To learn all about the new classification of periodontal and peri-implant diseases and conditions, all you need to do is attend the BDA’s roadshow, sponsored by Johnson & Johnson, which will soon be on its way to Birmingham and London.

Under the umbrella of ‘Periodontal disease management now and in the future’, Professors Nicola West (pictured) and Tim Newton will offer unique insight into periodontal care and treatment.

Prof. West, Professor/Honorary Consultant in Restorative Dentistry (Periodontology) at Bristol Dental Hospital, will be speaking about ‘Periodontal disease management: modifying diagnostic and communication behaviour for better oral health outcome’, including the new classification, and answering delegates’ questions.

Adding to this, Tim Newton, Professor of Psychology as Applied to Dentistry at King’s College London Dental Institute, will explore ‘Better oral health outcomes through changing behaviour: what does it all mean for me and my practice?’

The Leeds roadshow is currently underway but there are some places still available for the Birmingham (19th October) and London (7th December) events. For further information and to book your place, please visit https://bda.org/events/member-series.

PERIODONTOLOGY IN GENERAL DENTAL PRACTICE

A New, Simplified Classification System For General Dental Practitioners

By

@DentistGoneBadd

Introduction

We present here, the results of a thirty-five minute workshop on new periodontal classifications compiled by the only few General Dental Practitioner’s we could find that were even remotely interested in gums and jawbone. This is the first time GDP’s have been bothered to categorise (or take notice of) gum conditions and we feel it will be a more useful day-to-day guide than those new classifications issued recently by the American Academy of Periodontology and the European Federation of Periodontology. The workshop was carried out during a Curry Club Thursday at the Salisbury Wetherspoon’s.

Methodology

Brian wrote everything down on a beer mat because the screen on his iPhone stopped working after his ios12 update went pear-shaped. We wrote down everything we could think of regarding perio, without Googling it, not that Brian could anyway.

Classifications

GINGIVAL TISSUES

1. 1. Perfick

The patient has no inflammation, deposits or staining. This has nothing to do with you or your ‘diligent’ care. Either the patient has been to another practice, or is just extremely lucky. Treatment – NHS – none required.   Private – One to two sessions with the hygienist.

2. 2. Bit Gammy – But Not Worth Getting The Scaler Out

The patient has a little bit of plaque or stain that is forgivable bearing in mind the goofiness she presents with and having to control the three kids that are currently all trying to make a human pyramid on the nurse’s chair. Teeny bit of bleeding when you bodged it with the BPE probe, but no calculus. Treatment – NHS – MAYBE a polish. OH advice – “You’re missing a bit – get an electric.” Private – Two to three sessions with the hygienist.

3. 3. Quite Gammy

The patient has dirty-filthy-muk-muk everywhere as usual – I say everywhere, it’s mainly on the lower linguals of three to three (there MAY be other stuff but you didn’t look anywhere else). Some crowding is hindering OH, but the patient doesn’t really make an effort. Neither do you really. Treatment – NHS – get the blunt hand scaler out. No air scale since the phantom of the practice has bent all the inserts (how DOES that happen?) Private – Three monthly scales. This proves to the GDC disciplinary panel that you were providing continuing care.

4. 4. Incredibly Gammy

Even YOU can’t ignore the dirty-filthy-muk-muk between the 6’s and you are too scared to push the BPE probe in too far in case you hit a ‘3’ and end up having to do a full perio chart (even if you COULD find a perio probe). Treatment – NHS – See what you claimed previously and see if you can get a Band 2 perio out of it. Order an air scaler and hide it so it doesn’t get either nicked, bent, or boils the water as it passes through. Private – This pays the hygienist nurse’s wages for six months.

5. 5. Acutely Gammy

Punched out interproximal gingivae, necrotic look, breath that would stop a charging rhinoceros in its tracks at 100 metres. This is the first time you have asked if the patient smokes or is under stress. Treatment – NHS – Metronidazole and smoking cessation advice – SORTED! Private – The patient doesn’t return after the Flagyl.

6. 6. Pregnancy Gammy

You can breath a sigh of relief. It’s not you, it’s hormones.   Treatment – NHS – A quick prophylaxis. Private – You can’t, she’s exempt. It doesn’t seem right.

7. 7. “Brushed Too Hard This Morning”

This does not exist. Occurs because the patient uses a brush like a Brillo Pad and doesn’t try and get in between the teeth. This is YOUR fault.

PERIODONTAL TISSUES

1. 1. Bone Loss, But Patient Knows About It

You have inherited this patient from another practice or a colleague, so breathe a sigh of relief. Pre-existing bone loss, but patient is on top of OH. Treatment - NHS – Give the patient a pat on the back. Private – Two-monthly scales with the hygienist under local.

2. 2. Bone Loss, But You Didn’t Know About It

As you are flicking around the lower incisors with a blunt sickle, you notice the lower right one is a bit wobby. You sneakily apply a little bit of lateral force with the scaler to all the teeth and discover ALL are a bit wobbly. Treatment – NHS - As you were, but in the notes, emphasise that you reinforced the need for interdental OH and daily TePe use. Private – Refer to the hygienist and on the prescription note “Hygiene has slipped a bit.”

3. 3. Bone Loss, You Knew About It And Splinted It

Your pathetic broken splint is cutting into the patient’s tongue. Treatment – NHS – You casually mention the phenomenon known as ‘Immediate Dentures’ and hope the patient doesn’t listen to local commercial radio and catches an advert for dental litigation lawyers. Private – Not appropriate. The hygienist is a stickler and might report ‘concerns’ to the authorities.

4. 4. Terminal Bone Loss

You check how long you have treated the patient and then check your dental indemnity subscriptions are up-to-date. Treatment – NHS – Ask lots of questions about gum disease in the patient’s parents and plant the seed that the condition is inherited. Private – If the patient asks if they need to see the hygienist, either say you haven’t got one, or price the patient out of it. You really don’t trust that hygienist. Her eyes are too close together.

5. 5. Chronic Periodontitis

Also known as ‘chronic’ periodontitis. Has been there forever and you haven’t really addressed it. Treatment - NHS - Pull yourself together and do something about it before you retire. Private - NOOO! You keep checking the hygienist’s scrubs pockets for digital voice recorders.

6. 6. Acute Periodontitis

Also known as Peri Peri Periodontitis. You diagnose that a bit of Nando’s chicken has got stuck and irritated the gum. Treatment – NHS – Pull the bit of chicken out (preferably with your eyes closed – Ewww Ewww Ewww) and claim Acute Mucosal. Private – Squeeze in with the hygienist and get them to pull the chicken out. Charge £60.00.

PERI-IMPLANTITIS

1. 1. Also known as “What the Hell? I didn’t know that was even possible.” Treatment – NHS – Arrange the following words in order: Touch Barge Pole Don’t A With. Private – Refer back to the implantologist.

2. 2. Advanced peri-implantitis. Same reaction. Treatment – See above, but TWICE as fast.

Dental practices are currently facing another major legislative change on 1st October when the Insurance Distribution Directive (IDD) comes into effect, which has caused much discussion in the industry and a range of different approaches. IDD is a change in government legislation around insurance products designed to give consumers greater choice and clarity when purchasing insurance products.

Caroline Coleman, Managing Director of Simplyhealth Professionals said: “As a trusted partner, it is our responsibility to provide our members with advice and support on new regulation, and clinical and business issues. Everything that we do as a customer-led organisation is in the best interests of our dentists and their patients. This is why we have taken the time to fully understand IDD and its implications.”

Simplyhealth Professionals has concluded that in order to comply with the new legislation and give patients the choice that the IDD demands, from 17th September for all new joiners, their supplementary insurance product - historically included as standard within Denplan payment plans – has now become optional.

Sandy Brown, Director of Dentists at Simplyhealth Professionals, said: “We have done everything we can to follow the Financial Conduct Authority (FCA) regulations to make sure that we comply with the new IDD regulations. Giving patients the choice of whether they feel the supplementary insurance is the right product for them is the essence of IDD. It’s really important for those patients that opt in to be reassured in the knowledge that their claims will definitely be paid out according to the terms and conditions. We are working with our member dentists to make sure that they understand the new regulation, how it affects them and their patients, and has minimum disruption to day to day business.”

Simplyhealth Professionals offers patients dental emergency and injury cover that has the protection of a regulated product, with guaranteed pay-outs for valid claims and access to an independent appeals process.

Sandy Brown said: “Opting for insurance seems to me a very minimal monthly amount for absolute peace of mind. The main benefit of insurance is that patients have the legal protection to ensure that payments they are entitled to are paid out.”

About Simplyhealth Professionals:

Simplyhealth Professionals is the UK’s leading dental payment plan specialist with more than 6,500 member dentists nationwide caring for approximately 1.7 million patients registered to a Denplan product.

Simplyhealth Professionals also provide a wide range of professional services for its member dentists and their practice teams, including the Denplan Quality Programme and Denplan Excel Accreditation Programme.  Plus regulatory advice, business and marketing consultancy services and networking opportunities.

Dentist enquiries telephone: 0800 169 9962.

For patient enquiries telephone: 0800 401 402   

For details of all of our products, visit www.simplyhealthprofessionals.co.uk

About Simplyhealth:

For 145 years we’ve been helping people to make the most of life through better everyday health.  In 2017 Simplyhealth and Denplan united under one Simplyhealth brand and today we’re proud to be the UK’s leading provider of health cash plans, Denplan dental payment plans and pet health plans.

We help over three million people in the UK access the health and care products, services and support that they need, when they need them and at a price they can afford.

