Thursday 16th April 2015 is the day I will never forget.  I was in surgery with Amy.  Bea was at reception.  It was a life changing moment for me and I am sure, for all of us, by Dr Chris Tavares BDS

THE CARDIAC ARREST

We were ready to get the patient in.  At around 3:45 pm,  Amy went out to get him in.  As the surgery door opened I could hear him having a laugh with Bea.  He came in, we exchanged the usual superficial pleasantries, had a laugh.  Asked him how he was. He said “Fine, very well thank you”.   Soon, was this to change.

He told me he had fractured a tooth in the upper right area this morning. There was no pain but it was sharp.  I turned round to type this into the clinical notes.  I could see that his ASA rating was 1.  Nothing medically to worry about.  As I was typing, I heard heavy breathing behind me.  I turned round and saw his eyes had closed, his right leg was hanging off the side of the dental chair and as I faced him, calling his name and shaking him and lightly slapping his face, the breathing became more laboured.   I lowered the chair back right down and called him again.  Suddenly he came round and said: “Yes, yes I’m ok”…and then….he was ‘gone’ again. The breathing became more laboured to an alarming level. 

I asked for the emergency kit and Amy came back with it.  He was still breathing heavily.  As I attached the pulse oximeter to his finger, his head suddenly came forward, tongue protruded and his breathing become a desperate stridor.   His face then went completely purple / ashen. 

Immediately I instructed Amy to let reception know “Medical Emergency.  Cardiac Arrest. Call an Ambulance.”  She went straight outside.  I noted the time and started CPR immediately.  30 compressions to 2 breaths.   At one stage, I vaguely remember thinking part consciously, that If I don’t do this, he will die. It was a battle between death and I and death was not going to take him, not on my watch.  I pumped like mad.

I heard Bea, shout, if he was breathing. I shouted back: “No. Cardiac arrest. Not breathing.”  

Amy came back in and brought the AED in. We connected it up and followed the instructions.  Bea stayed on the phone in, in case 999 needed to speak to her.

The AED spoke in an incredibly loud ‘voice’:

“Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I did this and the whole chest arched and lifted off the chair with part of his body.  The AED assessed the rhythm again and instructed us to continue to carry out CPR. 

Meanwhile as Bea had more training in Med Emergency, she came in and Amy went outside to wait for the ambulance.  As I carried out compressions, the pulse oximeter showed a pulse of 110  and oxygen content of 70%.   This little bit of information was reassuring as our AED did not have a screen with the ECG tracing. 

The AED instructed again:  “Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I followed the instructions.

The first paramedic arrived. This was about 11 minutes from the time the patient went into cardiac arrest.   I continued CPR.  He took over immediately to check the back of the chair was firm enough and immediately said ‘yes’, good.  I then took over again as he got his gear out.

The AED instructed again:

“Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I did this and the chest arched and lifted off the chair.  The AED assessed the rhythm again and instructed us to continue to carry out CPR. 

Suddenly the patient responded and pushed my hands off his chest!  Then went still again.

The paramedic was in no hurry to attach his AED.  He asked if our AED showed what was happening on a screen.  I said no.  He seemed happy to continue with our AED at the moment.

The AED instructed again:  “Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I did this and the chest arched and lifted off the chair.  The AED assessed the rhythm again and instructed us to continue to carry out CPR. 

By now two more paramedic vehicles and the ambulance had arrived.  Literally minutes if not seconds, 4 more paramedics came into the surgery.   The lead paramedic, the first one who arrived, switched over to his AED which had an ECG tracing.   The second lead asked about the medical history of the patient and I informed him it wall all clear. 

The third paramedic took over external cardiac massage as the second put an IV line in.  Sugar level was tested. Negative.

It is difficult to recall exactly what happened when and what was done when and in what order.  An airway was put in.   A drip was set up.  At some time I think they also injected something.  They did other things I am not sure what.  They also attached a contraption that carried out external cardiac massage.

As they looked at the ECG I heard the second paramedic say to the lead, “That’s VT” (I think that’s what he said. There was definitely a ‘V’ in his sentence) and this was confirmed by the first.  Everyone was instructed to stand away from the patient, they pressed a button, you could hear a ‘whine’ as the defibrillator charged and they shocked the heart again. 

The ECG tracing went flat and suddenly started up again and I could see what appeared as a more ‘normal’ tracing.  Then it took on another pattern again. 

They were in the surgery for about 1 hr to 1 hr 30 mins.  The tracing on the ECG was erratic and inconsistent in that time.  Every time they shocked him, the line went flat and then started again.

I had to help to deliver the oxygen for a few minutes.   In total the patient’s heart was shocked 6 - 7 times.

I am sure he had ‘come’ round a few times in that 90 minutes.

After the last shock, I cannot say exactly when but I suddenly realised they had stopped the compressions and delivery of oxygen.   They were moving around more relaxed. The lead paramedic asked one of the ambulance drivers to bring something in.  Then he asked her to bring the stretcher in.  I thought: “What, is he…dead?”. 

I had forgotten about the ECG.  I suddenly remembered it and looked over at it…..even though the patient was unconscious and no obvious signs of life, to me, ……… there was a ‘normal’ heart tracing on the ECG.   Very regular and steady.  I looked at his chest…he was breathing on his own!  I thought: “My God, there’s a normal rhythm!”  

They lifted him onto the stretcher with the airway and ‘automatic cardiac massage’ contraption still in place, I think. The airway was definitely in.   I suppose in case he needed it again.

3 of the paramedics went with the patient to the hospital, having taken the patient’s personal details.  2 stayed behind to pack up and clear up.  I asked the second paramedic if the patient was OK.  He looked at me, looked at our AED the oxygen cylinder and said pensively:

“He’s OK. Will have to see if he pulls through.  Hopefully there is no brain damage.  You got the oxygen,…. (he looked at the AED again, which was lying on the surgery floor) …….you had the defib…….you saved his life.” He said nodding.   It had not dawned on me at the time the significance of what he was saying.

The two remaining paramedics left, saying that they’ll be back to pick up the last remaining paramedic vehicle when they’ve finished at the hospital.

THE IMMEDIATE AFTERMATH

The three of us sat down, numb and started talking about the incident.  Bea made cups of tea and we sat in the staff room.  We agreed we could not have done anymore.  When he had been put into the ambulance, Amy said she heard one paramedics say to another that the patient had pulled the airway out.  This was put back in then the doors were closed. So it was good, it was reassuring to know that he was alive when he left the surgery to be taken to the hospital. 

There were no elation and shouts of joy. Just numbness.  The shock and disbelief that we had just be part of and witnesses to a full blown cardiac arrest in our dental chair.

As Amy and Bea were talking, I remember I had asked one of the paramedics if there was something we should do or someone we should report to. He said there was nothing.  If the patient dies, the police will be round to make their enquires and investigate.  If he pulls through, we probably won’t hear from anyone.

When I look back now, I cannot help but feel what a sad and unacceptable and ridiculous situation the profession has been put into by those who have the authority to ‘rule’ over us but really have been given or taken more authority that they deserve.  I have been told by a paramedic that we did the right things and possibly saved someone’s life, at the moment, but instead of elation at a professional stance of doing the right thing, unfortunately I started worrying about whether I had all the right ‘paperwork’, dotted all the ‘i’s and crossed all the ’t’s if there was an investigation!

When we finished our tea and I could see we were alright, we went down stairs to tidy up.  Bea put a note to order a new set of adult pads for the defibrillator.  I checked the oxygen content whilst Amy put the Medical Emergency things away.

It would have been about an hour to 90 mins when the door bell rang. Paramedics 1 and 2 were there.  We looked at them holding our breaths.  I asked how the patient was.  The lead said, looking at the ground:

“We have some news for you.  Looked up and smiled. We have him up and talking.  He’s actually up and talking.  He must have had a massive blood clot in the artery. They are thinking of discharging him in a few days. Well done” as he looked at each of us.

The relief from the three of us was palpable in the air.  He’s OK!

The 2nd paramedic looked at the three of us, then at me in the eyes and said something about CPR, getting the oxygen in then…..

“You had the defib…….YOU SAVED HIS LIFE””, nodding and repeated as he looked round at the three of us: “you saved his life, well done” and smiled.

I thanked them for delivering the good news, thanked them for getting here so quickly and for all they had done.

The two then left.

We shut the door and elation!  The total release of suppressed, involuntary tension.  Earlier on once the paramedics had arrived, Bea had cancelled the rest of the patients for the day and evening. I felt they deserved to have the rest of the day off!  Fortunately we weren’t seeing patients the next day.  They went home.

I stayed behind for a bit.

PERSONAL REFELECTION

Bea and Amy were just great.  I could not have asked for better support.  This was the first, and last I hope (!), medical emergency we had to deal with and, for all that, in at the deep end.    Amy just carried out unquestioning what she was asked to do.  Bea, calmly called the ambulance and handled the reception area.  In fact, as Bea was cancelling one of the patients’ appointment, he commended her on how calm she was when talking to him, given what she was in the midst of.

We were lucky there were no other patients in then.  No one ‘collapsed’ , broke down in tears or freaked out.  They both held it together.  Just amazing.

I will forever be grateful for the regulation that insisted we had Continual Professional Development (CPD) on “Medical Emergency” every year.  Every year we had a hands on 3 hours training session and I would also attend an additional lecture session.  I was never sure how much of this I actually retained in my head.

I made sure we held a medical emergency drill once a month. Only I knew when I would call one. I would always choose a time so we had a different number of staff around. We may miss a month at most but we held the drill regularly.

I am in no doubt this was one of five things that affected the outcome.

INSTINCT

When something like this happens, there is no time to think, no time to work your way through some mental venn diagrams or following the boxes of a mental flowchart.  It had to be instinct and what was already in your subconscious. 

Everyone just went into action. Everything just went so smoothly.  The call for the ambulance. Staying online with the 999 operator. Waiting outside for the ambulance.  Amy saw him and made a beeline for him.  CPR: 30 compressions to 2 breaths.

I have no doubts the regular drills helped us all.

STRIDOR & SUBSEQUENT LOSS OF COLOUR

I did not have to work out if he was breathing or his heart was beating. This just told me …negative.  I was lucky to have had these signs.

I just started immediate CPR and the ambulance was called. 

The rapid response I am sure contributed to the outcome.

CARDIAC COMPRESSIONS

One can never know if one is compressing chest deep enough.  You can’t measure the depth of compressions in such situations.In this case the colour of his face instructed me.  I could actually see the colour come back to his face.   This helped a lot when one is not consciously in a thinking mode and operating on instinct.

AUTOMATIC EXTERNAL DEFIBRILLATOR

The enemy to anything we do …….is ‘doubt’.  If you start asking yourself, doubting your actions, for anything, it is a recipe for disaster or failure.

He was, as I came to know, in VT/VF. I have no doubts the AED contributed to the positive outcome, directly and INDIRECTLY. 

Before the AED was connected, I was just pumping away but no idea if it was helping. 

The question always in the back of my mind is if I’m doing the right thing at the right time. 

When I connected the AED up, the minute I heard its “voice”, I was immediately aware of a sudden mental, physical and emotional relaxation. It was like having the consultant cardiologist in the surgery.

“Stand back…do not touch the patient…assessing rhythm….shock advised….press the red button and shock.”  I just thought: My God, his heart is being monitored now.  “Somebody” knew what was going on.  There is nothing more to do but follow the instructions.  It had an immediate calming effect on the whole process.

I had wondered if I should buy the AED.  I did. We’ve had it for 5 - 6 years now, every day checking the “green ready” light is on, never once thinking we will need it.  I have absolutely no regrets in buying it. 

I am well aware that there is still going on a major disagreement amongst professionals whether the AED is necessary in the dental surgery.  I will have no hesitation now to say YES.  I cannot be more appreciative of the AED.  It made the whole incident so much more easy to handle and I will forever be grateful we had one.  It actually helped to calm the room.   Was it ‘the thing’ that saved his life?  I don’t know.

I remember hearing at a lecture on Medical Emergencies.  I cannot remember who it was.  What he said was that we can never fully know exactly what is happening to the heart muscle and how it will respond to anything we do.  The patient, to all intents and purposes, is dying or nearly dead. If there is anything we can do that will remotely contribute to a positive outcome….DO IT.

Of course there is never absolute certainty in life.  The consequences of our actions can never be fully predictable.  If one will only act if one is always absolutely certain of the consequences of one’s actions, then one would just sit and do nothing.

The AED contributed in two major ways:

1    It really calmed the room whilst we waiting for the paramedics to arrive.

2    As I saw on the ECG screen later, it gave the heart a chance to re-establish a normal rhythm.

I HAVE ABSOLUTELY NO DOUBTS THE AED CONTRIBUTED TO THE POSITIVE OUTCOME in this case.

LUCK

Pure luck had a lot to do with it.  We were lucky the paramedics were able to arrive so quickly and there were so many.   They were just amazing.  They went about what they had to do in a calm, confident and controlled manner. 

We were lucky, before the paramedics arrived, none of us freaked out.  I have no doubts the regular drills we had played a large part.

One can never say for sure what exactly it is that brought about the positive outcome but I am sure luck played a part in it.

WHERE AM I NOW?

There is the disbelief that I was actually  deep in the middle of it all.  I actually looked at the face of someone who was clinically dead and he pulled through?   I came back from the Dentistry Show the day after ‘the event’ and went straight to the surgery, to call the hospital to see how he was. There was a slight eerie feeling going into that empty building, into the surgery. It was all clean, tidy and quiet. I could not help but wonder if 24 hours earlier, did all that really happen?

The suddenness of it all is what is so frightening. There were no medical history concerns.  One minute he was there, two minutes later he was gone. If he had been in his car, 5 minutes late for his appointment, he would have had it in the car and could have ploughed into a bus stop with men, women and children.

I value my life much more now.  An appreciation of what I have, life, wife and children,friends and who I am.  So much we take for granted. 

I was surprised how well we all were when we attended to patients two days later.  It will take some time for the slight apprehension to dissipate.  Is this person going to suddenly have a heart attack on me?

The recent developments, all the nonsense, in the dental profession had really got me down.   All the effort in having to keep a surgery running with all the nonsense regulatory compliance and then having more piled on, unnecessarily.  I had been tired of putting so much effort into working as a dentist and getting so little back in return as the pressure of legislature piled on.  I was tired of legislature getting in the way of patient care. 

This ‘event’ has helped me to see things in perspective. This has been a good boost in morale as at least, all this effort came to fruition.  I am very proud of my staff and I hope they are of themselves too.

There is a mixture of emotions or feelings in myself.  Of course there is an immense feeling of gratefulness that we had a positive outcome.  Then, there is the feeling that one has been in a ‘privileged’ place, if that’s the word to use.  To have been involved in the thick of things and have a positive outcome.  Then there is something else I am aware of.   I am not sure how to describe it but it is a good feeling……….there is a deep seated feeling of stillness.

Every so often, the words that still ring in my ears:  “You had the defib……you saved his life.”

That inner stillness…..is….good.

Chris.

Dr Chris Tavares,

Dental Practitioner, Derby

April 2015

This blog was first published in April 2015, a few days after the event. In May 2016, after seeing more data, Dr Chris Tavares added the following:

I wanted to correct a few inaccuracies so as to be fair to the East Midlands Ambulance Service who did such a fantastic job on the day and to give credit when and where credit is due.

In the heat of things, a second can seem like a minute. A minute can seem like three minutes. I was able to download the data from the AED which records an ECG tracing every second. The AED analyses the rhythm every 2 minutes and advises to shock or not.  I was able to work out the exact timeline from this.

The heart was in VF.  CPR was started within 10 seconds of cardiac arrest.  The first shock to the heart was within two minutes of cardiac arrest.  The first paramedic arrived 5 minutes from the time we dialled 999. The five paramedics were in the surgery for about half an hour when a normal heart rhythm and spontaneous respiration were re-established and the gentleman was taken to the hospital. 

I have no doubts the rapid sequence of responses added to the positive outcome.

 The whole situation can best be summed up:

 “We did what we had to do ... the paramedics did their magic ... and the hospital staff performed the miracle.”

The gentleman is alive and leading a full life, no brain damage, no external scars.

Buy an Automated External Defibrillator and save a life.

On Monday 30^th March the Church Street Dental Practice in Caernarfon re-opened  under the expert guidance and leadership of Simon Gallier, a dentist with 32 years of experience.

Two recognisable members of staff are working alongside Simon; Sian Roberts and Jenny Ellis. The team worked  hard to get the practice back up to speed to welcome as many patients as possible.

Speaking about the reopening, Simon said, ‘We are excited to welcome our patients – new and old – to the practice. We’ve been busy behind the scenes getting the practice up and running again, and we look forward to delivering exceptional dental care to the local community.

‘Why not visit the practice to see some new and some familiar faces for yourself, working in a newly super-efficient and, as always, caring environment. We’d be delighted to see you.’

Church Street Dental Practice offers a unique model for running a dental practice. Maintained by Future Health Partnership as a community interest company, Simon, Sian, Jenny and their colleagues each own a share of the business, much like John Lewis partners do.

If you would like to book an appointment for a visit or to talk to someone about your dental care, please call (01286) 672601 or email This email address is being protected from spambots. You need JavaScript enabled to view it..

Leanne Ridley, Dental Nurse at Ghyllmount Dental in Penrith says:

“With The Dental Directory, online ordering makes it really easy and we are moving over to a big, monthly order schedule very soon. We use The Dental Directory for all our consumables.

“We have done price comparisons recently and The Dental Directory was shown to be very competitive. Our rep, Rebecca keeps in touch, which is great and will go through new deals with us, although we obviously get the flyers through the post and can see offers online. Rebecca is very efficient at dealing with our practice needs.

Our experience with The Dental Directory is that they are easy and positive to work with and I would recommend them.”

For more information, contact The Dental Directory on 0800 585 586 or visit www.dental-directory.co.uk

Practice Plan presents an overview of the current situation with NHS dentistry, to help dentists make an informed decision as to what may be best for their patients in the future.         

Dental contract reform – prototypes

On 15 January, the Department of Health announced that a new stage of reform will start in 2015/2016. In this new prototype stage dental practices will test whole versions of a possible new system, rather than, as in the pilots, key elements needed to design a new system.

The prototypes will consist of:

• A clinical pathway

• A set of clinical measures (DQOF – Dental Quality and Outcomes Framework)

• Remuneration better aligned with access and clinical outcomes (a blend of quality, capitation and activity).

The prototype stage is intended to be a forerunner of a reformed system, but is not the final version. Wider adoption of the approach depends first on the prototypes demonstrating this is a viable approach.

Prototype practices have not yet been selected, with the process potentially continuing until 2019, the earliest date at which a reformed contract could become the prevalent approach.

