Since I retired a couple of years-or-so ago, I’ve had many dentistry-related dreams/nightmares. Many of these dreams find me suddenly planted back in a surgery somewhere, working on difficult patients with tricky clinical needs.
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.
Discussions on GDPUK forum often stimulate my thinking and my thoughts in this blog are for the nation to consider in 2017. This blog uses dentistry for some of its examples, but is about the future of the NHS, and asks if the marketplace could help development of a different type of health care system, funded not just centrally. I have tried to keep this a short piece, so I have abbreviated the steps for my intelligent readers.
Today we are proud to have reached 20,000 topics created on the GDPUK Forum since mid-2008. An incredible achievement from all involved. Thanks everyone for all the contributions to the forum pages over the years and the many interesting topics created. The site continues to foster a special atmosphere and relationship between dentists throughtout the UK. The forum exists because of the community, the many different contributors to the site (979 different ones last year) plus of course the thousands of dentists who read the site on a daily basis.
As you can see from the image above, there has also been 226,000 posts on the 20,000 topics created, which means on average there are just over 11 replies to each thread, which again demonstates how much everyone cares about dentistry in the UK and how it is natural for colleagues to want to help or guide each other. We hope all this help over the years has improved the level of dental care and professionalism and that the forum continues to be an incredibly useful resource for many years to come.
Thanks to all the moderators of the site for keeping on eye on any controversial threads, thanks also to our webmaster Steve, who keeps all the forum software ticking along. A huge thanks, to the site owner Tony Jacobs whose vision and passion for dentistry in the UK, has kept the GDPUK community together and reaching amazing landmarks like today!
Bring on the next 20,000 topics :)
Here is a campaign in which GDPUK can be the leader and get the whole profession to change their thinking, and from there spread outwards.
I believe dentists, their teams and dental company offices and dental events must lead the way by being sugar free.
When we visit a dental organisation offices, or we go on a dental course, a conference, an exhibition, any event at all, we must demand that the organisers make the catering sugar free. As well as the granulated white stuff, we must banish the biscuits and the cakes, put out fruit and other snacks. Our chefs can conjure up delicious sugar free creations - let's make dental events the showcase for them.
I have found it weird that for years we would go to dental events and find white sugar, brown sugar, but we cannot find artificial sweeteners.
We need to banish the sugar from OUR events and encourage hotels, venues and offices to do the same. After dentistry, we must campaign for the NHS events to do the same, there must be hundreds of those every day. Minister of Health?
There are multiple alternatives to sugars for drinks, there are many sugar free options amongst soft drinks
In terms of table top sweeteners, there are intense sweeteners such as saccharin, and there are bulk sweeteners such as sorbitol or sucralose. Some people cope with artificial sweeteners in drinks, some dislike, we can accept that. At the premises of dental companies, and in our dental practices the law demands no smoking in the workplace, let dentistry take the lead and encourage adoption of sugar-free to trickle down to all food outlets, all hotels, all workplaces, and from there into homes. It does not have to be forced on anyone, no legislation, just a gentle change.
The larger dental organisations need to change their policies, and shout this from the rooftops. It would be good PR. Give journalists packets of sugar free sweets when the story is launched.
Let's do it, colleagues - we can take the lead and start the change to help our nation's health.
Acronyms should be catchy in dentistry, shouldn't they? Surely that's a rule? GDC, BDA, DPL, CQC, NVQ, CPD . . . It also seems to be a rule that they have to be three letter acronyms but maybe the exception proves the point!
I have been puzzled by the newer demand to note non-verifiable education. GDC call it "General CPD".
In my mind non verified means it cannot be defined nor denoted as a specified event in time.
I feel if written down, this act of noting the time spent means it is verified. Expressing this the other way, the act of writing, noting the activity, makes it no longer non-verifiable, to my mind. I therefore offer you 2 minutes of recorded general CPD for reading this article on a dental website, and of course, closing your eyes and reflecting on it.. There you go. Only 174 hours 58 minutes to go and RECORD!
