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A Dental Year In Review

A Dental Year In Review

2019
A Dental Year In Review

By
DentistGoneBadd

I won’t pretend for a second that the news stories breaking around dentistry in 2019 came up to the standard of those surrounding the world of politics. We didn’t have the dental equivalent of a Prime Minister resigning, the new one willingly calling a general election and that Prime Minister’s Pinky and Perky twin across the water being impeached. But it wasn’t completely without drama. The GDC, in particular, being the gift that keeps on giving.

January

The Daily Mail carried on its tradition of providing cheap and easy to read non-verifiable CPD, by highlighting the results of a Cochrane Review which found there was no clinical difference between patients receiving regular scheduled scaling and polishing against those not having a ‘scrape and brush-up’ (not the Mail’s term, my patient Mrs Cholmondsley of Milton-on-the Truss’s term for what our hygienist did to earn a living). The Dundee meta-analysis of two studies involving 1711 patients found that there was no difference in the two groups with regard to the development of early signs of gum disease. There was a noticeable difference in terms of calculus build up but the researchers didn’t think the build-up was significant although it was remarked that they didn’t know whether this build-up was more important to the patient or the dentist. As a dentist I always worried about munge building up around the gum margins, and fortunately Professor Damien Walmsley agreed with me. I also worried about stories like these in the general press, just in case people like Matt Hancock inadvertently see them while searching for their latest polling figures. It hasn’t happened yet, but just you wait for the government to reduce the number of scales NHS patients are allowed per year, with a concomitant reduction in fees.

Meanwhile also in January and in the same vein, the Journal of Clinical Periodontology published the results of a study which revealed that pregnant women are one and a half times more likely to go into labour prematurely, if they have gum disease. So here’s an idea – why not ensure pregnant women have closer periodontal supervision during parturiency by carrying out regular scale and polishes…oh!

But if the dental profession has less work to do because we ARE banned from doing scales, that will hopefully neutralise the effects of the inevitable reduction in EU trained dentists leaving the UK as a result of Brexit. The General Dental Council presented evidence that up to a third of EU qualified dentists on the dental register may quit UK dentistry after Brexit because of…Brexit and its associated uncertainties. Some of the EU-trained dentists also cited the difficulties of working under the NHS and dental regulation as reasons for leaving. I think these Europeans have their heads screwed on. Who could blame them for shunning a system which pays them a piddling amount for one filling and exactly the same amount for half a dozen fillings. Brexit means Brexit. Exploitation means exploitation.

Also in January, the British Dental Journal published a large-scale study of 2,000 practitioners which showed that almost half of dentists admitted that job stresses were exceeding their ability to cope. The study found that the most stressful aspects of their work was related to regulation and fear of litigation from their patients. It probably doesn’t help the mood of GDP’s that they’re being told that some of their ministrations are pointless (see above), that at some point a litigation lawyer might blame them for premature births and their workload is going to increase in 2020 when Manuel and Helmut escape back to the mainland.

February

February saw the revelation that practitioners were more likely to be struck off the GDC register if they didn’t have any legal representation at hearings. A Freedom of Information request to the GDC by Dental Protection showed that nearly two thirds of dentists who were erased from the dental register didn’t have a legal advocate speaking on their behalf. My first thought about that story was “What kind of fruitcake would go to the GDC without legal representation?” Having been a career-long member of one of the original ‘big two’ professional indemnity organisations, the thought never entered my head that such representation may be denied. But apparently, that’s not the case. Even though they often offer cheaper ‘cover’ to dentists, there are defence organisation or insurers who may decline assistance to dentists in personal conduct matters. You pays your money and you takes your choice. I personally preferred to pay a not insignificant amount per month in the hopes that if I got into trouble I would get Rumpole defending me rather than rely on my own inane ramblings that come out more like Elmer Fudd than Perry Mason.

