In the first of her new series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses common legal pitfalls in the business of Dentistry.
In the first of her new series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses common legal pitfalls in the business of Dentistry.
Believe it or not, it’s just over ten years since the CQC came into being.
I know! It doesn’t seem five minutes since the CQC burst into existence. Sometimes it seems like it’s been hanging over dentistry forever - like the extended impact winter that wiped the dinosaurs out after that postulated asteroid crash-landed without warning – which was a bit like the CQC itself really.
In England, the CQC is the independent regulator for the quality and safety of care, although to many practitioners, it’s more regarded as a major irritant – another regulatory body to which you have to kowtow, pay an exorbitant fee and produce a forest’s worth of paperwork.
I vaguely remember that the CQC landed on dentistry’s doorstep in about 2011. I was a practice owner in those days and I remember only too clearly, spending most of my spare time writing policies to fulfil forthcoming CQC requirements and being too busy to notice I could have just downloaded them from the internet.
I didn’t have any direct contact with the CQC until I had to go down to one of the organisation’s regional headquarters in the Midlands, for the registered manager’s interview, sometime in 2012. I seem to remember then having to go again a few months later, when the bizarre individual who was about to buy my practice had to have his registered manager’s interview and we had to tell the CQC how we were going to effect the ownership changeover. Naively, I had thought he would simply give me the dosh, and I would skip over the horizon, happily whistling the ABBA hit, Money Money Money. But no, the CQC wanted to make it more complicated and we had to outline our contingency plans for provision of treatment if the practice was consumed by a flood or a volcano. I thought I’d made that clear at my first interview – canoes and a Dyson.
I finalised my practice sale in 2013 so I’ve had no real exposure to CQC fees since, but I seem to remember a registration fee of £1500 or thereabouts. I had a quick Google this morning and there nowadays seems to be a complicated formula for working out how much dental practices have to pay in fees, based on the number of chairs the practice has, and if you are insane enough to work at more than one site.
I remember that there was a lot of resentment among dental practice owners around
2011-2012 at the introduction of the CQC to the dental field. Many questioned the need for yet another authority to oversee the profession. We’d already got the Health and Safety Executive, the Primary Health Care Trusts (as they were then) and the General Dental Council. Did we REALLY need another?
Yes. We certainly did.
Over the 19 years I had my practice, I had only a couple of informal routine visits from an NHS dental practice advisor. Near the introduction of CQC registration, I had a visit from the area infection control coordinator (until that point I didn’t know such a person existed) to ensure we were complying with HTM-01-05. As it happened, we weren’t - a sink in the decontamination room was in the wrong place and we had to move it to comply with the rules. Apart from that, there was no real oversight of the practice. In most of my ownership days, we still had the random checks from the RDO where the Dental Practice Board would choose a few patients for inspection at the local correction facility (as I liked to call the community dental clinic), but that was it. What went on in your practice was very much your own affair. Nobody randomly checked to see if you were boiling the instruments properly in new saucepans, or diligently spraying the reusable patient bibs with Febreze.
As it happened (and it was probably more luck than judgement), apart from a few bits of paperwork we needed to spruce up, we were pretty near compliant before the CQC came-a-calling. But having worked in a number of practices as an associate before I bought my own place, I can attest that there were a lot of places that would have really struggled to come up to basic CQC expectations, let alone those required by the CQC.
I will describe ONE such practice that I worked at.
It was 1990 and I’d been qualified a couple of years. I joined an old established practice on the Cotswolds border as an associate. The practice had five surgeries and was manned by a husband and wife who were the owners, a long-term associate, a hygienist and moi. The bosses had taken over from two very old school and respected dentists, one of whom appeared to have been grandfathered on to the dental register from his primary job as a barber and blood-letter.