1m health cash plan customers

1.5m patients with a Denplan payment plan

6,500 member dentists

1,900 member vets

1 million animals covered

11,000 corporate clients

We’re proud to donate 10% of our pre-tax profits to health-related charitable activities every year, and this amounted to over £1 million in 2017. Our Simplyhealth Great Run Series partnership raised an additional £42.6 million for charity.

Simplyhealth is a trading name of Simplyhealth Access, which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

www.simplyhealth.co.uk       

Dr Bawa-Garba and protecting public confidence

On 13^th August 2018 the Court of Appeal handed down its decision in the case of Dr Bawa-Garba v the General Medical Council. The GMC had successfully appealed against the decision of the original Medical Practitioners Tribunal not to erase Dr Bawa-Garba, but to suspend her from practicing for 12 months. The Court of Appeal upheld the original sanction, ruling that erasure was not appropriate in this tragic case.

Dr Bawa-Garba was convicted by a jury before the criminal courts of gross negligence manslaughter, for behaviour which the trial judge felt was so serious that it should be marked by a sentence of imprisonment, albeit suspended. Yet neither the MPT nor the Court of Appeal felt it necessary to erase her from the register. This left many wondering what would it take for public confidence in the profession to be damaged, if not gross negligence manslaughter?

Background

On 18^th February 2011 Dr Bawa-Garba was on duty at the Leicester Royal Infirmary Hospital. She had just returned from a period of maternity leave and had completed two shifts back to back.

Jack Adcock, a 6 year old boy, was admitted to the hospital at 10.15am that morning. When he attended he was unresponsive and limp. Jack presented with dehydration caused by vomiting and diarrhoea, his breathing was shallow and his lips slightly blue. Jack had a history of illnesses. He had been diagnosed with Downs Syndrome from birth. He also had a hole in his heart that required surgery. He was taking enalapril which meant he was more susceptible to coughs and colds.

Dr Bawa-Garba was the most senior junior doctor on duty and Jack was under her care for the next 8-9 hours. Dr Bawa-Garba was assisted by a nurse, Isabel Amaro and the ward sister, Theresa Taylor.

Jack was originally diagnosed as having gastro-enteritis and dehydration. After an x-ray it was determined that Jack in fact had pneumonia and was treated with anti-biotics. As a result of this not being picked up immediately, Jack’s body went into septic shock which caused his heart to fail. Despite attempts to resuscitate him, he died at 9.20pm. There was also a mistaken belief, perpetuated by Dr Bawa-Garba, that Jack had a ‘do not resuscitate’ in place, which hindered his care.

Criminal Proceedings

Initially Dr Bawa-Garba was informed that the Crown Prosecution Service would not prosecute. However, following the inquest into Jack’s death in 2013, the CPS reviewed its decision and in December 2014 she was informed she would be charged. Ms Amaro and Ms Taylor were also charged.

During this time Dr Bawa-Garba remained employed at the hospital.

At the hearing the prosecution advanced a number of failures by Dr Bawa-Garba, which it said led to her being grossly negligent. Dr Bawa-Garba’s defence was that Jack’s death was as a result of hospital computer failures, lack of staff and failures by others.

The trial judge directed the jury that the prosecution had to show that what Dr Bawa-Garba did was ‘truly exceptionally bad.’

On 4^th November 2015 Dr Bawa-Garba was convicted of gross negligence manslaughter. Ms Amaro was convicted of the same offence.

On 14^th December 2015 Dr Bawa-Garba was sentenced to two year’s imprisonment, suspended for two years. She was ordered to pay £25,000 in legal costs. The remarks of the judge when sentencing were ‘there was a limit to how far these issues could be explored in the trial, but there may be some force in the comment that yours was a responsibility that was shared with others’.

Fitness to Practice Proceedings

Under Fitness to Practice Rules a certificate of conviction is conclusive evidence of the offence committed and cannot be challenged. The role therefore of the Medical Practitioners Tribunal is to determine if fitness to practice is impaired and if so what sanction to apply.

On 20^th February 2017 a hearing was convened to assess whether Dr Bawa-Garba’s fitness to practice was impaired. Dr Bawa-Garba did not give evidence at that hearing. On 22^nd February 2017 the Medical Practitioners Tribunal held that Dr-Bawa-Garba’s fitness to practice was impaired. It found that she ‘fell far below the standards expected of a competent doctor’ at her level and that the conduct had brought the profession into disrepute. However, it went on to say that the clinical failures, although serious, were capable of being remedied and had been addressed.

On 12^th June 2017 the same panel reconvened to consider sanction. Again Dr Bawa-Garba did not give evidence; the panel commented ‘the Tribunal was unable to conclude that you had complete insight into your action as it did not hear from you directly’. On 13^th June 2017 it issued its decision to suspend Dr Bawa-Garba immediately for 12 months, subject to review. The panel confirmed that it had to bear in mind that the sanctions were not to be punitive but to protect patients and the public interest. The Medical Practitioners Tribunal weighed up the following factors:

The Medical Practitioners Tribunal said ‘whilst your actions fell far short of the standards expected and were a causative factor in the early death of Patient A, they took place in the context of wider failings.’

The GMC appealed the decision. The High Court overturned the Medical Practitioners Tribunal decision and replaced it with a sanction of erasure. In essence the judge felt that the panel had not taken into account the true force of the jury’s finding of ‘truly exceptionally bad’ behaviour on the part of Dr Bawa-Garba.

Dr Bawa-Garba appealed. Her grounds of appeal were that the court had erred:

1. By applying a presumption that a conviction of manslaughter by gross negligence should lead to erasure save in exceptional circumstances;
2. By failing to appreciate the distinct roles of the jury in a criminal trial and the Medical Practitioners Tribunal;
3. By unlawfully substituting its own judgment on the basis a suspension was not sufficient to maintain public confidence;
4. In concluding the Medical Practitioners Tribunal was precluded from taking into account evidence of systematic failures;
5. By reaching an irrational conclusion; no reasonable court could have concluded erasure was the only sanction.

The Court of Appeal confirmed that

The task of the jury was to decide on the guilt or absence of guilt of Dr Bawa-Garba having regard to her past conduct. The task of the Tribunal, looking to the future, was to decide what sanction would most appropriately meet the statutory objective of protecting the public pursuant to the over-arching objectives… to protect, promote and maintain the health and safety and well-being of the public.

As a result of this finding, the Court of Appeal held it was wrong of the court to presume a conviction of manslaughter should lead to erasure save in exceptional circumstances and to preclude evidence of systematic failures within the hospital at the time of the incident.

The Court of Appeal overturned the court’s decision and re-issued the 12 month suspension as the appropriate sanction in this case.

Conclusion

Having read the judgment it is clear Dr Bawa-Garba was well regarded amongst her peers; indeed a fund set up by junior doctors raised over £200,000 to go towards her legal fees. The incident itself  was deemed a one-off incident; a lapse in clinical judgment in an otherwise unblemished history. She had taken remedial action in respect of any issues. There were also failures on the part of others and the hospital itself.

If the public had all of this information, it would no doubt agree Dr Bawa-Garba’s sanction was fair.

If you need any advice or assistance in relation to fitness to practice proceedings, please contact Laura Pearce on 0207 388 1658 or email her at This email address is being protected from spambots. You need JavaScript enabled to view it.

Laura Pearce, Senior Solicitor

When browsing the news I’m always astounded at how many articles there are about the lax approach to oral care among the general populace of the UK. Whilst some of these headlines are more than likely sensationalised by the media to draw in an audience, there is often a grain of truth hidden amongst the hyperbole, and one article in particular that caught my eye recently detailed some harrowing statistics that couldn’t be ignored.

A result of the recent National Dental Survey performed by BUPA Dental Care, the article revealed that over 2 million UK adults hadn’t been to the dentist in over a decade.[i] I personally find it almost unbelievable that in this day and age there are so many people out there who are willing to ignore their oral health and avoid seeking out the proper guidance necessary to ensure that their teeth remain healthy, especially for such a long period of time.

I think in many of these cases people believe in the adage “don’t fix what isn’t broken” and if they aren’t experiencing any pain or visible signs of decay they assume that their mouths are in good condition. As professionals, we know this isn’t necessarily the case. However, when delving further into the article it seems that more than a third of British people mask or ignore dental pain with the use of painkillers instead of curing it with a visit to the dentist. This is an astonishing statistic that suggests that what we really need to do is go back to education and make it clear to these people that prevention and treatment are always better options than pain.

The findings of the survey revealed that many British people skip brushing their teeth if they are in a rush and that a third of them never floss or visit the hygienist either. In a way these statistics are less surprising – how often have you told a patient they need to floss and they return with no change? It still indicates a widespread problem that we, as professionals, need to do our part in changing. Perhaps to combat these statistics we need to explore new methods of guidance to help guarantee that the message really sinks in.

One method that I think could make a big difference is a wider use of dental photography. Not only does this ensure patients will be able to visually see the damage that they are causing to their teeth, but it is also a useful way to track the progress of any treatments you offer. These photos are also useful marketing materials for the practice as long as you ensure that your patients give you the proper consent. This is especially great as with the ever-growing rise in platforms such as Facebook and Instagram, these visual aids can really help people discover what your team are capable of and even bring in new business.

Another method worth exploring is the introduction of technology with visual aids such as animations and diagrams. Not only do these help educate patients by detailing procedures in a way that they can understand, but they also prove to be invaluable resources when faced with patients who have been repeatedly given advice and don’t seem to take it on-board.