March

Big news this month was that ‘British Teeth’ helped win an Oscar. Rami Malek won an Academy Award for his role as Freddie Mercury in Bohemian Rhapsody wearing prosthetic teeth made by dental technician Chris Lyons for British-based Fangs FX. Much to the mild annoyance of British dentists, Americans often use the denigratory term ‘British Teeth’ to describe not only our teeth, but British dentistry. Just a slight snag – Freddie was born in Zanzibar to Parsi parents. So they were more like Persian Pearlies than our pride and joy.

Birmingham University hit the dental headlines with its new dental model that reproduces the feel and ‘behaviour’ of real gums and the tongue. As well as helping to teach students how to examine the mouth safely and check for disease, the models reproduce the ‘feel’ experienced when checking pocket depths. In my opinion, this must be a welcome and invaluable teaching aid. The first time most dentists had to check for pocket depths was on a patient. Nobody can tell you how it feels to use a pocket probe or how much pressure to place on the tip.   This probably explains the squeamishness of a lot of dentists trained up to now, in tackling pocket depths. You simply didn’t know when to stop pressing – wait until the patient’s eyes rolled back into their sockets or simply sobbed and/or threatened litigation.

April

I warned you about this back in January. In April, the RAINDROP study carried out by the University of Newcastle proposed that ‘routine’ scaling and polishing of teeth should be stopped from the dental budget since the money would be better off being spent elsewhere. I personally felt this was poppycock. Since many NHS scalings, I would suggest, are completed on a Band 1 treatment with an examination, how is money going to be saved? The Nash gets a bargain out of dentists anyway for this service and money-saving will only be executed by cutting the fee for an examination I reckon. I repeat. I told you back in January and you wouldn’t listen, would you?

May

The GDC was seeking views on its consultation for its strategy for 2020-2 – “Working with the dental team for public safety and confidence.” GDC chair Bill Moyes boldly claimed that the overall decrease in GDC expenditure pointed to a significant reduction in the dentist’s Annual Retention Fee. My advice on that is – don’t hold your breath. Highly unlikely. I bet you believe in the tooth fairy as well, don’t you?

June

The Government’s Migration Advisory Committee announced that dentists would not be on the Shortage Occupation List, despite the BDA’s evidence that 63% of dental practices are experiencing difficulties in recruiting dentists and the GDC’s findings that a third of EU graduates may leave the UK in the next five years. A significant number of currently registered dentists are also thought to be considering retirement in the next few year – for ‘considering retirement,’ read ‘running for the exit like their backsides are on fire.’ One suggestion to alleviate the operator shortage problem – get a UK trained dental therapist before everyone catches on.

July

Thankfully, I never came close, but it was always something else to worry about. July saw NHS England and NHS Improvement (nope, I’d never heard of it either, I’ll need to Google it later) agreed to remove wrong-site blocks as a ‘never event.’ The British Dental Association had long argued that administration of wrong site blocks didn’t meet the threshold of a never-event. Although inconvenient to the patient and incredibly embarrassing for the dentist or student, giving a patient a dribble on the wrong side, is hardly likely to kill.

Removing the wrong teeth is considered a never-event and I would suggest that allowing your dog to bite a practice inspector really ought to be on the list. Dentist Aileen Hopkins was erased by the GDC after one of the three dogs she kept at the surgery bit an inspector. The dentist had 57 complaints about safety and hygiene also considered, but the dentist apparently thought the GDC was being a bit “nit-picky.”

August

Journalists know August as ‘the silly season,’ the time of year when people are on holiday and Parliament and public bodies uproot and go to the Algarve.   Hence, not a lot happens during August, which meant the The London Evening Standard reported on the UK’s first ‘healthy’ supermarket which was launched in Central London. In essence, the store was giving greater visibility to healthy foods such as fruit and vegetables and less shelf space to foods like chocolate, crisps and sugary drinks. And that was it really. Laudable though it is, it didn’t really press any journalistic buttons. Nobody was bitten by a dog and no one was brought in front of a disciplinary body for stacking M&M’s in front of the Monster Munch.

