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What’s in a date?

What’s in a date?


For those who despair at the actions of our fellow human beings at time, this weekend has been one to affirm that feeling. The 7th January will in time become as meaningful as 9/11 and 7/7 in its own way. [1]


What level of hatred inspires [if that is the right word] someone to kill a fellow human in cold blood? I for one struggle.  In the ‘Je suis Charlie’ motif, a worldwide empathy has poured upon our French neighbours as they ponder a surreal weekend. 


Dentistry does feel strangely safe after that sort of event. 


Of course, while a small number of unexpected and sudden deaths in the street of Paris seems to trigger a media frenzy, the mass loss of death in Africa from Ebola, [2] and the even greater human distress in the civil war in Syria seem to lie uneasily on our minds. [3]


Perhaps we struggle to understand the magnitude of the Syrian problem –  maybe that is one reason for the distancing of the issue. The UNHCR data indicates in excess of 3.2 MILLION people have been displaced. If you live in Manchester or Leeds, imagine just moving out. That is without pondering the 191,000 estimated deaths. [4]


West Africa seems so far away. At the time of writing over 8200 deaths have occurred from the disease 


And yet 20 die in Paris and we are not moved to fill the streets. I wonder why? 


As we all go to work this week, perhaps thoughtful, perhaps a little sad at matters outside our control,  just take a little more time perhaps to help your fellow human suffering. 


It’s what we do, and indeed it is by and large all we can do. 


The 2nd January marked the date of the second Dental Profession’s letter protesting our Governments dishonesty in dealing with our small but proud and effective profession. [5] 


Allthough the clock is ticking, The 7th May is after all far enough away that a week of reflection will do no harm. 


Indeed may you remain safe and loved.



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And the winner is …

And the winner is …

Those of you who read and digest the news and views of dentistry at large will perhaps have noticed the recent Private Dentistry Awards1.  A rip roaring time in London for all who attended.  A sore head or two the next day I’ll bet.

The recent announcement of the winners serves to highlight the lengths that many colleagues will go to strive for excellence. They are also extraordinary in that they can find the time to document their activities and seek to obtain external recognition. To all who entered and indeed were in the awards, heartfelt congratulations.

To all of you who did not enter, I am sure I am not alone in noticing that the effect rubs off.

You read about how others do things.  You read about ideas and marketing. You introduce these things in your own way into your own practice.  Just because you do not enter does not mean you are not a winner.

Of course, the clue is in the name – none of these particular practices lay claim to  providing dental care under the NHS, although how many of them employ NHS associates remains to be detailed.

But as we witness NHS England purging their Performers List with suspect letters of a dodgy tone threatening removal arbitrarily simply because it suits someone in London’s database management skills, it seems to me that there is no doubt about this: Beware the false security that the Government offers.

Left to its own devices, Dentistry as a business and a profession would make a far better job of marketing its services at the right price, in the right place, to best suit a particular patient base than any mish-mash of Reds, Ambers and Greens that the Government’s Department of Health lackeys can come up with. Why it is that our academic colleagues often fail to see or understand this paradigm remains a mystery.  Are we all really that imbued with social guilt so that any talk to do with the NHS simply proves it is culturally embedded?

That must be the counterpart message of the BDA as it emerges leaner, poorer, but fitter and raring to “engage”.

By all means engage with the DH, but the BDA must lay out the subtle threat that we do have to courage to do it ourselves, and will do it better.

Now that is a profession in a win-win position. The winners of such a brave approach would be everyone, patients included.





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Good and bad salesmen



So.. its all over. That’s it for another year.  

Farewell BDTA Showcase ....   Sadly true

Farewell BDA problems. ....   Sadly untrue

I find myself intrigued by the numbers. About 4000 dentists attend, and about 14000 ‘others’. It seems there is a massive networking opportunity here, and perfectly positioned at the centre of the country, and yet barely 20% of owner dentists attend. I wonder what would make it a “MUST” – maybe a GDC standard?

To those of you who did indeed support our industry, well done.  Your investment in the future of good dentistry, at your risk, using your money [well maybe with a little help from a finance company] speaks volumes for the ethics of dentists.  If you did not make that purchase decision, perhaps you were put off by a pushy salesman who reckoned he or she knew it all?