In 2014, John Milne, Chair of the BDA’s General Dental Practice Committee (GDPC), spoke at a series of Local Dental Committees-organised roadshows offering valuable insight into the NHS contract, both now and in terms of what the future might hold.

A significant issue for the dental professional as a whole, is that the potential reform of the dental contract has been the subject of considerable discussion for many months now, with pilots continuing in 2015.

As Dr Milne noted at the 2014 Local Dental Committees (LDC) Conference and was subsequently reported to say on the LDC website: ‘…on-going pilots were not the finished article but were intended to contribute to a workable reform. He [Dr Milne] reminded delegates of his demands of the minister at the BDA Conference: some clear commitment from Government to make progress; expansion of the pilots and modifying them to make them into a real test to be some sort of prototype and a clear timetable and a roadmap to implementation. He had also said that practitioners would need preparation as part of training time for practices, and maybe a release from the UDA targets during the transitional phase. The Minister wasn’t able to confirm this last demand, but was able to confirm the first three.’

Dr Milne ‘…also reflected on some of the big questions GDPC had discussed around capitation contracts at their recent meeting and urged delegates to consider these and discuss them with speakers; e.g., what are the risks and benefits of arguing for the highest possible percentage of capitation? How do we avoid neglect? How do we monitor the capitation contract? Should there be a limit on who gets care? How should activity measures be paid for? How do we avoid the disadvantages of the UDA with its perverse incentives? Should payment for activity be limited to just advanced or complex care? And can we actually define what those things are?’

Practical application

So, what does this mean in reality for NHS dentists? For most of those working at grass roots level, thus far nothing has changed, but for the piloting practices, it has been an interesting journey. 

For example, in July 2014 at the Westminster Health Forum seminar on oral health inequalities, dentistry commissioning, regulation, and the dental contract reform, dentist Sabrena Kara shared with the audience that the new system had led her to overcome a backlog in care by improving time management and using dental therapists to provide treatment, allowing her time to deal with more complex dentistry.

Other comments from pilot providers, published in last year’s report from the dental contract pilots evidence and learning reference group, include:

• ‘I think I could make it work better if I had a hygienist or therapist, that would make a massive difference because I could then you know, offload…I’m a very expensive hygienist at times really’

• ‘The patients are very positive… actually love it because they get such a lot of personal attention and they think it’s great, marvellous’

• ‘…to do the pilot properly takes longer… you’re talking to the patient more… I’m not saying that’s a bad thing but I just think it should be taken on board if we’re spending less time treating people… there’s either going to be a shortfall somewhere, there’s going to be complaints or there’s an element of people who might consider going somewhere else’

• ‘The throughput of patients has reduced and so there’s a pleasanter atmosphere. They’re [the dental team] not rushed off their feet like they were and it’s a more steady pace…they’ve had a little bit more work to do explaining to the patients about ICs and charges...I think they’re happier’.

These comments suggest that there may be a need to balance the time required to deliver the preventive aspect of the clinical pathway with treatment, but actually that isn’t anything new for NHS dentists. There is always a learning curve with anything new, and one hopes that results gathered from the ongoing pilots will help to make any transitions as easy as possible for the dental team.

Looking to the future

There is a general sense among the dental profession that we are most likely looking at the introduction of a reformed contract that will not drastically change, let alone improve NHS dentistry. 

With patient care the focus of the current contract, and, presumably any reforms, for dentists happy with the NHS status quo of restoring the function of dental health in the most cost-effective way possible, the big question is whether the remuneration will be sufficient to run a viable business. Sadly, as has been the case for many years, the NHS is squeezed for funds and, much as we would all like to consider only the level of clinical care, no-one can hope to continue to run a non-viable business.

Nonetheless, NHS dentists have worked hard to ensure patients get the best possible care under the existing contract and, no doubt, will strive to do the same under a reformed model, if the parameters of what is on offer allows them to meets their clinical goals and the needs of their patients, while maintaining a viable business.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions for more than 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs.

Dentist David Griffiths shares his experience of those first few, all-important years in practice with Young Dentist readers.

I knew from the start that I would begin working primarily under an NHS contract. Upon completing my training, it felt a ‘safer’ environment in which to initially advance the techniques, skills and practical abilities I’d learnt during my undergraduate studies.

I believe it would be almost impossible to be employed by a private dental practice as a new graduate (in the UK) without any prior experience, as usually employers would request a minimum of two years’ clinical experience post-graduation. Also, new graduates usually have zero business experience and are in no financial position to set up their own practice. Therefore, initially working under an NHS contract is the natural progression after graduation.

The ups and downs of the NHS

The benefit of working under an NHS contract is that it provides professional stability. I did soon realise, however, that there were some less favourable aspects. Despite the current NHS contract being able to benefit patients in the majority of clinical scenarios, there are some circumstances in which private options become more feasible. When treatment does not fall within NHS’ criteria, it can lead to patient dissatisfaction with the dentist, rather than the system.

Also, if a dental practice is to survive within any community, it must engage with it in a positive way, and so dentists must be able to spend time providing treatments that patients are happy with. The NHS contract may be seen as only allowing the time fundamental to completing treatment. Additional time would be appreciated to enable, for example, building rapport with patients so that they are more likely to return for follow-up care, or to expand on long-term treatment options.

Sharing knowledge

There is limited impartial guidance regarding the benefits and downfalls of a career either under an NHS contract or providing only private treatments within the undergraduate curriculum. This division is rarely discussed, as it is not a simple case of NHS versus private.

For those a few years behind me I would recommend they gain experience in both these areas either before or in the years following graduation, to experience the diversity of the spectrum of treatment for themselves.

Training should focus on the ability to carry out good quality treatment and be expanded upon during a dentist’s career within their level of competency. It is up to the individual to decide what form this should take

 Biog

After graduating from Liverpool University in 2011, David Griffiths moved to Newcastle to complete a two-year General Professional Training programme (VT1 and 2), which included working within a large NHS practice in the centre of Sunderland and within several specialist departments in Newcastle Dental Hospital. Following this, he worked as an Oral and Maxillofacial SHO in the Royal Victoria Infirmary Hospital in Newcastle. Currently, David is working back in Merseyside, beginning his first year within a General Dental Practice as a full-time associate dentist; he focusses primarily on NHS treatments and the practice offers private care through a patient membership plan administered by Practice Plan.

If you’re thinking about your future and would like some obligation-free expert advice you can trust, please call 01691 684120 or visit www.practiceplan.co.uk/nhs.

GDPUK are proud to be sponsoring the GDP Theatre alongside Colgate at next weeks Dentistry Show. 

This theatre will provide further insight into both new and everyday clinical techniques and procedures. Experts in their respective fields will run sessions covering a variety of subjects from endodontics to pain management to a new approach to electric toothbrushing!

Another focus of the theatre will also be the recent changes to the rule and regulations governing the profession, how they affect you and what you have to do to demonstrate your compliance to them.

Below you will find the latest timetable for the Theatre. (subject to change)

Please come and visit GDPUK at the Dentistry Show - Stand E01

The GDPUK stand will be situated next to the GDP Theatre.

Look forward to seeing you all at the Show.

Isn’t it funny, as a child you can’t wait to leave school and get away from all that ‘edumacation’ and then something weird happens.  

It probably starts to emerge in your late 20’s and really kicks in through the next couple of decades. We morph into stay at home information junkies and search the internet for books, DVD’s and training modules to expand our minds!  All done from the comfort of your home.  

Devoting other precious minutes of your time to ‘staying in-touch’ via Social Media which in many ways could be better named Social Pariah as the last thing it is ….. is particular social as you hammer out your latest Post from the bathtub!

So our internet based information driven society means we are becoming increasingly neglectful about personal contact and building those all-important relationships with colleagues as we would have done in the past.  

Dentistry IS all about people – from the Team in your Practice to your clients coming through the door.  So our ability to communicate the right way is fast becoming challenged.  Leaving many a Team’ lost for words’ which won’t build a motivated Team or a loyal client base.  

So for me the Dentistry Show is all about making new connections and reconnecting with others.  Putting the face of NBS Training at the forefront of everything I do and stand for.  But above all it’s about sharing valuable information with people.  People who truly want to build an inspirational Team who excel in the eyes of every client for their award winning Patient Care.

Tracy Stuart will be speaking at the Dentistry Show

Further information about her business and ideas can be found here - www.nbstraining.co.uk

Chris Barrow will be among leading business experts from across the dental profession speaking at Practice Plan’s Practice Management Conferences in June.

Delivering an unmissable session on how to develop and grow your practice, Chris will introduce delegates to the latest innovations and thought in practice marketing in his session ‘Boosting your profits and how to do it”.

In Reading on 5th June and Manchester on 19th June, Chris will take attendees on a guided tour on how to market and manage your practice and provide a clear understanding of ‘what you should do next’ and how to avoid missing the boat.

If you’re looking for solutions to your practice marketing and want to learn from the experts, make sure you attend the Practice Plan Management Conferences in June.

For more details please contact Sarah Whittall, Practice Plan at This email address is being protected from spambots. You need JavaScript enabled to view it.

For more information about the business services available from 7connections please call 01647 478145,

email This email address is being protected from spambots. You need JavaScript enabled to view it. or

visit www.7connections.com.

Spinalis UK is launching the unique concept of dental stools and lab chairs designed to allow free movements in all directions. Spinalis stools and chairs are designed to counter the ill-effects of sitting. The seat is mounted on a spiral providing flexibility without bouncing allowing your spine to stay in the correct position without 'breaking' in the lower back and relieving disc pressure. 

Spinalis stools and chairs are the perfect health solution wherever it is necessary to lean over a patient or a work surface while maintaining maximum mobility. The seat and the backrest rotate and move independently, allowing for comfort in unusual positions.

Spinalis flexible seat mimics sitting on a gym ball, improves core stability and postural mechanisms.

We supply three models of Spinalis dental and lab stools and seven models of Spinalis chairs in a wide range of colours and materials.

Spinalis chairs and stools are high quality EU products a recognized medical device across the EU. All backed up with our three year warranty.

http://spinalischairs.co.uk/

Visit us at this year's Dentistry Show at the National Exhibition Centre in Birmingham at D91 stand.

As the Chairman of the Lawyers section of the National Association of Specialist Dental Accountants and Lawyers (NASDAL), Andrew Lockhart-Mirams, Senior Partner from Lockharts Solicitors, will be in attendance and exhibiting as a member of NASDAL at this year’s The Dentistry Show. The Show is held at the NEC in Birmingham on Friday 17 and Saturday 18 April, 2015.

Lockharts will be supporting NASDAL in attracting various Dental professionals, practice managers and owners at the event, to share their knowledge and skills about a range of issues relating to the accounts, legal, and tax and business affairs for dentists.

Formed in April 1988, NASDAL’s objective is to ensure that it provides a means of establishing a high quality of service to members of the dental profession at all times. The Chairman of NASDAL, Nick Ledingham, along with various other respected members of NASDAL will also be attending.

Andrew Lockhart-Mirams, Lockharts Senior Partner, said “Lockharts Solicitors are delighted to be part of such a fantastic event for Dentists, and to also be supporting NASDAL as a member and exhibiting at this year’s event. It is a great opportunity to for each NASDAL member to bring their specialist knowledge and business to the table and showcase how their individual business are able to support Dentists and more importantly, also collectively under the NASDAL umbrella, to further benefit Dentists and to improve further in all areas of the overall business. NASDAL is the one-stop shop for Dentists for everything legal and accounting.”

Visit Stand G32 at The Dentistry Show to find out more, or visit www.nasdal.org.uk.

We hope to see you there!

Disclaimer: The content of this article is only intended as information and should not be considered to be legal advice. Lockharts cannot be held liable for any loss caused by any act or omission as a result of the information in this article.

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.

Friends and Family Test [FFT]

The FFT will be introduced to dentistry in England on 1^st April 2015, which some might consider an appropriate date to introduce such a tool. David Cameron is an enthusiastic supporter and believes this simple test will provide “a single measure that looks at the quality of care across the country."

Others, including the Picker Institute, the Kings Fund and the British Medical Association are somewhat less impressed with the value of implementing such a tool. Chris Graham of the Picker Institute has stated that “the ‘simple, headline metric’ used for the test does not provide a reliable basis for comparing services or identifying those performing best.” Dr Kailash Chand, deputy Chair of the BMA, is slightly more direct in his criticism. He has described the FFT as a “political gimmick” and asserts that the last thing we need is to collect “more meaningless or misleading data”, a comment which I’m sure will resonant with many dentists.

Sadly this point is obviously lost on the Prime Minister, who continues to believe that the FFT will allow everyone to “have a really clear idea of where to get the best care”. It is hard to believe that such a simplistic tool could actually improve the quality of patient care in dentistry. (I refer to the FFT, and not the Prime Minister!) 

The only value would appear to be in the free text question, which we have naively been given freedom to design ourselves.

The simplest approach would be to ask …. “Why?”

As in, “why did you answer the previous question in the way which you did?” Rather than “WHY?” in the context of a dentist screaming at the moon, as another pile of ill-conceived bureaucracy is dumped on them from a great height courtesy of some narcissistic NHS manager.

Other suggestions for free text questions have included:

“How much of a waste of time do you think this is?”

“What three words best describe the people who developed this questionnaire?”

In the spirit of Patient and Public Involvement, it might also be worth considering the following as a suitable second question…..

“What question do you think we should include as our second question?!!!!”

It is tempting to treat the FFT with the respect which it deserves. NHS England appears to be resigned to this approach, judging by the fact that there is currently no target set for the number of responses required! The introduction of FFT is a contractual obligation and I can’t imagine that this laissez-faire attitude will persist. Perhaps they will include it within a future iteration of the DQOF as another measure of how well we complete our paperwork. The term “biro dentistry” is about to take on a whole new meaning!

So what should you do?

In our practice, we are fortunate to have a highly motivated, efficient practice manager, who seems to revel in the imposition of NHS bureaucracy. She obviously looks at the FFT as yet another challenge to be overcome, and failure to do so would be seen as a sign of weakness. She has organised strategy meetings, staff training, team discussions and already delegated duties. None of which involve me filling in a pile of FFT forms…… as yet!

There is unanimous agreement within our practice that the FFT question is a complete waste of time. It is not a reliable indicator of quality and provides inadequate information compared to our existing patient questionnaires. We see this as an additional burden on our staff, our patients and our practice, but will reluctantly comply and attempt to use the free text question properly to gather some feedback.

So what should the profession do?

As a profession, we need the BDA to take a strong stance and challenge NHS England on the introduction of additional bureaucracy, which quite clearly has limited patient benefit. It is correct that the BDA support the introduction of measures of quality, but such tools need to be valid, appropriate and worth the paper they are written on. 

Patient experience data is of considerable value in terms of improving the quality of patient care and there is obviously an increasing amount of data that is going to be collected, analysed and interpreted. This takes time and resources, but can only be justified if the data collected is robust, reliable and can ultimately be translated into improvements in patient care. If the data is not robust and reliable, the exercise will be a waste of time and simply add to the level of unnecessary bureaucracy and administration, which we have to deal with. It is not acceptable to measure what is easy to measure, rather than what is actually meaningful. This is ineffectual, burdensome and demoralising for staff.  

Jocelyn Cornwell of the Kings Fund states that “patient experience measures will only work if clinicians as well as managers take them seriously, and in general they don’t. Clinicians will reject measures they see as inappropriate or unreliable, and will not act on the results.”

We have an opportunity to put quality at the heart of the dental contract reforms, and Patient Reported Experience Measures are going to play an important role in the evaluation of quality. The current approach of NHS England does not instill confidence and it is therefore vital that the BDA, the FGDP and others influence how quality is measured within general dental practice.

1.    Department of Health. NHS dental services in England - An independent review led by Professor Jimmy Steele. In: Health Do, editor. London: The Stationery Office; 2009.

2.    Professor the Lord Darzi of Denham K. High Quality Care For All. NHS Next Stage Review Final Report. London2008.

3.    Kings College London and The Kings Fund. What matters to patients'? Coventry2011.

4.    Department of Health. Dental contract reform: Prototypes, Overview document. In: Legislation and Policy Unit DaES, editor. London: HMSO; 2015.

 Image credit - Glyn Lowe  under CC licence

Get more from GDPUK. Save money and improve your services with our exclusive partner offers.

GDPUK is partnering with carefully chosen providers to offer you services and products that will be of value to you and your practice.

We’ve chosen trusted providers whose products or services have already achieved positive feedback from members, and who have promised to provide a high level of service and support, along with competitive pricing.

Commissions or referral fees earned by GDPUK as a result of introducing members to service partners will be ring-fenced by us for future use in advancing appropriate causes relevant to the profession.

Further information on what we are offering can be found here - www.gdpuk.com/services

Insurance is one of the services we are pleased to be offering to our members.

Save money and receive better service with our bespoke, brokered insurance for dentists. We have reached an advantageous arrangement with reputable insurance brokers who have extensive experience in arranging both professional and personal cover for dentists.

Through our partner brokers, you will receive all the claims handling and underwriting flexibility available from a good broker, along with highly competitive quotes.

What cover can you arrange?

Our brokers will be pleased to discuss your precise requirements with you, and then to prepare personal quotes providing you with the most suitable cover at the best available prices. Should you need to extend or adjust your cover, or need to claim against your insurance at any time, you’ll be assured of their attentive and knowledgeable assistance.

Insurance can be arranged in the following principal areas:

• Practice and Surgery Insurance
• Overheads and Locum Cover
• Household Insurance
• Pressure Vessel Inspection
• Buy-to-Let Property Insurance

Click on the link below for further information and fill out the form at the bottom of the page. We will then forward your details automatically to our broking partner who will contact you to discuss your requirements.

They will then prepare some quotes for you and progress your application directly and in a timely manner.

www.gdpuk.com/insurance

Visit GDPUK.com on stand E01 to find out how you can join the largest community of dental professionals in the UK for free! Established since 1997 the site has over 8000 members, who enjoy using the forum to discuss all things dental on a daily basis. The forum has recently passed the milestone of 18,000 topics created and 200,000 posts.

GDPUK frequently publishes exclusive dental news and additionally we have a number of paid writers who regularly blog for the site. The news and blogs attract thousands of readers.

The site is free to join and revenue is generated by dental businesses advertising on the site, if you are interested in reaching thousands of dentists on a daily basis please get in This email address is being protected from spambots. You need JavaScript enabled to view it. or have a look at our media pack which can be found here.

Additionally we have recently launched some extra services for our members, called GDPUK Services! The site includes the opportunity to make savings on practice energy usage and practice insurance. We also offer the option for you to create your own custom app for your dental practice, which is a unique marketing tool for your practice. Further information can be found on gdpuk.com/services.

