Alun Rees - Dental Business Coach

Alun K Rees BDS is The Dental Business Coach. An experienced dental practice owner who changed career he now works as a coach, consultant, troubleshooter, analyst, speaker, writer & broadcaster. He brings the wisdom gained from his and others’ successes to help his clients achieve the rewards their work and dedication deserve.
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Is it time to review Vocational Training in UK dentistry?

Is it time to review Vocational Training in UK dentistry?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So what’s going to scupper this?

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

•   Egos.

•   Involvement of medical educationalists.

•   No long term plan.

•   No leadership.

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

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

 

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

 

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Comments 3

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Ian Gordon on Thursday, 13 April 2017 09:18
Let's rescue what we have

Alun. Excellent article.
I have been involved with VT since 1990 , as a Trainer 13 time , as a VT Advisor for 7 years and now as a partner in a group of practices ( Alpha) which over the last 9 years has provided places for 36 DF1 dentists
I have always been passionate about VT and always challenged anything which theatened the great things achieved by it for the young dentists , the trainers, the practice , the professsion and of course patients.

Demise one started in 2006 when many excellent Trainers elected to not take up the NHS contract or themselves decided to only work privately. A minimum personal contribution of 1500 UDA was often needed. I challenged this at the time but by then NHS stalinalism was already taking a hold.
Excellent trainers and training practices lost overnight.

Then came concern about public perception. Residential conferences banned for fear that the public would misconceived their purpose. Even though practices paid a lot towards the event they were scrapped
Excellent CPD lost along with networking
Some schemes offered away trips for CPD. Chicago mid winter perhaps , my own scheme Teesside had an annual CPD trip paid for entirely by the Trainers visiting dental schools throughout the UK and visiting key lecturers in places like Jersey and Barcelona. No cost to the tax payer and fantastic CPD but banned through political correctness and dogma.

Then came National Recruitment and there is no need for me to say much about this other than to direct anyone who isn't familiar with this charade to the thread on this forum from 2011-13 VT National Recruitment opens

It remains a lottery with ranking still more a test of examiner moderation ( or lack of it) than candidate ability.
It still does not recognise 5 years dental school performance ( the excuse being cannot use this for overseas applicants - applicants who are not now eligible to apply !)
The result is some excellent candidates ranked v low or not at all and all done to protect HEE from legal challenge regarding recruitment and selection. Terror about nepotism favouring some , a culture which is only delayed 12 m when certainly who you know helps with the PRACTICE getting the right associate- let's face it it is still associates interviewing the practice not the other way round.

And to make matters worse the same process has been rolled out for Trainers The same closed interview with a question set and candidate marked on how many boxes their answer ticks - with no chance to deviate or sell ones self. Purely down to exam technique and whether anyone tipped you off about the question.
So once again excellent trainers lost because they perhaps didn't realise their appointment was dependent on saying the right phrases to a panel which might well contain lay people or non clinicians.

The allocation to practices has been taken to a new risk averse level. In Yorkshire this year no face to face meetings , only way to promote the practice being a 1000 CHARACTER text ( increased from 500 after I complained as LDC Chair about a the process)
Result is allocation by email saying you have been allocated Joe and you can now contact them.

What happens is Trainers complain to each other but are terrified to complain to HEE for fear of reprisal.
That the open and transparent recruitment process might still result in fewer ticks in the boxes at interview if the Trainer has rocked the boat.

So i agree there is an opportunity for private VT. I know Andy Lane tried this in about 2012.
I also agree Corporates are well placed to help and don't dismiss this as a possibility
The current VT scheme has a culture of being somewhat anti corporate - an interview question about clinical governance certainly weeded out some potential associate trainers as they just don't have to deal with CG in the same way as owners do.

So my request is save the scheme we have by resisting the changes being imposed by HEE , changes designed to protect them from legal challenge and nothing to do with the interests of patients FDs or Trainers.

