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JAN
28
4

Professional Suicide

Professional Suicide

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

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

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

And that is the problem.

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

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

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

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

 

Image credit - James Cridland  under CC licence -  modified.

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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
8983 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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Recent comment in this post
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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DEC
13
0

'tis the Season....

'tis the Season....

Tis the season to be jolly
Fah la la la lah, la lah la lah

 

Well after an autumn break to see how the land takes up the fertiliser of restful thought, we approach the Christmas break with a need for reflection.

What has 2016 thrown at us?

A reason to be cheerful? A season of Goodwill? A sense of hope?

There are three major areas that seem to be affecting the profession at this time.

 

There is the issue of the GDC and its new Case Examiners.

It is too early to say if this will genuinely make a difference. What we want is for the GDC to stop trying to be a Complaints House, taking everything on no matter how trivial.

 

Dr Colin Campbell, a widely-respected colleague in the Midlands, with a personal history of the dealings of the bludgeon that is FtP, clearly thinks not – again with personal experience.


But then again, why would CEs make a difference? They have been tasked and trained by the very organisation that had the problem in the first place.  And the problem is that the GDC do not reject anything.

Some of the recent cases suggest that the GDC still do not know what a proper complaint is. The whole list of FTP is awash with material that is either better managed locally and or indeed a simple internal disciplinary matter.


So, if you have not done so, get your £900 out for another year of outrageous wasteful use of your money. But do so with a good grace. It could be worse. 

Couldn’t it?

Is it me or have we become so numb and subservient that we just accept it as a nuisance nowadays?

 

 

NHS Pilots – self funded by dentists!!

Meanwhile, perhaps all is well with new NHS Pilots. We all know there is new money, and we all know that the DH wants to get bodies through the doors, never mind whether anyone does any dentistry.  But the idea of a Care Pathway appears to be well received on its own merits.

But there appears to be strange anomaly that the pilot practice may face up to 10% - YES TEN PERCENT – clawback – which if your profit is running at 20% reflects HALF THE PRACTICE PROFIT -  which for most Pilot Principals suggests a cold winter looms.

Good on the BDA for highlighting this matter, on stage at the Local Dental Committees Officials Day , with the DH Head of Finance and the “fabulous” Dr Sara Hurley [You did see the Good Morning interview spat between our CDO for NHS England and Dr Tony Kilcoyne didn’t you?] sitting along side as Dr Henry laid into them in no undertain terms.



Indemnity in Crisis?

 

Maybe all is well with our support network, the Medical Indemnity Organisations. You know – Dental Protection, DDU, MDDUS and the newer companies such as Taylor Defence Services.


Well, who knows?  There are stories of some colleagues finding their cover withdrawn in a discretionary manner halfway through a case.  There are many stories of colleagues finding their annual cover suddenly approaching 5 figures and beyond.  There is still no clear method for subscription calculation although one hears mutterings about the legendary ‘grid’.  A sort of Spot the Ball for Indemnity subscriptions!

 

Whatever the truth, there is a financial crisis in Indemnity, driven by a combination of commercially proactive lawyers and an overzealous GDC. So much so that there is a one day crisis conference being held in January

After many discussions about rising Indemnity and concerns some colleagues have been left with no cover or representation etc., A 1-day Seminar is being organised by Dental Practice at the Hilton Metropole, Birmingham NEC, on Friday 27th January 2017 from 08.30 to 17.30pm.

Concerns are being expressed across the dental sector about the delivery of Professional Indemnity cover and what is and is not included in the various offerings from the MDO’s. As a result, and in conjunction with many key decision makers, it has been decided to hold this 1-day seminar to look at the current situation, with much time for Q&As.

Places will be limited and are expected to be in high demand so, to avoid being disappointed, contact Rodney Pitt, Editor and Conference Organiser at This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Well that all makes for an energetic start to 2017.

It must be time for another letter to educate the public again, if the recernt rubbish written  by Hunter Davies in the Times is anything to go by!

 

I suggest we all turn to our loved ones and count our blessings.  In the year that we have lost Leonard Cohen, AA Gill and Greg Lake, we will not be short of words and music.

 

Put your practice to bed, and come back refreshed after a nod to the year, raring to go – unless of course you rely on Southern Railway in which case, the very best of luck!