Please visit stand E01 for further details about GDPUK.com and GDPUK.com/services. 

If you would like to register for the site, please click here.

We look forward to meeting you at the Dentistry Show on April 17th at the NEC, Birmingham.

GDPUK are proud to be a media partner of the Dentistry Show 2015, please have a look at our free guide to the show.

This year DPAS Dental Plans wants to learn more about the challenges faced by practice teams visiting The Dentistry Show, so are asking delegates to name the ‘3 key cogs’ that keep their practice machine running.

Visitors who share their ‘3 key cogs’ with the DPAS team on Stand B32 will be invited to play our new ‘Find the missing piece’ game, with the chance to win prizes ranging from high street vouchers to an iPad mini.

DPAS provides a flexible, comprehensive dental plan administration service tailored to meet the specific needs of your practice and patients. Our understanding of the challenges faced by practices has enabled us to develop bespoke practice support that includes a range of tools, from marketing and patient recruitment consultancy right through to team training and annual fee reviews.

Whether you’re considering your options ahead of NHS contract changes or want to attract more patients by re-launching your dental plans, the DPAS team will be on hand to offer advice and support throughout the show, so you can find the plan that fits.

Visit Stand B32 at The Dentistry Show to find out more, or visit www.dpas.co.uk

Measuring patient experience in NHS Dentistry

A consistent criticism of NHS dentistry has been the continued focus on treatment and activity rather than prevention and oral health outcome; a pre-occupation with “quantity over quality.” Jimmy Steele acknowledged this in his 2009 report and highlighted the need to design a contract which provides “much clearer incentives for improving health, improving access and improving quality.”¹

We would all agree that dental care professionals should provide care of a sufficiently high quality for our patients, and it would not be unreasonable to expect to work within a system that supports this. Sadly, it is generally accepted that the current NHS contract does little to incentivise or reward high quality care, and I guess we should be encouraged by the fact that the contract reforms appear to be addressing this by developing a Dental Quality Outcomes Framework (DQOF).

The DQOF was initially based on three dimensions of quality as recommended by Darzi²: Clinical Effectiveness, Safety and Patient Experience. This has subsequently been refined with the introduction of two additional domains (Best Practice and Data Quality) within the prototype contracts. The addition of a domain which rewards dentists for submitting NHS claims on time perhaps gives some insight into the level of confusion which exists around the concepts of quality management and performance management. Submission of claims on time is certainly important for the smooth running of the system, but it is difficult to comprehend how this is related to the quality of patient care.

The Dental Quality and Outcomes Framework (DQOF)

This lack of understanding about quality in dentistry is further highlighted by the current design of the “patient experience” domain within the DQOF. Patient experience is recognised as a key component of assessing quality within the NHS, and the current DQOF includes seven questions purportedly related to experience. At first glance these questions may appear relevant “How satisfied are you with the NHS dentistry received?” or “Would you recommend this practice to a friend?” or “How satisfied were you with the cleanliness of the practice?”

They all seem quite reasonable questions, but do they provide an accurate assessment of patient experience?

You would certainly hope so, as the current intention is to assign 10% of your GDS contract to DQOF, and a failure to hit your target will result in financial penalty. When the QOF for GPs was introduced in 2004, significant investment was made to incentivise improvements in quality with a 25 – 30% increase in practice funding. Unsurprisingly, the situation is very different in 2015 for dentists. There will be no additional funding and no financial incentives – only financial penalties if we don’t hit our targets. They get the carrot, we get the stick!

When we look more closely at the questions within the “patient experience” domain it becomes apparent that the focus is primarily on patient satisfaction. This would seem strange as the NHS Patient Experience Framework actually states that “measures of satisfaction have a commonsense and political appeal, but they are the measures that experts, including experts in quality improvement, consider the least useful”.³

This all might seem a bit academic, and in practical terms not that relevant. Surely if you provide a good patient experience you will end up with a high level of satisfaction? This is possibly true, but definitely not the whole story.

Patient satisfaction surveys are widely used within healthcare and are a very useful way to obtain feedback and improve services at a local level. Dental practices regularly use patient satisfaction surveys to understand what their own patients want and respond accordingly. It is a fundamental strategy in developing and maintaining a successful dental practice. However, there is a subtle difference in using patient satisfaction to improve services and attempting to use the same approach to measure quality across a wide range of providers.

Patient satisfaction has been developed from consumer marketing and is based on disconfirmation theory where the quality of the service is measured against the expectations of the individual. The level of satisfaction expressed can therefore be as much about the patient’s expectations as it can about the quality of the service provided.

This can perhaps be best illustrated by the example of two colleagues, let’s call them Eddie and Mick, who decide to go out for dinner at two separate eateries. Eddie decides to go to a Michelin star restaurant; Mick chooses McDonalds.

Eddie’s restaurant is very exclusive, with attentive staff and lovely surroundings. Unfortunately, Eddie has a bit of a weak stomach and he doesn’t particularly enjoy his grilled octopus. On completing his customer satisfaction form, Eddie considers himself to be “satisfied”, despite the disappointment of his main course.

Mick has fairly low expectations, but is pleasantly surprised with his ‘happy meal’ and the unlimited access to free ketchup. He is even more impressed when he receives a complimentary toy, which just happens to be ‘Olaf’, his favourite character from Frozen. On completing his customer satisfaction form, Mick considers himself to be “very satisfied”.

In analysing this data, one could conclude that both ‘customers’ were satisfied, although Mick was more satisfied than Eddie. We might therefore assume that the quality of the experience provided at McDonalds was superior to that of the restaurant. This may of course be entirely inaccurate, and could simply be an indication of the varying expectations of the two individuals.

I would not wish to repeat the same mistake as our beleaguered Chair of the GDC, by comparing dentistry to supermarkets, but hopefully this example might illustrate the dangers of using patient satisfaction as a measure of quality. In our world, the same situation applies where patients rate services based on their expectations and not on the quality of care provided. We all work in very different practices, in different communities with patients who have different backgrounds and very different expectations. It would therefore be inappropriate to use a measure of quality for dentistry based on patient satisfaction alone.   

There is extensive literature on measuring patient experience, which is closely aligned to the dimensions of “patient-centred care”. Various tools have been developed and validated, and it is disappointing, although perhaps not surprising, that NHS England have chosen to design their own non-evidenced approach. To be fair to NHS England, they have stated that they are developing new Patient Reported Experience Measures (PREMs) which they intend to validate before introducing them⁴. A refreshingly robust approach when compared to the imminent introduction of the Friends and Family Test.

Image credit -  Chance Projects  under CC licence - not modified.

A-dec are delighted to announce the appointment of Dean Hallows as General Manager of A-dec UK

Dean (pictured above) has more than 28 years of dental industry experience, both in the UK and internationally. Most recently as A-dec’s International Regional Manager for CIS, MEA and Eastern Europe.

He began his career as an Incorporated Engineer, focused on developing dental products for clinicians and improving business effectiveness for design, manufacture and commercialisation. This stimulated his interest in managing business improvement strategies relative to sales, marketing and customer service, which he took to the next level when he attained an Enterprising MBA.

Dean has held numerous director level positions, mostly within DENTSPLY International Inc. and his past UK responsibilities for customer service, equipment maintenance, sales and marketing will serve him well in his new role as General Manager for A-dec UK. He has been a member of several leading industry committees, assisting with the development of British, EU and International Standards related to Dentistry and is currently a member of the Institute of Directors and Institution of Engineering & Technology. 

A-dec UK
0800 233 285
This email address is being protected from spambots. You need JavaScript enabled to view it.
www.a-dec.co.uk

What is it about our profession that makes us targets for everyone? From the press to the government, from our patients to regulators, what have we ACTUALLY done to deserve the increased regulation, the increase in complaints and litigation, and the constant vitriol of the press?

There is a constant ‘hum’ in the background in my opinion that represents the unrelenting pressure we are under, and in my opinion, for no real reason.

We have the press always looking for a ‘Dodgy Dentist’ story, with hopefully some evidence of how we rip off the public, but if they don’t have that evidence, they’ll misrepresent something anyhow. We have some of the regulators literally strangling the freedom out of our profession, and we have the legal profession all too willing to take advantage of our (costly and rapidly increasing) indemnity.

Have we let ourselves become some sort of professional whipping boy by our virtue of our dignity and professionalism in the past? Or do some of our colleagues (both past and present) have to answer for this perception of us? By not standing up more vociferously in the past, have we allowed what amounts to the various playground bullies to keep on taking a free hit at us knowing we don’t, won’t, or can’t fight back? Whilst I agree we need to put our house in order where some things are concerned (such as gaming) for which I then feel the criticism is just; but I can’t be the only one who feels that we are just waiting for the next onslaught of negativity to land on us from somewhere.

Why else would the public still believe the often ridiculous stories printed in the press? Interestingly, they never seem to associate ‘their’ dentist with the type of stories that come out. In that case why on earth do we still have the bad press? Where is our PR? Why do we have to couch everything positive we do in such woolly airy-fairy language so we don’t look like we are blowing our own trumpet?

If this blog seems to be coming from a negative direction, then you’re right; The state of mind that I carry from time to time about my profession is the reason for this, and I know I’m not alone feeling this way. Both the BDA and DPL have recently released press statement with evidence that dentists (and probably by association their teams and families) are generally more ‘down’ than the rest of the population. Given that we are largely exposed to the general issues affecting all the rest of the populous in the same way, then the only reason we must be feeling more depressed is because of how we are additionally affected by the profession we are actually in.

Any profession that has a desire to care for another human will always have more than its fair share of pressure heaped upon its members; that comes with the territory. This isn’t the issue here though; it’s the overload that comes from all the different influences that drive down the morale and therefore the well being of the profession into the ground. In a previous blog, I asked the question  Are you Scared? It would seem we have good reason to be if the GDC figures for the likelihood of appearing before FtP are to believed (but then the phrase ‘believable GDC Figures’ is actually an Oxymoron according to the High Court J) and now DPL have added their figures that 90% of practitioners fear they are more likely to be sued than 5 years ago which further adds to that fear.

I remember being told when I first qualified that there was a chance that I would be sued once in my career. Because of the mindset now more common in Uk Dentistry, I think I’m now on borrowed time having not had this in 24 years of practice, rather than actually thinking I might be doing the right thing by my patients. It’s the same fact, but the wrong way of looking at it.

There seem to be more people wanting to leave the profession than ever before. I doubt that we know this solely because of the advent of social media making it far easier to share and disseminate ones feelings. We have always had some form of dental grapevine telling us what is going on, and social media makes news get round faster and more widely. The ripples of discontent are now turning into a tide, and one hopes this will stop before a veritable tsunami hits the profession. Add to that the tragic but increasingly common stories of professionals committing suicide as a direct result of the pressures they are under and we have to come to the conclusion that some of our colleagues are drowning under the waves of increasing risk, not of their own making.

We seem to be torn between pillar and post all the time. Comply with this, inform about that, don’t do that anymore, make sure you’ve certificates for this, you have to pay for this now, you need a licence for that, and so on seemingly ad infinitum. I joke with my patients (those that I don’t think will sue) that I wonder how many rules, regulations, recommendations, dictats and compliances I will breach in their appointment today…..

And then some bright spark comes along and thinks the Family and Friends Test is a good idea to load on a profession already appearing to spend most of its time on complying with stuff rather than actually producing things that benefit others. Remember it only takes that final straw to break the camel’s back.

The problem is that there often seems to be no-one to turn to for advice when we are suffering from this mindset. We are all in the same boat at moment and there is seemingly no escape from any of this. Is it any wonder then that people have a poor state of mind? The public has their perception of us that never seems to change, and there is little or no organized support from within the profession; we have to actively go and seek professional advice independently.

We are not alone in this though; it seems to be all medical professions generally that are coming under increasing pressure. For the GMC to actually consider the wellbeing of its registrants who are under investigation and begin to put in place a form of support network is both tragic and admirable. It seems it has finally dawned on a regulator that registrants are human beings as well. One would like to think the GDC have read the recent article in the BMJ about the impact of complaints on its registrants[i], and indeed I have submitted a freedom of information request to find out if they are even aware of this document.

From time to time I utilize the skills of a very skilled NLPT (neurolinguistic psychotherapist) in order to re-calibrate myself. I’m lucky that I have a support network around me and (now) have an ability to realize when professional life is starting to get to me. I have no issue admitting this, but I’m sure there are many who wouldn’t dream of taking this sort of step, let alone admit to it. Whilst some people might be happy to whinge on GDPUk or social media about how they feel, it’s the silent ones who we need to perhaps be more concerned about. We are all in this together, and we are a caring profession. That doesn’t just mean our patients though; it means those within our profession as well. There is no formal or indeed informal system in place for professionals to seek out the kind of positivity they need. Whilst there is a Sick Dentist Scheme and the BDA Benevolent Fund, there is actually nothing in place for the Wellbeing and State of Mind of the profession. This is something the BDA could and should run with in my opinion. Access to professional advice and counsel about our mindset is more important than HR, Indemnity and Compliance issues. After all, none of those are relevant if we are in the wrong personal mindset. Dentistry is ONLY a job, and we can personally survive without it if we have to.

Our responsibility as a caring profession MUST include ourselves. We have never been more united than recently, and I finally think that there is a tipping point being reached about how we can unify for the good of the profession and therefore the patients.

But how do those isolated and with the wrong state of mind know there is finally a light at the end of the tunnel?

I think that’s our responsibility. We have to continue to grow stronger, to grow more united, and to reach out to all our professional colleagues. We need to show people that there is a way to fight back against this feeling. The speed with which the legal fees for Keith Watson were raised within 48hours shows there is the support out there from the profession for each other, and this needs to continue.

So its time to stop this feeling and to draw together the collective support we can. We need to make ourselves available in physical or virtual form for our colleagues. More importantly lobby organizations like the BDA to put in place formal systems of support to allow practitioners to gain access to. If we felt it would be appropriate to trust the GDC to not act judgmentally, they would also be an ideal organization to have some form of support system allied to their role; after all, what better way of protecting the public than to ensure the well being of the registrants?

There is light at the end of the tunnel; and we’re holding it.

Image credit - Kudomomo  under CC licence - not modified.

Kick-starting year-long celebrations of the innovations that have led Nobel Biocare to be “First for 50 Years”, a new complete, cement-free treatment concept was unveiled at IDS Cologne, promising exciting new possibilities for implant treatment.

Developed specifically to address common challenges faced when restoring molar teeth, the complete posterior solution consists of the new 5.5mm NobelActive^® WP implant and NobelParallel^® Conical Connection (CC) system.

Designed for optimised emergence profiles, both implant systems are intended for immediate function and ensure improved stability and longevity of implant treatment.

The new NobelProcera^® Full-Contour Zirconia (FCZ) Implant Crown is the key restorative component of the complete posterior solution. Screw-retained and available with an Angulated Screw-Channel (ASC) abutment, the FCZ avoids the risks associated with cement excess while offering remarkable strength and flexible access.

Richard Laube, Nobel Biocare CEO, commented:

“This year we are marking fifty years since the late Per-Ingvar Brånemark placed the very first titanium dental implants. Nobel Biocare is proud to continue playing an important role in developing original treatment concepts to help restore quality of life for millions of patients. The innovations featured in our new complete posterior solution build on our heritage by further helping dental professionals to treat more patients better.”

For more information, contact Nobel Biocare on 0208 756 3300 or visit www.nobelbiocare.com

Whether you are looking to expand or replace a member in your dental team, is essential to make sure you hire the ideal person. Here are some tips to consider along the recruitment process.

Interviewing applicants

Firstly, check that the candidate has all the necessary technical or clinical qualifications and skills required to carry out the job, such as licences, professional certificates and training. First impressions are of course important as well as the applicant’s interpersonal skills and devotion to the profession. Furthermore, dentistry requires everyone to work in very close proximity and so it is vital to ensure that candidates have right attributes to work as part of a team and to make patients feel comfortable.

Checking references

It may be obvious for some but it is important to follow up on all references. Some references provide an excellent insight but others may be guarded and simply confirm dates of employment and ending salary. In this case, a good strategy is to follow up the reference with a telephone call after interviewing a candidate.

Making a start

When you have made your decision and offer an individual a position in writing, you should implement a probationary period. During this time, the new employee’s progress should be regularly reviewed at weekly or monthly one-to-one sessions.

A written appraisal system that is adhered to throughout employment, gives team members a sense of value as well as direction. It can be also be a great way to learn from team members, listen to their ideas and maybe bring to action any strategies that could improve or streamline the workflow of the practice.

Contracts

When you provide a new employee a permanent contract of employment, it is absolutely imperative that it is concisely worded to include detailed information on every aspect of the job and the practice. For example it should state the hours of work, annual leave entitlement, duties: including written protocols for HTM-01-05 and CQC compliance, protocols for sickness or long-term illness, disciplinary procedure, rules of confidentiality, details covering policies such as adverse weather conditions and the provision of uniform.

Special attention to detail

When employing practice managers or associates it is important to consider the inclusion of restrictive covenants to protect the business. These are typically clauses in a contract that prohibit an individual from poaching other members of staff, contacting patients or competing with an ex-employer for a certain period after they have left the practice.

Help is at hand

If you need help recruiting staff or advice on contracts of employment or contracts for services (for self employed staff) it is prudent to seek expert advice. The team at Dental Elite are experienced dental recruiters who work solely with the dental profession to help practices find suitable individuals to engage in locum or permanent positions. With the aim to provide all clients with such an efficient and effective service Dental Elite hopes to become the natural ‘first port of call’ for any recruitment needs. 

For more information and to find out how Dental Elite can help to recruit the most suitable members of your dental team visit www.dentalelite.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it.
or call 01788 545 900

The key to success for any business is providing the service and products required by its customers. Finding out what people want from the business is essential in order to tailor the service delivered and meet their expectations – and this should not be different in dentistry. As a trained professional, you will of course be best placed to understand the clinical treatments patients need, but it’s still important to find out what outcomes the patient desires.

Sheila Scott, renowned dental business consultant, believes practices need to take this into consideration, changing their approach to improve the patient experience and enable the business to survive and prosper in the dental industry:

“I have often come across situations where dental nurses and dentists in the same practice have contradictory ideas about what their patients want,” Sheila says. “Similarly, many receptionists, who are the first people to greet visiting patients and provide information, may have different ideas again, and additionally do not know what the practice has to offer or what goes on behind the treatment room doors.

“Practice teams need to understand patient needs accurately, and have protocols in place to deliver an excellent service that meets their patients’ expectations. Communication is key here – patients need to understand how the practice looks after them, and how it meets their perceived needs.

