Tony Jacobs writes: Massive thanks to Pramod for writing this series of blogs against a backdrop of political change both in Scotland and of a backlash against the Coalition's minority partner party. All at GDPUK wish him well in finding a job and settling back down again, I will make sure he keeps us informed!

These are politically exciting times in which we live. The earth shaking events in Nepal are unrelated of course and to those of you connected in any way, I hope that our thoughts and prayers provide comfort.

The French have had their revolutions. So have the Russians. The North American history is littered with conflict. Closer to home the Scots were victim of some brutal clearances.  The Irish found themselves on a similar receiving end of some English-driven realpolitik. The English have had their civil wars be they flower based or parliamentary in origin.

The definition of the word revolution includes this:

• a dramatic and wide-reaching change in conditions, attitudes, or operation.
  • synonyms:  dramatic change, radical change, drastic/radical alteration, complete shift, sea change, metamorphosis, transformation, conversion,innovation, breakaway;

The 8th May - the day things changed

And now we are about to witness a UK wide political revolution.  A conflict of ideas and ideals as dramatic as any more military revolution.

On Friday the 8^th May, the manifestos of the various parties will be torn into small bargaining chips. All political discussion will become secret and behind many sets of closed doors as the hidden powerhouses of advisers thrash out a deal which allows either Mr Miliband or Mr Cameron to pay a visit to Her Majesty and request that they be allowed to form a Government.

Your conversation with your patients on Friday 8th will at least be a bit different from the usual weather and holidays. But what will you think?  If we have no clear large party, by definition we have a coalition at best and minority Government at worst.  First past the post only work if you have a winner. Imagine you are overseeing a race and because you forgot your stopwatch and glasses, the result looks like a sort of fuzzy dead heat where does that leave the voting system?  In dentistry of course we used to have transferrable votes for electing the GDC - heady days, eh? We were ahead of the game I suggest.

Where does this leave dentistry in the minds of our politicians?

I for one find it quite extraordinary that less than a year ago we as a profession were making headlines with child dental health and child hospital admissions being the headline concern, but allied to issues of obesity, diet and refined carbohydrate.  You all know what it takes to be dentally healthy.

The drive for caries-free children is not a mystery. You all know that.

Dentistry... why, is there a problem?

So has dentistry been, if not a headline element, perhaps a second string part of any debate?

Nah.  Non.  Nyet.  Not a dicky bird.  It’s as though the 45% of the population who never visit a dentist are happy to take their own teeth out, [and for those of you so inclined to listen again, our colleague Dr Tony Kilcoyne had to endure a strange slot on Jezza Vine on BBC R2 recently].^[1]

Meanwhile the 55% of the population who do visit a dentist are commendably happy with their service and experience, and are no doubt filling out the FFT as we speak.

Well they will be, until told by dentist A that their crown and root canal must be privately funded, and yet dentist B can provide the same treatment for a friend under the NHS and everyone is correct!

Clarity of NHS provision in dentistry is a ticking political time bomb with a shortening fuse. The lawyers are the ones who keep relighting the fuse and at some point it will be a major problem.

And yet sadly, dentistry has as a profession and an NHS Primary Care service been parked in the sidings of political irrelevance. We have in political terms, been marked with a large tick.

Have the politicians taken their eyes off the dental ball? You might think so. If you read the NHS Confidence Survey by Practice Plan, ^[2]  the mood of dentists is darkening from so many angles it is hard to find true optimism anywhere for Government funded activity. ^[3]

Well come the 8^th May we are going to witness the start of a Revolution whoever polls the most votes.  Indeed those who poll the least may feature the most.

Perhaps dentistry will feature during the post-election negotiations?

And of course for those of you in Manchester for the BDA Conference…  ^[4]   Well maybe that will be the long-needed start of a dental revolution.

It’s not too late to check in and go have an excellent three days of networking and updating across a huge range of dentistry

A chance perhaps for at the very least a bit of private revolution.

Enjoy the long weekends coming up.  That grass is still growing...