If Christmas is your celebration, may yours be peaceful and joyful. That much we can be assured of

 

 

http://campbellacademy.co.uk/blog/failed-hurdle/
Dr Colin Campbell – the GDC have failed at their first hurdle

 

https://www.gdpuk.com/news/latest-news/2403-henrik-gives-update-on-prototypes
Henrik Overgaard-Nielsen, Chair, BDA General Dental Practice Committee, has posted an update about the prototype contracts on the BDA website


Also here for BDA members
https://bdaconnect.bda.org/dental-contract-reform-an-update-on-prototypes/

 

http://www.content.digital.nhs.uk/catalogue/PUB22526  for NHS report of Motivation

Dental Working Hours, 2014/15 and 2015/16 Motivation Analysis, Experimental Statistics

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6284 Hits
FEB
07

Inspirational training courses for the Inman Aligner

Inspirational-training-courses-for-the-Inman-Aligner.jpg

Dr. Nick Harrison, from Ponthir Dental Practice of the Restore Dental Group, has been providing the Inman Aligner to patients for the last couple of years.

 

“I had seen the appliance marketed in the professional media and decided to take the hands-on course in order to offer a new option to patients and compliment my professional development.  

 

“The course itself was excellent – very inspirational. The instructors, Tif Qureshi, James Russell and Tim Bradstock-Smith were all very knowledgeable and passionate about what they were doing. They were also really personable, so despite there being many people in attendance, they made an effort to speak to everyone on the course.

 

“Overall patient compliance has been good with the Inman Aligner and cases have progressed quickly with great results. I have already recommended the training course to colleagues and would definitely recommend it to others.”

 

 

For more information on IAS Academy, providers of genuine anterior alignment orthodontic devices please visit   HYPERLINK "http://www.iasortho.com" www.iasortho.com or phone 0845 366 5477

 

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2482 Hits
JAN
13
1

You don’t have to do this - letter to a wavering dentist.

You don’t have to do this - letter to a wavering dentist.

You don’t have to do this - a letter to a wavering dentist.

Is this really what you want to do? You don’t have to.

Many students have made their decisions to study dentistry at university in their mid-teens, an age when they are neither mature nor in possession of great insight.

Parents, family and teachers see dentistry as a well-remunerated, successful profession with a secure future. Well positioned on any socially acceptable list that makes it traditionally attractive to the children of immigrants. My mother, a migrant from Ireland was determined that both her children would have professions, her background, in nursing, favoured the medical. I became a dentist, my brother a doctor.

How many of us have the nerve to say that it’s not what they want? Many dentists are ill suited to a profession that makes extensive physical, mental and emotional demands on its members. I am not convinced that the undergraduate course prepares students for the rigours of general practice.

After 5 undergraduate years and now carrying a large student debt it takes a brave new graduate to dare admit to parents and family that they have studied the wrong subject. If you have a degree in humanities or pure sciences you are fortunate to be able to continue with your subject. Only with a “vocational” degree is the graduate able, and expected, to follow a career pathway.

Socially, turning away is akin to failing to show up at your own wedding. An individual might be secretly admired for admitting that they don’t feel the commitment needed for a happy marriage but it’s a brave dentist who says that they have done the wrong thing.

Turn things on their head, if you know in your heart of hearts that you are going to be unfulfilled and unhappy being a dentist isn’t it better to say so sooner rather than later? How many more miserable years can you tolerate? How much stress and heartache can you endure once you have admitted to yourself that you’re in the wrong place?

Far too many dentists have plodded on through degree, foundation training, associateship, partnership, marriage and children all carrying with them increasing financial pressures.

They thinking that this is the way that it has to be, that it will get better, easier, less of trial to get out of bed in the morning - next year. They live from holiday to holiday and get absolutely no fulfilment or satisfaction from the clinical work that they do or the people for whom they are supposed to care.

Often they succumb to the stressors. One of my contemporaries only accepted that he had a problem when he needed a quarter bottle of vodka to start work in the morning and was facing his third drink driving conviction.

I have attended funerals of successful and apparently happy dentists who have taken their own lives because they could only see one way out.