“Many patients still think that when they visit a practice, the dentist simply looks in their mouth to check for ‘holes’ and treatment needs. But we all know there are many more aspects to the examination than that, and we now know that what patients really want from a practice is ‘a clean bill of health’.  Patients need to be led gently through the full examination so they can fully appreciate that this is the purpose of the practice too – and so they can appreciate the full value of their visit. This will increase patient satisfaction and engagement due to enhanced understanding, and better engagement with dental health usually means that patients understand the value of any procedures needed for improvements.”

As Sheila goes on to discuss, effective communication requires teamwork.

“It is important for the whole team to work together so that consistent messages are conveyed to every patient. Showing patients how much the practice cares about their needs will further enhance their experience, ultimately boasting the practice’s reputation and increasing referrals.

“Additional benefits of close collaboration and effective communication mean that facilities and skills within the practice can be fully utilised. The hygiene department is the perfect example of this – I think they are the most under-used, under-rated profit centres of practices throughout the UK. We could double, triple or even quadruple the amount of hygiene services offered and it would go a long way to capturing the hearts and minds of patients, improving their experience and encouraging them to return time and time again.”

Sheila is taking on the role as Chair of the Dental Business Theatre at The Dentistry Show 2015 and will be giving a lecture entitled ‘The Healthy Practice’ as part of the two-day conference programme.

“The Dentistry Show is one of the key meetings of the year for everyone working in the dental industry. It is busier and busier every time - the formula just works. As the Chair of the Dental Business Conference I am looking forward to welcoming a variety of industry-leading speakers, who will discuss an extensive range of topics to enlighten professionals and encourage the long-term success of their businesses.

“I will consider the approach practices need to take to be able to establish what their patients need, and how to meet those needs. I’ll also look further into the importance of teamwork and a unified approach from the entire team, helping dental practices to add value to their services.”

Sheila will be speaking alongside Tracy Stuart, Nigel Reece, Sarah Buxton and Krishan Joshi within the Dental Business Theatre, with topics covered including employment and HR law, marketing and finances. An array of additional learning opportunities will be on offer for principal dentists and their teams throughout the event, with lecture programmes dedicated to different dental disciplines and designed to enhance both clinical and business skills.

Hours of verifiable CPD, hands-on workshops and live surgery demonstrations will also be available, as well as an extensive trade exhibition hosting all the leading dental manufacturers and suppliers. The exciting new Launchpad UK initiative will provide you access to the very latest products, materials and technologies to reach the UK industry, ensuring your practice stays ahead of the game.

To discover how much more The Dentistry Show 2015 has to offer you and your team, and to book your free passes, go online today.

The Dentistry Show and DTS 2015 will be held on Friday 17^th and Saturday 18^th April at the NEC in Birmingham. For further details or to book your free pass please visit www.thedentistryshow.co.uk, call 020 7348 5269 or email This email address is being protected from spambots. You need JavaScript enabled to view it..

Offering your patients finance at low and zero rates of interest is a proven way to increase treatment plan take-up – as if by magic.

To prove the point, Dental Finance is employing the talents of professional expo magician and member of the Magic Circle, Sebastian Hunt, on its stand F30 at the Dentistry Show on 17 and 18 April at the NEC.

By performing a series of magic tricks under the scrutiny of visitors to the Dental Finance stand, Sebastian will demonstrate how offering patient finance is a case of playing your cards right and always producing aces.

Brian Carter, Dental Finance director, says: "Some dentists believe the new process for setting up finance is a trick they'll never learn. With our free assistance we can help them pull that rabbit out of the hat!"

Magician, Sebastian Hunt (pictured above), will be appearing and disappearing from the Dental Finance stand throughout the two days of the show. For further information about the magic of patient finance, go to: www.dentalfinance.co.uk

Simon Reynolds of Patient Plan Direct, explains why when it comes to dental plans, simplicity is the winning formula

In helping practices day to day develop successful dental plans that prove profitable to the practice and attractive and beneficial to patients, my colleagues and I get a good feel for what works best when it comes to dental plans.

We work with a wide range of practices across the UK, all of which have different patient demographics, a different split of private and NHS care, and their own unique objectives. However, there is one common factor across all the practices that run the most successful dental plans: Simplicity!

Defining success

I define a successful dental plan as one that is an integral part of the practices patient journey. It is mentioned on a regular basis to patients (new and existing) and the message about the plan is rehearsed and consistent. The whole team believe in the plan and recognise that it is of genuine benefit to the patient’s pocket and long term oral health.

As such, a steady and regular number of patients join the plan week on week and loyalty once a patient joins a plan is excellent and long term. The plan generates a healthy regular income that proves profitable, aids cash flow and commits patients to regular visits, providing the opportunity to promote other treatments and services (clearly in an ethical fashion), generating further revenue streams and profits.

Defining simplicity

The simple and successful dental plans can be summarised as having three common factors:

1.      Limited choice – There may be a couple of different plan options available to patients to suit different requirements and budgets. But there should never be a overload of different plan options for patients to choose from. I have come across practices that have 10+ different types of plans. This serves only to confuse patients and your team, likely resulting in them not being comfortable or motivated to mention the plan to patients and thus hindering uptake.

2.      Simple marketing – Any marketing literature promoting the plan is concise, to the point, transparent and highlights the key messages in language the patient can understand. A brochure with paragraphs of text is not the answer.

3.      Quick and simple – The sign up process when a patient commits to the plan is rehearsed, quick and simple. Whoever is responsible for the final stage of sign up should be crystal clear in undertaking this process and explaining the detail of the plan to patients.

Stick to the above and you won’t go far wrong with making your dental plan a success.

Back in the fifteenth century Leonardo da Vinci explained; "Simplicity is the ultimate sophistication". As such, it’s no new modern day phenomenon that simplicity is a solid strategic approach. It shouldn’t be an approach that is limited to developing a successful dental plan. It is likely to prove beneficial when determining many other practice processes.

Patient Plan Direct is the UK’s most cost effective plan provider: Experts in dental plan launches, plan provider transfers and introducing private dental plans to create less dependence on NHS income. 

Tel: 08448486888 Email: This email address is being protected from spambots. You need JavaScript enabled to view it. Visit: www.patientplandirect.co.uk

For practice managers, those aspiring to take on the role, or anyone just wanting to increase their understanding of how the practice operates, the Practice Management Today session at The Dentistry Show 2015 is the place for you.

Niki Boersma is the President of the Association of Dental Administrators and Managers (ADAM) and practice manager at The Smile Rooms in Malton. She will be running the session within the Dental Business Theatre with Sarah Buxton of LCF Law and Tracy Stuart of NBS Training. Niki commented:

“The team at ADAM is very much looking forward to The Dentistry Show 2015. It is a great opportunity to catch up with friends and colleagues in the profession, to update your knowledge and gain valuable CPD, and hopefully return to the day job refreshed and re-energised for the challenges ahead.”

Commenting on the Practice Management Today panel session, Niki gives a taster of what delegates can expect:

“We will be discussing the role of the modern practice manager and the many challenges they face, including the ever-rising volume of regulation and CQC inspections, as well as the increasingly litigious society in which we live. The presentation will also cover the need to effectively market your practice in order to increase patient numbers.

“Understanding all of these issues is essential for practice managers today, so that strategies can be put into place ensuring the practice succeeds in the competitive dental sector.

“Hopefully those who attend will leave better informed and better prepared to face these many challenges - and with a realisation that they are not alone. There are many other practice managers facing the same challenges and, through ADAM, they can share their views and occasional frustrations, while also seeking guidance and direction from their peers.”

Alongside this informative lecture, The Dentistry Show will offer a range of other exciting learning opportunities available throughout additional theatres, including the new Endolounge, presented in association with the British Endodontic Society, the BSP PerioLounge, Facial Aesthetics Theatre and CORE CPD Conference, ensuring something for every member of the dental team.

Book your free delegate pass online today and benefit from world-class speakers, copious networking opportunities and much more at The Dentistry Show 2015.

The Dentistry Show and DTS 2015 will be held on Friday 17^th and Saturday 18^th April at the NEC in Birmingham. For further details or to book your free pass please visit www.thedentistryshow.co.uk, call 020 7348 5269 or email This email address is being protected from spambots. You need JavaScript enabled to view it..

Niki is Practice Manager at The Smile Rooms in Malton, North Yorkshire and President of The Association of Dental Administrators and Managers (ADAM) which was established in 1993 as a not for profit organisation and aims to represent all members of the dental administration team, including the Practice Manager and those who aspire to be Practice Managers. Niki also runs a Guest House in Thirsk, North Yorkshire with her husband.

It is a requirement of the GDC for all dental professionals in the UK to have adequate indemnity provision in place, or they may face removal from the register.

In order to comply, there are currently three types of cover that are recognised by the GDC, and it is crucial that each dentist makes the appropriate choice. The options are:

 - Dental Defence Organisation membership – held individually or as membership provided by the employer

 - NHS / Crown indemnity – most doctors employed by the NHS are covered for the duties described in their contract

 - Professional indemnity insurance held individually or by the employer.

At first glance, the concept of indemnity cover seems fairly straightforward: you are either covered or you are not. However, for a practice principal working with an associate the issue of indemnity, and more crucially the party responsible for it, can cause some confusion due to the nature of their professional relationship. For instance, a question that regularly arises is: Does an associate dentist count as an employee?

This is relevant because according to employment law, an employer is vicariously responsible for the actions and his or her employee and could be held accountable should any claims be brought against them. However, it is widely understood that this is not the case for dental associates who are often thought of as self-employed. Indeed, it is not uncommon for practice owners to operate under the assumption that they will not be held liable, or responsible, for the actions of an associate dentist working in their practice due to their self-employed status. Nonetheless, there have recently been more than a couple of incidents that show that this is not always the case. As such these situations have highlighted the necessity of ensuring any associates working at your practice are sufficiently covered.

The recent Whetstone case is often used by some legal firms to demonstrate how practice owners are vicariously liable for the actions of their self-employed associates. A somewhat unique situation, this case involved an associate who did not have indemnity and the practice owner has held liable for their actions. As the owner had not checked whether the associate had sufficient cover, he was held responsible, despite the self-employed status of the associate. Despite deliberate trying to demonstrate vicarious liability on his part so as to receive compensation from his insurance, he not only lost the case, but was also awarded all the costs.

This case and many others exemplify the position that many principals find themselves in, whereby if their associate was found to have insufficient cover they would face increased scrutiny around the relationship between the two parties, and potentially could be held liable for any claims against the associate. Following the correct procedures and taking reasonable steps to ensure sufficient cover is in place, will help practice owners avoid situations like the case above.

For more information about the ADG visit www.dentalgroups.co.uk.

Author: Ian Gordon BDS MFGDP

Senior Partner Alpha Dental Group 

Dental implants have revolutionised the dental industry and they are fast becoming an essential aspect of the modern dentist’s range of skills. Providing a significant improvement in function and aesthetics for partially or completely edentulous patients, implants restore the ability to eat and speak and can dramatically boost self-confidence.

As such, a real difference can be made to patients’ quality of life, enhancing both social and professional areas of their lives. It is unsurprising therefore that patient satisfaction is generally very high with implant procedures, bringing further benefits to the practice in the form of glowing reviews and increased referrals. In addition, clinical studies suggest that although most people would prefer to save their natural dentition (as would most professionals), implant therapy patients become more aware of their oral health following treatment, and ensure regular visits to the dentist for cleanings and check ups thereafter.[1]

The placement and restoration of implants does however require a specialist set of skills and clinical experience, and quality training is necessy in order to ensure the longevity and success of treatment. The clinician’s goal is to serve the patient by providing first-class procedures and care, and alongside sufficient training, this is further facilitated with use of carefully designed, cutting-edge technologies. Digital CAD/CAM systems have been developed to enable high-precision treatment planning and design of restorations, which are now well received throughout the industry. Such technologies also reduce laboratory time and improve the quality and precision of fit of restorations produced first time. This technological accuracy along with streamlined treatment capabilities enables clinicians to take their dentistry to the next level and consistently achieve optimum treatment outcomes.

Careful diagnosis and treatment planning is key to this success. Throughout the planning stages, every detail needs consideration from the design of the implant and restoration to the gingival surface characteristics. Effective planning can shorten surgery time significantly, as not only is the dentist prepared and the patient properly informed, but a satisfactory brief can also be delivered to the team and adequate information can be relayed to technicians during the restoration process. Established implant protocols require meticulous execution by the whole team for the best possible results, so collaboration between all professionals involved needs to be effective.

The patient also has a role to play in the maintenance and continued care of the implants for long-lasing success, which they must be made aware of before procedures have even begun.

Nobel Biocare, a pioneering company in the field of implant-based dental restorations, is dedicated to empowering dentists with the best solutions possible. Through fully integrated technologies that enable seamless workflows, Nobel Biocare helps clinicians not only enhance their clinical practices, but also grow their business.

The globally renowned dental product supplier will provide a morning’s programme at the ADI Team Congress in May 2015, designed to educate and provide a platform for discussion regarding restorative protocols, technological innovations and the latest trends in implant dentistry.

The subject of the interactive sessions will be “Preferred Treatment Concepts for Today’s Patient Needs”, and a range of topics will be covered to help delegates refine and broaden their skills for better treatment provision. Nobel Biocare will present some of the most experienced clinicians and researchers in the field throughout the corporate forum, including:

• Stefan Holst DMD PhD will ask: ‘What impact does implant designs, surface characteristics, surgical and restorative protocols have on the end result?’
   
• Alessandro Pozzi DDS PhD will explore ‘Maximising treatment outcomes in the aesthetic zone with efficient treatment workflow’.
• 
  Jose M Navarro DDS MS will discuss ‘The biology and protocols of immediate implant placement and tooth replacement’.
   
• Edmond Bedrossian DDS FACD FACOMS FAO will speak about ‘Managing failing dentitions and their transitions to edentulism’.
   

Nobel Biocare is at the forefront of implant and restorative dentistry and is dedicated to keeping practitioners abreast of developments as they occur in this constantly advancing market. First-class education is offered as well as products, materials and state of the art technology to enable practitioners to achieve high quality restorations and furthermore, outstanding patient satisfaction.

The ADI Team Congress Corporate Forums will take place on Thursday 14 May 2015 offering professionals a chance to discover the latest research and developments in the dental implant arena, while also gaining new ideas to ensure the highest standards in patient care.

To book a free place for the Corporate Forum, please indicate attendance on the registration form or online registration at http://www.adi.org.uk/profession/index.htm

For more information on the cutting-edge solutions available from Nobel Biocare, please call 0208 756 3300 or visit www.nobelbiocare.com

What if your child had toothache and no hope of help?   

With this message, dental charity Bridge2Aid hopes to increase vital support this year, making it possible to provide access to safe emergency dental treatment for millions more people in need in East Africa.

Chief Executive Mark Topley commented: ‘With not even the most basic dental service available for the majority of people living in the rural areas of places like Tanzania, there are countless untreated dental problems. And more than half of people with toothache and no access to basic treatment will develop complications; sometimes, very sadly and shockingly, the complications lead to death.’

However, Bridge2Aid is making a big impact – by training local health professionals already based in villages to extract teeth and relieve pain. And it works – over the past 10 years Bridg2Aid has demonstrated success in both Tanzania and Rwanda, making access to treatment available to over 3 million people. Health professionals trained by Bridge2Aid have shown they can immediately address 98% of dental problems.

To find out how you can help people in pain today, please visit the team at stand D20, where you can be sure of a warm welcome.

Alternatively, Please visit www.bridge2aid.org/whatif to join with Bridge2Aid in its mission to make access to simple, safe, emergency dental treatment available to all.

With the dental profession coming under increasing pressure in terms of regulation and compliance, it can be difficult to ensure that you are always up to date. There are constant regulatory updates to contend with, all alongside catering for your patients, running a busy business and undertaking high quality clinical work, so it's little wonder many feel snowed under with their responsibilities and, in particular, with regulatory requirements.

Especially with the changing CQC inspection procedures set to come into play from 1 April 2015, it’s important to know the facts in order to make sure you and your team are focusing on the important thing. This will help you to avoid confusion and potential problems in the future.

That's why The Dentistry Show 2015 is proud to bring you the Compliance Clinics in association with Apolline, leaders in bespoke, hands-on services and solutions supporting dentists and their practice teams. The sessions are designed to help you better understand the rapidly changing regulatory environment and work out solutions to current challenges. The Compliance Clinics will examine some of the obstacles the dental profession must navigate around in 2015 and beyond, while helping you to discover ways to survive and prosper in what can feel like an increasingly stormy future.

Topics covered will include: 

• Current professional environment – the challenges
• An update on the proposed changes to CQC
• Hints and tips on complying with the CQC’s new fundamental standards regulation
• What it means to be a professional person in 2015
• Challenges posed by the GDC’s ‘Standards for Dental Professionals’ and a risk-based approach to keeping medico-legally ‘safe’ patient records
• The importance of feedback in running a profitable, patient-centred practice and in demonstrating compliance to the CQC.

If that wasn't enough to keep you up-to-date, there are even more sessions to be announced in the run up to the Show.

Providing this practical advice on surviving and prospering in an increasingly challenging professional and regulatory environment will be Pat Langley, Chief Executive of Apolline; Jerry Watson, Director at Apolline and private practitioner; and Dr Philip Newsome.

Philip is an Honorary Associate Professor within Faculty of Dentistry at the University of Hong Kong, and in 2013 received an Honorary Fellowship of the Faculty of General Dental Practice (UK) for his contribution to the profession. Currently splitting his time between the UK and Hong Kong, where he maintains a thriving practice, he is a highly experienced and respected global lecturer. Within the Compliance Clinics, Philip will present a session entitled “What it means to be a Professional Person in 2015”, looking at what it means to be a professional, how our views of it have changed over the years and what is expected of us as professional people in 2015. Philip adds:

“I will be discussing what practitioners and their staff can do to maintain high professional standards. I will also show how such high levels of professionalism and ethical behaviour translate into a wide variety of benefits such as personal well-being and sustained business success.”

With more speakers to be confirmed nearer the date, make sure you don’t miss out on this fantastic opportunity to advance your knowledge at the Compliance Clinics.

Keep it fresh

Not only will this year's Dentistry Show provide you with vital updates on changes to the CQC and what practices need to do to get through their next CQC inspection, there's plenty more on offer for the whole dental team. The two-day event will be packed full of lectures dedicated to each area of the profession, offering verifiable CPD, inspiration and fresh ideas to help you enhance every aspect of your practice. You’ll also be able to speak to leading names in dentistry about the latest technologies and ideas, while networking with professionals in all corners of the industry.

New features such as the exciting Launchpad UK will also enable you to discover the latest products to reach the UK, materials and innovations in UK dentistry, with top international suppliers showcasing everything they have to offer.