[1]  Dr Tony Kilcoyne on BBC R2  http://www.bbc.co.uk/programmes/b05qsjpl

[2]  Practice Plan NHS Confidence Monitor  http://www.NHSDentistryInsights.co.uk

[3]  Dr Claire Roberts at Dentistry portal http://www.dentistry.co.uk/2015/04/22/reflecting-future-nhs/

[4]  BDA Conference agenda 
https://bdaconnect.bda.org/wp-content/uploads/2015/04/Conference-Preview-Brochure-2015-WEB.pdf

The Clock is Ticking

As of writing, there are about 30 odd days to go to the UK General Election [1] and politics may have changed for ever. The 2-party system may well be broken. It seems likely that the smaller parties will have a relatively huge amount of influence over the eventual policies of the Government that emerges. If Proportional Representation had no role to play in “First Past The Post”, it perhaps does under a mixed multi-party system of coalition where FPTP does not produce a clear Government.  A clear outcome is … well, far from clear. I sense a theme I might return to.

Who remembers the HSC?

Until then of course, we are in the frenetic work up to Election Day across the UK, allied to significant numbers of local elections are due to take place on 7^th May.[2] Parliament dissolved of course at the end of March. The Health Select Committee report of the GDC Accountability Hearing will now have to be signed off under the new Government.  Wouldn’t you just love to know what’s in the draft that no doubt sits in a pending tray somewhere?  You can never get a decent leak when you want one! For those of you with short memories in Wimpole Street, it was clear the HSC were collectively unimpressed with the performance of certain executives.

Dentist in Politics

Many Dentists and Dental Professionals play their part in local communities and will have local or national agendas of their own. To all of you, the very best of luck. It’s a busy time.  Stay focussed and may the votes go your way.

Indeed in the GDPUK forum we have our very own blogger Dr Pramod Subbaraman [3] who is a parliamentary candidate for the Liberal Democrat party in Edinburgh South. Scotland of course are still vibrant in their political engagement after the 2014 independence referendum. Sir, we wish you well.  Ironically, if present polls are to be believed, the Independence agenda re-emerge after the election because of the influence of an enlarged Scottish National Party in the House of Commons.

More wet fingered dentists in top level politics is a positive process – it can only help the cause of the nation’s Oral health and ensure that the dental and oral health inequalities rise up the political agenda.  There is a sense of “Rome burning” about the facts on the ground of GA Admissions for children for surgical dentistry [4] while the Department of Health and its mouthpieces at NHS England assure one and all that the system of UDA related access  has clearly been a big success, broadly speaking. I really must get a new pair of hindsight-o-scopes.

You ARE political influence

But imagine you are standing around one day in your local market place and the candidates for your local seat are canvassing your support.  You were planning to “do you bit for the profession” and therefore plan to ask one question. 

What should it be?

What would swing it for you if a candidate were to ask you for their vote?

Let me take you back to a previous blog in which I raised a “Trumpet Call for Clarity of the Deal”.[5]  In it I suggested the GDC might take this role on and demand clear rules on what dental care is available under the NHS.  For those who are interested, I did write to the Chairman of the GDC and he delegated his reply that “It was not their job”. Too busy counting the FtP hearings, I suspect!

The consumer organisation Which? [6] and the Office of Fair Trading [7] tear their hair out over the constant complaint that patients never know what’s available under the NHS and what’s not . Report after report is critical – and yet – this strange fudge is NOT of the dentists’ making.

We did not choose this system or the lack of clarity. 

The DH chose this. It is the Department of Health who seem content to see dentists accused of misleading patients.  What could their motive possibly be?  Surely not to deflect eyes and attention away from the other concerns over Government funding and management of oral health?

It is patently wrong that every individual dentist should decide what constitutes ‘need’ on a one by one process with every single patient.  How can anyone with half a political brain even remotely justify it?

Unclear Prototypes & Mixed Practice

The new Prototype Contracts are being rolled out at “Pilot” level and still there is no clarity.  The now retired CDO was on record as saying it was not required as part of the new contracts. We can but hope that the new incumbent will see sense and change this unsustainable approach.

The future of dental practice in this country will depend on the success of mixed practice.

The ability to fund privately some dental care alongside an NHS funded element is critical to the small business that is dentistry. Multiple strings of income may well be the ONLY reason that many practices will continue to subsidise the State offering for the benefit of their patients.

But there have to be clear rules. At the moment there are NO rules.  In fact it is so ridiculous at the moment that the rules appear to be written only when the patient complains. At that point the GDC seem to think that investing in your London Day Care might be a jolly good use of funds.

If McEnroe had been a dentist ...