The practice was set in a grand Georgian terraced house, and once you went above the surgeries on the first floor, it appeared that the last vacuum cleaner ever to be used on the 2nd and 3rd floors, was the Batty-Fang Carpet Beater 1900. I never saw those floors during my interview, and neither did I see my surgery. When I turned up for the interview, my surgery was in use by the hygienist (apparently) and I couldn’t see into it, the door being solid wood. When I arrived for my first day of work, my surgery was decorated in the style of a 1940’s London Underground station lavatory. Every square inch of the walls, ceiling and floor were tiled in a faded turquoise and the pipes for the aspirator and services lay on top of the floor, presenting a tripping hazard to anyone entering the room. I found out later in the day that the practice was supposed to be haunted. The legend went that the house was originally owned by a well-to-do family and the man of the house had an affair with the housemaid, who I shall call ‘Flora.’ When it all went pear-shaped and Flora became pregnant and was shamed, she hung herself in my surgery (which was the kitchen originally – the fireplace was still in the one wall). Her feet would have dangled over the reclining headrest. It’s another story, but my associate colleague heard Flora singing late one night on the top floor, and truly I saw an outline of her brushing her hair through a window, one dark winter’s afternoon.
After a week I could stand no more. I discovered that Tanya the hygienist only worked in the practice two days a week and although not spectacular, it at least had an acceptable, if dirty wall-covering. I asked if I could swap rooms and poor Tanya found herself in the lavatory. She never thanked me. I asked the practice owners if I could decorate the room myself and at my expense. The bosses agreed. I did it in a nice bright pink and I put some decorative borders up. The husband came in first thing on the Monday after I had decorated, put his head around the door and said without a hint of humour: “It looks like a bleeding tart’s boudoir in here.”
Unfortunately, the equipment was as old as the building and the delivery unit was the size of a modest Buckingham Palace fridge and it was about as manoeuvrable as trying to get a Dalek up the stairs. It had polyoxybenzylmethylenglycolanhydride (Bakelite) control switches and buttons and piping that had been repaired by shortening so often, when you moved the drills in a patient’s mouth, the unit was dragged with it. In the two years I was there, I never saw an engineer come in to service the equipment (not that the spare parts were still made for the units). I’m sure it would never have come through a thorough PAT test with flying or even submerged colours. My unit had a dodgy connection with the handpieces and every now and then there would be an explosion of air and what remained of the air-tubing would fly off and snake wildly about the room like a twerking cobra. I point blank refused to have anything to do with fiddling about with the equipment and so my nurse would go and fetch the husband. I REALLY want to name him, but I can’t, so I’ll call him Boris. Anyway, Boris would invariably come with a pair of scissors in his hand and a cannister of sturdy floss, and tie the tubing back on to the handpiece coupling until the perished rubber broke again.
Fortunately, the CQC also ensure premises are safe and up to the mark these days. Boris’s place wasn’t. I doubt that the electrics of the practice had been checked since Thomas Edison was a lad. One day I was doing a full denture try in. I had just given a deaf lady a mirror so she could have a good look and the small, white, straight set up. There was suddenly a loud bang and a flash from behind her. A Bakelite electrical socket (without anything plugged in) had just exploded with no provocation. I jumped and my nurse shrieked, but the patient just sat there wondering if the shade was maybe a little bit dark. She even carried on looking intensely at the denture while Boris ran into the room behind her with a fire extinguisher and started spraying powder all over the place. I can’t remember off hand if the socket was ever dealt with afterwards. We were probably told never to use it again.
One of the worst incidents that happened at this place and inspired me to look for a job elsewhere was when I was treating a patient and Boris’s nurse flew in and said “Can you give Mr Aguecheek a hand…NOW!”
I went into the lavatory-surgery to find Boris was struggling to keep a child anaesthetised. “Just pop the E out for me” he shouted. I went cold but did it. I hadn’t realised until that point that he was doing child general anaesthetics acting as operator and anaesthetist. I knew for a fact that his nurse wasn’t trained at all, being a newby. I rarely lost my temper, but told him as soon as the opportunity arose, that he was never to involve me in GA’s again.
But that probably wasn’t the worst of it. Oh no. I discovered while I was working my notice, that Boris and his wife Priscilla didn’t dispose of sharps through a clinical waste company. He apparently used to box them up and dispose of them just as the local tip was shutting and it was getting dark. I found that out from one of the receptionists as I was having a chat between patients. I had only just muttered “That is absolutely disgusting” to turn round to find Priscilla was standing behind me. Well it WAS disgusting and again, I told them that I would have to report them to the local Family Practitioner’s Committee (as it was then) if I witnessed them doing it again.
