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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1326 Hits
OCT
14
1

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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OCT
01
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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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5174 Hits
SEP
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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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3330 Hits
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A can of worms

A can of worms

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26
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Only Dentistry Can Save the Earth

Carbon Footprint

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2484 Hits
AUG
23
1

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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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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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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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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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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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

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

Robots in Dentistry

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Dental School Prospectus

Dental School Prospectus

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Easy Pickings – UK Dentistry And Dental Litigators

By Chris Tapper

 

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

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

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

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

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

 

"How’s it going?"

 

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

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

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

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

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

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

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

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

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

Being a Dentist

 

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

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

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

 

 

 

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Carestream Dental Announces New UK Sales Manager

Carestream-Mark-Garner

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

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

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

 

For more information please contact Carestream Dental on

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

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

 

  1237 Hits
1237 Hits
MAR
25
0

Dental Tales from the Mall online

Dental Tales from the Mall Online

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  3415 Hits
3415 Hits
MAR
13
0

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

 

  2015 Hits
2015 Hits
MAR
12
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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.

 

  4207 Hits
4207 Hits
MAR
08
0

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.
 
 
 
  1826 Hits
1826 Hits
FEB
28
1

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.

 

 

  3655 Hits
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
3655 Hits
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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

  4498 Hits
4498 Hits
FEB
05
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The Tale of a Dental Tyrant by @DentistGoneBadd

Safe air and fury

  4817 Hits
4817 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.

  7498 Hits
Recent Comments
Stephen Henderson

Correction

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

Correction

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

Typo

Thanks for pointing that out Stephen (it should read!)
Monday, 29 January 2018 09:32
7498 Hits
JAN
28
0

Enhanced CPD by @DentistGoneBadd

Enhanced CPD

  4083 Hits
4083 Hits
JAN
22
1

Child Caries

Child Caries

  4452 Hits
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
4452 Hits
JAN
15
0

EU Payment Services Directive now in force in the UK

EU Payment Services Directive now in force in the UK

 

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

Further info about the EU Payment Services Directive here.

  2036 Hits
2036 Hits
JAN
15
1

Is your dental practice ready for GDPR?

Is your dental practice ready for GDPR?

What is the GDPR?

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

6 Things you need to know now

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

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

1. Article 7 GDPR – Consent

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

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

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

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

To do list:

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

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

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

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

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

2. Articles 12-15 GDPR – Privacy notice

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

To do list:

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

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

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

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

3. Article 30 GDPR – Records of Processing Activities

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

To do list:

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

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

4. Articles 37-39 GDPR – Data Protection Officer

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

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

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

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

 

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

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

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

To do list:

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

– Consider who will be your DPO.

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

– Compile information on data processing activities within the practice.

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

5. Article 20 GDPR – Data Portability

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

To do list:

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

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

6. Article 84 GDPR – Penalties

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

What next?

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

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

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Recent comment in this post
Paul Carpenter

Really CCG be Data Protection ...

The local CCG cannot be the Data Protection Officer as the duties of the Data Protection Officer on [url]https://ico.org.uk/for-or... Read More
Friday, 02 February 2018 12:48
8212 Hits
JAN
14
0

Horrorscope 2018

Dental horrorscope 2018

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5228 Hits
JAN
08
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Learn the Lingo

Learn the Lingo

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4754 Hits
JAN
08
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7 Easy ways to save money and time in your dental practice in 2018

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

 

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

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

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

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

 

Insurance

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

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

 

Dental Supplies

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

 

Credit Card Fees

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

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


Water

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

 

Energy

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

 

CQC and Regulation

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

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

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

 

Software Systems

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

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

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

 

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

Thanks for reading.

  2972 Hits
2972 Hits
DEC
30
0

Follow the ARF Money by @DentistGoneBadd

Follow the ARF Money

  5067 Hits
5067 Hits
DEC
17
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The TRUE Dental meaning of Christmas by @DentistGoneBadd

The TRUE Dental meaning of Christmas

  5651 Hits
5651 Hits
DEC
12
0

It’s official; dentists are stressed out

It’s official; dentists are stressed out

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

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

Managing work place stress

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

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

What is Stress?

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

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

What duty does a practice principal owe to their workforce?

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

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

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

1.      That the employer breached the duty of care;

2.      That the breach caused the employee injury;

3.      That the injury was foreseeable.

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

Easton v B&Q [2015]

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

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

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

The key findings of the court were as follows:

1. Lack of promotion

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

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

2. Removal of night time staff

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

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

 3. Rejection of a grievance

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

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

4. No knowledge of stress

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

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

Conclusion

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

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

1.       Appraisal process;

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

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

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

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

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

  4653 Hits
4653 Hits
DEC
11
0

CQC Latest Policies - In Pictures

CQC Policies in pictures

  6125 Hits
6125 Hits
DEC
08
0

3 for 2 offer for advertising on GDPUK in 2018

3 for 2 offer for advertising on GDPUK in 2018
 
 
Want to reach dentists in the UK?
 
Want to increase exposure of a new product or service?
 
Want to move away from traditional advertising and instead utilise digital advertising?
 
If the answer is yes to any (or all) of those questions ..... then you have found the perfect offer to facilitate those needs
 
We are running an offer.
 
We are aware it's not manic Monday or black Friday but we have taken a risk and put a special offer out anyway.
 
