The GDPUK.com Blog

All that's new in the world of dentistry
FEB
28
1

I think I’ll go and eat worms

I think I’ll go and eat worms

“Nobody loves us, everyday hates us, think I’ll go and eat worms. “

Sometimes listening to discussions between dentists at my speaking events, or reading the opinions voiced online at various forums I have to wonder about the dental mind-set. There seems to be a dominant attitude that if there’s a way of seeing the worst in things they will.

It is understandable for dentists to feel unloved, let’s face it we’re hardly the most popular of professions. Very few others, even in medicine, routinely carry out potentially painful procedures in such a sensitive area with the patient supine and their airway exposed - rubber dam or not.

Dentistry can be an irritant both physically and financially; nobody leaps out of bed in the morning saying, “Excellent! Dentist today! I do hope they find something challenging to test their ability so I can lie there for an hour or two and then pay for the privilege.”

No wonder that more and more dentists choose to spend as much time as they can on such minimally invasive treatments as whitening and “short term orthodontics”. No drills, no needles and a result that the patient can see is a definite improvement, what’s not to like?

Perhaps social media has made things worse. Reading some of the “I’m more miserable than you, my life is worse than yours” Facebook postings recently has made me wonder if previous generations were more resilient or perhaps were better prepared for a lifetime of dealing with, “I hate these places” as a new patient’s open gambit.

In the pre-internet days the only place for dentists to share their misery was the local post-grad or BDA meetings. There the young bucks (yes, usually male) boasted about their gross whilst their more senior colleagues complained about anything and everything from the new practice down the road (unless the principal was present) to the price of alginate.

I recently I asked a group at a meeting to share what advice they would give to young dentists. Top of the list were “emigrate", “go part time” and “don’t be afraid to leave". This does point to a pretty low state of morale.

Everybody else thinks they know about Dentistry. Politicians, medics and now venture capitalists all believe that there are simple ways to “sort out dentistry”. The result is usually a few corners cut that are perceived as unnecessary by bean counters. So far few, if any, have succeeded in improving clinical care.

Add to the mix the dramatic reduction of dentists who have “skin in the game”. By this I mean the fall in partners and owners from 45% to 17% in general practice. This drift is taking us towards a situation where, in NHS practice anyway, associates are one court case away from being classed as employees. It also has a knock on effect on morale. If you have little or no say in the way your (work)life is being run and you feel like a cog in a machine then it does make it hard to feel valued.

I do wonder if the profession does enough to help itself.

As individuals dentists are often insular and divided, unlike medics we are not taught to be part of a bigger team, and are unable to see the greater good. Writing in “The Advance of the Dental Profession - A Centenary History of the British Dental Association”, N.David Richards noted that in the mid-nineteenth century there was a large group of “dentists” who attracted patients by blatant advertising. He also stated that, “at that time the vast majority of dental surgeons practised exclusively for their own individual and financial interests”.

One hundred and seventy years on I see some similarities. The dramatic increase in marketing and the insularity of many dentists come to mind. The rise in dentist-initiated referrals to the GDC says little good about those involved.

The profession has been played by government over the past dozen years where limited contracts have seen practices willing to join in a race to the bottom by undercutting their colleagues. There is little unity it seems except in complaining. The mantra of non-BDA members is “what has the BDA ever done for me?” Sadly there are too few willing (or able) to join in and serve, rather waiting on the sidelines for the benefits for which the members pay. The BDA has many faults and, by virtue of the inherent conservatism of its membership, tends to serve the late majority rather than be led by the early adopters.

Dentistry is a profession that is full of intelligent, flexible and adaptable people who are skilled at carrying out procedures that influence patients’ quality of life. They work well to deadlines and can make instant decisions (usually correctly).