September

The British Orthodontic Society and Oral Health Foundation announced plans for a national campaign to warn patients about the risks of internet-based/DIY orthodontics. GDPUK had warned earlier in the year that patients are being prescribed courses of adult orthodontics without seeing a qualified dentist face-to-face or having a full clinical examination. Although one of the companies involved in providing internet-based ortho offers ‘scanning’ in various centres throughout the UK, you CAN have a traditional impression taken – providing you take it yourself. Curious, I approached an online advisor at Smile Direct Club for further information. Just don’t try the following if you are keen on hanging on to your registration.

A Dental Year In Review

A Dental Year In Review

A Dental Year In Review

A Dental Year In Review

October

Bad news for parents of teething children, hoping for restful nights. The British Dental Association revealed that 9 of the 14 teeth products licenced for use in the UK could have potentially harmful side effects. The nine products contained either sucrose, alcohol and or/lidocaine and there is apparently little evidence that the products are effective in reducing teething pain. Where does that leave dentists when confronted with a red-eyed, half-lidded mum begging for advice on how to relieve teething pain? My guidance for the desperate parents would still be alcohol. Forget the child, just drink the alcohol.

But great news for dentists. Early in October, the GDC announced the new levels of ARF fees set for the next three years, ‘barring any unforeseen exceptional circumstances.’ The new level for dentists is £680 and £114 for dental care professionals. Two thoughts: a) why did they bring reduced fees in after I retired? b) what does the GDC define as ‘unforeseen and exceptional circumstances?” There’s still three months to go. Don’t bank on it yet!

Also in October, Medical News Today reported on a study linking periodontal disease with hypertension. This didn’t surprise me. Patients with perio often caused my blood pressure to rise.

More concerning was the revelation that overseas dentists are being allowed to register as dental therapists by the General Dental Council, without any practical examination of their clinical skills. Normally, dentists qualifying outside the EU have to take the Overseas Registration Examination (ORE) or the Licentiate In Dental Surgery. An investigation by GDPUK.com revealed that there is a high failure rate in the practical element of the ORE and yet overseas dentists are being allowed to register and carry out operative restorative procedures on patients, with no further checks on their skills. The GDC is apparently convinced that its checking of the dental syllabus of these dentists is ‘robust’ and yet apparently NOT robust enough if they want to work as dentists.

At the end of October, the GDC was again in the headlines, when it was revealed that the regulatory body withheld evidence from its own Professional Conduct Committee (PCC) which resulted in the erroneous reinstatement of a fraudulent dentist to the dental register. Justice Julian Knowles criticised the GDC in a High Court hearing brought against the GDC and the dentist, by the Professional Standards Authority. He said the GDC had committed a ‘serious procedural irregularity’ in withholding evidence from the PCC. The evidence was withheld following its late submission to the dentist’s legal counsel because it had been mislaid by a GDC solicitor.

November

The GDC was probably feeling hunted by now, much like their registrants. It was early in the month that the Daily Telegraph revealed that the GDC had spent over £17,000 on hiring private investigators to ‘investigate’ registrants. BDA chair Mick Armstrong described the GDC’s investigatory method as ‘entrapment.’ One case involved private eyes attempting to induce a clinical dental technician to provide treatment without a dental examination by a dentist, by claiming she was too unwell to go to see a dentist for an examination. This revelation just made me feel slightly grubby. I mean, the GDC is supposed to be setting the profession’s standards and all they are interested in is in putting on a heavily stained Columbo mac.