Suffice to say, they also ignored employment laws. A trainee nurse who had gotten fed up with £2.40 per hour they paid, handed in her notice. At the end of the first week of her fortnight’s notice, they withheld her wages, only giving them to her after the rest of the nurses and I, threatened to strike. After I put my own notice in, I found two of my monthly payments were delayed and Boris used to sneak out of the practice so he didn’t have to see me. He worked on the first floor and I was told by his nurse that he daily tiptoed down the stairs quietly so I wasn’t aware he was leaving. One morning, I finished early and waited for him. I flew out and ran at him, catching him halfway up the stairs. I’m not a big bloke, but when I get angry, I can make myself big. When he came back from lunch, he gave me two cheques.
The thing that was interesting here, and it accounts for the fact that I am not impressed by people on committees is that both Boris and Priscilla were ‘upstanding’ members of the local dental community. Both were big in the British Dental Association locally, and both had been LDC members, yet they operated like that.
So do we need the CQC?
Yes we do. The pally pally relationship they must have had with the local dental practice advisor obviously didn’t address major problems with their practice. In these days where we are all faced with a torrent of potential litigation every day, at least complying with the high standards set by the CQC reduces risks marginally and prevents inadvertent swamping by an avalanche.
But it all turned out okay in the end for Boris and Priscilla.
They both dead now.
What is Right Path 4?
Right Path 4 offer a system that covers everything you need for CQC Inspections and Visits.
Who makes up RP4?
RP4 is a small team of professionals who have a great deal of experience. We’re passionate about using this experience to help our colleagues to work within a team dedicated to providing the highest possible standards of health care.
What do you receive?
RP4 BLUEPRINT Modules on Clinical Risk Management, NHS Contract Management, PDP and Reflective writing and now ‘keeping your eye on the ball. All written by EXPERTS just for RP4 members.
RP4 are the EXPERTS by experience, there’s no joining fee and no ongoing contract tie in. We have the lowest fees and we have produced an RP4BLUEPRINT, the ‘go to’ people for more than 750 practices. Our Experts are all dentists with detailed experience of working with the Regulators and Indemnity Providers at the highest level.
Inspired by the CQC, Blueprint gives you the complete plan and Blueprint is only available to RP4 members
Below is video created by Keith, which explains the RP4 System.
If your practice would like to join RP4 today, there is a special offer for GDPUK Members (£59.95 a month for GDPUK Members), if you follow this link - https://pay.gocardless.com/AL00016VCPR74Z
For further information about RP4 and the team behind the system, please visit - https://www.rightpath4.com/blogs/
The keeping of records is a particularly cumbersome yet vital aspect, and the equipment used for decontamination and sterilisation lies at the heart of ensuring compliance.
HTM 01-05 2.4n states: “Equipment used to decontaminate dental instruments should be fit for purpose and validated. This means that the device should be commissioned, maintained and periodically tested by a Competent Person (Decontamination) or service engineer, that records of maintenance should be kept and that correct functioning should be monitored and recorded”.
Therefore all testing reports are required to be kept for documentary evidence of the effectiveness of equipment in the dental practice. However, the meticulous task of record keeping can be time consuming and also has the potential for inaccurate logging of data due to inevitable human error. It is therefore crucial to try to find a way to enhance the efficiency of your record keeping and streamline this process, whilst maintaining the quality of data.
One area that can be especially time consuming is the recording of daily and weekly test cycle data of your autoclave and/or washer disinfector. From the everyday ACT tests completed each morning to measure the time, steam and temperature of the autoclave, to the weekly residual air and air leakage tests, each check requires detailed annotation, documented in a daily logbook for every piece of equipment in the practice.
Although absolutely essential in terms of practice inspections, manually having to record this data and then store it can often be seen as more than a mere inconvenience. Some autoclaves will have a printer installed, which will print off a receipt that should be kept, which makes the process a little easier and more efficient, but it still requires time and effort to collate these print-offs, not to mention the physical space needed to store the data.