In her research in the 1980s Helen Finch concluded that the majority of people don’t like dentists as a profession but do like their own dentist. Instead of running scared of those who tell us that the sky has fallen in, we ought to embrace the respect that has been hard gained and exploit it. No, the GDC, CQC won’t do it, the DoH won’t do it, the BDA tries but can’t do it, the only people who can do it are individual dentists and their teams. It’s time that all dentists celebrated what they do, shared the fact that they are far more than the hackneyed drill & fill merchants and started to actively convert their patients one by one to the benefit of good dental health.

If not decide how you want to eat your worms.

 

 

  4401 Hits
Recent comment in this post
David Chong Kwan

Right on my mood today

You are not wrong. Nils desperandum. https://www.youtube.com/watch?v=XdFkTk3BThA... Read More
Wednesday, 28 February 2018 10:24
4401 Hits
MAY
31

Providing popular implant surgery with dental referrals | Tim Bradstock-Smith

Providing implant surgery with dental referrals

Tim Bradstock-Smith from The London Smile Clinic shares his thoughts on the increasingly popular field of implant surgery and how dental referrals can help you and your practice...

Although traditional dentures still have a place, implant surgery is fast becoming an indispensible part of mainstream dentistry. Global forecasts suggest that Europe will continue to drive and dominate the area of dental implants and prosthetics until at least 2018.[1] What’s more, the current economic recovery is likely to see a further push and market expansion.

Successful restoration for an edentulous patient takes both functional and psychosocial adaptation, but their self-confidence is significantly enhanced[2]  by their resulting satisfaction with comfort, function, appearance and health. When compared to conventional complete dentures, data has provided scientific evidence of an improved quality of life after dental implant therapy.[3] Implants are much more convenient for patients and offer improved appearance, looking and feeling like natural teeth. Additionally, patients with positive self-esteem have been shown to experience significantly fewer physical health symptoms[4] and some researchers have gone so far as to suggest that the larger your smile, the longer you may live.[5] Whichever way you look at it, successful smile restoration has both physical and psychological benefits for patients.

The medical advantages of implants are that they help to prevent bone loss and actually stimulate growth to maintain the structure of the face. Also, well-maintained implants placed into adequate bone can be expected to last for many years.

Replacing or restoring missing or damaged teeth with virtually undetectable implants can be a complex procedure. However, it can be extremely rewarding for dentists who are able to not only produce a beautiful smile, but also raise patient self-esteem and confidence.

Successful implant surgery requires considerable attention to detail, outstanding accuracy and a comprehensive set of surgical skills acquired through on-going training and experience. Specialist technology and imaging is also needed to plan and execute implant treatment meticulously, ensuring optimal placement.

One clinician or indeed one practice may not have all the technology, space or the surgical skills required to provide the scope of treatment necessary for all implant surgery, particularly if a practice already provides specialist treatment in an alternative field of dentistry. Equally the patient demographics of the area may not make it financially worthwhile to support this provision. In addition, the training and education clinicians require to place implants successfully takes a significant amount of time as well as expense and often, if this knowledge is not used regularly, it is difficult for practitioners to maintain the skills required to achieve high quality work.

Even when a clinician is qualified to undertake implant surgery, there are still cases that require more specialist surgical skills with treatment sites that require advanced preparation or enhancement before implant surgery can take place. Some cases will require socket augmentation procedures, for example, or advanced regenerative procedures such as guided bone regeneration, bone condensation, ridge splitting, particulate grafting, autogenous block grafting, sinus augmentation, connective tissue grafting and further special methods such as inferior dental nerve lateralisation and distraction osteogenesis.

However, successful implant surgery can be still be delivered by suitably experienced clinicians or specialists in a team approach.

A centre of excellence such as London Smile Clinic provides a referral service to practitioners to undertake implant procedures on their behalf. Dr Zaki Kanaan is a highly trained implantologist, who will work closely with you to form a team, ensuring the best possible results for your patients. Whether you wish to refer more complex cases to Zaki or just refer out part of the overall treatment, the team at London Smile Clinic will keep you informed throughout the procedure. The patient will then return to you for continued treatment or on-going maintenance and care. London Smile Clinic prides itself on delivering a 5 star service and first class dentistry, and referring dentists can be confident that their patients will be in safe hands.