December

It appears that the GDC only scares legitimate dental professionals. GDPUK.com ran a story that a Derby man who was fined for illegal teeth whitening in 2017 has been caught doing it again. A Derbyshire Live reporter set up a sting operation to catch Colin Vernall attempting to sell his whitening wares again. He told the reporter although he wasn’t registered with the ‘dental council,’ he did do a course. Mr Vernall, who prefers to be called ‘Vern’ Collins (sounds legit) is still taking money for his whitening service despite the £7,000 fine he received as a result of a court case brought by Derby City Council Trading Standards officers.  When the reporter revealed his identity, Vern said: “Teeth whitening has changed and it’s self-administered, I simply supply the equipment and you place the tray and products in your mouth yourself.” Thus abrogating all responsibility presumably. He added “I'm simply renting you the light to accelerate the procedure.” When it was obvious the reporter wasn’t going to use his services, Vern said:I just got a taxi up here, it has cost me a tenner to get here as well.” Vern has gone ‘mobile’ since his £7,000 run in with Trading Standards.

 

As I write during the hiatus between Christmas and New Year’s Eve, the GDC hasn’t yet found any ‘unforeseen exceptional circumstances’ which will destroy our dream of having to pay a mere £680 quid a year to have our names placed on an internet list.

But there’s still two working days, so don’t spend the savings yet.

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Negative reviews can be upsetting by @DentistGoneBadd

We'll be with you in 10 minutes Mate.

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'Tis the season ...

'Tis the season ...

...to be Jolly, fah-la-la-la-la,la-lah-lah-lahhh

 

It is the season of Goodwill to all Men [and Women of course]. Too much food, a touch too much liquid spirit, and comfy armchair beckon for many, while Granny sups the sherry.

It is a time of year to reconnect with family, and let loose the strings of attachment with dentistry.

It has been quite a year.  If anyone has recently been affected by the extreme weather and flooding, you will have our deepest sympathy and best wishes.

 

TWTYTW

 

We have a new CDO[NHS England]  who seems to have big dreams. While her grip on reality is yet to be proven, her grip on mission creep is patently in doubt too as the New NHS Contract slides back another year.  When does evidence seeking become procrastination I wonder? 

 

Let’s not forget to toast the former CDO [NHS England] spinning the revolving door of Corporate employment. A nice little earner, some might cynically say; I could not possibly comment.  For sure, the numbers-merchants all seem in agreement.  Corporate Dentistry is a House of Cards just waiting for the crutches to be kicked away.

 

What about our soon-to-be ex-Chief Executive Officer of that great body in Wimpole Street.  I wonder how many cards of goodwill she really will receive? Goodwill to Dental Colleagues has been the byword on her watch… NOT!

 

And then of course our congratulations to the newly elected members of the BDAs Principal Executive Committee.  Is it me or is a vote of 1900 on a membership of 18000 a 10% turnout?  Is a 10% turnout the sign of a well engaged campaign and a profession with fire in their belly?  Hmmm, thought as much. 

 

So there is much to be done and as ever so little time to do it. 

 

Crystal balls, anyone?

 

Maybe 2016 will be the year that as a profession of 100,000 like-minded souls we unite into one influential body, instead of Nurses here, Therapists there, Dental Technicians under the table, Dentists arguing and never agreeing, LDCs bangin’ on to no avail, the BDA in constant denial and the FGDP worrying about ‘stuff’.  No wonder the Government can run rings around us all.

 

To you all, I bid you a Happy Christmas and an Utterly-Butterly Joyful New Year.

 

In the South, we Sassenachs favour the early celebration. North of the border of course, our Scots colleagues will be awaiting the excesses of Hogmanay.  To our non-Christian colleagues, we know you will join us in celebration in whatever way suits.

 

But wait:

 

What is this with Santa’s paw prints all over it? A PSA Report I see? Now this is a Festive card of gargantuan size.

 

Ladies and gentlemen of the Dental Profession, now you know why the Chief Executive Officer and Registrar of the GDC has pulled the Ejection Seat firing handle and is departing.

 

A report on the investigation into the General Dental Council’s handling of a whistleblower’s disclosure about the Investigating Committee 21 December 2015

 

This is a 270 Page report on the investigation into the General Dental Council’s handling of a whistleblower’s disclosure about the Investigating Committee dated 21 December 2015, but from events through the previous 3 years.