PS. Old terms used. I know about TPDs ES and DF1

0
Alun. Excellent article. I have been involved with VT since 1990 , as a Trainer 13 time , as a VT Advisor for 7 years and now as a partner in a group of practices ( Alpha) which over the last 9 years has provided places for 36 DF1 dentists I have always been passionate about VT and always challenged anything which theatened the great things achieved by it for the young dentists , the trainers, the practice , the professsion and of course patients. Demise one started in 2006 when many excellent Trainers elected to not take up the NHS contract or themselves decided to only work privately. A minimum personal contribution of 1500 UDA was often needed. I challenged this at the time but by then NHS stalinalism was already taking a hold. Excellent trainers and training practices lost overnight. Then came concern about public perception. Residential conferences banned for fear that the public would misconceived their purpose. Even though practices paid a lot towards the event they were scrapped Excellent CPD lost along with networking Some schemes offered away trips for CPD. Chicago mid winter perhaps , my own scheme Teesside had an annual CPD trip paid for entirely by the Trainers visiting dental schools throughout the UK and visiting key lecturers in places like Jersey and Barcelona. No cost to the tax payer and fantastic CPD but banned through political correctness and dogma. Then came National Recruitment and there is no need for me to say much about this other than to direct anyone who isn't familiar with this charade to the thread on this forum from 2011-13 VT National Recruitment opens It remains a lottery with ranking still more a test of examiner moderation ( or lack of it) than candidate ability. It still does not recognise 5 years dental school performance ( the excuse being cannot use this for overseas applicants - applicants who are not now eligible to apply !) The result is some excellent candidates ranked v low or not at all and all done to protect HEE from legal challenge regarding recruitment and selection. Terror about nepotism favouring some , a culture which is only delayed 12 m when certainly who you know helps with the PRACTICE getting the right associate- let's face it it is still associates interviewing the practice not the other way round. And to make matters worse the same process has been rolled out for Trainers The same closed interview with a question set and candidate marked on how many boxes their answer ticks - with no chance to deviate or sell ones self. Purely down to exam technique and whether anyone tipped you off about the question. So once again excellent trainers lost because they perhaps didn't realise their appointment was dependent on saying the right phrases to a panel which might well contain lay people or non clinicians. The allocation to practices has been taken to a new risk averse level. In Yorkshire this year no face to face meetings , only way to promote the practice being a 1000 CHARACTER text ( increased from 500 after I complained as LDC Chair about a the process) Result is allocation by email saying you have been allocated Joe and you can now contact them. What happens is Trainers complain to each other but are terrified to complain to HEE for fear of reprisal. That the open and transparent recruitment process might still result in fewer ticks in the boxes at interview if the Trainer has rocked the boat. So i agree there is an opportunity for private VT. I know Andy Lane tried this in about 2012. I also agree Corporates are well placed to help and don't dismiss this as a possibility The current VT scheme has a culture of being somewhat anti corporate - an interview question about clinical governance certainly weeded out some potential associate trainers as they just don't have to deal with CG in the same way as owners do. So my request is save the scheme we have by resisting the changes being imposed by HEE , changes designed to protect them from legal challenge and nothing to do with the interests of patients FDs or Trainers. PS. Old terms used. I know about TPDs ES and DF1
Alun Rees on Friday, 14 April 2017 07:13
Thanks

Hi Ian
Thanks for taking the time to respond. I think we're in agreement about most things.
The problems that you describe are part and parcel of the bigger medical picture, Stalinism is spot on. My brother is a prof of Medicine in Edinburgh and the stories he tells me of admin over talent are scary, from student to specialism the powers that be supervise a race to the bottom with (their) control the only objective.
I was involved, albeit tangentially, with Andy Lane's scheme and was sad to see what he went through. I still think it has legs.
Of course the bigger corporates (I know all collections of practices are not the same!!) only want cannon fodder for the contracts so aren't interested in personal development for their junior dentists.
All very depressing really.
Kind regards
Alun