I propose, if the GDC insist we must continue to note this time spent, and they do, this part of recorded CPD has now become not-non-verified and must be renamed as "self verified personal study time".
I'm off to do some SVPST!
Now that's bound to catch on.
In forming the ideas for this blog, I have thought about the changes that have occurred in the leadership and role models for the dental profession in the UK in the last decade or so. Some bodies have not changed their style, nor the stature of their dental leadership. In some government controlled ones, they have.
I will consider two leaders, Chair of the General Dental Council [GDC] and the Chief Dental Officer [CDO] of the Department of Health [DH].
As you will know, an era is over with the retirement of Dr Barry Cockcroft as Chief Dental Officer, NHS England. I am sure the whole profession wishes Dr Cockcroft well, we hope he has a long and healthy retirement.
The dental profession knows the role of CDO was downgraded when this incumbent was moved sideways from the Department of Health, giving advice directly to Ministers. Of course this role has always been a civil service post, but included advisory duties as well as the expectation of leadership qualities.
During this recent tenure, the role of CDO seems to have changed to a more "director of dentistry" style, implementing imposed changes from the DH, in order to carry out the political will of the DH. Not necessarily changes which benefit patients, nor the public, nor the profession, sad to say, but changes which have benefited HM Treasury. No doubt this would be argued against by the outgoing CDO, the changes under his watch have been dictatorial, and controlling, often based not on evidence, but on political expedience. In fact that concept of lack of evidence base is a marker for his term, of course dentists must follow an evidence for all our decisions, but UDAs and HTM01-05 demonstrably lacked any proper evidence. Only one person would argue that they do.
The historical model was that a highly respected, highly qualified colleague fulfilled this role, and often with a public health aspect, and watched over dental developments emerging from the DH, supervising in a more nurturing, parental style. We do not know how internal battles were fought with the DH over dental policy historically, but the role of the CDO appeared to be protective of patients and the profession. Will these days return?
Now over to the GDC at Hallam Street and now Wimpole Street, and from 1956 to 2012 leadership was provided by a President, who served a fixed term, elected from the body of the elected GDC.
The Presidents of the GDC over the years have included some of the heavyweight names from the surgical and scientific fields of the profession. Those dentists may have been in positions of authority, but they were colleagues that other dentists could look up to, admire their achievements, and accept leadership in thoughts, philosophy and deed.
The same thoughts would also go for the holders of the post of Chief Dental Officer.
But, as we know, the present Chair of the GDC, imposed by the Government, and put into position by the Privy Council, has been a lay person, Dr William Moyes. Not a leader of the profession, and indeed, someone who has shown little insight into the way the UK dental profession ticks. For example, in a speech, he suggested that UK dentistry should be comparable to the supermarket industry, with shoppers able to choose between the Waitrose style practice, or the Aldi/Netto/Lidl style.
Colleagues in dentistry shudder to think who will be appointed to be the next CDO. I personally hope the appointee will be able to show the profession the way forward, to be able to speak to the profession, and not be one who is planning further degrading downgrades to professional status, or perish the thought another appointee who sets in train solutions which offer lesser results for the people of the country, or which transfers the blame for reduced outcomes back onto the profession. We need a CDO who stands up for the profession and professional ideals.
We have figureheads of the indemnity societies, the faculties of the Royal Colleges, the universities [who seem to be inward looking], trade unions, private care providers, corporate bodies, online groupings, in place, all carrying out their roles, but none of them have yet emerged as a true leader, widely recognised.
My hypothesis is there is a vacuum in strong, thoughtful, highly moral leadership of the profession, this vacuum has been created by barmy ministerial edicts over a decade or more, when politicians have either not had advice or ignored it, and have chosen to appoint different types of people, the wrong people. What do you think?
Who will provide the leadership? From where will this person or people of stature emerge, when the profession so badly needs the core values of moral, philosophical and intellectual guidance?