Keeping up in an ever-advancing industry can be both expensive and problematic. Equally, patient expectations are now much more forward thinking with an increase in people wishing to undertake corrective or cosmetic procedures.[6] It is not always possible to provide all services individually but by making use of the technology, facilities and skills offered by referral practices, it is possible to extend your areas of expertise and professionalism to enhance your treatment provision. In doing so, patient satisfaction and confidence is improved and as a result, these patients will return to your practice time and time again.

For more information, please contact 020 7255 2559 or
visit www.londonsmile.co.uk/refer

 



[1] Millennium Research Group (MRG), the global authority on medical technology market intelligence - http://mrg.net/News-and-Events/Press-Releases/European-Markets-for-Dental-Implants-072811.aspx#sthash.GPLy1315.dpuf [Accessed 11th February 2015]

[2] The psychosocial impacts of implantation on the dental aesthetics of missing anterior teeth patients

P. Chen, S. Yu & G. Zhu. British Dental Journal 213, E20 (2012) Published online: 7 December 2012 | doi:10.1038/sj.bdj.2012.1090.

[3] Roman M. Cibirka, DDS, MS a, Michael Razzoog, DDS, MS, MPH b,  Brien R. Lang, DDS, MSc. Critical evaluation of patient responses to dental implant therapy. 

[4] Antonucci TCPeggs JFMarquez JT. The relationship between self-esteem and physical health in a family practice population. Fam Pract Res J. 1989 Fall-Winter;9(1):65-72.

[5] Ernest L. Abel and Michael L. Kruger. Smile Intensity in Photographs Predicts Longevity

Psychological Science, April 2010; vol. 21, 4: pp. 542-544., first published on February 26, 2010

[6] Adult Dental Health Survey 2009’, Health and Social Care Information Centre, published 24 March 2011

 

  3327 Hits
3327 Hits
DEC
30
0

What's coming from CQC

What's coming from CQC

You’ve got CQC hindsight, but have you seen what’s coming?

The CQC have ‘Fresh Start’ plans for us in 2015        

It’s part of their strategy for 2013-2016, Raising standards, putting people first).

They are more focused than the previous ones and inspectors will be more

experienced in assessing dental practices.

The new standards are divided into eleven Fundamental parts. 

Fit and Proper Person (Directors) and Duty of Candour are 2 new standards.

The CQC have also beefed up their enforcement powers, meaning that they

may not give you a warning before they prosecute.

 

How do the old ‘Outcomes’ relate to the new Standards?

The simplest way to explain this is for you to complete my CQC survey: https://www.gdpuk.com/index.php?option=com_rsform&formId=57 and then I will send you an explanation of how to relate the old CQC to the new CQC and the new (ish) GDC principles. I will also send you an explanation of what the ‘Key Lines Of Enquiry’ (KLOE) is all about and how it will be applied in April 2015.

What effect have the CQC had so far?

Many of you kindly told me about your CQC thoughts in my survey, (see link above) which is still running.       By sending it back to me, you will now know what or who KLOE is. The CQC inspector will use these KLOE’s to guide the inspection process and make a judgement. The CQC still haven’t decided about publishing these.   

I have summarised what you have told me so far from my surveys and will be discussing them with the CQC. We may yet be able to have a sensible regulator looking at the right things in an intelligent way.

My prediction for 2015 is that FEES, Cosmetic dentistry and dermal fillers will also come under the spotlight.

Brief analysis (from 76 surveys)

I have used this as a pilot survey to determine whether there is a need to gather more information on how well the CQC registration and inspection process is received and what the beneficial effects may have been in driving improvement.

I think relatively few will have experienced re-registration and therefore a low %age answering YES to Q1 may be expected. However it is disappointing to see that 48% still felt that the process has not been made clearer. 