However, there are new technological solutions that can make all of this a thing of the past. The latest autoclaves from Eschmann are compatible with computer software that can capture all of the data necessary from your tests and automatically save it onto your PC. This means you have no forms to fill in and store, and you don't have to transfer data using memory cards or USB devices.
With such software you will benefit from quick and easy cycle sign-off at the click of a button and you could even monitor the progress of your cycle from your PC or laptop. The latest software will also show you when your instruments are ready for use, as the software operates in real-time meaning it is always up to the minute, which is precisely what you need in a busy dental practice.
The Eschmann real-time Wireless Cycle Logger with automatic daily/weekly test cycle software is compatible with the company's own autoclaves and washer disinfectors. Providing automatic population of daily and weekly test cycle records, this software is making manual record keeping and storage a thing of the past, while also providing added security through accurately recorded and validated cycles and tests ready for official inspection.
To take away any unnecessary worry in the lead up to your next CQC inspection, make sure you have everything in place now.
For more information please visit www.eschmann.co.uk, or call 01903 753322
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Because Dental Elite understands what selling a practice means to you, it works alongside charities BDA Benevolent Fund and Bridge2Aid, investing its time and money back into the dental community.
Anyone already buying, selling or financing with Dental Elite will receive this service included as standard for free.
Contact the friendly, profession team at Dental Elite today and discover how it can help you with your sale and CQC application.
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See what others say:
I just wanted to write to let you know how your package is working for us in our practice.
I’m not sure you are aware but we relocated premises in August 2014 moving from one surgery to three surgeries. We recruited new staff and increased from five to sixteen, which included a trainee nurse, a nurse who had not worked in general practice for a year or so, an apprentice and a new housekeeper who had not worked in a dental practice. It did feel like I was running around in circles as I did naively think you just transfer from one site to another.
I then came across the RightPath4 CQC package and purchased it at the start of the year and what an enormous benefit it has been to our practice.
Having read all the information I delegated everything to all the staff, we then come together during lunch times, staff meetings etc to discuss, plan, and modify. All the staff have completed the poisoned chalice, which is an interactive series of questions regarding each room. I can then review their answers and add any questions they were unsure of or did not know, to the agenda for our next staff meeting. It has led to interesting staff meetings, with debates and staff keen to demonstrate what they do and what we should do.
The virtual inspection and clinical governance have been areas that the assistant manager and myself as practice manager have completed, and what a huge help they have been. They look at: how we work in the practice, who should be doing it, why we should be doing it, when it should be completed, how it is completed and what we need to complete. We have looked at every aspect at what we do, again, working closely with all the staff, who have helped by giving their input on the paperwork, processes and procedures we need to complete. We have even kept all our working documents as evidence of how we have moved on.
From my point of view it’s all very well, writing a policy and procedure but does it really work in practice, I found that by getting all the staff involved, helps with morale and motivates them more to know they are being heard, and that their input is valuable and taken very seriously.
I know the package is something which we will use continually, to review and monitor our practice, and any questions I might have, I know I can email you.
Sorry for going on I just wanted to let you know how grateful we are for your package and the help you have given and continue to give to us.
Noah’s Ark Dental Practice
For further information on the Right Path 4 service, contact details are below.
The web-based, user-friendly programme has been designed specifically to help you meet requirements of both the CQC and HTM 01-05.
The software’s ability to gather all pertinent data and automatically generate comprehensive, industry-standard reports will simply your daily processes for maximum convenience and peace of mind. It can also be seamlessly integrated within the new CS R4+ practice management software, which offers further key features to help streamline protocols and analyse practice performance in real-time.
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This service is now available for purchase to anyone – not just for those with transactions being financed or sold by Dental Elite – and what’s better, after a small administration fee, all proceeds will be generously donated to one of the participating dental charities, including Bridge2Aid and the BDA Benevolent Fund. For current clients, this service is completely free but Dental Elite will still make a donation of £150 to the client’s dental charity of choice.