Running to Paradise Garden
by Nicolas Alejandro
https://www.facebook.com/nicolas.alejandro.ph Shown under Creative Commons licence
Disastrous events have and will still occur in dentistry, despite being, in the UK, the most over-regulated profession. But my question in this "open-letter" blog is not just about the right touch of the regulators, but about who runs and who controls the regulators.
In the good old days, the regulators of the professions were drawn from the professions themselves, people of good standing who were willing to put themselves forward, possibly by election or appointment, and it was the case that many good people did indeed come forward.
During the last twenty years, or less, political theories developed suggesting greater and greater roles for the lay members' control of regulators, and my strong contention is that the pendulum is proven to have gone too far away from professional input and control. In other words the regulators have visibly and clearly lost touch.
Regulators insist that professionals show insight into themselves. As professionals, do we educate ourselves correctly, probe our own weaknesses and failings, educate ourselves away from those weaknesses?
But have the regulators shown any form of insight? I also contend, in a very short time frame, the lay element just do not have insight of the profession. How it ticks, how practitioners think? Do they know? How new professional problems are viewed and solved? Intelligent people, as professionals, are put into the rapidly shifting sands of a hightly regulated and inspected system, how do the professionals respond to all those influences, and how do they cope? Do the lay regulators pick this up? How? GDC regulators, the people making the policies have now become so detached from this they have no idea at all. That detachment has been so vividly apparent this summer and autumn, with the GDC remaining with its' collective head deeper and deeper in the sands of 37 Wimpole Street.
Dentistry is also regulated by the Care Quality Commission [CQC]. The CQC early engagement with dental profession was disastrous. In many ways the initial relationship between the CQC and the English dental profession could have served as a case study in how not to engage, a manual on how to alienate. Even in 2014, when CQC have pronounced that dentistry in England carries a low risk for patients and inspections will be made each 5 years, the early alienation created by CQC remains at the forefront for the profession.
The style of CQC speakers, tasked with communicating to dentists in around 2010, was bullying, harrassing and when they saw the dental audience was visibly angry, they invoked the Health and Social Care Act 2008, and said they will do what they want, the law says they can. No negotiation, no compromise, no concept of listening to the senior dental people they were visibly insulting.
They got it wrong then and things may be improving [with added DENTAL input] but the D'Mello case shows how the CQC were getting it wrong. The report on that Mansfield practice shows an inspection was passed, but the main concern was that the mops were the wrong colours.  [For those who do not know, a system exists, which all dental practices must follow - mops used for the floors in each room must be the right colours, and cleaners educated and make tick charts of the use of the mops in differing areas.]  However, the lay CQC inspector did not note other more worrying aspects, such as, this dentist was seeing, to meet the demands of that particular NHS general dental contract, around 55 patients per day.
Even assuming a full 8 hour day, and knowing all professionals flag after a long day of executive processes and clinical decision making, that is close to seven patients per hour, an average of less than nine minutes per consultation. And we know some of those visits must have been for treatment, not just examination. And dear reader, think about the time it really does take for a patient to enter a room, take off their coat, say hello, be quizzed about their medical history, examined, explained, full informed consent given, explanation of costs, then final greetings, rinse, stand, coat back on. Could you do this in around 8 minutes? This is without allowing for the natural breaks in the day. Even if this dentist worked 10 hours every day, that only gives 12 minutes per patient, including treatment, day after day, hour after hour.
I omitted one thing here - time for cross infection control, several minutes each patient - and this was the thing D'Mello is now notorious, having been proven to have cut this essential aspect out.
But the lay inspector missed this massive aspect of how this practice was being run, something a dentist might not have picked up, but it is much more likely a dentist would have seen in a long, detailed, inspection visit.
So my words for politicians, civil servants, British Dental Association negotiators, and Department of Health; reforms of dental regulation are needed again, and do not cut the corners this time. We need appropriate intellectual and professional input at all levels of new regulation processes that urgently need re-specifying.
Since news emerged at the very end of June that the General Dental Council [GDC] was planning to raise its annual retention fee [ARF] from £576 to £945 per year for all dentists in the United Kingdom. This coincided with an announcement of a consultation on the matter of this fee, yet the fait accompli of the rise proposed was publicised.