The Dentistry Show provides a great day out for the whole practice offering a cutting-edge education programme brought to you by industry-leading speakers, a packed exhibition hall and plenty of chances to meet up with like-minded colleagues. If you only attend one event in 2015, make sure it’s The Dentistry Show 2015.

The Dentistry Show and DTS 2015 will be held on Friday 17^th and Saturday 18^th April at the NEC in Birmingham. For further details or to book your free pass please visit www.thedentistryshow.co.uk, call 020 7348 5269 or email This email address is being protected from spambots. You need JavaScript enabled to view it..

Your Landing Page

Neil Sanderson

Most people think of a website as an entity in its self, this is not the case. A website is a series of pages of which you need to think about landing pages.

What is a landing page? Well the description is in the name really, it’s where people land when they first come to your website.

Most people think that the place people should first see when they arrive at your site is the home page, this again is not the case, ideally you need people to land on the correct landing page, let me explain.

I’m sure that all of you have at one time or another gone to Amazon. Can you ever think of a time when you arrived on a home page which had menu options across the top for you to find what you are looking for?

No of course you haven’t. You always land on the page that you wanted. For instance if you are looking for a camera. I typed in the search “Canon EOS 70D” and below is the search I got.

Camer search screen

All the search items are about the EOS 70D which is what you would expect, some are reviews and technical pages others are sales pages, but effectively all of them are about this particular camera.

So whenI click on the search item which takes me to the “landing page”. It comes as no surprise that the page I land on is about the Canon EOS 70D.

Because Amazon is so good at this you are presented with everything you need to purchase this camera, there are reviews, things that people also bought when they buy this camera etc. In fact just about everything you need to make a purchase, this is a typical Amazon landing page and they are very good at it.

Amazon Canon landing page

So what has this got to do with your website and the landing page that your prospective patients land on?

Well it’s about this, we have all been tought by the likes of Amazon that we want to land on exactly the page we are interested in. We don’t want to land on the “home” landing page, we know what we want and we want it right now.

People are not prepared to come to a “home” landing page and navigate around the website until they find the item they are looking for, this is why you have to promote your landing pages all the time, so that your visitors get exactly what they are looking for immediately.

If someone is looking for teeth whitening, most dental websites are set up so they will come to the “Home” landing page, they will then click on the treatment tab, then they will find the whiting link and click on that, do you see the issue?

If you want people to visit your teeth whitening page you need to start optimising this page so that Google can pick it up and display it, this needs to become your whitening landing page.

The same goes for all your other treatment, such as facial aesthetics, implants, straightening etc. etc.

Writing a blog is a great help but having the right key words on the page is also crucial, along with the correct meta description. Get ahead of your competition and ensure that your treatment pages are optimised to be your landing pages.

However you can bypass all this an just use Google Adwords, which will always send people to exactly the page you require, this is one of the huge benefits of Adwords.

If you would like more information on your website, call me on 01767 626  398 or email me at This email address is being protected from spambots. You need JavaScript enabled to view it. or visit our Facebook page.

www.dentalmarketingexpert.co.uk

Now that 2015 is well under way, New Year celebrations seem like a distant memory and everyone is looking to their next holiday, I thought I’d take a minute to look ahead.

I’m going to suggest three main predictions for the coming years, which I think will affect dental practices the most. These changes will not only shape the profession as a whole but also will affect the way practices are operated and how their services are marketed to patients.

Firstly, we will see a significant increase in the number of individual practices sold to corporates and groups. Many practice owners are worn out from the economic struggle of the past few years, from growing competition and the ever-more time-consuming regulations. They have had to work 10 times harder than they would have done 20 years ago, and as a result, I have seen a huge increase in the number of practitioners over the age of 50 considering selling their practice to alleviate the responsibility and stress.

Secondly, I predict further downward pressure on remuneration in dentistry. Salaries will, at best, freeze, as will remuneration packages for dental associates, hygienists and therapists; although it is more likely that they will decrease. This goes hand-in-hand with a continuing transfer of responsibility to dental care professionals – I think associates will become more limited regarding what they can do, as more work is allocated to other members of the dental team.

This is obviously not good news, but you need to be realistic in order to prepare and protect your future career. As a dental associate, I believe your value will depend on the degree of specialisation you develop. The skills you offer in disciplines such as implantology, endodontics or high-end cosmetic dentistry, which cannot be emulated by other team members, will become fundamental for success in the dental profession. The key, therefore, is to be at the top of your game in whichever niche you chose, and it is important to recognise this in order to protect your future.

This could lead to a decrease in the number of general dental associates working in dentistry, and may even call into question whether the role of the dental associate has a future in the modern profession.

Finally, I predict a continued increase in the level of enquiries made to the regulators as a result of patient complaints. With the existing Fitness to Practise system within the GDC widely discredited, steps are already being taken to try to modernise the process for greater effectiveness and efficiency. I think the extent to which the governing bodies regulate the profession will inexorably continue to increase. That will necessitate greater diligence with regards to record keeping and marketing language and increase the importance of providing appropriate and affordable dentistry, as there will be a higher chance of legal problems should any issues arise.

Depending on your perspective, these predictions may not seem particularly positive. You can look at them in one of two ways – one, the profession is doomed; or two, we will create a better, leaner profession which will provide more ethical dental treatment and care to patients.

In an interesting paradox, I am one of many crusaders who support the concept of emotional marketing. It can be a very effective way of attracting new patients and encouraging people to enquire about and go ahead with treatment. With the above points in mind, however, the importance of managing patient expectations and not promising anything you can’t deliver, is very evident. As a healthcare professional, you are often presented with opportunities to improve people’s quality of life, but you also have a responsibility to protect their health and safety and to make sure they understand all the risks and possible outcomes involved.

Consequently, your marketing strategy needs to strike a careful balance between evoking the emotions that will lead people to act and undergo treatments, and giving them realistic expectations of what you can achieve.

Whether you are looking to boost patient numbers so as to improve profits or create a position where you are able to offer staff pay-rises, you need to attract business effectively, and in a way that doesn’t leave you vulnerable.

This is where support such as that offered through the Ultimate Marketing Academy with 7connections can help – we will not only demonstrate how to properly utilise emotional marketing, but also help you to ensure an ethical approach that protects both your business and your patients.

Whatever the next 12-24 months hold for the dental profession, we would expect to see several changes and new trends emerging. It is important that all dental professionals prepare for such changes, so as to protect their careers and secure a successful future in dentistry.

For more information about 7connections and the Ultimate Marketing Academy, please call 01647 478145, email This email address is being protected from spambots. You need JavaScript enabled to view it.. or visit www.7connections.com

Enacting an exit strategy can be one of the most complicated tasks you will face as a practice principal. However, with efficient planning and time management, you can eliminate a lot of the hassle and stress and ensure both you and your team benefit.

In an ideal world, you should start thinking about your exit strategy at least five years before you intend to leave. This will ensure you have sufficient time to get all your accounts in order and to showcase the best possible profits for your practice. You should also look at staffing situations, income levels and the ways in which your associates are remunerated in order to produce the most accurate and useful overview of your practice’s performance and potential.

One of the most common pitfalls principals fall into during this process, is that they start to slow down by taking on fewer patients and working fewer hours. While this is completely understandable, it can actually have a detrimental impact on the sale of the business – income will reduce but costs will remain the same, therefore profits decrease rapidly. From the bank’s perspective, a business with falling profits is a business in decline, despite the reasons for this being easily reversible. It is therefore essential to not only maintain income of the practice, but to grow it as much as possible in order to create the most appealing deal for a buyer. Reassigning work to associates and building a strong practice management team will go a long way to helping you do this without putting all the hours in yourself. Ensuring an efficient team is in place will also make the practice less contingent on you as you prepare to leave, strengthening the business as a whole.

With regards to non-financial factors, it is vital to ensure that associate dentists have entered into an official associate agreement so as to protect the goodwill of the practice. This demonstrates that your clinical team plan to remain with the business for the foreseeable future, ensuring the stability and long-term success of your practice. Protecting the goodwill in this way not only puts you in a stronger position to sell with the practice seeming more attractive to potential buyers, but it further encourages a smoother sale procedure.

The team at Dental Elite, with over a century of combined experience in the sector, have made a reputation for themselves for giving pragmatic and practical advice to dental professionals. They are in the perfect position to help ensure that planning your exit strategy will not be the complicated and stressful process it has the potential to be.

For more information and to find out how Dental Elite can value
and assist your practice sale visit www.dentalelite.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 01788 545 900

• This year sees more innovative events than ever before. They range from screenings of Charlie Chaplin’s ‘The Dentist’ to a marathon to raise awareness of oral health.

• The new World Oral Health Day 2015 poster customisation app will help support participating organisations.

Geneva, 10 March 2015 - As World Oral Health Day 2015 approaches countries worldwide are preparing to celebrate in their own way. The theme is ‘Smile for life’.

Planned activities in 2015 include: a media campaign on local radio stations and free dental check-ups for over 500 children in Senegal; a selfie contest under the theme ‘Smile for life’ in Spain; free oral health assessments and fluoride treatments for all children attending a camp in Liberia; and an attempt to achieve a world record for the most amount of voluntary dentistry done in one day in Australia.

The challenge is for National Dental Associations, Student Dental Associations and World Oral Health Day Partners to match or outdo last year’s vast array of activities, which included an attempt on the World Record for the number of people brushing their teeth simultaneously.

Also this year, a new application provides participants with the means of customizing their World Oral Health Day campaign poster with pictures and other features adapted to their local, regional or national needs.

‘It’s wonderful to see the enthusiasm of so many different groups in the pursuit of raising oral health awareness within their communities,” said FDI President Dr Tin Chun Wong. “World Oral Health Day 2015 is set to be bigger and better than ever before, helping to spread the message of a ‘Smile for life’ across the globe.”

To find out if there is an activity near you or to get involved yourself, visit the World Oral Health Day website, which offers the latest news and a range of downloadable material to help celebrate a ‘Smile for Life’ on 20 March 2015.

WOHD is celebrated throughout the world on 20 March each year with a wide range of awareness-raising activities organised by dentists, dental students and National Dental Associations (NDAs). It offers the dental and oral health community a platform to take action and help reduce the global disease burden of oral disease.

Ninety per cent of the world’s population will suffer from oral diseases in their lifetime and many of them can be avoided with increased governmental, health association and society support and funding for prevention, detection and treatment programmes.

About FDI

FDI World Dental Federation serves as the principal representative body for more than 1 million dentists worldwide, developing health policy and continuing education programmes, speaking as a unified voice for dentistry in international advocacy, and supporting member associations in global oral health promotion activities. FDI is in official relations with the World Health Organization (WHO) and is a member of the World Health Professionals Alliance (WHPA).

For more information, visit: www.fdiworldental.org

About World Oral Health Day

World Oral Health Day is celebrated every year on 20th March. The theme of World Oral Health Day 2015 is ‘Smile for life’. It reflects the major contribution oral health makes to our lives. Around the world, FDI member dental associations, schools, companies and other groups will celebrate the day with events organized under this single, unifying and simple message.

For more information, visit: www.worldoralhealthday.org

World Oral Health Day 2015 partners

LISTERINE® brand Mouthwash, part of the Johnson & Johnson Family of Consumer Companies

As the world’s number one daily mouth rinse, LISTERINE® Mouthwash has been used by more than one billion people in more than 85 countries. Professional dental organizations around the world have awarded LISTERINE® Mouthwash with their seals of acceptance.

LISTERINE® is distributed by Johnson & Johnson Healthcare Products Division of McNEIL-PPC, Inc., a part of the Johnson & Johnson Family of Consumer Companies, which is the world’s sixth-largest consumer health company and is a segment of Johnson & Johnson, the world’s most comprehensive and broadly based manufacturer of health care products.

Unilever 

Unilever Oral Care is a leading global manufacturer of oral care products, including toothpaste, toothbrushes and mouthwash, represented by brands including Signal, Pepsodent, Close Up, Mentadent, Aim, P/S and Zhong Hua. Unilever recognizes that good oral health and the sense of well-being and confidence it brings, is a vital element to making people look good, feel good and get more out of life and that small every day actions, such as twice daily brushing with a fluoride toothpaste, add up to make a big difference for the world. Through its science, products, partnerships and international network, Unilever Oral Care is privileged with the power to make a sustainable and measurable improvement to oral health around the world.

Henry Schein

Henry Schein, Inc. is the world's largest provider of health care products and services to office-based dental, animal health and medical practitioners.  A Fortune 500®{C}[1]{C} Company and a member of the NASDAQ 100®{C}[2]{C} Index (NASDAQ Ticker: HSIC), Henry Schein employs more than 17,500 Team Schein Members and serves more than 800,000 customers. Headquartered in Melville, N.Y., Henry Schein has operations or affiliates in 28 countries. Through Henry Schein Cares, the Company’s global corporate social responsibility program, Henry Schein helps expand access to health care for underserved and at-risk communities around the world. For more information, visit the Henry Schein Web site at www.henryschein.com.

Wrigley Oral Healthcare Program (WOHP)

WOHP partners with dental professionals worldwide, helping them improve their patients’ oral health through one extra simple and enjoyable step in their daily routine: chewing sugarfree gum after eating and drinking on-the-go. WOHP supports independent clinical research into the benefits of chewing gum, including saliva stimulation, plaque acid neutralization and tooth strengthening. For more information, visit: www.wrigleyoralcare.com

The Chancellor of the Exchequer, George Osborne, delivered the last Budget of this parliament today. Jon Drysdale highlights items of interest to dentists.

Tax cuts

Big tax cuts for income tax payers and help for savers through greater flexibility on ISAs. With the majority of dentists being higher rate tax payers, this is positive news.

Simplification of the tax system was announced with the annual tax return removed - more details to follow. The fuel duty increase will be frozen again.

The personal tax-free allowance will be raised to £11,000 in 2017. The higher rate tax threshold, which affects most dentists, will rise to £43,300 in 2017/18.

Pensions hit

On a more negative front, the Lifetime Allowance on pensions is to be reduced to £1m from next year. This is likely to significantly impact dentists with NHS pensions. It remains to be seen what transitional protection will be offered to those breaching the new reduced allowance. The change is potentially going to encourage dentists to draw their NHS pension earlier than planned to avoid a Lifetime Allowance charge. 

Savings

Four major new steps on savings were announced:

1. Greater access to pension annuities. 

2. A more flexible ISA with annual savings limit increasing to £15,240 (2014/15) and allowing withdrawals and re-contributions in the same year without losing tax-free allowance.

3. 'Help to Buy' ISA for first time buyers with a 25% top-up – effectively tax relief on ISAs.

4. First £1,000 of interest on savings income to be tax-free.

Business

Corporation tax will be cut to 20% in two weeks time, with small business rates also to be cut. Class 2 National Insurance to be abolished.

Comment

Jon Drysdale, an independent financial adviser from PFM Dental, commented: “While there are positives in this budget for dentists the most worrying single announcement today is the further cut to the Lifetime Pension allowance to £1m. Many dentists are already subject to a charge as the allowance has fallen in recent years. Hopefully, some transitional protection will be available and we will be following developments on this closely. The need for specialist advice in this area has never been greater." 

PFM Dental offers independent financial advice exclusively to dentists. For more information visit www.pfmdental.co.uk

Bringing the curtain down on dentistry for 2014, Nigel Jones shares with readers some of the more noteworthy news from this year in relation to the New Contract and private dentistry.

Nigel Jones is part of the change support team for Practice Plan. With 24 years’ experience within the dental industry, he has guided many dentists through the 2006 NHS contract and continues to do so today; contact him for further advice and support on This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.practiceplan.co.uk/nhs.

With the knowledge that the New Contract pilots were to continue into 2015, this year the dental profession were keeping a keen eye out to see how they would progress.  In addition, there was a renewed interest in whether private dentistry might, for some, be a viable way forwards.

It was in February at the Dentistry Show that the first significant discussion of the year took place on the issue of the New Contract. This dialogue clarified that Professor Steele was committed to taking all the time needed to review the data available to produce an effective system that would focus on prevention rather than cure.

Also speaking at the event was oral epidemiologist Liz Kay, who emphasised the need to take into consideration the full oral health picture in the UK, not just to create a contract based upon the needs that could be ascertained from average figures. She asked delegates to consider the realities of dental practice where, for example, the majority of Baby Boomers – who grew up without preventive advice – would need dental treatment in the coming years.

In March it was reported that, for the first time in eight years, the profit level of the average private dental practice was almost the same as the average NHS dental practice, based on the latest benchmarking statistics from the National Association of Specialist Dental Accountants and Lawyers.

Figures showed that the average net profit in 2012/13 for a principal of a private practice was £124,086 compared to £125,958 for a principal of an NHS practice.

In April we also learned that after a difficult economic time, private dentistry is set to ‘bounce back’ and make the most of the opportunities offered by an industry currently valued to be worth £5.9bn every year, according to latest report into the UK dentistry market from LaingBuisson.

That same month, Lloyds Bank Commercial Banking Healthcare Confidence Index suggested that uncertainty over NHS dentistry was affecting dentists’ choices. It reported that 80% of those questioned were apprehensive that the NHS would provide adequate financial support. In addition, it was revealed that 69% of dentists are planning to grow their business to help overcome any possible financial pressures brought on by the NHS contract.

Commenting on the results, Ian Crompton, Head of Healthcare Banking Services, Lloyds Bank Commercial Banking, stated: ‘The wider economic uplift has boosted dentistry morale, with dentists again the most confident profession in the short-term, and it is interesting that there has been a noticeable shift in the number of dentists expecting private practice to again become more profitable than NHS.’

The summer months

At the 2014 Conference of Local Dental Committees in Manchester in June, John Milne, chair of the BDA’s GDPC, expressed disappointment at the slow progress being made with designing the prototypes for the New Contract and suggested that the government needed to get a move on.

In July, at the Westminster Health Forum seminar on oral health inequalities, dentistry commissioning, regulation, and the dental contract reform dentist Sabrena Kara spoke about her practice’s experience of taking part in the pilots. She offered a positive view on time management, which then allowed her to focus on delivering more complex dentistry to patients.

August saw a story in The Telegraph reporting: ‘Patients are having to travel up to 40 miles to see a dentist or being forced into private care because they struggling to find treatment locally, a consumer watchdog has warned.

‘Healthwatch England said that patients are experiencing ''increasing frustration'' about NHS dentistry as patients struggle to know where to turn.

‘Some are travelling up to 40 miles to find somewhere that will provide free care while others are so discouraged by their attempts to find a health service dentist that they end up paying for private treatment, it said.’