There continues to be much confusion over legal entities and I know (from personal experiences of clients that this is still a problem now, 76% of respondents agree.

 

81% felt that the inspection was not structured to reflect dental practices; even higher (87%) saying that the nuances were not understood and many said that a dental adviser is required.   

It seems that few felt that they understood what the CQC expectations are regarding safe, well-led and managed practices. I was particularly pleased that our own clients were in general more ‘upbeat’ about the potential benefits of CQC compliance and also felt more empowered and knowledgeable (judging from some open question comments).

The open questions were designed to test whether the process of declaring ‘compliant’ 48 times in the original application had sparked an interest in them to get things done before inspection, just in case. It seems that this was the case in as much as 72% said they had done some things, although I need to look more closely at this figure because some of what was said was fairly minor ‘window dressing’ was one comment.

The most significant results I feel were relating to the perceived benefit of CQC registration and inspection.

The positive improvements noted by patients and staff reached only 14% and the consequential improvements to the business reached 21%. Finally regarding your additional thoughts, there were many suggestions and yet only 6.5% of these were positive. I have concluded that an improved and much larger survey spread amongst a wider audience is required.

OK, so what?

From April 2015, CQC inspection reports will look quite different. Instead of considering just 4 or 5 Outcomes; the inspection will be constructed in a different way to test whether your practice clearly demonstrates that it is safe, caring, responsive, effective and well-led? A CQC inspector has described how the new process enables them to ‘get under the skin’ of the practice and see what is really happening.

Safety is now considered of paramount importance following on from the terrible instances of poor care graphically illustrated in the past few years. Although the CQC had considered that dentistry was relatively much lower risk; there was a severe jolt to this belief recently in Nottingham. The GDC are also convinced that there are also still much greater problems within the Profession. So it is my guess that safety will share top billing with being well-led.

It is hard to imagine that a well-led practice would be unsafe or that there would be many unresolved complaints or that there is a high staff turnover or patients don’t have fees explained properly.

RightPath4 can provide a system of governance mapped to 2015 CQC requirements which is simple to implement and does not cost £thousands or run to thousands of pages. It is easy to bespoke it to your practice and use as an important part of your practice meetings and induction. We have a unique template tool which helps you give confidence to the CQC that your practice is safe, caring, effective, responsive and well-led.

In the next blog article, I’m going to discuss how the CQC are going to assess and inspect in 2015.

Here’s wishing you a Happy, Healthy and Prosperous New Year,

Keith Hayes BDS

Clinical Director www.rightpath4.co.uk This email address is being protected from spambots. You need JavaScript enabled to view it.

  5719 Hits
5719 Hits
MAY
27
0

Are you Independent?

Are you Independent?

Welcome back from the long weekend, now just a few weeks to run and you can all zip off to the sun again  smiley

 

Monday  was perhaps the new Independence Day, as the Euro results poured in. I worry that this word 'Independence' is being politically hijacked

 

So:   Are you independent of mind and decision? Really?  Truly?

 

The EU elections this weekend have thrown three major GDPUK topics into a shaft of light.

Those of you who gaze from a distance at the sheer energy of some of our more vocal members will have notice three threads of great length. One touching on that supposedly untouchable subject, matters of belief and faith, while another has been exploring the issue of the Scottish vote on Independence due to take place later this year. 

Combined with the now famous histrionics of the orthodontic thread, you would be forgiven for having pressed the ‘snooze’ button.

 

So wake up at the back.   I want you to answer a question for yourself.  What does being independent mean to you?

 

Mr Farage is celebrating scoring some points in what is normally a three horse race, by arguing for the UK’s independence, and arguing against the £12Bn net spend to the EU every year.

As dentists, we pride ourselves on being independent – in practice, in thought and in action.

Ask 10 dentists a question to which the answer is Yes or No and you will get 20 different answers.

 

But are we independent? Really? Truly?  Where is the fine line between that and bloody mindedness?