Whatever the reason behind this wide-scale neglect it’s from clear reports like these that there is more work to be done. Professionals need to be vigilant when encouraging good oral care habits in our patients, and if that means we should explore new methods to make them aware of the dangers, then it’s something worth considering.

Of course, patients too must take some responsibility, however, when making it clear that regular brushing and interdental cleaning are a necessary part of maintenance and giving the best service we possibly can, we can reassure those who have avoided the dentist for years that seeing us isn’t as scary as they may think. Hopefully these measures will help minimise these worrying statistics detailed by the report over time.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.

[i] Dentistry.co.uk. Over 2 Million Brits Haven’t Seen a Dentist in More Than a Decade. Link: http://www.dentistry.co.uk/2018/05/25/2-million-brits-havent-seen-dentist-decade/ [Last accessed june 18].

As concerns mount over recruitment issues and impaired growth of dental businesses, assistance from a specialist agency with dental experience is more vital than ever.

Dental Elite has many years collective experience across the team, and with a customer rating of 4.8 out of 5 it is one of the profession’s must trusted recruitment, sales and acquisitions, valuations and finance agencies.

“I would definitely recommend Dental Elite to others, and would certainly give them a call if I ever needed to find another job in the future,” says associate Justin George.

Veronica Balbontin who sold her practice through Leah Turner and Sue Humphrey also has high praise for Dental Elite. “The transition was seamless, and I am really happy with the service I received from both agents. They were both extremely helpful and very professional; I couldn't have completed the process without them.”

If you are experiencing recruitment issues, looking for a new role, or want to sell or buy a practice then visit Dental Elite on stand E26 at the BDIA Dental Showcase 2018.

For more information contact Dental Elite. 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

Window Shopping or Serious Shopping?

Dental Showcase takes place the first week of October and if you haven’t already registered, now’s the time to do so.  If you went a couple of years ago and are concerned that not much will have changed, then think again.  With no other UK event attracting such a wide range of dental suppliers under one roof, there will be plenty that’s new.  Whether you want to check you’re taking advantage of the latest advances in technology or want marketing or financial advice, all the leading players will be at your service.

An Exhibition First

This year, for the first time, there will be a specific day dedicated to Foundation Dentists which is being sponsored by MyDentist.  One of the keynote lecture theatres will be committed to the needs of trainee dentists.  Topics will cover how to bridge the gap from DFT to Associate, organising your CPD, risk management, effective treatment planning and complaint handling.  As well as formal lectures, there will be a specific Foundation Dentist Hub where you can get one-on-one career advice.  The opportunities don’t cease when the exhibition hall closes, for there will also be a Foundation Dentists’ Ball on Thursday 4^th October on the Sunborn super-yacht, which is conveniently moored alongside Excel London.  Why not organise a reunion with your former students, where you can share your FD experiences?

Education….the Passport To Your Future?

If education is your driver, then there will be no shortage of opportunities.  Whether you prefer the longer length lectures by keynote speakers in the Dental Update Theatre, or would rather ‘dip in and dip out’ of shorter sessions in the Innovation Theatre.  There’s a lot of focus this year on the NHS, with its landmark birthday, so maybe you want to learn more about what the government is doing to support dentistry.  Sarah Hurley, CDO for England, will be talking each morning about the development and provision of NHS dental services.  There’s also a specific CDO Zone should you want to discuss matters with Sara or one of her representatives.  Whatever you need to know, Showcase is the place to find answers!

It’s Good to Talk

Dental Showcase provides an invaluable opportunity to network.  All key associations will be in attendance, so you can discuss matters pertinent to your community whether you’re a dentist, hygienist, nurse or practice manager.  If perio is your passion, then talk to the BSP, or if ortho enthuses you, then the BOC will be on hand to support, listen and advise.  

Fun Matters

Exhibitions are social events too and there’s plenty to do whilst you’re at Dental Showcase.  A host of catering options will provide an opportunity for you to informally catch up during the day with colleagues or you could take the fun up a notch and attend the ‘Boat Bash’ being hosted by Dental Sky on the Sunborn on Friday 5^th October, all profits of which go to the charity BrushUpUK.  The evening will consist of two parts.  The downstairs bar will have live music, canapés, a vintage photo booth, as well as charity events such as auctions and raffles. The second part of the evening will be in an exclusive bar at the top of the yacht, where there will be a casino night, complete with vodka luge!

To register, or for more information, visit dentalshowcase.com.

It’s the Tortoise and the Hare all over again…

Boota Singh Ubhi, Principal of Birmingham Periodontal & Implant Centre (BPI Dental), Specialist Periodontist and implant dentist, shares a long-term referral case that highlights some important lessons.

The patient was initially referred to us for full arch reconstruction with guided surgery in 2006. She presented with failing upper bridgework, which was partially implant-retained. There were multiple problems including failed apicoectomies, fractured roots, and the two anterior implants were failing as well (Figures 1-3).

The treatment options discussed with the patient were to either do nothing for as long as possible or to replace all existing restorations and implants. As the patient was keen to find a solution sooner rather than later, she chose the latter option.

A full clinical assessment was conducted with radiographs (Figures 4-5) and photographs. The only good tooth remaining was the upper right canine, but other than that the natural upper dentition had a hopeless prognosis and was unrestorable. A very large lesion was detected on the UL5, the UL3 was 

apicoectomised and both the anterior implants were positioned very poorly, which had affected the smile aesthetics with a midline shift to the left. These implants had been placed about 13 years previously, so they featured very old designs. 

Initial treatment and surgical planning 

The treatment process was explained to the patient and informed consent obtained to proceed. The existing implants were removed (Figure 6), as were the few remaining natural teeth. As poor bone quantity had been identified in the assessment radiographs, bone augmentation was indicated if we were to place new implants with a good level of primary stability. The procedure was performed at this time around the implant site to preserve the sockets and in the upper left quadrant. This was left to heal for about six months, during which time the patient was provided with a removable temporary denture.

After this healing time period, the patient returned to the practice for a follow-up CT scan and wax-up, which was used for the guided planning process of the implant placement. The ideal implant positioning, angulation, length and width were determined using Simplant software.

Surgical treatment

On the day of surgery, mid-crestal and midline reliving incisions were made (Figure 7) and a full thickness mucosal flap was retracted back. A bone-supported guide was used (Figure 8) to place six Astra Tech dental implants (Figure 9), which at that time enabled the guided planning process with Simplant software. The flap was closed and sutured (Figure 10). Six multi-unit abutments were then placed (Figure 11) in preparation for the new screw-retained bridge. The post-operative X-ray demonstrated good positioning of the implants, which were all parallel to each other (Figure 12). The bridgework was fabricated (porcelain fused to Cresco gold framework), once again utilising compatible products. Due to the effective angulation of the implants, there was no need to angle the screw channels and we achieved a very passive fit for the bridgework. In this time, two implants were placed in the LL5 and LL6 areas, which were restored with two splintered crowns (Figure 13). The lower right bridgework was left alone despite the distal cantilever, as it was causing no problems at all.

Several try-ins of the upper bridge were conducted with the patient in order to achieve the right aesthetics. Once the patient was happy, she went on her way.

Review

After about a year – during which time the patient saw her routine dental team for check-ups and general care – she returned to our practice for her annual clinical review, involving X-rays and full six-point pocket charts on every tooth and implant. The restorations still looked great (Figures 14-17) and the patient reported no issues.

Images show the result at one year review.

The patient continued to frequent her routine practice to ensure on-going maintenance of the dental implants and restorations and to help optimise her oral health. She also had access to our dental hygienist at BPI Dental on a yearly basis to support this maintenance programme. Around 10 years after we performed the surgical treatment, we were lucky enough to see the patient again and, as shown in the photos, the restorations still looked great (Figures 18-20). There had been very little soft tissue change and the aesthetics were fantastic, so the patient was still delighted with the final outcome.

Images show the result at ten year review.

Discussion

This case highlights a few important aspects worthy of note. First, we don’t always need to rush treatment – this case required treatment over several months and the final outcome was highly appreciated by the patient. Secondly, dental implants placed in the right positions will facilitate long-term soft tissue and hard tissue stability for durable outcomes.

As in all dental implant cases, the presented case emphasised the importance of excellent maintenance by the patient – only by attending on-going review appointments and adhering to strict hygiene routines at home can patients enjoy long-lasting results. Finally, this case demonstrates the superior aesthetics of porcelain both in the short- and long-term – I don’t think it can really be bettered and therefore it would remain my gold standard restoration material wherever possible.

For more information on the referral service available from BPI Dental, visit www.bpidental.co.uk, call 0121 427 3210 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

Author biography:

Boota graduated in 1992 and later gained an MSc in Periodontology from Liverpool University. He became a lecturer at the University and passed his Membership in Restorative Dentistry form the Royal College of Surgeons of England in 2000 to become a registered Specialist in Periodontology. Since then, Boota has lectured at universities and educational events in the field of periodontics, dental implantology and bone / soft tissue augmentation, running his own implant training programme for colleagues as well. He is also an active member of the British Society of Periodontology, the Association of Dental Implantology and the American Academy of Periodontology.

Keeping an eye on the GDC by Victoria Holden.

My next concern relates to conflicts of interests and, again, I have raised these with the GDC and I remain concerned hence I am ‘going public’. 