These problems are not unique to dentists and many people “live lives of quiet desperation” so I would encourage them to change also, if they can.

What else is possible?

The answer is anything that you want to be. There are ex-dentists who are successful architects, writers, lawyers, musicians and businessmen. I know of one former specialist orthodontist who now builds dry-stone walls (and will also teach you how to build them). The discipline of your training means that you are suited to re-train in many disciplines.

Let’s not forget those people who are stuck in a rut. NHS dentistry has never embraced excellence, though lots of good work is done in spite of the system. You will never perform at the highest level on the conveyor belt of UDAs or whatever imposed system of production is in vogue this year.

If you are having second thoughts then I suggest that you examine your reasons. If you feel that you aren’t right for a job that demands a high standard of manual dexterity in order to practice at its best then you should explore your options.

Darwin says that empathy is instinctive not learned, so if you are not a person-person will you be happy going against the grain and attempting to gain the trust of your patients day in day out for the next 30 years?

If you are doing it just for the money, you will probably be disappointed at the amount of further training, dedication to a career pathway and sheer hard work that it will take. You might get a better return on the invested time in some other field.

On the other hand if you stay and you choose to dedicate yourself to a unique discipline, then every day will give a new challenge. You have the opportunity to grow as the leader of a team in a niche where you help your patients not only to achieve and maintain an important element of their general health but also to have an enhanced sense of confidence, comfort and function.

If you want to be happier then say so, and do something. This isn’t a rehearsal, there is no second chance, no re-run, no “it’ll be all right on the night”. If you want to be better nobody can do it for you. If you need help ask those who have already done it, study excellence and embrace it.

Polonius said to his son:

“This above all: to thine own self be true,
And it must follow, as the night the day,
Thou canst not then be false to any man.”

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Recent comment in this post
Gaurav Vij

Great post....

Great post and sums it up succinctly. My experience is very few are cut out to be dentists. You are basically a surgeon in the cla... Read More
Saturday, 16 January 2016 07:20
11446 Hits
AUG
13
0

Comfortably Numb?

Comfortably Numb?

Is there anybody out there?

These words introduce the beginning of my favourite song, Pink Floyd’s ‘Comfortably Numb’, the title of which has always struck me as a particularly apt song for dentists.

Several times in my career different parts of the song have resonated with me for various reasons, but this is perhaps the first time the whole song in its entirety relates to dentistry at the moment. For those that don’t know the song, it’s about a reluctant performer who is made to keep going on stage by the various influences and promises of those who seek to benefit most from him, without any consideration as to how the performer is actually feeling inside. Sound familiar? Give a performer a new drug (the continued promise of a new contract??) and that’ll keep you going through the show….(despite the eventual catastrophic effects).

However, I’m not going to muse about the wider issues of dentistry that are analogous to the lyrical musings of Roger Waters otherwise this will be a very long blog.

So, in particular given the recent Professional Standards Authority paper looking into the rethinking of regulation, one has to ask if there is indeed anyone out there who is actually listening to what this paper suggests.

Here we have what is effectively a toothless organization in the PSA (show me precisely what it has actually done to rein in the GDC given its publicized failings over the last few years?) that is suggesting a completely new way of thinking with regard to the regulation of the professions. Its worth a read as there are many things that have been mentioned within the pages of GDPUK.

However, it’s one thing suggesting this radical rethink, but who with the power to actually instigate change is listening to what the PSA have to say? The Health Select Committee still seem to be getting their diaries in order after the election, and with no apparent repeat hearing for the GDC in the offing one has to wonder if other more pressing health matters will take priority over our issues. There appears to be no pending Government Bill in the offing to set up a super regulator (which is what I personally think will happen eventually) or rewrite the outdated legislation of the current regulators. It is obvious that the PSA sees radical failings in the current scheme of regulation, and we all know the opinion it has of the GDC in particular. However, we need to be careful about thinking the PSA is our knight in shining armour riding to the rescue; one of its remits is to review all the decisions of the GDC FtP process and if it feels they are insufficiently protective of the public (i.e. not a harsh enough punishment) then it can order further action against the registrant via a re-hearing. So they are no particular friend of the regulated, but I would counter that by suggesting they are at least an organization with the ability to actually understand what modern regulation requires. They, after all, they keep referring to the paper written by them for the Council for Healthcare Regulatory Excellence on what ‘Right Touch’ regulation means, and it doesn’t appear to always be the touch of the executioner’s sword.