 

If you practice under Government funding in any of the 4 parts of the UK, do you really feel independent? Or are you reluctantly beholden to how someone else wants you to help and practice dentistry for your patients against your better instinct??

If you are in private practice, are you one of those for whom the next big case is always the one to clear the overdraft?  Therefore you are always on the lookout for some poor soul to benefit from your great skills? Or perhaps you feel you cannot practice good dentistry because of a limited private capitation funding stream not of your making?

We even have this long abused concept of Independent Practice, as though “Private Practice” could be rude and insulting perhaps?  Will the BDA rinse that off for the next batch of unknown NHS England contract changes, I wonder?

Perhaps independence of thought and action is actually impossible without feeling pressurised or being selfish.

 

Cooperation over independence?

 

What dentists are masters at is cooperative action.  We run or work within highly efficient micro businesses and at a moments notice we can adapt and cooperate with whomsoever requires our skills and time.  The CQC roll into town – we change and adapt.  A patient arrives – we change and adapt.  New staff requirements develop - we change and adapt.

Long may this be the case because with EU and Scotland and a General Election, the next 18 months are going to be interesting.

That old French phrase has come to life.  Plus ça change, plus c'est la même chose.

Strangely while everything around you seems to be up in the air, it takes a very strong sense of independent spirit to simply wind the windows shut and focus on your patient needs with one hand while with the other you change and adapt

So that’s why four-handed dentists have developed !!

 

May your June be flaming. Ta-rah for now, fellow enamel warriors

  4817 Hits
4817 Hits
NOV
21
0

The Tooth Trip

The Tooth Trip

I was surprised to see the advice we give our patients has not changed much in over 40 years! I am reading a book called “The Tooth Trip” that was written by dentist Thomas McGuire in 1972; he describes the same prevention based dentistry we practice today. This book was written for the public to understand oral diseases and their role in preventing it.

Some of the book is way off the mark with recipes for making homemade toothpaste with Sage, Myrrh and powdered roots. Making toothbrushes from twigs and sticks does not sound like the best use of an hour of your time. What resonated so strongly with me was the descriptions of self-examination of your mouth and emphasis on prevention and working together with your dentist. A whole chapter was on dental emergencies and what constitutes a real emergency- severe or recurrent bleeding or severe pain not relived by painkillers. Just getting your patients to read this chapter alone would save thousands of wasted dental appointments. There was sensible honest advice on how and why teeth can hurt and how you can prevent it and work together with your dental team to stop it recurring.

In our modern age, if we educate our patients in the causes of dental disease and how it is entirely preventable, they too could have healthy mouths and lower dental bills. Despite the fact that most of this information is freely available on the internet or in the leaflets that some dental practices give out, not much has changed. Why is that?

I feel that until the information is specifically tailored to our patents and they can see the benefit from following that specific advice, they will switch off. If you promote the fact that you fix teeth, they will just come and expect you to fix them. This is where modern dental teams come in. We need to genuinely listen to our patients, do not interrupt them, let them get their whole story out. Examine their mouth, show them the evidence of disease in a clear and non-judgemental way. Explain their options and how as a team, you can return their mouth to health. Make them understand that without them, all your treatment will fail. Spending extra time now will save hours of treatment in the future and help educate a generation that loves going to the dentist. All good dentists want their work to be appreciated and to last a life-time.

Four Dental sins from the 1970’s that Dentists still do to this day:

1. Leaflet avoidance. Handing your patients reading matter to explain your treatment and asking them to go home to go through it. Nothing beats a face to face discussion where you allow them time to discuss their personal fears and questions. Leaflets should be only a back-up once the conversation has taken place.

2. Technical jargon. Using dental terminology or complex words to explain your diagnosis and treatment. All professions have jargon. The skilled dentists explain it in a language that that specific patient will understand.

3. Carrying out treatment whilst discussing the patient’s options. No-one can fully concentrate when lying on their back with theirs mouth open or having treatment carried out. Stop, sit the patient up and have a face to face conversation.