Having been taken to task myself by Counsel once over an issue of a conflict of interest during a Fitness to Practise hearing, I fully appreciate that expert witnesses and FtP panel members must be, or at least be seen to be, ‘whiter than white’.  That is, of course, subject to the phrase not being in anyway offensive to any sectors of society as it certainly isn’t intended to be, or otherwise inappropriately bringing the profession into disrepute, in which case I mean ‘holier than thou’.  Or do I? Truthfully I’m not sure what I can and can’t say these days.

The GDC also seem to grasp the impact that conflict of interests may have on the disciplinary processes, as they have a document titled ‘Managing Interests Policy for Council members and Associates’. In this document it says:

So it all sounds like, on paper at least, the GDC takes the issue of conflicts of interests very seriously indeed.   And it is with reference to conflicts of interests and the Pate case that I am writing this blog.

There has already been plenty written on the GDC v Pate case elsewhere.  On Dentistry online their 4 most popular links refer to the proverbial ‘FtP case of the year’. 

At the time I started writing Mr Hill was winning with over 9,000 views.  Coming up fast at the back with a late article on the subject was Mr Anis with a tidy 4000 views of his re-iteration of the points Mr Hill makes, but it feels with more insistent tone that negative Islamic comment equates to hate speech.   Mr Rees and Mr Watson also give opinions on the subject and there are some excellent arguments made in all these pieces, including within the comments.

Much is made of the fact that the Met Police said that no crime had been committed by Mr Pate and that this means nothing in terms of FtP.  Actually, I would have to concur.  But the problem is that the Chief Constable of the Met did not simply say ‘no crime committed here, everyone move on’.  What he appears to have said as I read it, is that what was said wasn’t that bad.  The police letter, which is not mentioned in the determination, but I shall add it here for transparency, says:

Interesting. Controversial views, and at times unpleasant to the majority, but certainly not criminal, offensive or even religiously offensive says the Chief Constable of the Met.  And, there are well-known individuals saying the same things.  Not an entirely helpful letter for the GDC’s case, which presumably explains why it is not referred to the determination.  The transcript does refer to the letter, but these are not publically available and only available to the parties directly involved in the proceedings.  Well, correction; they are available to the public, at a cost of approximately £250 per hearing day as I found out recently from an FOI. 

Anyway, I am side-tracking.  Back to the conflicts issue.  Further to the complaint, and the Met letter, the hearing progressed with an unrepresented Mr Pate, as non-clinical issues fell outside of his defence indemnifiers remit as it has been reported. Having read the transcript, the need for representation at these hearings is clear.  Many of the arguments and points Mr Pate put forwards would have been better made, and no doubt have carried more weight if made by Counsel. ‘Stories of the Law’ by the Secret Barrister who explains how self-representing people frustrate the hell out of everyone else in any kind of legal or quasi-legal hearing.  So the GDC got a great opportunity to make the point that registrants should tone it down, or better still, completely shut up on social media by securing a four-month suspension of Mr Pate. 

Chair of the FtP panel, Mr Adair Richards was soon after noted to have listed the General Dental Council as a previous client when tweeting about his new training and consultancy company website earlier in the year:

Indeed, the GDC are right in their warnings that social media can be hazardous. 

Unfortunately, the level of trust in our regulator appears to be so low that registrants are now at the point of scrutinising the background and motives of associated individuals. Here, it appears that we have an FtP panel member who has been paid by the GDC to provide training and consultancy to the GDC.  A Freedom of Information request was submitted to request Mr Richards declaration of conflicts and other information about his previous business relationship with the GDC, of which nothing was apparently declared.

I was told that Mr Richards ‘made an error’ on his website, and as if by magic, one week later the website had been altered to remove the GDC from the previous list of clients.  I’ll be honest, and say I am not sure that I buy this is an ‘error’.  FtP panel members go through rigorous testing of their critical thinking skills.  They are not unintelligent people.  To make an error implies that Mr Richards either misunderstood that his role on the FtP panel was somehow an extension of his consultancy services, or perhaps that he was completely unaware that the website copywriter had listed the GDC as a client.  The other possibility that crosses my mind is that it could have been a ‘deliberate error’, made with the intention to mislead potential future clients into thinking the company had trained or consulted with the GDC.  Either way, it does not look good.   The Managing Interests Policy document tells me that these are the possible interests, of which I pick at the very least a ‘perception of a conflict’:

As a result of this error/lie on the website, which seems to have been swept under a rug in Wimpole Street, I also perceive that Mr Richards could be in breach of the Nolan Principles listed in appendix 2:

I think it is great that Mr Hill came online to explain why the GDC took the Pate case so seriously, and highlighting why protecting public confidence in the profession is so important.

However, I can’t help thinking that the large number of dissenting registrants would be more respectful of the Pate hearing outcome were it not for the issues that I have exposed here and in my previous blogs.  It is not just the registrants that are responsible for public confidence: the GDC also have a major role to play.  If registrants do not have confidence in the regulator and those associated with them to act professionally and properly this can only lead to damaged public confidence at the end of the day. 

Next time, I will be looking at Prejudicial Interests, and delving a bit further into the Pate case.

In the meantime, if you have been affected by any of the issues raised in my blogs, do not worry.  You could waste 15 minutes of your life that you will never get back by sharing feedback about our regulator with the Professional Standards Authority here.

 Image credit - Best Picko ; under CC licence - modified.

For Part One of this blog - click here.

Ivoclar Vivadent UK & Ireland are pleased to announce their new generation of Intensive Seminars and Expert Symposiums. The first event is Mi Expert Symposium: Minimally Invasive Dentistry with Digital Technology, taking place on Saturday 13th October at The Lowry in Greater Manchester. The event will host five exceptional speakers who will educate dental professionals on how to achieve outstanding cosmetic results with techniques leaning on minimal intervention.

With increased education and an ageing population, patients are keeping their teeth for longer, therefore, preservation of sound tooth tissue alongside disease prevention is common practice. Advancement in materials and adhesive dentistry means aesthetic outcomes can now be achieved using minimally invasive techniques.

This full day event brings to you the expertise of five industry leading Dentists who follow this philosophy whilst creating aesthetic, functional, healthy smiles. Chris McConnell, Ash Parmar, Lance Knight, Adam Nulty and Quintus van Tonder will explore how using digital technology and minimally invasive techniques with a variety of materials can provide predictable, aesthetic and efficient treatment options for patients.

Mi Expert Symposium is Ivoclar Vivadent UK & Ireland’s first educational event led by Professional Services Business Manager, Leo James, speaking ahead of the event-launch Leo commented; “At Ivoclar Vivadent our passion to improve dentistry and outcomes for patients is a continuous priority. We strive to offer high quality materials and efficient processes to support everyday dentistry and we are committed to providing first-class education to dental professionals in the UK & Ireland to advance the skillset of the dental team.”

“Our exciting new series of educational events aims to bring interesting, inspiring and innovative concepts and techniques to our customers to help them achieve the best outcomes for their patients."

Tickets for the MI Expert Symposium are priced at an early bird rate of £149.00 + VAT up until the end of August, and can be purchased here. The lectures will provide delegates with 6 hours of verifiable CPD. For full details, including individual aims and objectives, please visit: www.ivoclarvivadent.co.uk/en-uk/clinical-courses/mi-expert-symposium

On 15 March, Johnson & Johnson hosted The OH! Panel at the British Dental Association in London.

Chaired by Stephen Hancocks, it brought together eight key opinion leaders in dentistry: Ben Atkins; Julie Deverick; Penny Hodge; Tim Newton; Anthony Roberts; Julie Rosse; Nicola West; and Helen Whelton. Each was selected for their ability to provide unique insight into how the dental profession can be best supported going forwards, given the current oral health landscape.

A vision was agreed by The Panel as something all dental professionals should work by to help improve patients’ oral health:

‘The ultimate outcome is to improve oral health and therefore systemic health. The vision is that every dental health care professional, upon seeing a patient with gingivitis and / or periodontitis, can and will:

• Make a diagnosis(es) and communicate the relevance of the condition to the patient. Explore risk factors and modify behaviour for successful outcomes

• Help every patient who receives the diagnosis(es) to be empowered to improve their oral health for life.’

Julie Deverick commented: ‘I’m excited about the vision in the statement, because it’s something we can all now bring to our Societies and to our profession.’

Johnson & Johnson have an ongoing commitment to the vision statement, and will work with that in mind, ensuring that all professional communications support the concept, to the benefit of the profession and patients.

The OH! Panel was a natural extension of The OH! Challenge, which was launched at the 2017 British Dental Conference and Exhibition. At the event, dental health care professionals (DHCPs) were invited to undertake a simple survey, created to test their knowledge in relation to key oral health topics. This provided valuable data for the creation of a communications programme to support DHCPs in keeping their knowledge current.

In total, 464 dental health care professionals took part in the survey. Overall, the average score amongst all participants was 51%.

Further key findings included:

• 46% did not know that gingivitis and periodontitis are a continuum of the same inflammatory disease

• Only 44% knew the updated BPE guidelines for code 3 sextants

Please visit www.listerineprofessional.co.uk to see the results in more detail, to take the test and to access the supporting programme of evidence-based content.

Panel bios

Ben Atkins is the lead clinician of a prototype practice. He is a council member for the National Association of Primary Care, a BDA Press and Parliamentary Representative, a clinical advisor to NICE, and a Trustee of the Oral Health Foundation.

Julie Deverick is a dental hygienist and President-Elect of the British Society of Dental Hygiene and Therapy (BSDHT), taking on the role of President in November 2018.

Stephen Hancocks is a dentist and Editor-in-Chief of the British Dental Journal. A well-known personality within the dental industry, he is also an accomplished speaker, lecturer and performer.