With a team that is proud to have over a hundred years of experience in the dental sector, Dental Elite is in an ideal position to help professionals in all aspects of selling their practice. By partnering with a number of different charities, they can make sure this help is extended to the entire dental community.
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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
Pantomime season with a Grimm warning
I’ve had a busy couple of days and upset some applecarts; perhaps I should apologise if I have bruised any fruit?
On Friday the 21st, I spent an interesting day in Corpus Christi College, in Cambridge with my fellow NADA (National Association of Dental Advisers) colleagues as well as a selection of the great and the good and quite a few of our younger dental colleagues who had come along for the verifiable CPD and to find out what sort of profession they were entering into.
Sarah Rann (assistant medical director East Anglia Area Team NHS England) kicked off proceedings by asking us and then telling us what we should be doing as National Dental Advisers. The only aspect that she missed off her list was influencing the Regulators, (aka upsetting the established applecart by proffering an expert opinion).
We were then treated to a relatively complimentary double act between Barry Cockcroft and John Milne’s views on Contract Reform. There was a large amount of agreement even concluding with synchronised retirement from their respective roles early next year. Barry emphasised that ‘access’ was less of a political hot potato now than it had been and he saw this as one of his successes during his tenure. John talked about the impact of pilots and possible implications.
A little local difficulty about a dental practice not far from Nottingham was briefly mentioned.
A question regarding access to certain less privileged groups was aired and this is where I must apologise. I raised the question of ‘access to what quality of care?’ And I then asked ‘who was responsible for the World Class Commissioning of such ludicrously large and unmanageable contracts?’
Well there was a stunned silence and poor Barry looked like he had been stabbed in the chest. Fortunately John was on hand to ride to his rescue and acknowledge, although not answer the question and then draw stumps on this part of the meeting.
We were treated to some joined up thinking from David Geddes (National head of primary care commissioning) who discussed intelligently and without too much smoke and mirrors what the future 5 year plan may mean to dentistry, please read this if you haven’t: http://www.england.nhs.uk/ourwork/futurenhs/
Amanda Crosse (consultant in Dental Public Health) went a little off piste with her unguarded comment regarding perhaps planning to have dental NHS commissioning overseen by CCG’s. An interesting idea which seemed to irritate the level headed David and which he was forced into backtracking a little.
David Behan was cut short, the previous part of the agenda having overrun by 50 minutes meant that David only had 10 minutes to get his message across about the new CQC. He did it very well I thought and was only sorry that it was necessary to tell the gathered throng of dental advisers that he was disappointed in their union attitude to pay and perhaps we would like to put something back into the profession. He was having no more of discussing an inflationary fee. Actually I agree and am happy to spend my time for free advising the CQC.
This is where all of you come in…...’Efficacy and the CQC inspection, on the right path now? ‘It’s your opportunity to get the message across and its coming to GDPUK soon.
Poisoned apples for ‘afters’………..,
The afternoon was devoted to a Brother’s Grimm pantomime about a dodgy dentist with decontamination and NHS gaming tendencies, played brilliantly by Bryan Harvey (DDU), who was frighteningly good at getting into Character. We were assured that this was not based on any recent situation and I pointed out that it couldn’t have been, since they failed to notify the Press or recall 22,000 terrified patients…., Oops!
The GDC on this NADA inspired day was represented by Mike Ridler (Head of Hearings) who displayed distressing figures on FtP hearings. Mike expressed his inability to understand the reasons since in his experience there had not been an associated decline in professional standards. Somebody in the audience mentioned that it might have something to do with National advertising?!! Mike did not wish to be drawn further on this.
He obviously didn’t feel inclined to join in with the GDC pantomime either and suggested that if anyone wanted to talk about other ARF type issues they could do this individually later, although it wasn’t his ‘field.’ He then failed to answer the other questions, since they weren’t his field either.
The meeting closed with another unplanned shedding of apples just as stumps were drawn and flat hats were on; Jason Stokes leapt up on stage and shouted that if the younger members of the audience felt slightly dismayed by opinions voiced by the demobbing great and the good; NOW is the time to make their voices heard. Oyez, oyez!