4. Bulldozing. Talking it through you your patient until they are worn down and just say yes. Nothing is life or death that you need to decide there and then. Place a temporary filling and then explain the options; pros, cons and cost. Then let them go away and think about it.

 

How are you going to make the most of your patients next tooth trip?

 

Photo by Jenn Durfey, licence info

 

 

James Goolnik is a practising Dentist and his book “Brush” donates 100% of the profits to Dentaid. He recently led a team of 8 dental professionals to Malawi to install two dental chairs, equipment and deliver skills transfer workshops from these proceeds. He is a trustee of the charity “Heart your Smile”.

 

www.jamesgoolnik.com


 

  19580 Hits
19580 Hits
JUN
14
0

LDCs: BDA will seek your backing for ‘New Contract ‘ ….

Well, the summer has been, and the summer it would seem, that fickle season of the North, has gone. The suntan is rusting, but the LDC fortunately met indoors, by and large, if one ignores the lightning strike hazard of the Golf match.

It intrigues me that Denplan are the Platinum Sponsors of this quintessentially NHS aimed representative body.

It is almost as though Denplan see themselves as the ethical side of ‘mixing’.  I mean… what can THEIR interest be in the machinations of turgid DH driven change?

But perhaps the biggest news to come out of the LDCs appears to be the wording on Page 12 in respect of the 2012 LDC Motions . An informed reply elsewhere on this forum pointed out that the GDPC are obliged to act upon any LDC Motion, and one assumes therefore that given the serious nature of such motions, any reply issued on behalf of the GDPC will carry due authority and weight.

Such is its import that I have taken the liberty of quoting direct from the LDC 2013 papers at http://www.ldcuk.org/documents/doc_download/142-2013-ldc-conference-papers

 

LDC Conference Motions 2012  GDPC Activities

Birmingham LDC motion

This Conference believes that, …, the Department of Health cannot be trusted to install a new dental contract with thetrust of the profession.

GDPC Response:

GDPC understands LDC Conference’s view but … will continue to ensure that the voice of the profession is represented during the formation of any new contract and will not offer support to any new contract without the backing of the profession.

 

So your heard it here first.

The GDPC will not offer support to any new contract without the backing of the profession.

 

Which to my mind means that some form of personal opportunity to say yea or nay to the New Contract is assured.

 

NHS Bullshit Agency?

Maybe you should renew that BDA Membership after all? You are only 2 weeks late.  Which of course is nigh on criminal in the minds of the CQC Factoring Agency [NHSSBS] who seem to have installed a CQC fee collection system which makes DVLA look positively benign.  When the CQC phone you, simply say you have passed your invoice to your accounts office who  “No, you cannot contact”. Or tell them to get lost! 

 

May your June continue be flaming.

 

  18503 Hits
18503 Hits
MAY
13
1

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.

 

  35321 Hits
Recent comment in this post
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
35321 Hits
MAY
08
0

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

Continue reading
  7600 Hits
7600 Hits
APR
28
0

Health & Safety Quiz

Continue reading
  9636 Hits
9636 Hits
APR
24
0

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.

Ref:
https://www.gdpuk.com/news/latest-news/1254-direct-access-decision-misguided-says-bda
http://community.bda.org/forums/p/5406/9295.aspx#9295

  36244 Hits
36244 Hits
APR
15
0

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?

  50512 Hits
50512 Hits
APR
09
1

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”

  25958 Hits
Recent comment in this post
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
25958 Hits
APR
01
3

Direct Access - threat or opportunity?

 


Ta DA  -  here it is folks.

Roll up, Roll up, it’s the finest oil you can buy.

What a week!