Penny Hodge is a specialist periodontist and an Honorary Senior Clinical Lecturer at the University of Glasgow Dental School. She is also the President of the British Society of Periodontology. 

Tim Newton is Professor of Psychology as Applied to Dentistry at King’s College London Dental Institute. He has worked in behavioural sciences in relation to dentistry for over 25 years.

Anthony Roberts is Professor of Restorative Dentistry (Periodontology), Clinical and Academic Lead for the Diploma of Dental Hygiene, and Head of Department of Restorative Dentistry, all at University College Cork.

Julie Rosse is a practising dental hygienist at three dental practices. She was the President of the BSDHT between 2012 and 2014, and is a member of the British Society of Periodontology.

Nicola West is a Professor/Honorary Consultant in Restorative Dentistry (Periodontology) at Bristol Dental Hospital, Honorary Secretary of the British Society of Periodontology, and Secretary General of the European Federation of Periodontology (EFP) 2019.

Helen Whelton is a Professor and Head of the College of Medicine and Health at University College Cork. She is a recent past-President of the International Association for Dental Research.

Switching dental plan patients from one provider to another is about to become a whole lot simpler and automated, without the hassle of patients having to sign a new Direct Debit instruction, explains Patient Plan Direct.

Before now, switching plan provider usually meant writing to patients to ask them to complete a new Direct Debit instruction. However, thanks to new rules introduced by the organisation that manages the Direct Debit scheme (Bacs) and the Payment Systems Regulator (PSR), plan providers will soon have to utilise the ‘Bulk Change Process’ if a practice wishes to switch plan provider.

The Bulk Change Process allows for plan patients’ Direct Debits to be transferred automatically from one provider to another, making life simpler and more convenient for everyone involved:

The changes have been driven by the PSR – Its objectives include the promotion of fair competition amongst organisations processing payments.

In late 2017, the PSR investigated the operations of organisations processing third party Direct Debits, which, of course, includes plan providers in the dental industry. The PSR recognised that, in some instances, such organisations were not utilising the Bulk Change Process at the request of their client, e.g. a dental practice.

Subsequently, from January 2018, a new accreditation scheme was rolled out, requiring all organisations processing third party Direct Debits to agree to utilise the Bulk Change process, should the organisation for which they are processing Direct Debits wish to switch to an alternative provider.

Patient Plan Direct is proud to announce it is the first plan provider to obtain accreditation under Bacs new rules.

Simon Reynolds, Commercial Director at Patient Plan Direct, comments: “We have been crying out and lobbying for such change for many years. The Bulk Change Process is ideally suited for scenarios such as a dental practice wishing to switch the administration of its plan from one provider to another, without the hassle or inconvenience of patients having to sign a new Direct Debit instruction.”

Simon goes on to explain, “It’s important to understand that the Bulk Change Process has always been available as a facility under the Direct Debit scheme. However, before now, other major plan providers in the market have not agreed to utilise the Bulk Change Process as a proposed transfer method. Under Bacs new rules they will now have to do so, creating a competitively fair market and affording practices the freedom of choice when it comes to deciding which provider to work with, without being put off by a previously cumbersome switching process.”

“We are currently working closely with the PSR and Bacs to ensure all other dental plan providers are identified as organisations falling under these new rules, therefore undertaking the required accreditation process as quickly as possible.”

“Naturally, as a plan provider offering significantly lower administration fees versus other plan providers, Patient Plan Direct has already generated significant interest from practices interested in switching from their current provider via the Bulk Change Process to cut costs significantly via this simple process. We encourage practices interested in switching to register their interest at: www.patientplandirect.com/simpleswitch or call 03448486888.”

What could your practice save by switching to work with Patient Plan Direct?

For further information register your interest here:- www.patientplandirect.com/simpleswitch or call 03448486888.

This is an advertorial article supplied by Patient Plan Direct and published by GDPUK.com

‘Trust Experience. Discover Excellence’ was a fitting motto for the 2018 Ankylos Congress held in Berlin at the end of June. The event attracted more than 1000 dental professionals from over 50 countries, who gathered to learn more about the Ankylos implant system which has been used to successfully provide ‘front row smiles’ for 17,000 patients.

Ankylos is a system with 33 years of implant heritage and long-term proven success, but this Congress looked forwards and not backwards, giving the assembled delegates a new vision, of modern protocols including digital dentistry and new product innovations.

Fresh scientific findings in implant dentistry formed the event’s foundation, and this was perfectly blended with news of the industry’s latest and most relevant trends, all presented by 40 renowned international guest speakers. 

Clinical content was themed around the importance of trusting experience, a particularly important element when choosing an implant system. The tone was set with an inspirational session entitled ‘Based on evidence, proven by experience – state-of-the-art implant design’. Speakers Barry Goldenburg (USA), Ye Lin (China), Valdir Muglia (Brazil) and Marco Degidi (Italy), reviewed the clinical evidence that makes Ankylos, with its TissueCare Concept, the most suitable implant for use in almost all indications and specifically advantageous to restore long term periodontal health in the anterior aesthetic zone. UK speakers included Antony Bendkowski on ‘How to make your implant practice successful’, Steven Campbell and Martin Wanendeya lectured on the Atlantis CustomBase® solution with Martin also discussing The Virtual Patient, in relation to patient-focused implant dentistry.

A diverse range of focus sessions, held on day 2, explored treatment options and enabled delegates to discover new techniques and hone their skills. Two-hour workshops, lectures and hands-on opportunities enabled clinicians and technicians to deepen their knowledge on topics relevant to their day-to-day work.

The Inspiration Hub One of the weekend’s highlights for many was exchanging experiences and networking with peers and friends in the ‘Inspiration Hub’, an exhibition covering the full range of comprehensive solutions for implant dentistry. Here, the latest Dentsply Sirona products were presented, along with innovative solutions and digital implant workflows that demonstrated the ease with which long-lasting individualised restorations can be created.

Bursting with opportunities for visitors to meet with global experts in the field, the Hub included a Speaker’s Corner that hosted short presentations and put delegates face-to-face with the experts. Whilst in the Science Hub, Dentsply Sirona’s clinical and evidence-based ethos was clear, as its science and research experts were available to discuss clinical solutions and emerging innovations and how they are backed by sound science.

A taste of the futureOf course, no implant congress would be complete without reference to the impact that digital dentistry is having on this treatment. ‘Why digital? Why now?’ was a short presentation by Mark Ludlow (USA), which brought the Congress to a close, and Mark reiterated the importance of lifelong learning in applying these new techniques to create faster, more predictable treatment.

The congress effectively managed to convey its central theme – how implant dentistry and a dedicated community with a focus on the digital future can create the best results for patients. Specifying the event’s take-away message, Group Vice President of Dentsply Sirona Implants Lars Henrikson said, “Clinical experience, professional skills and scientific evidence is the basis for the development of new treatment protocols and for overcoming challenges, ultimately leading to a long-term contribution to oral health.”

To find out more about the extensive range of implant solutions, materials and equipment, please visit dentsplysirona.com or call us on 01932 853 422. You can also access a range of education resources, video tutorials, courses and CPD webinars at dentsplysirona.com/ukeducation Earn Dentsply Sirona Rewards on all your implant solution purchases at dentsplysirona.com 

Facebook: @dentsplysirona.uk

Twitter: @DENTSPLY_UK

At the DentalForum UK 2018 held in Marbella, Dental Elite hosted an Ignite session on how dental groups are evolving and what will be the best route to market moving forward. Presented by Co-founder Luke Moore and the Director of Recruitment Services, Luke Arnold, the insightful session explored both the current difficulties surrounding recruitment, and how this might impair the growth of dental businesses in the future.

“It is no secret that practices are finding it increasingly more difficult to recruit,” reflects Luke Moore. “What we’re interested in is how this might have an impact on goodwill values, and in turn a principal’s ability to grow and sell their dental practice.”

Similar concerns were raised by a number of other delegates over the course of the two-day event, with recruitment and business growth discussed at length by a range of professionals.

“Above all else, this shows that everyone has been affected by the current state of the market,” adds Luke Moore, “not just independents. If anything, larger dental groups and corporates are feeling the affect more than smaller groups and individual practices.”

For more on current market trends or for advice on how these changes might affect you, contact Dental Elite.

For more information on Dental Elite 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

Image by rakka_pl

Dear Mr Brack,

I have previously been a harsh critic of the GDC, especially in the days of the previous registrar. Indeed, I wrote many blogs that were well received by the profession. With the departure of the previous registrar, there was an opportunity for the GDC to begin to repair the damage it had done to the profession by the draconian and inefficient manner in which it had been led.

There appeared to be a time when the new team seemed to be developing a far more appropriate attitude to regulation, and I therefore felt it appropriate to perhaps watch the situation without commenting further. It was disappointing when Jonathan Green left, although I did feel that with you at the head of the Organisation (for indeed it is NOT a business but a QUANGO I think you will find) then there would be a continuation of the bridge building that was sorely needed.

However, whilst there seem to have been some minor improvements, fundamentally there seems to be no real change in the way the GDC wishes to be perceived by the profession and how it executes its statutory duty. Under the aegis of protecting the public, it is actually doing more to negatively affect the public it serves to protect by continuing to prosecute its role in a draconian and often arrogant manner. There is still huge a lack of insight into the damage it is doing to the morale and the well being of its registrants; damage that can be squarely blamed on the actions of the GDC itself.

Because when a profession is so scared of its very shadow that it can no longer function as it is supposed to, then the ONLY thing that will happen is harm to the public. That these professionals are so scared of virtually every treatment they do, every comment they make (including ones like this), and every action they take is a sad indictment of the way that the GDC is systematically destroying the very profession it regulates.