Contrary to a lot of advice found on social media, these offers work incredibly well for GDPUK.
 
In fact one of these offers, actually produced one of our most loyal clients over the last few years and it has helped us build up a brilliant working relationship with that particular business.
 
So today we are offering a 3 for 2 offer for booking advertising on GDPUK in 2018.
 
Book advertising in Jan and Feb 2018 and get a third month of advertising absolutely free.
 
 
 
Leaderboard Banner - appears at the top of all Jan & Feb 2018 plus an extra month - £1650 + vat
 
Forum Banner - Appears on forum pages on left hand side - £990 + vat
 
Front page Banner - Appears on front page and blog page - £990 + vat
 
Email Banner - Appears on daily digest email in 2 spots - £780 + vat
 
 
*All advertising includes opportunity to post special offers / PR to our products update page, this gets shared on social media.
 
**For £150 + vat for the 3 months booked, your banner can also appear on our mobile app in the 3 months you book above. Please ask for further details. 
 
If you would like further information about these offers or would like to receive further information about GDPUK. This email address is being protected from spambots. You need JavaScript enabled to view it.
 
 
 
 
  1222 Hits
1222 Hits
DEC
07
0

Amazon Threat to the Supply Chain?

Amazon Threat to the Supply Chain?
 
A slightly US focused story but yesterday (6th December) an interesting report was released by Morgan Stanley.
 
The report by Morgan Stanley says Amazon isn't gunning for pharmacies or medical devices just yet. Instead, it's turning its attention to the dental supply business.
 
Should the traditional dental supply businesses (such as Henry Schein) be worried? 
 
Probably not just yet but I do believe that Amazon Business will be a force in the next ten years, supplying consumables, stationery, office supplies, food etc for all businesses both big and small. (not just dental)
 
How will this work?
If we take a dental practice as an example. The person who does the purchasing for the practice will have an amazon business account (many already do) and will start to buy dental consumables and even equipment on the amazon site. It will be convenient, familiar and reliable. This is definitely something to watch over the coming months / years in the US first and the UK won't be far behind.
 
Read more here.
 
Further Info on Amazon Business UK
  1444 Hits
1444 Hits
DEC
06
0

Cult Fiction

Cult Fiction

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

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

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

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

Or is it?

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

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

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

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

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

Dentistry is absolutely full of cults.

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

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

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

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

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

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

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

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

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

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

 

 

Image credit - Legominifig under CC licence - not modified.

 

 

 

 

 

 

 

 

  4399 Hits
4399 Hits
DEC
04
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Notes - Post It?

Notes - post it?

  8053 Hits
8053 Hits
NOV
28
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We Did Not Sign Up For This

We Did Not Sign Up For This

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

Read it here 

 




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

My shortlist would be:

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

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

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

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

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

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

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

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

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

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

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

Tony Kilcoyne.

 

 

Image credit - hierher under CC licence modified

 
  5166 Hits
5166 Hits
NOV
26
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12 Days by @DentistGoneBadd

The twelve days of Practice

  6038 Hits
6038 Hits
NOV
19
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Perceptions

Dental Perceptions

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5804 Hits
NOV
13
1

Wash your hands of responsibility

Wash your hands of responsibility

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

 

Image by Benjamin White

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Paul Carpenter

Nice Idea shame about the impl...

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

Dental Karma

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

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

 

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Don Gibson

Abuse

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

Personal Developent Plan

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What makes a successful banner ad?

What makes a successful banner ad?

 

 

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

 

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

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

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

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

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

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

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

 
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2017 GDPUK Conference: 17th November - Book Today

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

Dental Body Language

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Fraud

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

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What is stopping your landing page converting sales leads?

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

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

Social Proof

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

Being Clear?

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

Too Much Text!

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

What is your USP?  

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

Too many details.

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

Always be testing.

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

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

 

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Social Media isn’t the Real World

Social Media isn’t the Real World

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

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

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

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

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

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

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

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

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Recent Comments
Richard Charon

Social Media isn’t the Real Wo...

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

Social media can sometimes be ...

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

Hoe to survive CPR Training

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

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

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

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

Accusations against Dr Bates

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

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

Barclays’ vicarious liability

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

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

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

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

When is a relationship “akin to employment”?

When the following criteria are satisfied:

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

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

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

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

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

 

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

 

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

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

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

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

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

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

 

Tort closely connected with the employment

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

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

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

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

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

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Stephen Henderson

Unusual circumstances

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

Dental Software

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Why don’t dentists work privately?

Why don’t dentists work privately?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fear.

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

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

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

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

Comfort.

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

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

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

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

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

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

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

 

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

 

So - why don’t dentists work privately?

 

 

 

 

 

 

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Breaking the News

Breaking the News

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GDPUK is 20 years old.

GDPUK is 20 years old.

 

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


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

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

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

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

 

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

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

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

Thanks for reading and helping GDPUK grow for 20 years.

 

Tony

 
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Switch and save

Switch and save

Change payment provider today and save up to 60%

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

Complete Dentures by @DentistGoneBadd

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More Danger than Prosecco? by @DentistGoneBadd

Prosecco

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Being a Dental Nurse for Dummys

Being a Dental Nurse for Dummys

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The Tipping Point

The Tipping Point

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

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

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

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

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

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

 

Indemnity.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Dental Confidence Survey by @DentistGoneBadd

Dental Confidence Survey

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