Dr Cockcroft responded: ‘Our figures tell us that 93% of people who tried to get an NHS dental appointment in the past two years were successful. Of the 6.5% who tried to get an NHS dental appointment at a practice that they had never attended before, 76% were successful.’

Drawing to a close

In October, the BDA’s GDPC came together to discuss the New Contract, welcoming the fact that Alternative Contract Reform (ACR) input had become part of the debate on contractual change. The case for change was described as ‘irresistible’ by the chair, Dr Milne, who continued: ‘We have an historic opportunity here to turn the page on activity targets and put prevention at the heart of dentistry. And the GDPC is determined to get it right on behalf of the profession.’

 Looking to 2015

Despite some disappointment surrounding the slow implementation of the New Contract, 2014 still managed to deliver interesting signposts for dentists looking to the future. Given the well-publicised financial pressure on the NHS, the Government's imperative will be to find a form of contract that will extract the best value it can from NHS dentists.  Come May 2015 and the results of the general election, the dentistry ball may well be up in the air once again. Whatever the outcome, this will mark a new beginning for dentists choosing between NHS and private dentistry to fulfil their commitment to looking after their patients while running a sustainable business.

Practice Plan considers what the current dental contract has to offer and takes a look at what changes could be incorporated into NHS dentistry when the revised contract is fully rolled out.

In 2006 to much fanfare – on the Government’s side at least – a new NHS dental contract came into force. At the time some dentists chose to leave the NHS altogether preferring the private route, some created a mixed practice but the majority stayed put, believing in the provision of dentistry to those in need.

Over the following years, again, some have changed the way they practise; but still a large number have continued to operate within the parameters of the contract while others have joined the NHS. Statistics released by the Health and Social Care Information Centre tell us that 23,723 dentists performed NHS activity during 2013-14. This is an increase of 522 (2.2%) on 2012-13, and 3,563 (17.7%) more than 2006-07.

With a revised contract on the horizon, what does the 2006 contract offer and what might we reasonably expect the next one to deliver?

John Milne Chair of BDA GDPC once said: ‘How can a system improve oral health, deliver prevention, continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?’

Remuneration

As we know all too well, the contract to which the majority of NHS dentists are working operates on annually targeted UDAs (the exception being those on the piloting scheme).  This has, of course, raised some financial issues; a popular view is that dentists have not been receiving fair remuneration for their work in more extensive cases. It should be noted, however, that, committed as they are to patient care, the vast majority of dentists who have stayed in the NHS have worked hard to provide a quality service.

The contract currently being piloted shuns UDAs and instead a capitation system is being tested. Essentially, capitation provides payment according to an agreed number of patients seen during a specified period of time. Three are being piloted:

• Type 1 – guaranteed remuneration for guaranteed NHS commitment

• Type 2 – weighted capitation payments applied within tolerance of contract value with capitation payment covering all care

• Type 3 – weighted capitation model applied within tolerance of contract value with capitation payment covering only routine care and remaining contract value attributed to complex care guaranteed.

Weightings are applied to the registered population, which aim to reflect the workload involved in meeting patient needs. In the report ‘Dental Contract Reform Programme. Early Findings: Opportunity to give feedback’, the following example for a hypothetical practice treating 100 patients was provided:

• Twenty high-need patients: £10 per patient = £200

• Fifty low-need patients: £5 per patient = £250

• Thirty medium-need patients: £7.50 per patient = £225.

This provides a weighted capitation of £675.

With these pilots ongoing, which of these three options are achieving success is unknown, but it seems fair to suggest capitation is likely to feature in some form. 

It would be remiss while on the subject of finances to move on without considering the forthcoming contract’s affordability for the government. Contact reform offers an interesting conundrum; you might achieve happy patients and dentists but realistically only at a cost that would be unacceptable in a wider roll-out. For example, the new approach involving a preventive pathway takes more time and means longer appointments than before, which is why patients tend to like it. Within the pilots, the dentists are happy as they have had their income ring-fenced so they can essentially take as long as they want without incurring any financial penalty. In addition, that all means that access has dropped and fewer patients are being seen which, given that has been a priority for successive governments, won’t be deemed acceptable. There seem to be three possible solutions to this – making more money available (which, let’s face it, is never going to happen in the current economic climate), finding a way that forces individual dentists to improve access for the same money or to accept lower access per dentist but pay individual dentists less.

Quality

There’s little to be written about the 2006 contract and quality treatment that you haven’t already heard or read many times over. Suffice to say, it constrains care to providing treatment to achieve oral fitness and little else; this is a system that does not easily lend itself offering a high level of care and NHS dentists remain the unsung heroes for achieving high quality results. Considered by many as an incentivising scheme gone horribly wrong, we all look to the future with great expectations.

The (hopefully) forthcoming contract aims to deliver high-quality, prevention-based care based upon three indicators:

1. Patient safety

2. Clinical effectiveness

3. Patient experience.

This is where the much talked about Primary Care Clinical pathway approach comes into play. The clinical pathway begins with a comprehensive oral health assessment, recording information on caries, periodontal disease, tooth wear and the soft tissues. Needs and risk are then assessed based upon both clinical information and that obtained from the patient. A preventive plan is then created and shared with the patient and dental team. Lastly, a review date is set according to risk and NICE guidelines.

Advanced care pathways are also being piloted in endodontics, periodontal care, indirect restorations and metal-based partial dentures.

All of this is being supported with the use of software provided by one of three software companies.

Thus far, overall the concept has been considered to have a sound basis but, again, things are still being ironed out so while the future looks to be preventive based there are no guarantees.

Registration

Under the 2006 contact, formal registration with a dental practice, which had been introduced in 1990, came to an end.  In essence, nowadays no-one in England and Wales is registered on the NHS with a particular practice although, in truth, this is not on many patients’ radar. However, access appears to have been a problem for some patients, with pre-pilot figures indicating that 24,292 patients received emergency dental treatment in hospital casualty departments in 2009/10, compared to approximately 17,400 in 2000/2001. These statistics certainly do suggest that fewer people were getting the dental treatment they needed between 2000 and 2010.  
 

The future contract, meanwhile, promises provide a formal system of patient registration, ensuring patients will receive ongoing care as and when clinically needed. We don’t know much more than that, but it sounds like a good plan to improve access and long-term oral health.

Tentative hopes…

So here we are; the majority of practices are still working within the confines of the 2006 contract and the minority piloting the next contract. The possibilities are tantalising but there is still so much that we don’t know.  When will the pilots end? How will the general election affect NHS dentistry?  And last, but by no means least, how will the government, whatever their affiliation, work within the confines of national finance to deliver what is being promised? We have hope that the resources available can be used to best effect.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions since for over 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs.

Last weekend (14th/15th March) saw the 200,000th post to be penned, posted and published on the GDPUK forum, an amazing achievement! The milestone has been reached in approx 6 years since we created this present site (over 100,000 posts on the old site) and is something that demonstrates the passion and high levels of interaction that exists in the community.

To put it into context, it means there has been an average of 92 posts a day on the forum for 6 years!

In 2014 alone there were just under 1000 different contributors to the GDPUK forum pages which gives a further idea of the amount of varied opinion and information that is shared in the GDPUK community.

Thanks again to the whole dental community for supporting the site and making 200,000 posts possible. We hope you continue to find gdpuk.com an incredible resource.

The site also continues to publish news and original content on a daily basis.

The site continues to develop, with the launch of a GDPUK Services site which offers our members a range of useful services, with two added features, group discounts and donating to the GDPUK Fighting Fund for UK dentistry.

If you would like to join the GDPUK community, the link can be found here.

Advertising is also available on the site, please find a link to our media pack here and if you need further information please drop a line toThis email address is being protected from spambots. You need JavaScript enabled to view it.

Contributing to the excellent educational programme at this year’s Dentistry Show, Carestream Dental will be hosting two sessions.

Within the popular Dental Business Theatre Jane Guinn, Managing Director of Carestream Dental, will explore the vast benefits of effective data collection to help drive practice growth. Discussing how real-time data affects your patient communication and the efficacy of your recall systems, Jane will also show how crucial proper data management is and demonstrate how the innovative CS R4+ Springboard can help.

Dr Maria Harman, a highly experienced general dental practitioner and principal of Clinic 95 in Oxford, will also be delivering a session in the ADI Implant Theatre entitled ‘Improve your implantology with a digital workflow’. She’ll look at how high quality CBCT technology enables a more predictable, accurate and speedier diagnostic and treatment planning process, for an improved patient experience in a shorter treatment time.

To advance your practice management systems with real-time data, or to make the most of a digital workflow, make sure you don’t miss sessions hosted by Carestream Dental at The Dentistry Show 2015.

For more information, contact Carestream Dental on 0800 169 9692 or visit www.carestreamdental.co.uk

The BDIA’s ‘Dental Industry Manifesto’ sets out five key priorities for action in the dental sector for the next Government. BDIA Executive Director, Tony Reed, explains, “The industry believes that positive and focussed investment and support from Government is vital to ensure the highest quality oral health outcomes for patients and an efficient and sustainable future for the provision of dentistry in the UK”.

The Manifesto urges the next Government to focus on five areas: ‘Investing in the nation’s oral health’, ‘Protecting patients’, ‘Building a better future’, ‘Championing innovation’ and creating ‘A favourable business environment’. By acting in these areas a future Government can significantly reduce the burden on the NHS by improving the nation’s oral health, protect patients, whilst supporting dental professionals and the industry, foster innovation, encourage investment, improve the business environment and develop exports.

The Manifesto also builds on the industry’s initiative against counterfeit and non-compliant dental devices and instruments seeking full Government funding for the Medical and Healthcare Products Regulatory Agency.

It has been circulated to key opinion formers in the political parties and Government departments, as well as Ministers, MPs, senior civil servants and NHS England.

Established in 1923, the British Dental Industry Association (BDIA) represents and supports manufacturers and suppliers of dental products, services and technologies. BDIA members gain access to a range of services designed to benefit them and promote the well-being of the industry as a whole and the profession gains the reassurance of dealing with like-minded individuals who are committed to providing a high quality standard of service.

For more information please contact Edmund Proffitt on 01494 781183 or email This email address is being protected from spambots. You need JavaScript enabled to view it.  

Lynn Leach presents 10 of the more common concerns dentists feel when considering whether their future lies within the NHS or private practice.

Lynn is part of the NHS Change Support Team for Practice Plan. As a Regional Support Manager with over 25 years’ experience, she has guided many dentists through the 2006 NHS contract reform and continues to help practices evaluate their options out of the NHS. Contact her for further advice and support on This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.practiceplan.co.uk/nhs.

One of the greatest challenges facing many dentists in deciding whether to practise within the NHS, privately or a mix of the two is overcoming fear of the unknown. It is important to note that you are not alone in your concerns and, based upon everyday conversations with dentists from all backgrounds, I’ve outlined 10 of the most common worries here.

1. The future of NHS dentistry is uncertain

The forthcoming revised contract has been in the piloting phase for some time; this exploration of possibilities will continue in 2015 with the prototype contracts and there’s no deadline for a national roll-out. There is no doubt that this contributes to difficulties in making decisions about your professional future. However, if you look at it pragmatically, unless you are involved in the protoypes you’ll continue to work within the 2006 contract, so consider your plans for the next few months in light of that. There are no guarantees of what is coming next but you can consider all your options and tentatively put plans in place for further down the line, once you feel better placed to gauge what the NHS will offer dentists and their patients long-term.

Essentially, if you firmly believe that the NHS may have something better to offer you and your patients, it’s probably best to hold fast until the reformed contract is finalised  However, if you feel the new contract will be about different degrees of unpalatability, then it may be worth starting to take steps now to take control of the future of your practice.

2. Is it unethical to leave the NHS?

We acknowledge that for some dental professionals the NHS is the only place for them, feeling strongly as they do about offering those in greatest need a high level of dentistry within the constraints of the 2006 contract. That doesn’t mean, however, that looking to move away from the NHS is unethical. The GDC requires that dental professionals ‘Put patients’ interests first and ‘act to protect them’. This is absolutely a criterion that can be met in private practice; it is simply a different way of working. Many practitioners find there is a tension between their loyalty to the NHS and their commitment to providing the best care possible to their patients and only you can decide what’s right for you.

3. Will enough of my patients follow me into private practice?

There are two initial questions to ask:

1. How many patients is “enough” ?

2. Will my patients want to change?

The first requires some number crunching that considers your income streams and profitability expectations as well as the number of clinical hours you can make available.  This can be influenced by, for example, the availability of a hygienist and if you don’t have a hygienist but plan to introduce one, then those additional costs need to be factored in.  Other financial aspects include the impact on your pension arrangements and any investment in the practice you feel will be necessary.  Only  once all the relevant considerations have been factored in, can you gauge the proportion of patients, at a given hourly rate, that you need to retain to meet you financial requirements.  For a few, this will be too many and caution is the better part of valour.  Most though, will be pleasantly surprised at how realistic the target number of patients feels and in fact, in many cases, practitioners actually need more than half to leave in order to free up the time needed for the level of care the dentist  wants to provide !

As for the second, it depends on your patient list and your ability to communicate the benefits of remaining with you on a private basis. Clearly, if your practice is in a highly socially deprived locale and a high proportion of your patients are exempt from NHS charges then it is unlikely that patients will have money to spend on what they may perceive as ‘optional’ private dentistry.  However, many practices have been able to make a successful transition in all kinds of locations with a variety of patient demographics.

The most important factor influencing the loyalty of your patients is likely to be the length of time you have been seeing your current list and therefore, the number of interactions you have had with your patients.  It is also important to note that if a dentist has only been treating their patient list for a short period of time, that loyalty has probably not had chance to develop to the level that could be tested by a move away from the NHS; this is a significant issue to consider.   For many, however, the trust of patients in them has developed and grown over many years and more than enough will be very reluctant to give up the strong relationship that will have developed.

A final consideration is the way the change is communicated to patients as handled badly, this could have a detrimental effect on the number that decide to stay with you.   It is imperative that you and your whole team feel confident about communicating why you are making the change emphasising aspects such as offering an even better, customised patient experience or the desire to maintain an already high level of care. (see point 4 for more on this). 

There is no substitute for face to face communication with patients in respect of the changes.  However, many practices have found it helpful to signal the change as early as possible via a well crafted letter that might be supplemented by supportive messages through email, your website or social media. Circumstances vary so the content of the letter will vary but most practices that have gone down this route use it to outline the reasons why they are changing – emphasising, for example, how they feel they will have the ability to spend more time with patients understanding their needs, the benefits of a preventive approach, the extra services they will be able to offer and the advantages of having a greater variety of materials to choose from. Some have also felt it worth reminding patients that NHS dentistry is not ‘free’ and that while care was being delivered to the highest possible standards, they felt it was becoming harder and harder to do so.

 4. How will my NHS patients feel?

For many of your patients, the important thing is the ability to stay with the dentist in whim they have built up trust and the value they attach to that relationship will override the additional cost they will incur.  It is also fair to assume that a number of your NHS patients might initially express some concerns. However, it will be important to keep this in perspective and to remember that this is often a reaction that can be managed very effectively.  Providing the whole team are comfortable with the messages they should be putting gout and the way to handle questions from patients, careful and caring handling of the situation ought to mitigate the risk of them voicing a negative opinion about the practice if they chose not to stay.

5. What if my team wants to stay in the NHS and I don’t?

Ultimately, whether your practice works within the parameters of the NHS or private dentistry is your choice. But it’s absolutely true that you can’t do it without the support of your team. It’s important to clearly communicate your ideas about NHS versus private practice early on, so that they can understand the reasons and be involved in a consultation process. Every member of your staff has their own perspective and some are extremely likely to make some good points that haven’t yet occurred to you. This is a big step that has a matching learning curve, and everyone will discover something new if you discuss the options together. You may change your mind, as they might too. If, once you have made your decision, not everyone wants the same thing that is a challenge but it shouldn’t stop you making changes. If you keep the lines of communication open, ultimately everyone can find a situation that suits them best.

6. How do I choose between full or partial private practice?

If you feel that the time is right to seek independence from NHS dentistry, deciding whether to have a mixed or entirely private practice can be daunting. The trick is to ask yourself what you want to achieve and work backwards from there. If you want to continue offering your patients an NHS option then you might, for example, choose to have your associates fulfil that contract while you offer private dentistry. That way you maintain the financial stability offered by the state system while benefiting from the ability to spend more time with patients and provide additional services, which should translate into greater profit. If you feel you’re done with the NHS, then private is your way forwards.

7. Is moving to private dentistry expensive?

It doesn’t have to be. As an NHS dentist you will already have all the equipment you need to provide everyday treatment. This isn’t going to change. You might want to give the practice a coat of paint and that doesn’t need to cost very much. Where investment may be needed is in training for new services and, potentially, the equipment needed to deliver that treatment. But the key terms here are ‘investment’ rather than ‘cost’. Consider what treatments you may want to offer, gather information on the expenditure needed and then get some advice to help you to consider the options. If you can realistically expect to make the money back in a reasonable amount of time then it’s worth serious consideration. Of course, however, there are no guarantees so do be prudent. 

 8. How do I set fees?

There are no set limits on what a private dentist can charge but that doesn’t mean pushing the boat out is a good idea. A balance is needed between affordability for the patient and the dentist receiving fair remuneration for their expertise and time.

You may find it beneficial to get some advice to help you calculate your overheads (e.g. mortgage/rent, staff costs, utilities, lab fees, consumables bill, staff training, etc.). This is your starting point because this is the point at which you will break even. After that it is about valuing your time and skills without going off the deep end. Don’t undervalue yourself but at the same time don’t price your patients out. For a little guidance, it is interesting to see what other private practices in your area are charging but remember your practice and your relationships with your patients are unique.

9. How can I compete with the private practice down the road?

Truly, a little competition can be healthy for the practice but that isn’t to say you want to offer all the same services and undercut your local colleagues. Success in such a situation is about looking at your own practice is a positive manner and emphasising what is unique about your offering of which the most important is you! Ask yourself why a patient would choose you over another practice and focus on sharing that story.

10. Marketing adds to my workload

As briefly mentioned above, if you offer a private dental service marketing is important to let people know the treatments available. The good news is that marketing really doesn’t need to be time consuming or expensive.

The biggest misconception about marketing is thinking it is about ‘selling’ and akin to an advert. Categorically, it is not. The aim is to build trust and interest in your service, practice or new offering so that people want to talk to you to find out more. You are not going for a hard sell, so there’s no need to worry that marketing will make you feel awkward or alienate your patients. Rather, it will serve to show patients how you can help to meet their needs and wants.

Once you have identified what makes your practice and services unique, as well as your target audience, it really is simple to get your message out there. For information on how to get your marketing underway, a good place to start is at our resource library (https://www.practiceplan.co.uk/resource-library) and our Facebook page (https://www.facebook.com/practiceplanuk), which offers useful tips.