0
Hi Ian Thanks for taking the time to respond. I think we're in agreement about most things. The problems that you describe are part and parcel of the bigger medical picture, Stalinism is spot on. My brother is a prof of Medicine in Edinburgh and the stories he tells me of admin over talent are scary, from student to specialism the powers that be supervise a race to the bottom with (their) control the only objective. I was involved, albeit tangentially, with Andy Lane's scheme and was sad to see what he went through. I still think it has legs. Of course the bigger corporates (I know all collections of practices are not the same!!) only want cannon fodder for the contracts so aren't interested in personal development for their junior dentists. All very depressing really. Kind regards Alun
Ian Gordon on Friday, 14 April 2017 08:13
In defence of Corporates!

Thanks Alun.
You are of course right that not all Corporates/groups are the same - but from time I have spent with CEOs and CDs of the major companies through Association of Dental Groups they do ALL want the engage good dentists and deliver good patient care.
Everyone recognises that wanting and delivering are two different things - this can be a challenge for a single practice engaging one associate - its just that doesn't get reported or extrapolated.
The profession faces an increasing challenge of younger dentists qualifying having had less experience and joining a risk averse litigious over regulated culture which stifles their desire or ability to push their clinical skills.
Some of course break out of this and I am often amazed by the time spent and dedication to learning shown by some young dentists.

The 2006 contract once again has a lot to answer for.
Pre 2006 a good VT could look forward to the opportunity to remain in their training practice and develop their patient list. Practices grew and developed with this model.
Patients had continuity and VTs had mentorship and support in years 2 3 4 or beyond. Unless there is commissioning of additional UDA ( when did that last happen?!) practices cannot grow their NHS side and jobs are only available when dentists leave.
Barry Cockcroft even applauded this fact by saying the 2006 contract broke the chain of trainers attracting dentists via VT and using VT as a recruitment agency - he wanted this chain breaking so VTs would be forced out of their training practices into where they were needed.
It was one of his views I never understood!

You might find it interested to visit the {my}dentist training academy in Manchester - I am sure they would be happy to show you what they are doing in relation to training of their teams.
Oasis/BUPA do try to encourage career development as well
I agree that a private scheme does have legs but also there is the opportunity to engage more with the Corporate and group sector regarding training and career development - it would be knocking at an open door - its just knowing who to talk to
Ian

0
Thanks Alun. You are of course right that not all Corporates/groups are the same - but from time I have spent with CEOs and CDs of the major companies through Association of Dental Groups they do ALL want the engage good dentists and deliver good patient care. Everyone recognises that wanting and delivering are two different things - this can be a challenge for a single practice engaging one associate - its just that doesn't get reported or extrapolated. The profession faces an increasing challenge of younger dentists qualifying having had less experience and joining a risk averse litigious over regulated culture which stifles their desire or ability to push their clinical skills. Some of course break out of this and I am often amazed by the time spent and dedication to learning shown by some young dentists. The 2006 contract once again has a lot to answer for. Pre 2006 a good VT could look forward to the opportunity to remain in their training practice and develop their patient list. Practices grew and developed with this model. Patients had continuity and VTs had mentorship and support in years 2 3 4 or beyond. Unless there is commissioning of additional UDA ( when did that last happen?!) practices cannot grow their NHS side and jobs are only available when dentists leave. Barry Cockcroft even applauded this fact by saying the 2006 contract broke the chain of trainers attracting dentists via VT and using VT as a recruitment agency - he wanted this chain breaking so VTs would be forced out of their training practices into where they were needed. It was one of his views I never understood! You might find it interested to visit the {my}dentist training academy in Manchester - I am sure they would be happy to show you what they are doing in relation to training of their teams. Oasis/BUPA do try to encourage career development as well I agree that a private scheme does have legs but also there is the opportunity to engage more with the Corporate and group sector regarding training and career development - it would be knocking at an open door - its just knowing who to talk to Ian

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