There was a suitably robust call from the BDA for the government to take action as a result of the PSA paper, and whilst this is the sort of thing we need to see and hear from the BDA, once again I have to ask if there is anybody out there to listen? We are unlikely to ever get any press sympathy like the GP’s do; when the Daily Mail is happy to run a story asking if we are all Natural Born Killers as a result of the recent Lion hunting episode then we really are going to lose that battle before we begin. As a profession we already know the issues, so really the BDA is only going to be preaching to converted. How they get the message out to the wider public is the key to getting the regulatory change we so desperately need. That is going to require an awful lot of positive PR and I don’t see much evidence of that. Even the fact we have been harping on about the perils of refined sugar for years seems to have fallen on deaf ears until our medical colleagues woke up to it.

The PSA paper recognizes that over-regulation costing more offers no additional benefit to the patients, or the fact that healthcare has inherent risks that cannot be regulated out without a disproportionate amount of money and time, and that attempting to do so only serves to not only stifle the beneficial innovation that can help the patient, but also the general benefit to the patient overall. None of this will be news to any ethical practitioner reading this; but it’s not us that needs to take heed of this, we need to be listened to by the people who can instigate change and actually have a desire to do so.

The PSA also admit that one of the problems with the current outdated regulation mechanisms is that the action or words of a registrant last lasts only a mere moment or so but can result in serious damage to not only their careers and lives, but the lives of their families too; often having a serious and lasting effect. Again, not news to us particularly, but at least it is being recognized by the PSA. The disproportionate effect of a minor, spurious, or downright vexatious complaint should not be able to carry this threat, and indeed never used to; but more recently seems to be something that we must all be prepared to bear as an occupational risk no matter how diligent we are in our care and dealings with patients.

More interestingly for the GDC though is that the PSA warn against the expanding of the boundaries of regulators and the lack of clarity and tensions this then produces. It’s no secret that Mr. Moyes has said he would like to develop the role of the GDC and broaden its remit. It is already apparent that this seems to have begun, as the GDC is no longer just the upholder of Standards within the profession but has become the de-facto complaints service which will happily look into every single issue it is made aware of. A stop to this ‘mission creep’ as the PSA call it must come sooner rather than later, but again, the PSA has little power to prevent it at the moment.

Yet the GDC in its latest press release once again refuses to acknowledge that responsibility for regulatory failings are in any way its responsibility, choosing to blame once again the legislation that constrains it, and actually indicating it doesn’t go far enough currently. I think most registrants would be of the opinion that when a single complaint can have you in front of a committee that can end your career, then there isn’t actually an issue with the legislation not going far enough. The GDC is also apparently putting in place a series of ‘measures’ to help support the profession in delivering high standards of care and maintain public confidence in the profession. What these measures are we don’t know yet, but of course one way of doing this would be to make sure there are less people able to meet the standards they enforce, either my repositioning the interpretation of standards to make them virtually unattainable, and then ‘help’ by removing the registrants who fall short via the FtP process or by just driving them out of the profession by fear. Maybe this is too cynical a view but it’s hard not to have such thoughts in the current environment.

More and more I hear of dentists leaving the profession due to the immense pressure placed on them every day. Despite their best efforts to remain positive, it is increasingly difficult to not think that the next patient could be the one that ends their career, despite not having done something bad enough to justify such a draconian result. That makes the risk of practicing dentistry increasingly difficult to justify. It would be interesting to see if you are likely to have a longer career these days in the field of professional bungee jumping or crocodile wrestling than clinical dentistry. In what way does this help patients when good practitioners decide to leave our profession?

I remember a satirical comment a few years ago that eventually there would be 100% employment in the UK. Only one person would actually have a job doing something, but all the others would be employed to regulate them. I can see the dental profession going this way if someone in power doesn’t start to listen soon, as there will be less and less people electing to remain in or join our profession. We as individuals therefore need to unite and show the public that the pressures on our profession will directly affect them. Only when the voting public is affected will the situation come to the attention of those in power and change can be made. Although how this will pan out if the supposedly unelectable Jeremy Corbyn takes control of the Labour party and renders the opposition as toothless as the PSA remains to be seen.