When the new Government contract comes around, you will be fully IT’d up … won’t you?  Do it now, build your IT Ark  BEFORE the storm.

It was also of course an opportunity for some big organisations to get down and dirty. 

The GDC stand saw a steady  passing of interested people, many of them DCPs …  I wonder if like me you feel nervous going up to them – should you be anonymous just in case?  Can they really call you to account for just ‘having a go’ at the stand? I sincerely hope not.

GDPUK of course ‘trailblazingly’ set the standard for shiny shoes - but I never did find an answer to how to get shiny white crocs in the surgery!  It was THE place to meet and chat though.  If there was a centre to the Showcase, the GDPUK stand was it.  Just like it’s the centre of open opinion now. And if you have one, about anything, please come online and jot it down.

Talking of pushy salesmen, the BDA missed a trick in Birmingham, choosing instead to simply whip up a bit of spin with their racket by issuing yet another “All part of the grand plan” statement, care of the Chief Executive and PEC Chairman.  Good on you, lads.

Dodgy salesmen eh? You can smell that reptilian oil from a mile off.


With thanks to Matt at The Telegraph for the image. The original may be found at

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Recent comment in this post
Nigel Bannister

Good and bad salesmen

Enamel Prism, Good blog-thank you. The Exhibition layouts need a big shake up in my humble opinion. A good place to start-The I... Read More
Sunday, 27 October 2013 14:44
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Which voice rules UK healthcare?


The NHS remains an institution loved overall by so many in Britain. Yet in 2013, more and more reports and comments remind us that the system is not always offering the best for patients. The voices of the professional and the voices of the patients are ignored these days, even though the leaders say those inputs are received. Only one voice rules, those of the healthcare technocrats.

One aspect is that an element of harm is allowed to occur to patients, unbelievably it is seen as the norm by the managers, this failing is enshrined in the NHS Constitution “The NHS aspires to put patients at the heart of everything it does”.  Sadly it is only aspiring.

In a major speech reported widely in early May, David Prior, Chair of the Care Quality Commission (CQC) reminded us the CQC has already found around 20% of hospitals are “not terribly good” and a further 20% are “coasting along . . not doing terribly well”.

Yet these hospitals seem to have billions spent on them, thousands of managers, yet the system is failing the most important people, the patients. If you buy a fridge and the fridge goes wrong, you can complain, you can always buy a new one. In healthcare, if the end result goes wrong, you may die. This has happened to thousands of people in the UK already.

In dentistry, fortunately, thousands do not die. Yet the lessons of the past are ridden over roughshod by the managers of the present. The professionals, the clinicians with experience, may review the new systems brought in with metronomic regularity by those managers, they may express their reservations in writing on paper, in protests, and most definitely online, yet the managers invariably roll onwards and just do what they want. Thousands of years ago, Genghis Khan found decisions made by committees did not work!

There are many examples in dentistry where warnings were sounded, but the system ploughed on. Millions of people must have had extractions of teeth that would have, or could have been saved. Millions of pounds have been wasted repeatedly autoclaving sterile instruments. Out of hours services? Don’t even ask.

The managers remain on their merry-go-round of jobs, only staying a few years in each role, as this is better for their career. The system allows them to make mess after mess, public enquiries are not heeded, healthcare professionals are ignored.

My proposal is not dictatorship, but there must be a method for the voice of the professions and very importantly the voice of the patients to be heard with clarity, otherwise the NHS loved by millions, will reach the point when people realise other countries do manage healthcare better.


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Keith Hayes

Which voice rules UK healthcar...

There are many examples in dentistry where warnings were sounded, but the system ploughed on. Millions of people must have had ext... Read More
Monday, 13 May 2013 08:24
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Choices? Out of stock, Sir


Dentists told to 'go compare'

Welcome back from the long weekend. Sunshine does starnge things to people and so this little gem could well be evidence of sun spot activity on Government activity!

The DH stated in early May that  NHS Choices will shortly write to all dentists offering them the opportunity to manage their pages on the NHS Choices website

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Health & Safety Quiz

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Direct Access: An issue to unite dentists?