GDC maintains a register of all dentists working in the UK, and it remains illegal to practice any form of dentistry without this registration. This monopoly held by the dental profession is there to protect the public from imposters, and despite this serious registration process there are always queues of impending prosecutions of people who feel they can practice forms of dentistry without a degree, training, nor the proper registration and indemnity cover.
It appears the large rise has been caused by the exponential increase in complaints against dentists administered by the GDC, a very stressful process for dentists who remain innocent until findings are proven. GDC accepts cases, investigates, and will proceed with a risk to the professional future of a dentist even if there is a single incident of complaint. This wall of actions has led to delays and blockages in the GDC processes, something dentists are finding unacceptable, and this is one of the factors behind the social media congregations in the last 48 hours.
GDPUK has had a large rise in visitors, one thread on the topic has had over 90 replies from dentists within 36 hours of the first posting on the topic. Twitter has been ablaze, and on Facebook, one page, The Project, in which dentist Prem-Pal Sehmi has commenced a campaign for colleagues to pay £576 when the ARF becomes due next December has attracted more than 2400 colleagues on Facebook, also within a very short time frame. [At the time of writing]
On twitter this image shows the sort of exchange progressing. The profession is like a bear which has been poked in the eye too many times, says Eddie Crouch of the BDA PEC and Birmingham LDC.
On the Government’s e-petitions page, Dr Vereen Gupta commenced a petition on the matter, and within 24 hours, this has over 5,500 signatories.
Statistics emerging on GDPUK show that the anger is derived from this rise in Fitness to Practice [FtP] cases, which GDC figures state are stand at 3,700 presently. There are around 24,000 dentists in general practice now, so almost 15% have a case against them. Foir na serious and learned profession, this alone shows the system is very wrong.
The Professional Standards Authority, which oversees the GDC, has reported its grave concerns with the running and governance of GDC, which seems to roll along, unfettered.
All the groups must unite and harness the energy being generated on this matter, so it is up to BDA, Facebook groups, GDPUK, Twitter devotees to keep up the pressure, ensure this campaign goes to the heart of its target.
Open letter to David Behan, Chief Executive of CQC.
Are you really listening?
It is interesting after two full years of regulating dentistry in an illogical and frustrating manner, CQC has now changed its method of charging dentists for its dubious services to the nation. Has the CQC changed to some form of listening mode, rather than the one way, top down approach?
If so, the door is open, I’ll push and see . . . . . .
Dentists told the CQC 24 months ago the previous method of charging was not right but CQC ploughed on in its dictatorial way. I remain uncertain if the new method of charging announced this week is fair, especially when compared with the general medical practitioners, who have their own problems? Why are the medical practice annual registration fees so much less when CQC policy has insulted dentists by saying that medical practices are much busier than dental practices, so they get a two week notice of inspection. By implication, CQC thinks dentists are sitting around twiddling thumbs, therefore our profession can be given 48 hours notice of an inspection. If the medics are busier, they must need more inspection, therefore higher fees. Please explain, Mr Behan.
Inspections of dental practices are now to be three yearly, we hear, so why do total fees collected remain at effectively the same level? And if the CQC is not recovering 100% of regulatory costs from the medical practice sector, the dental sector should pay at the same rate or raise the medical fees. I suggest a solution, CQC should halve dental practice registration fees to make a semblance of equality.
From the early days when the CQC engaged with the dental profession, there has always been a stance of being in charge, the profession are in an adult-child relationship, and dentists must do as we are told. Otherwise the blunt, and oft-repeated threat is that our practices will be closed down. Even now your Fixed Penalty Notices are doled out without warnings, it seems, and are wildly disproportionate to the "crime". During March 2014, CQC sent a communication by email only, it was mandatory, a survey of dental chair numbers. This email contained a threat of a larger registration charge of £1300 if not completed. What if the email was not delivered, or found its way into spam folder? CQC still likes to use the big stick, even in a simple email question. Did the inspectors not record the number of dental chairs in each practice during the exhaustive inspection process?