Overcoming barriers

The question of deciding whether to offer NHS dentistry, mixed or private practice is something that worries a significant number of dentists. The challenge is determining the degree to which those worries are holding the practice back. Your top 10 worries are unlikely to be the same as those presented here, but they are indicative of a common sentiment throughout the profession.  Whether you decide NHS or private dentistry, you can overcome your worries and you need not do it alone.

www.practiceplan.co.uk/nhs

Dentist Kris Leeson considers the problems with the 2006 contract and contemplates how a revised contract and/or private practice may improve the situation for dental healthcare professionals and patients alike.

Kris Leeson, BChD Leeds, MJDF RCS Eng, MSc (Implant dentistry), graduated in 2005 from the University of Leeds and is the principal dentist and owner of Thorpe Dental Group York, a mixed practice. Kris has a special interest in the treatment of anxious patients and has gained extensive experience in the use of intravenous sedation. He also has a special interest in dental implantology, and completed his Master’s degree in implant dentistry from the University of Warwick. In 2013 Kris achieved his Royal College of Surgeons qualification. In addition, in December 2012 Kris was crowned winner of The Dentistry Awards Best Young Dentist North East.

Why does the 2006 contract need to change?

It’s a good question with no easy answer but I, like many of my colleagues, have my own view of the situation.

Back in April 2006 when the contract came into being I was still in my VT year, finishing late that summer. It was quite scary for me because my career was starting by stepping into the unknown. In my VT year I was involved with a contract that was basically a piloted scheme. It was like the new contract but without UDAs; you could do whatever you wanted.

From the start I wasn’t happy with the contract and I was in the fortunate position to be able to buy a practice straight away and, in fact, bought the practice in which I had completed my VT. I personally moved away from NHS work, although the practice was, and remains, mixed. For me, the system was inequitable as PCTs varied in how much funding was available. Mine offered me a contract but the funding was unequal to the task. Financially it was impossible to achieve; however, I do recognise that I might have felt differently elsewhere, if a different PCT had been involved.

However, my biggest problem with the 2006 contract is the UDA system. First of all, for example, a band 2 course of treatment is worth 3 UDAs whether you perform a simple occlusal amalgam filling or molar endodontics, which just doesn’t make sense. In addition, from now until April, many NHS practices in this country will need to cram UDAs in to meet their targets. Is that good for the patients? If you do it the other way and see as many patients as possible at the beginning of the year, by the end of the year you can’t see patients because you won’t get paid for it. That side of the system is ridiculous; it’s an organisational nightmare. The NHS expects us to hit 96% of the target and it’s so difficult. You don’t know what’s going to come through the door every day and it’s impossible to get that balance right. We have a small contract and even that’s very difficult. 

What’s next?

Beyond the organisational aspect of UDAs, for me the biggest issue is that there is no payment for prevention or patient education. But it looks like the next contract might remedy that situation. In theory, we’ll have capitation, more time with patients and a simple traffic light system. We do need to work on prevention and spend time with our patients, which will reap rewards in the future.

If the proposed contract, as I understand it, works, it sounds like it could be fantastic. The issue is how it works. Take the computer system for example; it will be different, we’ll have to input a lot more information and first appointments will need to be longer. Where are all the patients going to go? Some of my NHS dentists are booked for the next three months, so imagine the waiting list if appointments need to be longer.  They’re going to be booked up for the next year just doing check-ups.

That leads me onto another of my concerns; that the revised contract, as a preventive scheme, does not financially lend itself to being associate-led.  As a practice owner, I don’t need to pay a dentist to educate patients on their oral health. I can employ a dental therapist who can do the job for less money. Where does the associate dentist fall in this scheme? I would prefer an associate in there, but am I going to be able to pay an associate to do that job if the focus is on oral health and prevention? As always, money is a big issue. How could it not be?

Making it work

Dentists are very good at getting used to a contract; we are adaptable because we have to run our own businesses in a very stressful situation. We get what we’re given and we try to work with it in the best interest of the patients and our livelihood.  The 2006 contract doesn’t balance those two elements and things get missed. What we want is something that will help with the prevention side of dentistry. Capitation with some sort of target and some monitoring is needed. Whatever we’re given we will work with it, as long as it doesn’t hit us financially.

It’s my livelihood, but the contract is changing to be better for patients; it’s not about making things better for dentists. If it isn’t affordable for me then I’ll have to convert to purely private dentistry straight away. I can’t do the same work – or more – for less money.

There is, however, definitely a place for mixed practice. I actually don’t think purely NHS practices exist. There are plenty of NHS dentists with NHS patients on their books, but they offer a private element if those patients want something beyond the contract.  For example, if a patient asks for cosmetic replacement of an amalgam filling you’re not going to do that on the NHS because it isn’t clinically indicated. A patient pays privately for that filling because they’ve requested it. So there you have a mixed course of treatment.

In summary, in my opinion the 2006 contract needs to change because the system is financially inequitable, there is no payment for prevention or education and UDAs are an organisational nightmare. Hopefully, the answer lies in the next NHS contract and if I get a fair deal then I’d be happy to carry on in mixed practice. But if the new contract does not address the fundamental issues, then I will have to seriously consider moving away from NHS dentistry.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions for over 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs

The GDC Current state of play

Last week saw the GDC Accountability Hearing - the link is below. If the state of play of the GDC is anything like England's cricket, thety are back in the pavilion and on a losing wicket again.

As presentations go, it reeked of nervousness bordering on the incompetent. Professional beaurocrats being good at their jobs – which in this case seemed to be to avoid answering questions and to avoid taking responsibility.

I know it is the ultimate in boring TV that may well not come a close second to Jeremy Kyle – but do it, people. I  strongly suggest you watch it. In fact why not mail me privately and I will send you a vCPD Certificate for 2 hours.

Answer the question, if you please Dr Moyes

It started dramatically as Dr Moyes seemed ill prepared to answer the first question directly much to the annoyance of HSC Chair Dr Sarah Woolaston. Dr Woolaston is of course medically trained. Dr Moyes’s doctorate in Theoretical Chemistry may have been of more use if he had majored in The Chemistry of Body Language, whether from in front from the MPs or indeed from behind, where a motley commoners jury of his dental peers had gathered.

Given that on appointment he was nice kindly “Bill” I do wonder if he has started using his proper title to gain some presence in the company of those he seeks to lead?

The state of play with FtP

If there was one line of questioning that caught my eye, it was Rosie Cooper MP “What is the current state of play with respect to FtP?” she asked time and again.

She drilled deep on the state of FtP numbers. Persistent as she was Ms Gilvarry simply did not know the answer. It was stark, and if it had been a job interview, she lost the job at that point.

So I urge you to watch this report.

By watching this select Committee meeting you will learn:

• ·       Why parliament is to blame for failing to legislate
   
• ·       Why the Professional Standards Authority audit is flawed
   
• ·       Why confidence in the GDC profession wide is actually high
   
• ·       Why the GDC see Dentists as a minority stakeholder group
   
• ·       Why the BDA is a minority representative body of a minority stakeholder and can therefore be disregarded
   
• ·       Why e mails from the GDC are not arrogant
   
• ·       Why a case load of 1400 per year was reported as doubling
   
• ·       How this was used to justify the ARF increase
   
•        In turn how 1400 doubled means an annual case load of 1600
   
• ·       The nature of  body language in communication.
   
• ·       Reflect upon the quite informative posturing by both the Chief Executive and Chairman toward each other.
   
• ·       Learn About the GDC having a contract with the NHS’s National Clinical Assessment Service for triaging FtP with clinical input.
   
• ·       Why dental knowledge and experience at Executive level is not required
   
• ·       The Patient panel of 5000 patients, 2500 of whom are mystery shoppers coming to a reception desk near you soon
   
• ·       How to avoid answering a question
   
• ·       Which lessons have not been learned and will, in the opinion of the Select Committee, will never be learned.
   
• ·       How, as a Chairman, your role is to protect the Council at the expense of your Chief Executive
   
• ·       How Case Examiners won’t save [much] money but will improve the FtP process.

·        

Cringe TV

For those of you who do not worry about the GDC in a resigned sort of manner, move along now, there is nothing for you here.

For those of you who like use wonder at this broken regulator, this House of Commons TV presentation is critical watching.

So what is the GDC current state of play?

After an admitted tough year in 2014, my advice is not to place your bet on a proven level of improvement just yet

The future for the Chief Executive looks at best in the balance.

The future of the Chairman [for that is how he referred to himself] is perhaps better since he distanced himself from his colleague

The future of the GDC?

I think that will be a subject for a future Parliament – with 50 Shades of Grey Electioneering upon us, the time is lost and this matter is deferred until the next Accountability Hearing. 

Their folders are shut but I think their report may well be damning

Caught at First Slip

For me … it’s that contract with NHS’s National Clinical Assessment Service that catches my eye. Contract? 

Now there’s a regulator that has crept under the radar.  As old fighter pilots used to be trained, "Check your Six" because you need to CYA

http://www.parliamentlive.tv/Event/Index/7e1458c7-a8ef-48a6-b5b2-248f85597ecf

http://www.ncas.nhs.uk/

GDPUK is a community of practice. It is a group of people that share in the same activity; dentistry.

This means that in a community of practice, our members are encouraged to share their best advice, filter out the good from the bad, and steer discussions towards what lies upon the cutting edge of the sector or profession. So for instance what changes in the political, social, economical, or technological environment are impacting upon the sector? From observing GDPUK over the last few years, that seems to be the majority of threads that prove popular!

In the last couple of weeks we have seen a different side to the community. The GDPUK community have rallied behind the profession, shown amazing engagement and made something happen. I am course talking about the recent case of Keith Watson. Brief details below:-

Keith Watson lodged the defamation action against Andrew McIntosh, relating to claims that led to him being investigated by the dental industry's governing body.

Mr McIntosh made a series of allegations about Mr Watson's professional conduct at Discovery Dental Centre in Dundee and the case was taken to a full hearing by the General Dental Council (GDC).

Mr Watson was subsequently cleared of all misconduct and lodged a £50,000 defamation damages claim at Perth Sheriff Court, but court officials have now confirmed that he has instead been granted a Minute of Abandonment and ordered him to pay £10,050 in expenses to Mr McIntosh, from Invergowrie, Perth and Kinross.  

So Keith was suddenly in the bizarre position of having to pay £10,050 legal fees, after he had won the case at the GDC!

This is where the GDPUK community spirit came into action. Victoria Holden, one of the GDPUK Moderators setup a gofundme page and within 5 days over £10,000 has been donated. An amazing achievement by all and a fantastic demonstration of the power of a community.

From a GDPUK perspective we think that it is amazing that within a few days, over ten thousand pounds was raised and at the same time we saw generosity and charitable behaviour from the dental community which should make us very proud.

Moving forward, we believe GDPUK can be a force for the good of the profession in getting involved in situations that need support from the ground up and as the sites influence and popularity continues to grow, we will continue to facilitate great achievements like the one mentioned above.

An amazing example of the power of the GDPUK community, where else can this be seen in UK Dentistry, where thousands of dentists are actively engaging on a daily basis?

http://www.gofundme.com/keithwatson

In forming the ideas for this blog, I have thought about the changes that have occurred in the leadership and role models for the dental profession in the UK in the last decade or so. Some bodies have not changed their style, nor the stature of their dental leadership. In some government controlled ones, they have.

I will consider two leaders, Chair of the General Dental Council [GDC] and the Chief Dental Officer [CDO] of the Department of Health [DH].

As you will know, an era is over with the retirement of Dr Barry Cockcroft as Chief Dental Officer, NHS England. I am sure the whole profession wishes Dr Cockcroft well, we hope he has a long and healthy retirement.

The dental profession knows the role of CDO was downgraded when this incumbent was moved sideways from the Department of Health, giving advice directly to Ministers. Of course this role has always been a civil service post, but included advisory duties as well as the expectation of leadership qualities.

During this recent tenure, the role of CDO seems to have changed to a more "director of dentistry" style, implementing imposed changes from the DH, in order to carry out the political will of the DH.  Not necessarily changes which benefit patients, nor the public, nor the profession, sad to say, but changes which have benefited HM Treasury. No doubt this would be argued against by the outgoing CDO, the changes under his watch have been dictatorial, and controlling, often based not on evidence, but on political expedience. In fact that concept of lack of evidence base is a marker for his term, of course dentists must follow an evidence for all our decisions, but UDAs and HTM01-05 demonstrably lacked any proper evidence. Only one person would argue that they do.

The historical model was that a highly respected, highly qualified colleague fulfilled this role, and often with a public health aspect, and watched over dental developments emerging from the DH, supervising in a more nurturing, parental style. We do not know how internal battles were fought with the DH over dental policy historically, but the role of the CDO appeared to be protective of patients and the profession. Will these days return?

Now over to the GDC at Hallam Street and now Wimpole Street, and from 1956 to 2012 leadership was provided by a President, who served a fixed term, elected from the body of the elected GDC.

The Presidents of the GDC over the years have included some of the heavyweight names from the surgical and scientific fields of the profession. Those dentists may have been in positions of authority, but they were colleagues that other dentists could look up to, admire their achievements, and accept leadership in thoughts, philosophy and deed.

The same thoughts would also go for the holders of the post of Chief Dental Officer.

But, as we know, the present Chair of the GDC, imposed by the Government, and put into position by the  Privy Council, has been a lay person, Dr William Moyes. Not a leader of the profession, and indeed, someone who has shown little insight into the way the UK dental profession ticks. For example, in a speech, he suggested that UK dentistry should be comparable to the supermarket industry, with shoppers able to choose between the Waitrose style practice, or the Aldi/Netto/Lidl style.

Colleagues in dentistry shudder to think who will be appointed to be the next CDO. I personally hope the appointee will be able to show the profession the way forward, to be able to speak to the profession, and not be one who is planning further degrading downgrades to professional status, or perish the thought another appointee who sets in train solutions which offer lesser results for the people of the country, or which transfers the blame for reduced outcomes back onto the profession. We need a CDO who stands up for the profession and professional ideals.

We have figureheads of the indemnity societies, the faculties of the Royal Colleges, the universities [who seem to be inward looking], trade unions, private care providers, corporate bodies, online groupings, in place, all carrying out their roles, but none of them have yet emerged as a true leader, widely recognised.

My hypothesis is there is a vacuum in strong, thoughtful, highly moral leadership of the profession, this vacuum has been created by barmy ministerial edicts over a decade or more, when politicians have either not had advice or ignored it, and have chosen to appoint different types of people, the wrong people. What do you think?

Who will provide the leadership? From where will this person or people of stature emerge, when the profession so badly needs the core values of moral, philosophical and intellectual guidance?
 

http://www.gdc-uk.org/Newsandpublications/Publications/Publications/Thefirst50years_Gazetteinsert_summer06[1].pdf

http://www.thetimes.co.uk/tto/health/news/article4081701.ece

http://www.breathebusiness.co.uk/blog/make-a-visit-to-the-dentist-more-like-a-supermarket-trip/

https://www.flickr.com/photos/pedrosimoes7/


 

When I qualified back in the early 1990’s, social media wasn’t exactly on the radar. The thought of being able to connect with a multitude of people instantly was the stuff of imagination. The Pub was our Facebook, and the only ‘likes’ we had were the various guest beers.

Now it’s such a part of our everyday lives that normal channels of communication are seemingly used in the minority. When you can connect with the entire world’s population from the comfort of your home, and carry on multiple conversations about multiple subjects simultaneously, the days of popping out for a beer and a chat with a mate seem numbered.

But what about the social etiquette, and more importantly the professional etiquette we employ when online? The GDC have standards that we should adhere too, and indeed GDPUk is actually specifically mentioned in them such is the impact social media has made on the profession. Specific specialist sites like GDPUk aren’t generally the issue, and whilst there are sometimes a few comments made that might get the GDC or lawyers a trifle interested, these sort of sites are generally appropriately populated and commented upon.

The problem are the wider platforms especially those such as Twitter and Facebook. Some users don’t seem to get the fact they are in no way whatsoever a place to remain private and anonymous despite what you might think.

Whilst the ‘more mature’ professionals seem to have the general hang of the way we should conduct ourselves, I worry that some of the younger members of the profession haven’t quite got the gist of what being a professional is yet and how they should present themselves in public to the public. Because no matter what steps they take, if they have a social and professional presence on media like that, they are well and truly exposed to public scrutiny.

There are a multitude of Facebook pages for Dental matters. Some are better than others, but all suffer from the same fundamental problem. They are not private. In order to use them you have some sort of visibility. For instance, if I wanted to discuss a case over a beer in the pub with a mate, I wouldn’t be doing it whilst posing in a mirror with oiled muscles. But that’s what communicating with some of the personas on social media is like. Some of the fairer sex seems to be somewhat less than modest in their attire on occasion, and one has to wonder if this is what the public expect of its professional classes. A couple of clicks and you generally have a range of private information about ‘friends’, particularly the more self-obsessed ones.

What about commenting into the perceived anonymity of an electronic device in such a way that you wouldn’t do in person? I’ve witnessed many an argument that would never happen in real life due to the social ethics the majority of us have; but once in the safety of the digital world the ‘keyboard warriors’ tend to lose all sense of propriety and the moral compass seems to have lost its direction.  And then there are the artists of self-promotion who feel every other comment has to be some form of pseudo advert for a business venture, or course you can’t possibly miss. I’m becoming guilty of the last one as my Twitter account now is used almost solely for the promotion of this blog and GDPUk. You see, the boundaries of who you are as a person, and who you are as a professional are becoming so grey with social media like Facebook that it feels safe to make that sort of comment, and think there is no comeback.

Finally, there are the vast numbers of photos of patients and cases that we see bandied around social media. The GDC is very clear on this,  in standard 4.2.3, where it states ‘You must not post any information or comments about patients on social networking or blogging sites’. Period. We can use ‘Professional Social Media’ but social networking sites are a no-no according to the exact wording. Personally, I think the GDC are possibly a little behind the times on this, as there are a good number of very good Facebook pages where some quite good discussions take place; however it remains to be seen if the GDC feels this is ‘professional social media’ when used in this way, as after all, they are the ones who get to decide….

The big problem though is that many people forget just what can happen to these comments and photos once they've been posted.

I’ve heard stories of people using screenshots of comments made on social media and then threatening to use them as evidence to send to the GDC. Screenshots can be shared outside the domain we think we are posting in, and as such can be disseminated far more than we might have considered when we posted. Unfortunately the self-righteous are rife on social media, and often mistake what is only free speech for something to get offended by, and take draconian steps.