The present Chair of the General Dental Council, someone I have a great deal of time for, Prof Kevin O'Brien stresses the concept again and again, that the role of the GDC is "protecting the public". Dentists understand this, but for so many years the GDC regulated the profession in a different way, in what was a different world. But I personally, along with so many professional colleagues, cannot see how Direct Access will make things safer for the public. Risks must be higher, and there will be people who effectively have to be examined by dental hygienists and dental therapists, within their scope of practice, and inevitably they will carry out examinations, and will effectively become dentists.

What about the career pathway and the investment young people must now make to become a dentist? £9,000 a year for five years in tuition fees alone. We anticipate in five years from now, some colleagues will qualify with debts of £70,000. Will demand for dental school admission hold up when sixth formers and their parents do the maths?

What will the role be for dentists in the UK when successive governments have fully taken out their revenge on the dental profession for having the temerity to think and act independently? Politicians and the media all fail to recall a simple fact - the existence of any general dental service in the UK is provided by the investment of the profession, often based on the security of their homes, dentists are almost all independent practitioners, and some decide to enter into contracts to provide NHS dental services. These simple facts, dental practices are small businesses in which efficiencies are high, and nimble brained practice owners make rapid decisions on what is best for their financial well being, both in the very short term, as well as the longer term over-view. Unfortunately, when analysed, the decision on DA must be based on the revenge for independence created by the system which dentists inhabit.

The GDC sought advice from the profession in general in a wide operation. The BDA [representing 18,000 dentists] made their input, which was against DA. Both the content and the weight of this advice were discarded by the GDC in their deliberations.

Interestingly, there are not many issues which unite the UK dental profession. In this case, and in my opinion, there is strong feeling amongst the grass roots, this is now a cause
which could be used by the BDA to really pull together disparate parts of the profession.


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The cycle of reprocessing life … whither Paragraph 2.4 [l]

Well another week, another major document to chew up...


A mere 98 pages for this one -a mere 4 years in the making and of course I could be referring to the Hobbit . But that is no way to refer to the esteemed CDO [of the DH, or NHS England, or the deputy underling CDOs- you choose which job is being shared in the new logo-free Department of Health].  And no, I am not referring to 50 Shades of Porcelain. 

Calm yourselves , but its true. HTM 01-05 [2013 edition]  has or is about to thud its way into your inbox.  And a riveting piece of contraceptive literature it is.

Of course instead of highlighting the differences between the documents, in a formal, living document method, the whole text has to read alongside the 2009 edition to see where the changes are… so you need both copies on the desk.  What, you mean you can’t find the other? Shame on you, you bug ridden cesspit of casuality, you!

Let me skip you to the good news.  Paragraph 2.4k – leave them in the bags for a year now – shhh… you are not supposed to say that ….

Even stranger though: the continuing mystery of what should have been in 2.4l [for Lima] which never made the final 2009 cut is also kept out of the 2013 version. So invisible redaction is alive and well.. Oh well. In this case you could make it up.

Lots of bigger brains than my little apology have cast their eyes over this and its preceding ‘advice’ only to find it a glorified version of Civil Service speak for ‘our opinion is worth more than yours’. As we remind ourselves of the numerous infection related deaths, epidemics and microbial population flares that have arisen over the years  from day to day dentistry, what exactly is the purpose of HTM 01-05 in dentistry?

One assumes that this stuff is taught to the point of theatrical performance at Dental Schools. The implication is that much of the EU now adopts such thinking. If all of that is true why do the Department of Health feel the need to allocate so many resources of manpower to such a tome?  The first evidence they should present is the stuff to prove there was even a problem in the first place!

I love it when the preamble states

It is not the intention within this suite of documents to unnecessarily repeat international or European standards, industry standards or UK Government legislation. Where appropriate, these will be referenced.

So we are to assume that while a 5 years degree confers an assumption of learning ability we are not be trusted with reference to the documents that are causal in the need for 98 pages of …[ you fill in the adjective of choice]. Stuff transparency – we know better and you do not need to know.  How very quaint, how deliciously old fashioned. How unfit for purpose the arrogance of the DH makes them.