Well, what a week it has turned out to be. Just as the BDA go all inclusive on us, ‘inviting’ membership of this august Trade Union-esque body at various levels, they go all protectionist on us with their latest missive [1]. Maybe they are modelled on the old dinosaur Unions after all? What on earth are they on about?  If ever there was a bullet in the foot, this latest BDA tripe is worthy of ribald derision. Whether this stance will prove a monumental cock up or success will of course remain for the future to know.

It all started of course with what many might consider to be perhaps one of the earth shattering weeks in the history of the UK dental profession.   

Actually, not true: it all started with the OFT report of 2012[2] in which the threat of a full market review was hung over the profession and the GDC. The condition for its NOT being actioned was, amongst other things, the opening up of access to DCPs.

The GDC of course like being a strategic body. But I am sure they felt like a rabbit in the headlights of the OFT and an academic onslaught from Dundee, Manchester and Kent.  

With too many opinions to be able to “lead”, they did the classic “Large Committee” thing and sat on the fence examining their navels, asking the whole world what they thought about something of which they had not heard [Evidence Based Policy[3] …  hmmm ]  and then promptly fudged through the Direct Access changes come what may despite many shortcomings and misgivings.

This was not, it might seem, because they genuinely felt it was an appropriate release of professional skills.  It seemed that they were more concerned that having built up such a head of advance steam with the various reports and consultations that the only release was DA at any cost of any sort. Just get the OFT off their backs …

So what have we got? 

Well, on Easter Tuesday, not much has changed. Relax mes amis. 

 

Go to work and start to think about it.  As of March 2013 there are 38777 registered dentists.  There are 6265 hygienists and 2077 therapists, and encouragingly all have a known gender.

 

In practice I simply cannot see how DA will change much – other than oiling the wheels of efficient Dental Health Maintenance.  The need for a periodic dental examination to simply re issue a prescription for care can be eased back – who knows to what interval? Would a 5 years examination be acceptable in the presence of a trail of DA Maintenance by a DCP?  

 

If I were a Clinical Dental Technician I would feel I had been shafted and ignored – but since there are only 230 of this rare breed, I sense they were trampled by the rush. It seems they may be doomed to remain a niche business – but good luck to them for they are a light of success in many cases.

 

But in a fine example of joined up Government there remains the lack of freedom to prescribe simple analgesic drugs for placement in the mouth – how stupid can they be? If ever the GDC missed a trick of leverage, it must be here. Still I am sure it is high on the MHRA’s agenda.  Yeah, right.

DA is a bit like all the hype about 4G mobiles – it would be nice if they got 3G working everywhere first.  The OFT and GDC “selling” DA as “the next big thing” seems to have a whiff of snake oil about it if you ask me – and I work closely with a hygienist so declare an interest.

On the other hand, that occasional comprehensive examination by a dentist will now become a full works task – full charting, full mouth photographs, appropriate radiographs, TMD and parafunctional evaluation, aesthetic discussions, orthodontic review – you get the idea. 

Every Challenge is really an Opportunity

Maybe suddenly the periodic dental examination is actually a marketing opportunity to add value instead of down selling a simple “check up” [Don’t you HATE that phrase anyway ?]

But for the 6500 odd practices who employ DHs and DTs, little will change. In house protocols WILL change but surely this will be to the benefit of all involved. Patient care will become better for being seamless. Surely even the BDA can see that?

Will DCPs be rushing out to start their own practices – well not without substantial access to the capital funds required. And I cannot see HMG suddenly discovering a pot of money in the next 10 years.

Will DCPs now be able to obtain a Provider Number from the NHS Commissioning Boards? – well, there is an interesting prospect.  Because many might feel that this OFT driven change by the GDC is barely worth the paper it is written on without such a possibility.

Will the long term NHS Access strategy be to allow access to employed DCPs in enhanced outreach?  While many would see that as a very positive step [just thinking of the Scottish model] that raises issues of employment such as access to the NHS pension.

Perhaps what is clear is that there remains a conflict between the many thousands of Practice Owners and how they lead their teams, and a very small cadre of Dental Academics [4] who, seeming to have the ear of the CDO and his DH advisers, are re-writing the agenda for the provision of State funded dentistry.