Recently one colleague told GDPUK forum his practice passed a recent inspection with one proviso, the floor mops were stored the wrong way round, they must be kept with the mop head upwards. The inspector insisted on a further visit to check this, before signing off the livelihood of the practice. Life saving equipment counted for nothing, cross infection controls all passed with flying colours, reams of paperwork counted were discounted, vocal satisfied patients - nothing. The practice might be carrying our complex implant operations, or microscopic endodontic treatments. But it all came down to the mops. But if those mops are not the right way up - that is just not good enough - the public must be protected.
Yet another example of how the CQC have not adapted nor heeded the dental profession has been the issue of having a Nutrition Policy, Outcome 5. Even as a simple dental practitioner, it is easy to understand why, for example, a care home should have a policy for the nutrition of the residents. However, the fact that every dental practice, up and down the country, has to have a Nutrition Policy for its patients is a farce. Dental practices are not care homes, we do not have in-patients, we do not feed our patients. Let's see some sense and remove this glaring foolish error.
Inspections have also been done badly by the CQC, using lay inspectors, people with training in care homes or pharmacies who cannot check dental aspects with a knowing eye. They can carry the clipboard, they can empathise with patients, but what do they know about running a dental practice? A simple example - emergency drug boxes contain dangerous items - but they have to be easily accessible and not double locked and secured in a locked room, otherwise they cannot be accessed in an urgent moment. Dentists would understand this, some inspectors have not.
As a dentist myself, I do not know enough to properly inspect a nuclear power station, or an abattoir, and many other places. I am sure the right people check on power stations but my point is that the real knowledge of any sector, any profession or industry, is held by people who are immersed in that sector. Inspectors from the sector know the shortcuts, they know the boxes that are ticked without real care, they know where the secrets might be hidden, the true ins and outs.
The Health and Social Care Act dealt the CQC a hand that was difficult to resolve. Each health sector has to pay for the inspections and administrations for their activities, but dentistry continues to feel it has been given a tougher set of cards, then bullied by CQC carrying a big stick.
My message, Mr Behan – listen more, get off the back of the profession, cease the bullying style, and equalise the disproportionate fees our sector bears.
CQC release http://www.cqc.org.uk/public/news/registration-fees-1-april-2014
Notes from CQC http://www.cqc.org.uk/sites/default/files/media/documents/20140331_fees_2014-15_legal_fees_scheme.pdf
GDPUK disucssion thread: https://www.gdpuk.com/forum/gdpuk-forum/cqc-no-fee-increase-in-registration-for-dentistry-16500
The Mirror recently reported a story as a consumer interest item, about a beautician who paid for training and supplies for a tooth whitening system but then failed to get her money back from the company when she found the practice was illegal. Megawhite continue to trade as suppliers to the beauty salon industry. The Mirror story is benefiting the dental profession in reminding again both the public and the beauticians that whitening teeth is part of dentistry, that is the law, it remains in the domain of the highly regulated dental profession. In this way the public are protected.
But the supplying company continue to advertise, make sales and attend consumer shows, they continue to dupe beauticians into "investing" in training and materials they cannot legally use. The article goes on to suggest the GDC is getting to grip with this, by writing strong letters to alleged law breaking beauticians. But the wholesaler is quoted as saying "all our customers have had this GDC letter and all ignore it".
Common sense tells us the average beautician, with a salon, or working at their client's premises, does not wish to break the law. They do not want trouble and they certainly do not want to harm their clients. However, it is the suppliers who have vested interests who now need to be brought to task.
The dental profession should not call for the beauty industry and its suppliers to be regulated. However, this news story and the established trade in knowingly selling whitening products for illegal use shows how gullible people can be, and on the other side, it reminds us how persuasive sales tactics can be, particularly when one side of that trade tells blatant untruths to their potential customers.