Another quote caught my eye for all you entrepreneurs out there:

Where new practices are commissioned or new premises contemplated, it is advised that the full best practice provisions of this guidance be utilised wherever reasonably practicable.

So presumably your essential pre-opening CQC registration will take due note of this…

Don’t you just love this little ‘get-out-of-jail card?

References  - It should be noted that this list may not be totally inclusive at the time of reading. Advice should be sought on the currency of these references and the need to include new or revised documents.

Now I am all in favour of good standards. Indeed in a funny sort of way I can understand the need for consistent proper standards in such a basic area of patient safety, and like any proud profession we should be jumping at the chance to trumpet our safety standards to our patients. Ok, so maybe  we can argue about the science behind it all, but there is an irrefutable logic.  

If the only way to sterilise is to have a validated process , then the only way to wash and disinfect, given the huge variety of human skill and competency, is to use a….washer drierPatently it does not fix the problems of the world and self evidently they are pain in the neck in the cottage industry of compact, no-free-space practice.  But there is a logic to the need for some such technology if we genuinely believe in profession wide standards.  The clever bit would be to combine science and evidence with the technological, low cost outcome. But then again, when was the outcome of a Government Department ever to be regarded as clever?

So what happens if in 2015 another 10% of the profession - 1500 practices give or take - use the best practice espoused in HTM 01-05 [2013] to argue that they can longer, as independent businesses who must put the safety of their patients above any business need [cf GDC Guidance]  decide that compliance with the HTM protocols requires the practice to operate outside the NHS?

For sure it seems that it will be down to practice owners to fund any compliance – and it seems unlikely that there will be any Scottish methods of grant based funding from the English side of the border. Wales is an interesting area though – and we shall see how they handle the matter. Across the water is also a different climate of political process.

So maybe the true unspoken purpose of HTM 01-05 [2013] is to force upon dental business owners s who may be eeking to equip a practice such onerous costs that they may prove  unsustainable under the nnGDS, but perfectly manageable for for a future outside the NHS?

Many of us have been saying that for years. Maybe as we come out of recession another cycle of the private practice life will begin. 

Exciting times, eh Caruthers?  And what was paragraph 2.4 l-Lima?

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The Iron Lady went to the dentist

Mrs Thatcher went to her dentist. As she lay back she asked, “Now Dr Rill – may I call you David? How are  things going? Do not spare me – I am here to listen”.

 The dentist proceeded to let her have it in true Exocet style. 

“Mrs Thatcher, I run a micro business, it is my business and I get no subsidy from anyone.  I pay my taxes and employ my staff. I am the most efficient arm of delivery of Government policy. The banks lend me money which I pay back. The dental laboratories rely upon me for my dental work and their businesses in turn. The dental supply businesses rely upon my successful business and the investment I make in this new chair for example.

 So why are you lot attacking me and my colleagues from all angles?  It almost like politicians are jealous of all we do and all we achieve.

I have to pay £800 to the CQC to tick a load of boxes. We all know how efficient they are – they could not find a rabbit in a phone box, let alone a dud practice. They do not change anything about what I do in day to day practice.  What they do is create a heavy load shelf full of manuals.

We have to pay to be CRB checked before we even get to work [or whatever they call themselves today – barely worth the expensive anti fraud paper it is written on . And remind me – how many dentists have assaulted their patients?

Your Department of Health has produced the HTM documents , and in dentistry we have HTM 01-05 which others clutch at as being as though handed down from the Cross Infection God when in reality they are merely the assembled. Remind me … how many patients have dentists infected or killed?

Now we have a new NHS and no one knows how it works or who to write to for queries.   Meanwhile our UK graduates cannot get NHS Provider Numbers and are unemployed , God help us, without undertaking first year post graduate training [so called FD1] but our EU colleagues can by and large waltz in and start work unhindered by such detail.  This is madness, sheer madness.

There is a new NGS contract being piloted but the CDO  has gone off to NHS England to enable all the changes to the NHS – so there is a feeling of impending worse chaos down the line as once again those of us who are the most efficient contractors  the Government has are once again expected to squeeze an impossible litre out a 100ml bottle. The DH expect us to believe that all is hunky dory with selective statistics when you and I know that extracting children’s decayed teeth is the third commonest reason for admissions for Gas & wrecking hospital paediatric plans  It simply cannot go on Mrs T. The Big Lie of successful politics in dentistry is getting Bigger.