My goodness me. I take it all back.  The PSA do have teeth, they are most certainly sharp and their Regulatory jaws have closed around the neck of the GDC.

 

Close typed pages of absolute dynamite. Evidence based critical analysis of what the GDC did with your ARF that led to it having to be increased...A pantomime with an unbelievable plot by any other description.

 

Please do go read it Ladies and Gentlemen.  2016 may indeed be “The Year”

 

I also urge you to read it in the context of Dr Alyson Lockyer's brave attempt to drive this agenda in 2011 with the PSA in their report entitled An investigation into concerns raised by the former Chair of the General Dental Council Advice to the Department of Health February 2013

Many would say  she was right all along. How sad it has taken this long to prove it

 

Broadsword calling Billy Boy  …  Broadsword calling Billy Boy

 

Dr Moyes? Are you reading this…  You know what you should do.  Prove to us that you are the honourable and ethical Gentleman we believe you to be.

As should the whole Council, given the implications of poor oversight.

 

Pull up the table, You get the mulled wine, I’ll get the nibbles. Just feast on these nuggets of you will.

 

  • 6. Overall conclusions
  • What was the outcome of the failings in the Investigating Committee processes and support during 2013?
  • 6.1 The outcome was that the independence (and perceptions about the independence) of the GDC’s Investigating Committee were jeopardised by various practices that were designed to improve the quality and consistency of the Investigating Committee’s decision making, but which at the same time sought to restrict the Committee’s autonomy to an extent that infringed upon the appropriate separation of powers within a regulator. This could have had very serious implications for the GDC in terms of the robustness of decision making, potential judicial review actions and the consequent reputational damage. Those practices also had serious implications for the culture that developed in the Investigating Committee Secretariat, which in turn affected the working relationships between some Investigating Committee members and the Secretariat team.
  • 6.2  “   Changes had been made to the reasoning of Investigating Committee decision documents after the event and without appropriate authorisation … “
  • 6.14 …”The Chief Executive is ultimately accountable for the decisions taken about the level of information disclosed to the GDC’s committees and the Council, staff and GDC associates. The Chief Executive also had several opportunities to identify the seriousness of the problems emerging, even if they were not properly brought to their attention.”

 

And finally

Sub note 257, with my highlighting of the PSA final words in the Report. Hah!  Pass that English Sparkling Wine, dear - the one that knocks spots off Champagne ...

 

Here's to 2016 dear colleagues.

 

  • 257 We note that the Chief Executive has responded to our conclusion by stating that they believe that they acted appropriately and quickly in response to each risk as soon as it became apparent, and that they reported fairly and fully to the Audit/Audit and Risk Committee and the Council. The Chief Executive has stated to us that their view is that they have responded to each of the “shocks” that have occurred to the GDC with honesty and transparency and by taking appropriate action. In response to seeing a draft of this report the GDC has said that the Chief Executive’s reliance upon the former Director of Regulation was reasonable, has noted that the Authority’s 2012/13 performance review of the GDC did not identify problems relating to the Investigating Committee, and has referred to the fact that no complaints had been made by the Investigating Committee members, and has drawn the conclusion that the Chief Executive could not have had visibility of the problems emerging in these circumstances.
  • We [The PSA] do not agree

 

 

 

Try this by the way

http://www.englishorganicwine.co.uk/products/pinot-noir-chardonnay-2013-organic

 

Happy Christmas to one and all, and especially all our colleagues trying to level the GDC Playing Field.

 

 

 

 

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NHS Chooses - Dental Reviews

If Stephen King wrote dental reviews

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Immovable Object meets Irresistible Force

Immovable Object meets Irresistible Force

What happens when an Immovable Object meets an Irresistible Force?

 

Impasse. And so it would appear to have been for the last couple of weeks after the initial thrust of the BDA’s threats, and the parry and riposte of the GDC’s response.