Our old ranting tennis star John McEnroe would have had something to say.  “You cannot be serious” [8]

The patient has a right to know where the boundaries lie. All patients should be able to share an experience of the same rules being applied. The dentists need to know where the boundaries lie. 

Otherwise there is a great risk that the GDC call you to order at an FtP hearing should the patient complain that you applied too harsh a judgement of NHS “need”.

So the one question, I put to you, that you should raise with your candidate who asks for your vote is

“Will you ensure Clarity of NHS Dental Treatment?”

Our politicians need to look at dentistry through the patients eye’s, not through the upturned bottle lens that the Department of Health use.

Patients deserve better and it is the Parliamentary candidates you will meet in the next 4 weeks who will influence future policy

At present 22000 dentists apply different rules across 20 patients per day – because that is what the DH require.

That’s half a million confused patients per day

Ask them:  Will you put a stop to the confusion?  Will you provide absolute clarity on what the patient can expect under NHS dental care?  

If not, why not?

Meanwhile – control that excitement out there.   I am off to watch some paint dry …

“Now, will you be voting Mrs Goggins, open wide, there’s lovely, bring the next one up Nurse …!

Makes a change from talking about the weather and holiday plans. May your Easter break be relaxing and Spring like. The onslaught has yet to come!!

[1]          http://may2015.com/

[2]          http://www.parliament.uk/about/how/elections-and-voting/general/general-election-timetable-2015/

[3]          https://www.gdpuk.com/news/bloggers/pramod-subbaraman

[4]          http://www.telegraph.co.uk/news/health/news/10964323/Tooth-decay-is-the-biggest-cause-of-primary-school-children-being-hospitalised.html

[5]          https://www.gdpuk.com/news/bloggers/enamel-prism/entry/907-the-gdc-clarity-of-purpose

[6]          http://www.which.co.uk/campaigns/dental-treatment-costs/

[7]          http://webarchive.nationalarchives.gov.uk/20140402142426/http:/www.oft.gov.uk/shared_oft/market-studies/Dentistry/OFT1414.pdf
 

[8]          https://www.youtube.com/watch?v=ekQ_Ja02gTY

This week marks the beginning of the election period. Parliament has been dissolved, there are no longer any sitting MPs and the most unpredictable and arguably the most interesting election begins! I have had a busy month leading up to this.

There were two Liberal Democrat conferences ( one Federal and one Scottish ). I had the pleasure of meeting with Norman Lamb, the Liberal Democrat health spokesperson at the federal conference and I informed him of the various concerns of the profession, especially those to do with the GDC.

Obviously, it was too late for anything specific from our discussions to get into a manifesto for the election, but I remain hopeful that Liberal Democrat MPs in the next parliament will be more amenable to our concerns especially to do with proposals for a new NHS contract for dentistry in England. In addition, I also met with Jim Hume the Scottish Liberal Democrat health spokesperson and informed him of the issues faced here in Scotland. Unsurprisingly, the GDC figured prominently in that chat too! One thing is for sure and that is " The era of single party government has come to an end ". Whatever the combination of parties in the next government and whatever their arrangement ( coalition or confidence and supply ) it surely will not be a government with the agenda of just one party.

There will have to be discussions about policies and no single person or single group of persons can have undue influence on any policy decision. I also spoke at the Scottish Conference where I gave the EMLD (Ethnic Minority Liberal Democrats) address. In this speech, I stressed the importance of diversity. We see it in the dental workforce and industry where there are more women and minorities than ever before, why is parliament lagging behind so badly? And diversity isn't just about ethnic minorities, it is also about the representation of women, sexual minorities, the disabled, in fact anyone who isn't a pale male! Parliament does need people from non political backgrounds in it and we all lose when there is insufficient diversity. The most successful businesses are those that can represent the diversity of their target populations in their work forces and on their boards. Parliament should be ahead on that count! Not far behind as it is now!

I had a hustings on the 26th of March which I attended on behalf of the Edinburgh North Lib Dem candidate. The hustings was conducted by the left leaning Common Weal. It was a very interesting first experience and I will report on the various hustings' that I attend over the coming weeks. This week, my nomination papers will be filed and I will be working on producing a second campaign leaflet as well as an election address. Interesting times ahead! I now hope to be able to contribute to this blog weekly and then maybe daily in the last few days leading to polling day and afterwards until the formation of a new government with an analysis of what I see on the ground.

Next week, my plan is to discuss the various manifestos.