By retaining the ARF at the same level again, with yet another different reason than before, is symptomatic of the disdain and the contempt with which the profession perceive the GDC have for them. The profession are happy to be regulated, but by a fair, just, and right touch regulator. The continued heavy touch that the GDC continues to use cannot continue if the profession is to survive to be allowed to serve its patients as there will come a tipping point where we will no longer be willing to accept the duress of just turning up to work. If we placed a colleague under this type of stress in our workplace then WE would rightly fear being reported to our regulator.

We are human beings who set ourselves out to care for other human beings. There is no higher privilege than to care for another. However, we make mistakes, we are fallible. You are the same as us, a fellow of the Human race.

We rarely do things wrong deliberately, but we shouldn’t live in fear that the next thing we do both privately or in our jobs could end our careers and destroy our lives.

Please think of the damage that is being done to our profession by this apparent continued lack of insight displayed by the GDC.

Kind Regards,

Simon Thackeray

Image credit - Rakka_pl under CC licence - not modified.

Lookout: Image by Dave Bleasdale

The GDC have recently being taking a stance over professional conduct and particularly in regard to social media.   The Standards say that we must not publically criticise colleagues unless this is done as part of raising a concern.  I should like to make it clear at the outset of this blog that what follows is part of me raising concerns.  Concerns that I feel are not being taken seriously enough, and some not even acknowledged as being concerning at all.   This blog is in 2-parts.  Part 1 will look at ‘bringing the profession into disrepute’ in the context of social media.  It is perhaps timely in view of Mr Hill’s recent effort of justification over the need to suspend retired dentist Mr Pate under the pretext of ‘protecting the public’.   Part 2 will look at my concerns over conflicts of interests.  Both will, as usual, look at this in terms of recent events and cases. 

So my part 1 concern relates to a fellow dentist who is a Clinical Advisor providing early advice reports to the GDC and the material posted on the public stream of their Facebook page.  Our regulator tells us that we must not post material on public media that may undermine public confidence or bring the profession into disrepute.   On this public-facing social media page, there is a joke about a sexual act, several slang references to parts of male anatomy and masturbation, a profile picture that is potentially racially-offensive (depending on the generation of the particular panel that might be selected by the GDC), but the finest one has to be the picture which blames patients for their gum disease and tooth decay because they are “*insertslangformasturbators*’’.  Yet this Clinical Advisor, wrote in an early advice report for the GDC that a dentist who communicated with a patient using Facebook Messenger, was unprofessional for doing so. This would be funny apart for the stress that the registrant was put under as a result of it being included in their initial allegations which contributed to the case being forwarded for a full hearing. There will be more of this to come in another blog.   

I emailed the current Director of Fitness to Practise to ask him what he thought about the content on this Clinical Advisor’s Facebook profile page, and whether he felt it was appropriate for someone affiliated with the GDC.   The GDC ought to know how their Clinical Advisor was behaving whilst giving potentially life-changing advice about other registrants’ professional conduct.  Perhaps my tip-off might assist them in getting their own house in order after a run of bad hearing outcomes for them and at a time when the mood of the profession is resembling that at the time of the ARF debacle.  At the time I had started to draft this blog I had not received any reply, and suspected that the GDC’s email filters might have kicked my email with its supporting attachments of profanities straight into their Spam Folder. I have now received my reply, so I will come back to that later.

On this particular issue of ‘unprofessional’ social media comments, 2 registrants recently received letters from the GDC reminding them of their need to uphold standards when using social media.  They had both used an inappropriate word, albeit on a single occasion, on a Facebook thread and a helpful colleague had very kindly pointed this out to the GDC without raising their concerns with the group moderators or the registrants themselves.  The digital evidence suggests that the anonymous informant was another registrant. In terms of the naughty word used, it was quoted ‘verbatim and in italics’ in the GDC letter.   If the GDC think that word is inappropriate they ought not visit the Dr Rant page and see their ‘affectionate’ nicknames for Jeremy Hunt which are used on an almost daily basis.  The GMC don’t seem to concerned however, but perhaps doctors do not refer each other to their regulator over spats and spite instigated on social media platforms.

Anyway, I felt pretty strongly that this particular display of conduct on social media referred to above really should not go unquestioned, all things being considered.  

The Standards apply to all and this Clinical Advisor who is a fellow dentist, is held to the same standards as us all.  No-one should believe that they sit above us mere-registrants, somehow ‘protected’ by a relationship with the GDC.  A colleague has a four-month suspension for alleged religiously-offensive statements made visible only to other dental registrants, yet I found his comments less offensive that this advisor’s silly, misogynistic and sexist posts. Also, someone with the infantile mentality that is publically displayed arguably unfit to assess whether any other registrants’ behaviour is professional, surely.

Whilst waiting for my email to be replied, rather hilariously, another registrant got a letter from the GDC courtesy of another anonymous informant reminding them of their professional obligations, and advising them to take action so they too could be better behaved in the future.  However, the letter gave no information on what was posted that caused offense or deserved some kind of GDC-referral retaliation.  An SAR sent the GDC may well clear that one up in time. 

Taking screenshots from Facebook and using them to make complaints to the GDC is a rather petty way to retaliate against another dental registrant in my opinion.  Those doing it really need to take a long hard look at themselves, especially if they are in the subset of registrants whinging about our high ARF.

As it happens, the GDC Annual Accounts and Report show that by 2018, 9-10% of incoming GDC complaints (as per my little infographic below) currently arise from other registrants.  This is a record year.  Well done registrants!!  Keep this rate of progress up and in a few years we might actually beat the patients. 

So actually, never mind the GDC: we also need to get our own house in order here.  Please can we all stop being so childish? If you don’t like what’s on Facebook, get off social media, leave the groups that aren’t to your taste or contain people you don’t like, block people who wind you up, or if what’s being said is about you is that bad, spend your own money on legal proceedings rather than wasting all our money artificially inflating the ARF telling tales by the use of screenshots.  Still, it’s nice to see that the GDC has healthy reserves of £20 million against a back drop of a decreasing number of incoming complaints.  Maybe this is in preparation for the day we achieve a level of 100% of complaints arising from all the back-stabbing and bickering going on between ourselves. 

This is the problem with the ‘duty to report concerns’:

LEGITIMATE CONCERNS REPORTED TO THE GDC OFTEN END UP IN ONE OR MORE REFERRALS IN THE OPPOSITE DIRECTION.

This is the sheer reality of the dire situation that faces us.  The minute you act on a professional duty to raise concerns with the regulator, you are at risk that ‘concerns’ will be raised about you, and there will be GDC referrals all round.

But back to my email:  I did get a reply regarding my Clinical Advisor issue.  I was advised that I should use the online form to report the matter to the Initial Assessment Team.  

It looks as though we are not the only group happy to throw dentists under the bus, which is always nice to know. 

 

Image credit - Dave Bleasdale under CC licence -  modified.

Employed or self -employed?

On 13^th June 2018 the Supreme Court, the highest court in the UK, gave its long awaited judgment in the Pimlico Plumbers case.

Mr Smith was a self-employed plumber who had been dismissed after six years of service. He claimed he was a worker and therefore entitled to certain rights such as holiday pay.  The court found in his favour despite Mr Smith being registered as self-employed and benefiting from this status. He claimed tax relief on a home office and had his wife on the payroll of his company.

Sound familiar? Many associates are labelled as self-employed and benefit from this status for tax purposes. However, could they challenge their status in the employment tribunal and also benefit from basic employment rights?

In recent years the courts have been awash with cases in respect of worker status. With the rise of the gig economy, companies are taking advantage of those who want a more flexible way to work by offering ‘self-employed’ contracts. But is this being done at the expense of basic employment rights?

It is often the most vulnerable that are affected by the imbalance of power in such relationships. A prime example of this is in relation to a case involving a City Sprint courier. The courier took the firm to the employment tribunal claiming they were a worker and won. However, instead of changing all contracts to worker status the firm changed the contracts 'to simplify the language in these, further clarifying the rights and flexibilities available to self-employed couriers who provide their services to us'. It should be noted that in order to enforce worker rights, a claimant will need to issue a claim at the tribunal. This can involve time and money, which many in lower paid jobs do not have.

There has been a further case in the employment tribunal against Hermes, in which their couriers have also been found to be workers. Tim Roache, GMB general secretary, said: “This is yet another ruling that shows the gig economy for what it is – old fashioned exploitation under a shiny new facade. Bosses can’t just pick and choose which laws to obey"

Pimlico Plumbers Decision

Turning now to the case in hand, however, in which Mr Smith was paid highly for the work he completed, he was also able to add a 20% mark up on materials which he got for discount via the company, and he had a great deal of flexibility in his role. Is this really a vulnerable individual being taken advantage of?

Either way the Supreme Court has determined that Mr Smith was a worker and as such should benefit from the rights associated with this. As a result of another recent decision on worker status that we reported on, his claim for holiday pay could now date back to the start of his employment.

The two main issues for the court to determine were whether Mr Smith had to perform the services personally and whether Pimlico was Mr Smith’s client or customer.

Personal Service

If a person has to personally perform the services under the contract it is likely that they will be deemed a worker. Here the court looked at Mr Smith’s right to send a substitute to determine if he had to personally perform the services.

The employment tribunal held that whilst Mr Smith could send a substitute for any reason such as illness, holiday or other reason, he could only send another Pimlico plumber. This was seen as akin to employees swapping shifts. As a result of this limitation the Supreme Court held Mr Smith had to personally perform the services.