 

However, I always thought it was going to be right at the end of the ‘consultation’ process that the BDA would make their next attack, and as we have seen yesterday, Mick Armstrong has told the GDC in no uncertain terms ‘ it’s 1 minute to midnight’. Waiting until the last minute has made sure the Judicial Review can’t be halted or paused to allow the consultation to finish, had it been launched prematurely and has made sure the GDC don’t get to see the BDA’s hand of cards early.

 

But this hasn’t actually seen the announcement of the BDA taking legal action to go to Judicial Review, and as such I bet a lot of people will be disappointed if they just look at this video superficially. I can see the posts on GDPUK forum that this is just BDA posturing again, and they haven’t the guts to carry out the threat.

 

But if you read the full press release as well as watching the video, and especially take time to look at the additional information within the release regarding the figures in the consultation, it is obvious the BDA are actually giving the GDC a final chance to back down. The GDC will suffer a humiliating loss of face if they do, but we as registrants and members won’t then have to foot both sets of legal bills.

 

I don’t get the impression Mick Armstrong is messing about when he says the BDA are committed to following this through. But as a fellow Yorkshireman I appreciate the sporting nature of letting your opponents know you’re going to hit them, hard, and give them a final chance to back down. But you only do that once you know you have the upper hand. The BDA might not have a Royal Flush, but it seems like the GDC only has a pair of Jokers at the moment. Reading the documents attached to the BDA’s submission leaves one in no doubt of the intention of the BDA to go to JR.

 

By engaging the services of a FORENSIC accountancy company the BDA appear to have pulled off a masterstroke; utilizing the skills of professionals specializing in detecting high level fraud, regulatory scrutiny and anti-corruption, and then publishing a précis of the findings publically must surely send the a big signal to the GDC that the BDA is not playing brinkmanship here, but actually means business. This is serious stuff now, and the BDA have now shown their cards to the GDC by revealing financial inconsistencies are what the JR will probably be based on.  

 

The forensic analysis of the accounts has apparently shown the GDC’s own published figures for the ARF hike are somewhat contradictory. These inconsistencies not only call into question the validity of the need for the ARF increase by questioning the basic level of evidence, but the inconsistency of the figures must surely now call into question the bigger picture of the integrity of the GDC in all of its financial matters. Whether this is part of the Judicial Review or not, the financial matters of the GDC must be impeccable, and they appear not to be.

 

The analysis of the figures would appear to go beyond the fact insufficient and inconsistent information has been given to registrants so they can’t actually make an informed response to the consultation. It seems to confirm the GDC is actually so contemptuous of us as intelligent people that they feel they can knowingly release confusing figures, expect us to then swallow the ARF rise, (after what we have all agreed is a sham consultation) and carry on as before. If a dentist were to confuse a patient in that manner, it would be cause for a registrant to be hauled before the GDC. Alternatively, it suggests incompetency and a lack of communication in the organizational structure of the GDC. Once again, they are grounds for a registrant to appear before the regulator. Whichever way you look at it (and it may be a combination of the two), our professional association appears to now have more robust evidence of the failings of the regulator and is prepared to act on it.

 

However since the GDC’s regulator is the PSA, and they seem to be about as threatening as a periodontally compromised 3 legged chihuahua with trismus and a sore throat, and as much use as a pair of waterproof sandals then you can’t really blame the GDC for not being too worried about the consequences of their actions.

 

Judging by the interview with Ms Gilvarry in Dentistry magazine, she doesn’t have appeared to understand what the profession is finding such a problem with. The penny certainly hasn’t dropped with her; perhaps this is because there aren’t actually any spare pennies left to drop at the GDC since their accounts seem to be in such a tangle.

 

But surely there must now be a realization by at least someone in power at the GDC that the BDA and the profession as a whole just might have a point. It would be useful if it dawned on them simultaneously that they have picked a fight with what seems to be a quickly developing Irresistible Force.

 

And they as the Immovable Object appear to have some ominous cracks developing, which wouldn’t do them a lot of good if they continue on the course they seem hell bent on taking…….

 

 

Image credit - James Cridland  under CC licence - not modified.

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