We have a GDC that seems to be seeking to grab practitioner by the nether regions and is chucking unlimited amounts of money at their cases, which seem to consist of one charge and 20 charges in the “and another thing” classification of i-dotting and t-crossing. Meanwhile any Tom dick or Harriet sets up a whitening parlour and simply snubs all and sundry with two very white fingers. And don’t get me started on Dental Nurse registration which is by any description nothing more than a tax on employment.

Now Mrs Thatcher, I do not need to remind you that we need each other, and in particular you need my skills with a local anaesthetic.

What we need is a proper recognition that dentistry is the original Privatised Industry – we lead the way and you lot are trying to stop us.

What do you say, Mrs T?”


As Mrs Thatcher fell asleep, she murmured “Leave it with me Dr Rill. I will see what I can do”

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Anthony Kilcoyne

Mrs Thatcher visits the Dentis...

Wouldn't it be great IF we could have direct and unfettered access to the Top? I think if they could hear us, they would empathis... Read More
Tuesday, 09 April 2013 09:01
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A Fold for a Flock of Sheep or a Den for a Wolf Pack?........

Many of you will have noticed a worrying discussion occurring in GDP UK. The obvious stress and uncertainty of professional life at the various levels of practice in dentistry appears all too often to take an invisible toil.

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Anthony Kilcoyne

BDA and bold comments like NHS...

A very interesting article about the BDA. I suppose the main point from the diagram is that whilst all Members are placed at the ... Read More
Wednesday, 27 March 2013 09:01
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Range of opinion

The first in a series of blogs by this writer, covering all the wide range of topics which are current in UK dentistry.
Enamel Prism is a dentist in practice in the UK, involved in hands on work as well as education.

Any one who casts an eye around the virtual dental world will sense that the heat of practice is growing. A junior colleague on another site is struggling to understand how he interacts with his colleagues and whether a whistle needs to be blown. The argument for and against the benefits of CDT based denture treatments seems to have pricked a conscience or two. And now we have an interesting discussion emerging about the idea of private gaming.

It seems that whether you are trying to make the NHS work in day to day practice or are in patient-funded private practice, there is a wide range of opinion about any circumstance - clinical or administrative. Those of you of a confident age value that very opportunity to be 'individual'.

The beauty of the profession of dentistry is that it accommodates a wide range of characters with a wide range of opinion which by and large marry a wide body of patients in a mutually satisfactory manner. That range of opinion is the very essence of professional practice.

It has always been difficult for dentists to be consistent in their approaches and their activities. But suddenly it seems that the width of the zone of acceptable opinion may be narrowing. Are we witnessing a profession wide loss of tolerance?

Perhaps the unexpected outcome of a long recession , regulatory changes by the truck load, and an uncertain Government commitment, allied to the perverse certainty of uncertain but major change, is that we have all become a bit too twitchy - in planning our self-defence, maybe the trigger is a little too light. A word or warning to all, though: there is a fine line between a healthy difference of opinion and infighting. And we all suspect we know which way the Government would like things to develope, so that they can slide though their changes of choice.

Calm down dears, its good to differ. But let's remain allied in professional friendship and mutual respect.

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Closing Ceremony

The Closing Ceremony will already be getting reviews in the press by now, generally very positive but it's also difficult to please all viewers I guess.
From my perspetive we got to see the preparations beforehand, on a vast scale, with the blue bowler hat light-bulb people numbering over a thousand alone.
The Athletes also have to be lined-up in the village then pass-over to the Olympic Park away from public access points. I was fortunate enough to be helping with this on the night, though it does mean missing the actual ceremony within the stadium, which starts before we have even got the athletes over there and ready. Again there was so many of them I even needed to hitch a ride in the police buggy to get from the end of the moving line to the beginning before they reached the Stadium!

Once there they entered through the audience, with much music, pomp and celebration and of course the obligatory firework display near midnight.
Awesome is a word used a lot for these London 2012 Olympic games - it's not difficult to appreciate why!



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