In assicoate contracts, there will often be a right to send a locum. However, is this right fettered? Does the Practice get the final say as to who can undertake the locum role? Or do they merely require a minimum qualification, DBS check and performer number? This could have a bearing on whether the associate is a worker or self-employed. 

Business Undertaking

The court looked at whether Mr Smith was an independent contractor not in a relationship of subordination with the person who receives the services.

Pimlico tried to argue that they were the client of Mr Smith and he was a business in his own right. They relied on his tax return, which put his annual gross profit at £131,000, costs of materials around £53,000 and his net pre-tax profit at £48,000. The court disagreed with this for the following reasons:

• Pimlico’s tight control of Mr Smith, including Mr Smith wearing branded clothing, driving a branded van and carrying an ID card;
• Mr Smith’s obligations to follow administrative instructions from the control room;
• The fact Pimlico placed a tracking device on Mr Smith’s van;
• The severe terms as to when and how much Mr Smith would be paid (he was paid 50% of the fees paid by the customer) meant he was not economically independent.

As such the Supreme Court found that Mr Smith was not truly independent as there was an element of subordination.

Whilst many associates have clinical freedom and would not be required to wear a uniform, they do have to follow Practice policies and Practices decide the fees to be charged and when payment will be made. 

Conclusion

This case does not suddenly change the status of self-employed associates. As stated above, someone needs to challenge their status in order to be afforded the necessary employment rights; until then the status quo will continue. Even then, simply because one associate does challenge their status this will not automatically affect other associates are affected. It must be borne in mind that dental practices come in many shapes and sizes. 

However, this case is a warning for those that employ self-employed contractors of any nature. Now is the time to review contracts and ensure they are truly self-employed. If they are not, you need to take steps to protect your position as the risk to you is much greater.

If you have any questions about this article or need a contract reviewing, please feel free to contact Laura Pearce on This email address is being protected from spambots. You need JavaScript enabled to view it..

Laura Pearce

Senior Solicitor

Branding on the gazebo where the screening is based

Boundaries for Life was founded in 2010 to provide free health checks to fans or staff at sports grounds at major matches, engaging with people who may otherwise not encounter professional medical and dental advice.

Sponsored by SimplyHealth Professionals, they hope to help even one person prevent illness, using simple health checks followed by a little more sophisticated follow up which I will detail further.

I had the pleasure of visiting Chet Trivedy and his team at the Old Trafford One Day International between England and Australia, the series that England won 5-0, on Sunday June 24th. All the team there were volunteers, and the presence of their tent was helped by The Lancashire Cricket Foundation and Healthy Stadia.Helping even one personn  change the course of their future health was the aim.

Chet is the founder and clinical lead of Boundaries for Life. He is dual qualified as a dentist and medic, with an interest in emergency medicine and maxillo-facial emergencies. In addition to his clinical work, he is an Academic Clinical Lecturer in Emergency Medicine at Warwick Medical School.

Chet said: “Given that men in their 30’s and 40’s are particularly poor at presenting early symptoms of diseases to their GP, and with limitations on access to dental services, the availability of free health and dental checks in the relaxed atmosphere of a sporting event is a valuable resource in the early detection of symptoms associated with chronic diseases. We are particularly pleased to be offering fans a ‘heart age’ test for the first time in 2018, and explaining why it’s important to know blood pressure and cholesterol numbers.”

Amongst the health checks made in the small branded gazebo    

• height
• weight
• waist size,
• body mass index
• blood pressure
• cholesterol levels and ratios
• heart age assessment
• diabetes - will check the HbA1c with blood testing run by xxxxxx

Each person is given a login to review their health results online, with a secret question and answer to safeguard future logins. The subject will then get an email follow up in several months to nudge them to follow the recommendations made during the short check at the cricket ground. The Biochemistry tests and team members who do this from minute blood samples are provided by BHR Pharmaceuticals of Nuneaton.

He set up these screening events after founding the Boundaries for Life organisation, then amazingly Chet suffered a stroke, he briefly lost his vision then found he was diabetic but thankfully has returned to good health. Ironically, as a dual qualified dentist and doctor, he hadn't had his own checks!

BFL is really proud to have helped over 3500 people have these health checks over the last eight years, with your help more can be seen in the future.

An appeal to dental readers of this blog – Boundaries for Life is seeking further dental volunteers for the oral health screening at future cricket matches. The schedule of matches is planned, but the number of dental colleagues volunteering is small. On the day I was there, one colleague was working the whole day and getting more volunteers shares the load. The ones who are off duty can watch the top class cricket!  The more the merrier, it becomes a win-win-win.

To volunteer please use our contact page https://www.gdpuk.com/more/contact-us and GDPUK will pass on your details. I might join you, four colleagues, we can do checks for 2 hours, watch cricket for 6 hours!

Simply Health Professionals, using their network or practice contacts are also seeking dentists to volunteer to do the oral health screening. On Sunday, one family was helping their father, with daughters measuring height, weight and measuring waists! Chet reminds us it’s all worth it - if one helps the health of one person.

Boundaries For Life also seek further sponsors, and hope to cover even more sporting events in the future, dependent on their team and their funding.  

​

Links:

http://boundariesforlife.co.uk/

Twitter @Boundaries4Life https://twitter.com/boundaries4life

Twitter @SHP_Dentists https://twitter.com/shp_dentists

Lancashire Foundation http://foundation.lancashirecricket.co.uk

Healthy Stadia http://healthystadia.eu/  - Enabling sports clubs to influence health and behaviour.

news article http://healthystadia.eu/boundaries-for-life-fixtures-2018/

Blood biochemistry tests https://www.bhr.co.uk/  - small machines which run rapid tests of blood biochemistry.

What is HbA1c? https://www.diabetes.co.uk/what-is-hba1c.html

GDPUK article https://www.gdpuk.com/blogs/entry/2133-knocking-mouth-cancer-for-six-simplyhealth-professionals-announce-boundaries-for-life-sponsorship

It was a glorious September afternoon in 1966. The sun was streaming through gleaming windows. England had won the World Cup, and I had just moved to an exciting and brand new senior school. The classroom had spanking new desks with inkwells, filled with free ink you could draw up into your refillable Parker fountain pen. All was well with the world.

Mrs Wojciechowski, who was also our form teacher, was beginning our first ever French language lesson. I was trying hard to concentrate and confess I missed the meaning of ‘je m’appelle,’ because Peter Hadley who was sitting next to me, was crushing and drowning wasps in his inkwell, with what I regarded as an inferior fountain pen – the sort that scratched, rather than flowed Quink luxuriantly on to the page. Another failing of his pen was that as a tool for Vespidacide, it was failing miserably, one poor creature valiantly struggling to get itself out of the inky torture chamber. Not knowing at that point that Peter Hadley was a distant relative of a notorious Birmingham crime family and was destined to become the school’s head ‘hard-knock,’ I nudged him out the way and offered the tip of my pen to the bedraggled Hymenoptera, so that it had a means of escape from an indelibly inky death.

I suddenly heard a scream that sounded like a French woman shouting ‘murderer,’ but later realised I was in fact witnessing my first ever French swear-word - ‘merde,’ to be precise. I looked up to see Mrs Wojciechowski (French-born, despite her name) bearing down on our twin desk with a wooden ruler in her hand, and quicker than one of my Maryland bridges falls off, she had whacked the back my hand with the EDGE of the ruler, with all the might that her 4ft 6in frame could muster.

This episode was not only painful and a miscarriage of justice, but humiliating to boot and for the rest of that year, Mrs Wojciechowski looked at me with a deep loathing, like I had presented my dentist with the post-crown for recementing after I had retrieved it from the bottom of the Armitage Shanks two days after swallowing it. Upon realising I was under constant surveillance by Mrs Wojciechowski, I made sure I was never near a wasp, bee or inkwell ever again in that school.

I switched to a BIC not long after.

“My theory is along the following lines. Ahem."

We all know inherently, that it is becoming more and more difficult to avoid complaints these days, bombarded as the public is, with targeted Internet adverts and radio advertising. Even looking up and typing ‘dental complaints’ in Google as research for this article, brought up a host of dental litigation firm’s adverts on my Facebook page and various online news sites I read regularly, within an hour.

I strolled into a colleague’s surgery the other day to catch the end of a radio advert by ‘THEM’ – you know, the Cheshire-based mob, enticing dental patients to use them for all their dental litigation needs. I was appalled – I never listen to radio in the surgery – I just inflict my old-bloke’s iTunes playlist – from the Bee Gees to The Eagles to Snoop Dogg on my nurses day in, day out. It’s the reason I oppose permanent nurses, it means they don’t fatigue and burn out on my repetitious Barbara Streisand and Pussy Riot.

I couldn’t believe that these litigation firms were so ‘in-your-face’ with their radio ads, but my colleague confirmed that she heard them at least a couple of times a day and she often talks loudly over them to distract the patient in the chair from memorising the phone number.

Not only are civil claims mediated by the specialist dental litigation firms rising at a seemingly exponential rate (if you don’t believe me, look at your indemnity organisation’s annual subscriptions year-on-year), but cases brought to the GDC’s Fitness to Practice (FtP) process are also rising faster than caseworkers can write ‘dishonest’ on a charge sheet even if you haven’t been charged with dishonesty. From 2010 to 2014, FtP cases rose by 110 per cent. What the rise in civil and GDC cases is now, in the four years since 2014, is difficult to ascertain, but I feel it’s not outlandish to bet that the same rate of rise is probably not far out.