Right Path Ltd
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.
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
We thought we would reminisce over the popular dental news stories published by GDPUK in 2013. Overall in 2013, we have published 286 different news stories.
We have focused on the articles which as well as having a large number of hits, they also make our top ten because they caught the imagination of the forum and the wider dental community. It is unsurprising that the majority of the articles chosen for the top ten, are an indication of ongoing issues, politics and controversies in UK dentistry that are likely to rumble on till 2014 and beyond....
1. Olympic Health Survey – news story published on the surprisingly poor oral health of Olympic Athletes - https://www.gdpuk.com/news/latest-news/1430-olympic-dental-problems-revealed
2. Problems at the BDA – An example of a story that caused pages of debate on the forum pages and will there be more to come? - https://www.gdpuk.com/news/latest-news/1388-bda-to-make-staff-redundant
3. NHS / Private Gaming – Another extremely popular / contentious issue on the GDPUK forum – This news item was about a dentist who got struck off for “gaming” https://www.gdpuk.com/news/latest-news/1335-dentist-struck-off-for-gaming
4. Teeth Whitening - A number of articles published on the issue, something that is still happening illegally, will we see this subject reappear in 2014? https://www.gdpuk.com/news/latest-news/1303-gdc-stance-on-whitening-upheld & https://www.gdpuk.com/news/latest-news/1292-more-moves-to-eradicate-illegal-tooth-whitening & https://www.gdpuk.com/news/latest-news/1230-stop-illegal-whitening-debates-at-the-dentistry-show
5. NHS Pilot Scheme – This is an area we will all be watching in 2014, the direction of NHS Dentistry is still unclear and will lead to continued debate next year - https://www.gdpuk.com/news/latest-news/1210-shortlist-for-new-dental-pilot-practices-announced
6. Corporate Dentistry – Corporate Dentistry continues to dominate the landscape in UK Dentistry, next year it is expected that supermarkets will look to expand their dental coverage. Oasis Dental Care sold for £185m - https://www.gdpuk.com/news/latest-news/1256-oasis-dental-care-sold-for-185m
7. Direct Access – An area of dentistry that is still being understood and digested but the BDA’s response was strong - https://www.gdpuk.com/news/latest-news/1254-direct-access-decision-misguided-says-bda
8. HTM01-05 amended – https://www.gdpuk.com/news/latest-news/1259-2013-version-of-htm01-05-published
9. Dentist Commit Suicide – A topic that unfortunately does not go away, with a number of recent cases being in the news - https://www.gdpuk.com/news/latest-news/1299-bda-calls-for-inquiry-into-dentist-s-suicide
10. Dental Graduates – It was confirmed that UK Graduates would be given preference for Foundation Training – Common Sense Prevailed - https://www.gdpuk.com/news/latest-news/1381-uk-graduates-to-be-given-preference-for-foundation-training
Thanks for having a look at our top ten news stories published by GDPUK in 2013. Next year we would expect to see similar topics reappear with many issues in UK Dentistry still to be resolved. Watch this space for further GDPUK Exclusives!
Please let us know if you think we have missed important dental news from 2013?
What do you expect to see in the dental news in 2014? Predictions welcome...
Whistleblowing and responsibility
The UK law related to whistleblowing changed significantly at the end of June with the result that legal protection for employees who report wrong-doing by their employer is only now afforded to those raising allegations of public interest. In other words, now the element of “good faith” required previously has been removed, disputes over personal issues, such as pay or performance management which lack a public interest element, will no longer be protected under the legislation.
So perhaps you should ask yourself; should I be blowing a whistle and what is the purpose?
Team members are often the first to realise that there is something amiss within the practice. However, they may not wish to express their concerns as they may feel that speaking up would be disloyal to their colleagues or to the practice.
Whistleblowing should primarily encourage and enable team members to raise serious concerns within the practice rather than overlooking a problem or 'blowing the whistle' to an external body. It is important that every organisation, whether it be a dental practice or even a body such as the Care Quality Commission (CQC) itself recognises their responsibilities and takes them seriously and intelligently.