Getting back to the title of the song then, the problem is that too many of us are (un)Comfortably Numb with inactivity. So we are reaping the rewards of our complacency and intransigence and will continue to do so unless we unite to do something positive. If we were as vociferous and active as dairy farmers have been recently when things finally got too much to tolerate we would have arranged some form of peaceful and professional group action. Perhaps we should round up a few hundred small cats (lions would be too difficult to risk assess and probably attract the wrong type of dentist) and release them into the General Dental Council chamber at the next meeting. Trying to herd said bunch of cats into Wimpole Street is likely to be simpler than getting dentists to do anything en masse. We could then say not all dentists have a desire to hunt cats (including small ones), and given that social media these days seems to be obsessed with the antics of cute kittens then surely this is guaranteed to get positive press interest. A flock of sheep might be easier to manage, but we don’t really want them in the Council Chamber do we? Tongue in cheek maybe, but food for thought nonetheless.

In all seriousness though, whilst it appears the public at large don’t appear to have a clue what damage over-regulation and the current litigious and complaining environment is doing to the ability for dental professionals to care for them appropriately, these are the same people who in their chosen fields are also likely to be suffering from similar threats. Speak to many of your working adult patients and you’ll find we are not alone in suffering the pressures we are currently under. Admittedly there might not be the same degree of threat to their career and livelihood, but certainly anyone in one of the professions and the emergency services have very similar issues as we do. ‘Guilty until proven Innocent’ is not unique to dentistry.

This is the message that needs to be conveyed in no uncertain terms to the public by both our professional leaders and us as individuals. Only when the public has empathy with us will we have their support. If nothing changes then the profession will dwindle more and more as a lack of morale grows.

For it is they the public as patients who will then suffer most when there are no longer any of us out there.

 

 

Image credit -Samuel Rodgers under CC licence - not modified.

 

  14339 Hits
14339 Hits
JUL
07
0

A Big Thank You

A Big Thank You

Grateful thanks

Like many I am grateful for the services of the GDC. I pay the ARF secure in the knowledge that my patients are safe and the money well spent.

Presently though I feel I have more to thank them for than usual.  I hope my readers understand irony ...

 

Professional disunity?

Just when the state of the dental profession cannot look more perverse, the GDC have achieved something that the last 8 years of the DH and their man at the helm of the 2006 UDA disaster has failed to cause.

Numerous LDC Conferences calling for this and calling for that – the ever calm and serene profession of dentistry has just adapted and carried on.

Implosion at the BDA and barely an extra glass of claret was supped at the ripples on the water of our profession as calm discussion took place about politics.

A raft of daft changes came along such as the UDA system, the HTM document, the OFT report you all now the form – and we ranted for a few months but quietly took another blow to the body, absorbed the costs and “moved on”.

The public acknowledgement that the Contract Pilots have been a sham and that any changes to come will be merely prototype in nature and at least 2 years down the line.  Dentists have had a bit of a cough to their colleagues and carry on, “being busy”.

The dreadful farce of Foundation Dentists lacking places allied to their debt and many were heard to comment widely and indeed care deeply, but the rump of the profession have likely returned to their skate-like lying on the bottom.  “They’ll get by” we all thought. “Wouldn’t recommend it to my chidren” we muttered. Next please.

The CQC came over the horizon brandishing a large bill and a lot of empty folders and by and large we have paid the charge and filled the folders, only to carry as before doing what we do – meeting, greeting, interacting with & treating patients with their range of ailments and fears.

 

Incoming, incoming ...

But the GDC, in their proposed hike of the ARF to £945, allied to a comical  consultation so pre-determined as to be reminiscent of a past communist regime have caused the profession to both awaken and threaten to unite in a way never seen before.

Just when it was looking very interesting, the satellite of the GDC, the Dental Complaints Service fire their own salvo at the profession. The DCS may be “at arm’s length” and independent or so they claim – but they are wholly funded by the GDC, ergo our ARF’s – so how independent they are is, shall we say, somewhat debatable.