It’s simple guys and girls:  Stop panicking like headless chickens and take a chill pill.  This “DA” seismic shift is fantastic news but not in the way the Government would like it to be.

The market is no sensibly estimated even by the OFT at £7.2B, and Private Practice is now £3.88B and rising. [Why the OFT excluded the ‘cosmetic element ‘ of £1.47B remains a political mystery – I don’t think so!] [5]

The Business of Dentistry needs DA to develop proper dentistry in high investment, high technology ultra professional Private Practice while the Government and its academic luvvies merely fans the flames of Rome-like “access” while living the NHS Big Lie of “Problem, what problem?”

 

 

Private practice needs DHs and DT more than the Government will pay them, and so exactly how will DA help Government policy? Well, it won’t and by the time the next Government start installing the next contract, dentistry will be up and away and the NHS offering will be sidelined to a minority social backstop.

 

I put it to my assembled colleagues: in the classic event driven by The Law of Unexpected Consequences,  Direct Access alongside the New Contract   will be  the death knell for Government management of NHS Dentistry because Private Dentistry will make better use of the work force and skill mix , more efficiently  and more  quickly than anything the DH can achieve. And it will pay better.

 

Finally we will have a core service indeed from the DH.

 

It is perhaps a shame that the apple is rotten.

 

[1] http://www.bda.org/news-centre/press-releases/41760-direct-access-decision-misguided-says-bda.aspx

[2] http://www.oft.gov.uk/shared_oft/market-studies/Dentistry/OFT1414.pdf

[3] http://www.gdc-uk.org/Newsandpublications/viewfromthechair/Documents/Evidence%20based%20policy%20Feb%202013%20Final.pdf

[4]  The OFT has had detailed discussions with a number of academic experts from dental  schools in England and Scotland, including Manchester, King’s College London, Leeds, Newcastle, Kent, Surrey and Sussex Deanery and Glasgow. The consensus among these experts  is that direct access can be implemented without compromise to patient safety and is necessary in order to make dental provision more efficient, effective and flexible for the patient, with benefits to be gained for the profession as a whole

[5] From the OFT Report 2012 - 'Dentistry UK Market Report 2011', Laing and Buisson, page 4.
The estimate that the dentistry market is valued at an estimated £5.73 billion a year is for 2009-10 and does not include cosmetic dentistry. The value of the dentistry market including cosmetic dentistry was estimated as £7.2 billion in 2010 according to 'The UK Dentistry Market Development' Market and Business Development (2010)

  53629 Hits
Recent Comments
Anthony Kilcoyne

Ta Da - Direct Access actually...

There are still issues to be resolved for Direct Access, which is really Wider Access for some DCP groups limited to their Scope (... Read More
Tuesday, 02 April 2013 22:39
Chas Lister

So where next

interesting points AK with which one can but agree surely, and of course I am conscious pf your official standing too. What about... Read More
Tuesday, 02 April 2013 23:42
Anthony Kilcoyne

Socially deprived Pro Bono?

Whilst this SHOULD be the job of the NHS system, like a lot of Charities are finding in a recession, HMG simply cannot cope and de... Read More
Wednesday, 03 April 2013 00:48
53629 Hits
MAR
27
0

Will profession have to face more uncertainty?

 

MP Jamie Reed put his foot in his mouth this week when asked about a Parliamentary question. His comment suggested he thought that patients can register with an NHS dentist in England, when this registration concept and payment for registration was removed by a Labour Government in 2006 when the present GDS contract was imposed on the profession and patients.
 
 
Continue reading
  27575 Hits
27575 Hits
MAR
20
0

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.

  15786 Hits
15786 Hits
AUG
14
0

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!

 

 

  11628 Hits
11628 Hits

Please do not re-register if you have forgotten your details,
follow the links above to recover your password &/or username.
If you cannot access your email account, please contact us.