Raising awareness of serious concerns when you work within an organisation asks a lot of the individual and this is the reason why it is necessary to emphasise that they are protected in law by taking appropriate actions. It should be a clearly stated Policy that the practice recognises that the decision to report a concern can be a difficult one to make. If what you are saying is what you believe to be true, you should have nothing to fear because you will be doing your duty to the practice and the patients alike. Furthermore the practice will not tolerate any harassment or victimisation and will take appropriate action to protect the team member who raised a concern in good faith.
Sometimes circumstances have a habit of being rather more intertwined don’t they?
Whenever there is a problem within a dental practice, whether this relates to patient care directly or working relationships; it is wise to attempt a locally agreed solution. Usually a discussion of the circumstances involving all relevant team members will itself point to the correct solution. However sometimes the problem may be so serious or the reaction of the management so ineffective that as a GDC Professional Registrant you feel compelled to take matters further. Whilst doing this, it is extremely wise to examine one’s own position carefully. A thorough investigation will include all parties. All concerns will be treated in confidence and whilst every effort should be made not to reveal the identity of the team member who raised it; at the appropriate time they may need to come forward as a witness.
So that’s clear is it?
I want to encourage everyone to re-confirm the legitimacy of their intending whistleblowing and to be certain that they have:
· Disclosed the information in good faith.
· Believe it to be substantially true.
· Not acted maliciously or made false allegations.
· Not sought any personal gain.
These points could have a significant bearing if you are shown to have decided to speak to the Press or acted in connection with another practice or organisation which work in competition.
There may have been a number of situations where organisations have been subjected to malicious whistleblowing. I imagine that it’s not a pretty sight and I’m afraid it would have a habit of rebounding badly on the perpetrator as well as the victim. Some of these people may even have found it necessary to leave Dentistry.
The more one thinks about it; the more one can see that whistleblowing can be used in a positive way for the general good, but equally it can be used in a negative malicious way.
One may envisage a situation where a regulatory body has experienced ‘difficulties’ with a Provider and has then approached another regulatory body to re-examine the Provider. This used to be referred to as ‘double jeopardy’, although now it could even be triple jeopardy. You may possibly feel that such things could never happen in this fair Country of ours; I couldn’t possibly comment.
How to raise a concern in your practice
As a first step, anyone with a concern, should raise it either verbally or in writing with the Practice Manager or the Principle if it involves the practice manager.
All concerns must be taken seriously and the team member treated with respect and dignity. The matters involved should then be investigated and the team member advised of what is happening at all times.
Thank you for reading this and whichever of the R’s you feel you may be; Registrant, Regulator or Registrar, I would like to remind you that the use of intelligence, proportionality and responsibility are not your exclusive rights.
RightPath4 is committed to the highest possible standards of openness, probity and accountability. In line with that commitment we look forward to working with all dental practice teams to help them be the best they can be and be justifiably proud of their achievements.
RightPath4 will continue to work on behalf of those in peril on the C, whether that be CQC or GDC and you may be interested in inviting us to visit you. We hope that you will find that you can spend a small amount of money, very wisely!
You could arrange a practice visit from me for as little as £275.00.
Have a look at our website
An autoclave should be viewed as if it were a working motor vehicle when making the decision which one to purchase. After all it is now an integral part of the everyday running of a dental practice.
When choosing a motor car or van one considers the marque, the standing in the market place, the residual future value, the running costs, the reliability, the service costs, availability of spare parts, the back-up, and how it is to drive.
If we take the engine and transmission of a motor vehicle the equivalent for this on an autoclave is the steam generator and the vacuum pump (B and S type to ISO En13060). The steam generator on the majority of autoclaves is simply two plates with water channels and a heating rod, sealed by a series of o rings and heat resistant rubber seals. In days gone by motor engines were susceptible to choking up with carbon deposits, causing major and expensive problems. Steam generators clog up because of the build-up of mineral deposits and foreign particles which block the channels and cause back pressure on the vacuum pump and valves (3 in a vacuum autoclave), which inevitably leads to the machine to fail. The steam generator is not usually part of an annual service so the potential problems can go undetected. The problems can be minimised by servicing, such as air filters and water filters being changed annually, however calcium can by-pass these filters creating a baked calcium effect on the plates due to high temperatures.