What effect was intended, I wonder when the DCS took a full page advert in the weekend colour magazine of the Daily Telegraph claiming to act on anything less than COMPLETE satisfaction for every patient.

I have a three letter acronym of my own - FFS!!

 

Professional unity?

Never in 35 years have I seen such united sentiment and anger, perhaps however more importantly associated with individual response and action. The electrons are red hot with e-mails, complaints and letters to MP’s and these bodies.  How ironic that when a patient complains about us, we are always assumed to be in the wrong. When we complain about these bodies, they are always correct and indeed learning. Is it just me? 

 

So, what now?

Well this is an unprecedented time, and it will call for unprecedented action.

Perhaps a mass sentiment requires a big organisation to coordinate a big response. There seems to be a widespread sentiment that the GDC has lost completely any confidence it may have had with the profession. Of course they will blandly point to some piece of biased research they did to show how well regarded they are. 

They may not realise but the rules have changed and the gloves are off. Big boys games demand big boys rules. And it is the GDC and the DCS who started this.

Who will rid us of this poison organisation, who will deal it a fatal blow, for it is a big monster and well protected by the armour of politics?

We must thank the GDC & DCS – the profession appears to have finally awoken, and if I am not mistaken, this time it is getting to its feet.

Interesting times with a little smoke of excitement.  Who will wager what we see next? I won’t!!

Have a good week, worker bees. Tootle pip.

 

 

  4487 Hits
4487 Hits
DEC
13
0

The Pace of Change

The Pace of Change

 

 

What on earth is going on in dentistry? 

Is it me?  Has the pace of prospective change suddenly become turbo-charged?

It is worth reminding the profession and its representatives that by and large, in GDP we are NOT employed. We are independent contractors.  So why do the DH and our academic colleagues keep trying to treat us as though we are their whipping boys. 

If you are an associate, I reckon you might be worrying about the lie of the tea leaves.  Ever fancied re training as a Therapist?, Sorry to say , but it might be a good investment.

If you are a practice owner, under the NHS, the Ides of March 2015 look an ominous date.  Your business is dependent upon Government funding; you are NOT employed and yet you are being treated as an employee.  Is it really worth the [soon to be emasculated] pension?

As a private practice owner, are the Government REALLY going to impose rules to eliminate your freedom to practice the way you see fit?  You have the freedom to plan and the capacity to respond. But there are massive changes a’coming.  Bone up ... you have been warned.

In no particular order we have

  • ·         The CDO stating that NHS dental care will continue to be an unspecified [and ergo unlimited] commitment.
  •           Piltos continuing to point to disastrous Patient Charge Revenue allied to the "It can only work with Therapists"  big picture.
  • ·         Suddenly there is a proposal to break up the skill base for GDP into “Tiers” – and as many are already wondering, with associated ‘registration and accreditation’ costs.  Allowing Quangocrat driven deskilling is by any description professional suicide.
  • ·         The Chairman of the GDPC starting to play some cards as the negotiations continue for “Contract Reform”.
  • ·         There seems to be a groundswell of academic attempt to wield influence over the activities of GDPs –from Prof Steele’s changes underway to Dr Chate at the RCS Edinburgh starting to flag GDPs activities in simple orthodontics

Well, I might be a cynical old git, but I reckon the Dept of Health horse has probably already bolted.  I think it highly likely that we are about witness a pre-planned  move to the date of Contract Reform.  Standby for change and press releases on a quarterly basis. Standby for the BDA being outflanked and out-manoeuvred as the soul of dentistry is once agin under threat.  Having a Big Stick is of no use against an out-of-reach elephant.

I reckon the purpose of all this phoney consultation is simply to drag the profession along with a mouldy carrot.

If, as a profession we do not like what Prof Steele’s changes are presenting, and do not think that these changes will either benefit our patients or our businesses, and our associate colleagues, we have a duty to act.

We have a duty to say NO.

The BDA has a duty to say NO

We have a follow on duty to carry our patients with us in this Brave New World.

Its looks like Christmas 2013 will be line-in-the-sand time folks.

Which version of Brave New World do you want to be part of?   The Government’s or your own?

Do you want someone else whipping you at their pace or do you want to control how your career and business evolves?

Strap in guys and girls, the ride is getting bumpy.

  5088 Hits
5088 Hits

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