To conclude this personal view, I do call for Trading Standards and exhibition organisers to clamp down on the activities of the suppliers of illegal whitening materials. Dentists must also ensure they stay well clear of these companies too - don't let your name be sullied by their poor reputation.
Mirror story http://www.mirror.co.uk/news/uk-news/teeth-whitening-dispute-nothing-smile-3210595
Facebook campaigns https://www.facebook.com/StampOutIllegalToothWhitening
Recent news stories:
This period of low interest rates in the UK combined with changes in society and demographics have had some long term effects which are far from coming to roost. Since the financial collapses of 2008, UK Government policies have been to minimize the economic shock; people have been protected by saving the banks from failure and also by continuing low interest rates.
History tells us that economic policies designed to insulate from short term shock tend to come with a long term consequences. But no-one has thought about a cohort affected more badly by this economic effect, hard working young adults. They have to deal with high property prices and high rents, less secure employment together with rock bottom interest rates if they manage to save, but high interest rates if they have credit card or pay day debts.
Will there be friction between the younger generation whose lives are markedly different from their parents in so many ways? There hasn't been a revolution or even a rebellion, just a combination of changes of circumstance in society at large – greater access to further education, starting careers later on average, starting families later, so many important aspects of life have been shifted by a few years.
One piece of good economic news in the UK, along with growth of the economy, has been the gradual fall in the employment rate in late 2013 and early 2014. However, in UK dentistry, this seems to be in reverse, through unintended consequences, and the combination of many seemingly unaccountable people acting in what they think is the right way, but having a terrible effect on the lives of young dental graduates.
In our dental profession we are now seeing, possibly for the first time in history, unemployment of newly qualified dental professionals. What is now known as the Dental Foundation Training [DF1] scheme, which was commenced as an educational process to help young graduates move to the pressures of working as a trusted professional from those of a dental student. This scheme has now, over many years, become a requirement that dental graduates must complete before they can do any work within the NHS. They have to have a "performer number", obtained by joining then completing this scheme.
Interestingly, graduates of dentistry from the EU do not have to gain this requirement in order to work in the NHS. However, in the present national foundation dentistry scheme, EU dental graduates have equal standing with UK graduates, and each year some of those from the UK miss out, and cannot work. They may reapply but can only enter the recruitment process twice. After that, if they fail to get through an interview and psychometric assessments, they can have no future career in NHS dentistry EVER.
In the interview process which started in November 2013, with results issued in mid January with no fanfare nor press release, it is estimated [and this is a SHOCKING figure] that more than 10% of UK dental graduates have been left with no employment next summer when they graduate.
What a waste of studying, hours of hard work and sacrifice. Students these days live from loans, those qualifying presently have student debts around £30,000 with potentially no prospect of working in dentistry. Last year, tuition fees rose to £9,000 per annum, so those qualifying soon will have debts of £60,000 or more, yet carry this risk of not having a job when they pass their university examinations and graduate. A further insult is the 18 month rule, where applicants have two chances to apply and go through the process. If then unsuccessful, the artificial rule that bars them from following their career in the UK adds to the injustice.
In addition, this pre-judgment of their chance of a career is insulting and morale sapping, to say the least, before even sitting for their final exams, which seems to relegate those exams, which are the true arbiter of whom is fit to practice, not this FD1 assessment.
Dental colleagues rightly ask where is the British Dental Association in all this? Cannot the dental schools do something – teams of staff there must be angrier than GDPs. And what about COPDEND, who administer this – you must know what is going on? Why can someone take the problem by the horns and change something to benefit UK dental graduates and exclude EU nationals qualifying elsewhere in the EU? Even if you believe there is a risk of breaking an EU law, surely that is better than wrecking the careers and morale of hundreds of young dentists, prejudging the results of their university finals?
The inter-generational friction I referred to earlier might surface in the dental school. Morale must have been affected by this unjust system, university staff must feel that action must be taken for the sake of those they educate.
This is now the third year of this disastrous situation – something must be done, someone must take responsibility, and make the system fair for UK dental students.