In summary the most common design of steam generators are susceptible to failure due to a small amount of debris, excess minerals etc. easily getting trapped in the water /steam channels. These foreign particles become baked on by the high temperatures generated by the heating rods in the steam generator. An everyday example of this can be seen by looking at a domestic iron that furs up through the steam ports.
When the steam generator fails it is a sign that it has started a chain reaction with the inline valves and expensive vacuum pump. To remedy the steam generator problem, the engineer has to attend site and spend hours removing it, splitting it, cleaning it (sometimes the deposits are that baked on they cannot be removed), change the seals and o rings, and re assemble it. The engineer will have to then check the valves and vacuum pump causing a lot of work which could have been easily avoided. If one has this type steam generator then the policing of what enters it is crucial. This breakdown is a worldwide problem and so the industry had to come up with a better design.
Well the industry has-say hello to the Mocom Futura and Classic range.
The new patented steam generator has moved away from plates and introduced a serviceable cylindrical design, which is easy to clean and is an engineering masterpiece.
Just to make sure this is probably the most reliable vacuum autoclave on the market they have put the three valves together on a manifold for ease of servicing, and long term reliability.
The vacuum autoclave is now much, much more reliable saving time, money and creating durability.
Phone:- 01253 736355
In a week that the CQC almost imploded we now have three examples of groups for whom professional respect runs low. Low – ! If only our respect was THAT high! It’s more the unfairness of it all: we do our job and they simply don’t do theirs.
In dentistry, all we are asked is to do the job. Whether it be the check up, the filling, the root canal or the moistening of nervous brows – we just get on and do it – in arguably the most efficient health care delivery model around – namely the small practice.
IT'S NOT DIFFICULT we all think - actually - since there are so many incompetents around, maybe we should start by recognising how good we are doing a very demanding job. Back to revolutionary thoughts ...
Firstly there is the dreadful CQC. Moving aside the argument of whether they achieve anything toward patient safety, this last week has seen both previous and current senior management trying to bury the Bay truth about incompetence, incompetently. They were saved only by the Metropolitan Police ringing the Stephen Lawrence bell.
Next up the gallows are those at hospital level who invented Triage Referrals – all we want is for Mrs Grumbles and her nasty wisdom tooth to be seen to get the bloody thing out safely. Now the forms have to be the latest version, and every box ticked in a remake of that 1970’s film noire The Ultimate Revenge. Only one “tick” need be “a cross” by mistake and voilà! You have helped the hospital meet their waiting targets. How magnanimous of you all …
Finally and worryingly Madame la G awaits NHS England. The stories of what is happening with Local Area Teams and the slow moving nature of this organisation give little confidence. When you consider what has happened to LDC Levies, allied to the fact that the new contract will likely be finalised by this already seemingly incompetent body - don’t even mention the seniority payment scandal [also known as THEFT, Minister] - we all have good reason for “CONFIDENCE Zero” – an organisation free from all useful contents! Dentistry risks, once again, being cut out of the healthcare planning loop.
The NHS Changes on 1st April it appears served simply to shut all the PCT offices, reopen some new ones [at your expense] while many of the old guard simply ported their redundancy payment & employment to the new organisation, around the corner in its new offices with its new water machine and new coffee facility. A change of biscuit was no doubt also essential. These doors were revolving so fast that Superman would have struggled to keep up.
The only consistent cause factor has to be the politicians. We need to rise up ladies and gentlemen. Our MP’s need to be attacked eruditely and daily by a vociferous professional demand.
Enough is enough and this has to stop.
The summer is a great time because that’s when they go away. But we must believe that in this revolution, the pen IS mightier than the sword.
It is YOUR politicians who have created these organisations and undue authority to act with ALL power and NO responsibility. Their purpose is solely to deflect responsibility from Westminster.
It has to stop. I don’t know about you lot but for me, the time for professional revolution is fast approaching. Where's my pen?