I’ve seen the fallout when comments in a public section of a site then get even nastier privately; and I’ve seen wholesale bar-brawls break out in some places (although they’re usually involving musicians ? ). This is like taking a voice recorder or video camera to every meeting you have with a professional in case they say something that offends you so you have evidence and can report them. Since the GDC love nothing better than a good old Fitness to Practice case, we need to really be aware of what we put on social media, how we do it, and the persona we use on there. I think it is only a matter of time before there will be a full-blown case against a registrant involving some indiscretion or inappropriate comment on social media.

Now I’m no Luddite, prude, or some ‘holier than thou’ observer; as a forthright Yorkshireman I tend to say how it is and if you don’t like that then that’s your problem not mine. I’ve got patients as Facebook friends, and I tend to be exactly the same person online as I am in real life. I’m aware that anything I say there is something that I should be happy to share in a professional environment. I’m a real person and don’t have any airs and graces or chip on my shoulder that mean I think I’m some sort of superior being because I’m a dentist. But I can’t help thinking that some of the comments, personas, and attitudes we see as the public face of some of those in dentistry give the GDC every right to be concerned about the public perception of the profession, because if people can’t differentiate between a digital persona and a real one when they are posting then they really do deserve the attention of our regulator. The rationality and politeness filters seem to disappear from some of our profession when they get infant of some kind of keyboard. Couple all this with a competing bunch of the self-righteous, and the self-obsessed and we have a recipe for the profession to start imploding.

It certainly feels like it is one rule for the GDC and one for us where social media is concerned; the sheer fact you can ‘like’ the fact a colleague has been struck off, suspended etc, is not what I call professional. There’s also no associated comment when a colleague has been exonerated, like in the case of the Scottish dentist Keith Watson, who then attempted to take a vexatious patient with an apparent history of suing dentists, to court for defamation, which unfortunately he has had to abandon at great financial cost to himself.

But, this case shows there can be huge good come out of social media and its immediacy. In the space of less than 24 hours a fund had been created to support Dr Watson, a newly qualified member of our profession who would no doubt be financially challenged by a huge legal bill this early in his career.

http://www.gofundme.com/keithwatson Not only that, the messages of support for Keith have been flying around social media all day and latterly on GDPUK itself.  When used appropriately then, we have a fantastic medium to help people.

We need to embrace social media as its here to stay; it can be hugely useful, and massively informative; but we must use it appropriately, and think about the consequences of our presence in the virtual world. That’s what it means to be a professional.

As the Chairman of the Lawyers section of the National Association of Specialist Dental Accountants and Lawyers (NASDAL), Andrew Lockhart-Mirams, Senior Partner from Lockharts Solicitors, will be in attendance and exhibiting as a member of NASDAL at this year’s The Dentistry Show. The Show is held at the NEC in Birmingham on Friday 17 and Saturday 18 April, 2015.

Lockharts will be supporting NASDAL in attracting various Dental professionals, practice managers and owners at the event, to share their knowledge and skills about a range of issues relating to the accounts, legal, and tax and business affairs for dentists.

Formed in April 1988, NASDAL’s objective is to ensure that it provides a means of establishing a high quality of service to members of the dental profession at all times. The Chairman of NASDAL, Nick Ledingham, along with various other respected members of NASDAL will also be attending.

Andrew Lockhart-Mirams (pictured below), Lockharts Senior Partner, said “Lockharts Solicitors are delighted to be part of such a fantastic event for Dentists, and to also be supporting NASDAL as a member and exhibiting at this year’s event. It is a great opportunity to for each NASDAL member to bring their specialist knowledge and business to the table and showcase how their individual business are able to support Dentists and more importantly, also collectively under the NASDAL umbrella, to further benefit Dentists and to improve further in all areas of the overall business. NASDAL is the one-stop shop for Dentists for everything legal and accounting.”

So, come and visit us on stand G32 this April 2015.

For further information, check out our website: www.nasdal.org.uk.

We hope to see you there!

Disclaimer: The content of this article is only intended as information and should not be considered to be legal advice. Lockharts cannot be held liable for any loss caused by any act or omission as a result of the information in this article. 

Let me start with an apology ...

Those of you of a certain age may recognise my poor attempt at an ironic pun. That of course is nothing to do with my age – I am just a poor punner, so to speak.

One Week to go, Eight Weeks from certainty, 

We are 8 weeks from a General Election the outcome of which is regarded widely as the most uncertain for many generations. We are also less than a week from a most important event: Roll up, roll up, it’s the GDC under the microscope of political accountability … [well, hopefully!]

By the time you read this the House of Commons Health Committee will have parked dentistry [though the GDC Accountability Hearing] on the electoral back burner.  We’re done, the politicians will say, slamming shut their leather bound folders.

Long live the GDC

Of course we have all blown a lot of hot air about the GDC. I for one wrote majestically of the

“Delusional Management Executive and Council, demonstrably out of touch with the real events”.  I have to say I was rather proud of that!

What’s the point is making such a comment, though, if the examining Health Committee were to be so easily misled by a slippery GDC presentation?  We shall see. Our medical colleague, Dr Sarah Woolaston [a GMC Registrant] strikes me as a good pair of hands to chair the Committee and we live in hope that the GDC are “flamed”.  I for one called for the GDC to be placed in Special Measures.  Will there be tears for the GDC? I suspect not.

So for this Parliament, dentistry is all over. The Chief Dental Officer [NHS England] appointment is not even worthy of news yet.

Tiers of Tears?

And yet an ominous clinical change is afoot which will potentially be a most divisive one.  I refer to the introduction of Tiers to the delivery of dental care.  Orthodontics is now beginning to see it being proposed, while it has been flagged for some time in GDP and of course Oral Surgery have systems being rolled out.

In essence, perhaps we could liken it to our childhood friend Noddy:

Tier 1  -  Noddy can talk to Big Ears about driving but not drive a car

Tier 2  -  Noddy can drive, but not on the road at the same time as  Big Ears

Tier 3  -  Noddy can drive on the same road as Big Ears at the same time

Tier 4  -  Noddy and Big Ears can share the driving of Mr Plod’s police car

If there is one subject you should examine for your future practice, I urge you keep your eye on this ball.  As a young practitioner, it may simply guide your career development.

But as an older practitioner, the way these tiers are being mooted may expect to have an enormous impact on your ability to provide more advanced dentistry as part of your mixed practice.
 

You may wish to plan your practice development now, before the prototypes come in and before Tiers are presented to you on a plate, rather like a new diet of limited crumbs

Because I suspect many practices are only truly viable because of the ability to mix NHS and private care. Their clinical skill comes from the apprenticeship that is a life in General Dental Practice

While Tiers are arguably driven by good thinking about the big picture, and are here to stay, I worry that the unexpected outcome will be to drive unexpected massive change through older practitioners, who in many cases of course are the practice owners.  In all of this, the reality of Austerity 2 after the election – there has already been flagged real terms budget cut of up to 20% - makes the reality at GDP level quite different

Don’t let you and your practice be the one to experience Tears for Fears.  The Law of Unexpected Outcomes may well be alive and well

Valedictum

On a closing note, not unrelated, I am sure tears will be shed for the retirement of our colleague , the Chief Dental Officer, Dr Barry Cockcroft. The old position of CDO was of course downgraded, politically speaking, to NHS England, now outside the Elephantine corridors of power in London. This poacher turned gamekeeper [for he was indeed in high office at the BDA] can have improved access to a safe retirement in the knowledge that his project of UDAs has lasted the test of time, even if did not pass any other test!!  Let us hope that the next incumbent of the position does not also leave office with the same defunct system in place in years to come.

We reserve the right to have a barney with you Barry, but the least you deserve is a drink on us.  A glass of Chateau Fluoride perhaps – the one with the varnished cork?

 May your retirement be a long, happy and enjoyable one. 

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/inquiries/parliament-2010/2015-accountability-hearing-general-dental-council/

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/membership/

http://www.england.nhs.uk/wp-content/uploads/2013/02/commissioning-dental.pdf

As the focus in modern dentistry shifts further towards to prevention, effective teamwork is necessitated in order to deliver an excellent patient service. Collaboration between the team ensures that a coherent message is conveyed to patients no matter who they speak to, giving credibility to both the clinical advice given and the practice itself.

The same teamwork also enhances clinical outcomes, as practitioners are able to support one another to improve the results achieved.

Ian Dunn is a Specialist Periodontist with a wide variety of experience in practice as well as teaching. He is the Periodontal Teaching Lead at Liverpool Dental Hospital while also working in practice alongside a wide variety of other specialists in the fields of endodontics, orthodontics, prosthodontics and dental implants. Ian knows the importance of a full team approach in the management of periodontics and will be speaking at The Dentistry Show 2015.

"I have attended The Dentistry Show as both a delegate and speaker on four occasions and have had the pleasure of listening to some of the biggest names in dentistry speak on a wide range of topics. The different lecture programmes mean that there is something for the whole dental team. I have always found the Show to be very well organised and it has one of the best trade fairs I have been to. 

"In my lecture entitled 'I'm a periodontist, How can I help you?' I will be looking at some of the ways a periodontist can work with other members of the dental team for the benefit of the patient. I will spend a large section of the lecture looking at periodontal diagnosis and common misdiagnosis – something that should be of great interest to hygienist and therapists in light of the new rules around direct access and the need for other members of the dental team to be involved in the diagnostic process. I will finish the lecture looking at some of the advanced treatment options such as surgical management of periodontal disease. 

"I would hope that delegates attending the lecture will better understand the role of the periodontist and how we can help them stabilise their patients’ periodontal health. I would also hope that delegates will leave with improved diagnostic skills and be able to better avoid the common misdiagnoses that I see on a regular basis. Finally they should also be able to discuss the range of options available to patients once they are referred into specialist care."

The Dentistry Show 2015 is a two-day event tailored to the needs of the entire dental team offering a wide range of products, verifiable CPD lectures, hands-on workshops and opportunities for networking. Register for your free delegate pass today and make the most of everything available to you at The Dentistry Show 2015.

The Dentistry Show and DTS 2015, Friday 17^th and Saturday 18^th April, NEC in Birmingham. To register for your free delegate pass please visit www.thedentistryshow.co.uk, call 020 7348 5269 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

A recent appointment with a particularly happy patient got me thinking about what is it that makes us, as dentists, happy? And when are we happiest?

Is it satisfied patients? Successful treatments? New technology and gadgets? Holidays? Certainly all of these elements contribute to a sense of momentary contentment and satisfaction, but what is it that creates a more long-term feeling of happiness? And what can we do to make our profession happier? 

There are many psychological studies that put choice, autonomy and control as major contributors to feelings of happiness. It would appear that we are happiest when we have control of our own destinies, when the decisions that affect us most are the ones that we have the power over. Thus, as dentists, we may be happy in our day-to-day practices and surgeries because this where we are in charge and make the decisions, but, as soon as this control is taken away we can feel uncomfortable, unsure and less content.

In a wider sense, this is something that many dentists are feeling at the moment and there is a growing sensation of unease and unhappiness across the industry. This can be attributed to an increasing sense of a loss of control over a profession that we are all care deeply for and are so passionate about.

The well-documented problems with the GDC certainly don't help the situation and for many the lack of perceived control in this area in particular is a source of anxiety and distress. Many felt that eventually something had to change and the GDC is now firmly in the dock, facing the wrath of a disgruntled profession as LDCs across the country have expressed their disdain and frustration. The latest wave of disapproval from professionals stems from the significant increase in retention fees for practitioners, but also has deeper roots in the way in which the GDC operates as a whole. But the question remains: how do we change all this and what would actually make us happier?

In its response to the LDCs, the GDC released a statement saying that it was anxious to ‘engage constructively with the dental profession’ and has planned discussions that it hopes professionals will participate in. Certainly entering into a two-way discourse is the first step to achieving some sort of mediated appeasement, but will this make us happier as a profession?

Ultimately, what dentists want is to feel like they have some degree of control over their industry and their future. It is therefore time to examine the roadblocks that are getting in the way and begin changing dentistry for the better. By wrestling back some control, perhaps we can all be a little bit happier?

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.

‘Networking’ is not simply a personal sales pitch. It is based on trust, which means building on and maintaining relationships over a period of time. The benefits in having a broad and vibrant network are huge. Even if you are not a natural extrovert, it is relatively easy and enjoyable to network successfully and connect with people that will have a long-term, positive impact on your career.

Like any good relationship, networking should be mutually beneficial. See it as a tool to exchange information about best practice, new techniques and products as well as gaining introductions to practitioners with similar interests. When you meet regularly with your peers, you put yourself in a position to seek their advice about similar challenges they will have faced. Active networking can put you at the front of people’s minds when job opportunities arise. Sharing your own ideas will help you to build a reputation as an innovative thinker and being able to offer assistance or advice means people will hopefully reciprocate in the future.

Connecting with more experienced professionals will open the door to career guidance that money just cannot buy. You may even find a mentor or, at the other end of the scale, finding someone to mentor is a richly rewarding experience.

So, how does one begin? The simple answer is to get out there! Go to professional events, take courses and attend lectures - participate. Be a familiar face on the circuit and you will become known as someone who is enthusiastic and supportive of the industry.

The best way to use your networking time efficiently is to join an established group, such as a professional academy. Choose one with high-calibre members. For example, the British Academy of Cosmetic Dentistry (BACD) boasts hugely some hugely influential and well-liked dentists, such as Julian Caplan, Tif Qureshi and Zaki Kanaan who are all regular attendees at the Academy’s events as well as frequent award-winners in their fields. The BACD attracts world-renowned speakers to its Annual Conference every year, giving dentists the opportunity to meet with them in a professional, yet relaxed setting. BACD dentists have also participated in high-profile media projects, and members are encouraged to diversify, for example by writing articles or presenting at its events.

Networking will not only keep you in touch with the industry, but will help you to focus your career path – the earlier you start, the better. Professional academies facilitate networking, but it does involve a degree of commitment too – the more frequently you get out there, the more your confidence will grow. You will not become the best you can be by going it alone.

The BACD’s 12^th Annual Conference runs from 12^th - 14^th November 2015 at The Hilton London Metropole Hotel. Go to www.bacd.com, email Suzy Rowlands at This email address is being protected from spambots. You need JavaScript enabled to view it. or call 0207 612 4166.

The very first evidence of dental impressions can be found as far back as the early 18^th century. Dentist Phillip Pfaff described a technique of taking impressions using sealing wax softened in hot water, before pouring plaster of Paris into the mould to form a rigid cast.[i]^,[ii] A letter by Isaac john Greenwood in 1861 also suggested that beeswax was used to create models for early dental prostheses.[iii]

While the general concept for taking impressions has remained the same, methods of acquiring data has of course changed. The first true precision impressions using hydrocolloids were taken in 1925, and the fundamental compounds have been used ever since. Various products have been brought to the global dental market over the years, each designed with the latest technologies of the time to improve the experience for both practitioner and patient, while enhancing the clinical result.

The test of time

In the last century alone, few products and technologies have stood the test of time. In fact, many of those that have been around even a decade after inception owe their survival to continual development and refinement in order to cater for the ever-evolving demands on dental professionals.

Modern suppliers and manufacturers have therefore invested much time, money and effort in the research and development stages of any and all products on offer. Clinical trials, studies and assessments are performed to test products before general release into the market, and user feedback is used to refine both existing and future solutions.

No company understands this better than 3M ESPE, who is delighted to be celebrating an impressive 50 years of the Impregum Polyether Impression Material family, from which several widely recognised and highly praised products have been borne. It was the first polyether impression material available.

Where it all began

Since its introduction in 1965, Impregum F was immediately popular with dentists around the world. Properties of the polyether material such as its incredible hydrophilicity, snap-set behaviour and monophase characteristics lent well to wet environments, and dentists were afforded good handling with the desired long working and setting times. Its rigidity when set allowed for superior accuracy and detail capture, as well as dimensional stability and outstanding reliability. Polyether products have since been the material of choice for most implant dentists, and even to this day, the Impregum Impression Materials remain the only true polyethers available on the market.

In the early 1990’s came the 3M ESPE Pentamix Automatic Mixing Unit – another first of its kind. The initial material to be made suitable for the Pentamix Mixing Unit was the high-selling Impregum F, which henceforth became known as Impregum Penta. Similarly, Permadyne Polyether Impression Material followed two years later, which was also suitable for automatic mixing. As many dentists preferred a heavier viscosity material in the impression tray and a lighter less viscous running material around preparations in the mouth, this is exactly what Permadyne provided.

Continual development

In order to improve the smell and taste of Impregum Impression Materials, while also offering a less rigid-set option, 3M ESPE developed Impregum Penta Soft in 2000. Combining all the characteristics of the highly popular polyether family, this product was designed to be easier to extract from the mouth while also being more forgiving with a softer set state. A year later the Impregum Penta DuoSoft was launched, meaning ‘two softs’, which provided a heavy viscosity yet softer material for the tray and a light viscosity material for the prep.

By this point, the clinical practise of dentistry had changed somewhat since Impregum was first developed. As such, a new demand for short working and setting times needed to be met. The entire 3M ESPE polyether family so far had an approximate overall working and setting time of 6 minutes. Customers had expressed a desire for faster setting times in order to enable smooth and streamlined workflows, and so came the Impregum Penta Soft Quick range in 2004, which dropped the working and setting time down to about 4 minutes. For the first time, dentists could employ fast setting modified polyethers for monophase and one-step / two-viscosity techniques based on the revolutionary ‘snap-set’ behaviour. Dental laboratories also reported a very high quality of casts with this material.[iv]

Industry recognition

Giving dentists even more confidence in their 3M ESPE products, Impregum Penta Impression Material and Pentamix Automatic Mixing Unit have gained several accolades over the years.

Impregum Awards:

• The Dental Advisor, Preferred Product winner, 2010 – highly rated and considered one of the best products in the market at that time.
• The Dental Advisor, 2013 Clinical Problem Solver – recognised for its ability to capture margin detail with subgingival preparation.
• The Dental Advisor, 2014 Clinical Problem Solver – praised for its rigid set state and ability to provide an accurate representation of an implant for more precise impressions first time, even when haemostasis is difficult to achieve.

Pentamix Awards:

• The Dental Advisor, Editors’ Choice.
• Reddot design award, 2009 – praised for its compact and versatile design and ease of use.
• The Dental Advisor, Assistant’s Choice, 2009 – awarded for its smaller size and easy use.

50 years later

Proving its worth half a century after its initial creation, Impregum Impression Material remains a highly suitable product for a wide range of indications including inlays, onlays, crowns, bridges and implants. Offering flexibility of working times and viscosities, Impregum enables you to work the way you want to and is often the preferred material for implantologists the world over.

For more information, call 0845 602 5094 or visit www.3Mespe.co.uk