Most of us will know someone who is currently experiencing a spot of bother with the NHS Area Team, the GDC, or more likely, some chancer who has been taken in by a law firm who has found their supply of whiplash clients has suddenly dried up. A colleague of mine has recently been pursued by a patient claiming damages for a dry socket. Sheesh.

But, is the increase in patient expectations, fuelled by the easy access to no-win-no fee legal services, the only reason for the large rise in dental patient complaints?

“Ahem. This theory which belongs to me, is as follows. Ahem. Ahem. This is how it goes. Ahem. The next thing that I am about to say is my theory. Ahem. Ready?”

Well, here goes.

We all know nowadays, that the most important issue surrounding litigation is the paperwork. Have you recorded the BPE? Have you recorded why you are taking radiographs? Have you recorded why you aren’t taking radiographs? That’s what we’re obsessed with – getting the paperwork right so the statistical algorithms down at the NHSBSA don’t flag us up, or so we have a nice neat piece of work to show your defence organisation when they summon you for a day long grilling at a plush lawyer’s office in Lincoln’s Inn Fields.

But the whole reason you have ended up in trouble is that the patient wasn’t happy with your treatment (or some pig of a dentist who never liked you dropped you in it, but that’s another matter).

<

So. I would ask the question: Have we taken our eye off the ball?

“My theory is along the following lines. All brontosauruses are thin at one end, much MUCH thicker in the middle, and then thin again at the far end. That is the theory that I have and which is mine, and what it is too.”

Before 2006 and the introduction of the UDA-based ‘new’ contract, we all had, every few weeks, a sample of completed patients pulled by the Dental Reference Service and dragged into some God-forsaken community dental clinic, to have their work checked. The Dental Reference Officer (DRO) would check that you had a) carried out what you had claimed for, and b) done it nicely and hadn’t missed anything.

Admittedly, quite a few patients didn’t attend as requested (despite the fact they had consented to do so in the small print), but as a recent graduate, I was always quite on edge knowing that my work was going to be scrutinised by dentists that I considered by be my elders and betters. Dentists had the option of attending the DRO’s examination. In the main, I chose not to go. On one occasion, I did go.

And frankly, these checks focussed the mind. I was never accused of missing perio during that time, though I was once criticised for leaving a sub-gingival ledge the size of Chiswick on the distal of an upper six. Knowing that ANY patient could be pulled in for post-op examination by a DRO meant you left nothing to chance, even if you did note it. The DRO’s rebuke over the ledge, to my FACE, was like Mrs Wojciechowski’s ruler across the back of the hand. I have been very wary of ledges ever since. They have a nasty sting. I've missed LOADS of other stuff, but ledges are at a minimum.

I have no evidence for my theory, but I do wonder if the increasing litigation, particularly with regard to periodontal problems, could be as a result of there being no, what I would call ‘proper,’ check on the work carried out by dentists. (And this is by no means confined to NHS dentists). Even when cases against dentists go forward, patients are RARELY actually examined.

Anyway. That is my theory. That is what it is. Do we need to go back to DRO checks?

I would frankly, welcome them.

Epilogue

In 1983, after I had been at dental school for a year – some ten years after leaving school, I attended a summer garden party with my wife. Across the garden, I noticed a pair of latecomers. An elderly, tall, burly, Eastern European looking man with a shock of white hair, and a petite little lady of similar vintage, hanging off his arm. I instantly recognised Mrs Wojciechowski.

Encouraged by my wife, I approached her. My former teacher clearly didn’t recognise me ( l like to think I had by that time turned into a swan), so I introduced myself as one of her former pupils.

She said three words to me (this is absolutely true) and walked away:

“Oh **** off!”

And it wasn’t in French.

Simplyhealth is pleased to announce it has signed a fifth 50/50 Dental Practice Partnership with Highgate Dental Practice in Beverley, East Yorkshire.

The new partnership between Simplyhealth and Highgate Dental Practice will enable the business to further develop, grow and continue to serve its local community.

Highgate Dental Practice [the team pictured below], which has been established since 1963, is a family based practice providing preventative, minimal intervention and cosmetic dentistry. 

As part of an ongoing commitment to investment and innovation in the dental market, Simplyhealth’s partnership scheme offers dental practices the opportunity to enter into an equal partnership that plays to the strengths of both parties for their mutual benefit.

The partnership model ensures both partners have equal rights in the practice and enables dentists to retain day-to-day clinical management. Simplyhealth is well positioned to partner with member dentists due to its existing strong relationships with them and expertise in the dental marketplace.

The model is an appealing option for dentists looking to secure the right future for themselves, their practice and patients and Simplyhealth supports effective succession planning to ensure the same high standards of clinical care continue to meet customers’ needs.

Raman Sankaran, Chief Commercial Officer at Simplyhealth, said: “It’s great to see our dental partnerships grow as we continue to diversify our health and care solutions. We’re delighted to enter into a partnership with Highgate Dental Practice and working in partnership means we can help more patients make the most of life through better everyday health. We look forward to working closely with the team to continue providing an excellent service and develop new services into the future.”

Steve Burke, Principal Dentist at Highgate Dental Practice, said: “When choosing who to go into partnership with, trust is the most fundamental point and having had many fruitful and successful years with Simplyhealth Professionals and using Denplan products in our practice, we felt we had a strong and secure relationship to build on.”

“We converted fully from NHS to private dentistry in 2005 with the help of Simplyhealth Professionals who have been an integral and supportive part of our team ever since. I am happy knowing that when we finally retire, our practice will continue and our great and loyal staff will have a secure and prosperous future.”

About Simplyhealth

For 146 years we’ve been helping people to make the most of life through better everyday health. In 2017 Simplyhealth and Denplan united under one Simplyhealth brand and today we’re proud to be the UK’s leading provider of health cash plans, Denplan dental payment plans and pet health plans.

We help over three million people in the UK access the health and care products, services and support that they need, when they need them and at a price they can afford.

We’re proud to donate 10% of our pre-tax profits to health-related charitable activities every year, and this amounted to £1.13 million in 2017. Our Simplyhealth Great Run Series partnership raised an additional £42.6 million for charity.

We’ve worked with employers to develop Care for Life, a personalised solution that provides access to a range of trusted experts and local networks that support carers’ specialised needs. In addition, we’ve teamed up with technology company HealthUnlocked to develop an online freely-accessible peer-led forum so that those caring for elderly friends or relatives can share their concerns in a supportive environment. Visit https://healthunlocked.com/careforlife

Simplyhealth is a trading name of Simplyhealth Access, which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

Visit http://www.simplyhealth.co.uk for more information.

Have you been waiting for the chance to install an NSK electric micromotor into your practice? Or are you thinking of upgrading your entire treatment centre to one with an electric micromotor built in?

Now is your chance with the GO ELECTRIC prize draw offer from NSK, the manufacturer of high quality, precision dental equipment:

• Purchase an NSK Electric Micromotor* with Multi Pad and have it installed into your existing treatment centre for a 1-in-10 chance of winning the cost of your installation back.

• Purchase a new treatment centre fitted with an NSK Electric Micromotor*, from our partners Belmont or A-Dec for a 1-in-10 chance of winning the cost of your NSK electric micromotor back from NSK.

Electrically driven instruments deliver functional flexibility with less noise and fewer vibrations to provide a smooth and more precise cutting action and a more comfortable patient experience.

To enter the prize draw, simply register your purchase at www.nskgoelectric.co.uk

For more information on NSK’s micromotors and range of other equipment, visit www.nsk-uk.com or contact your preferred dental dealer.

Facebook: NSK UK LTD
Twitter: @NSK_UK

* An NSK NLX nano or NLX plus Electric Micromotor 

If you’ve a passion for learning, then Dental Showcase is the event for you.

Learning Through Engaging

Dental shows provide the ideal opportunity to learn what’s new from the dental trade – even if you’re only window shopping! It’s much easier to explore trade innovations under the convenience of a single roof, rather than visit many separate showrooms or try and squeeze in a rep demo between patients.  There will be over 350 exhibitors at this year’s Show, many of them choosing to launch new products at the event.  If you like to ‘try before you buy’, and be sure you’ve thoroughly researched all possibilities, this is your ideal opportunity.  Our two headline sponsors, Oral-B and Colgate, both have news for you, and offer a plethora of resources and products to ensure your patients take care of their oral health between appointments.

Learning Through Listening                                   

Dental Update Study Day – 4 October

For those wanting to polish up their clinical skills, then look no further than the Dental Update Theatre, which will again be hosting a Study Day.  The theme this year is ‘Avoiding Risk in Dentistry’. High standards are a sine qua non for any lectures coming under the Dental Update umbrella.  Profession Trevor Burke will be both chairing and presenting this year, his lecture aptly entitled ‘Minimising Failure with Direct Restorations and Crowns’.  John Milne, Head of the CQC, will also present an engaging and potentially contentious session on regulatory matters.  Tara Renton, will look at specific risks associated with oral surgery and the afternoon will be rounded off by a fascinating lecture by Steve Hawkins, the Chief Training Pilot for British Airways.  As an industry keen to learn from its mistakes, his lecture ‘Lessons from the Cockpit’, will give all attendees plenty of food for thought.  These lectures are free to attend, although priority will be given to Dental Update subscribers.

Dental Update Lecture Programme – 5-6 October

A full programme of lectures continues Friday and Saturday, with some equally engaging presentations, covering a wide range of topics.  Louis MacKenzie will be giving practical advice on anterior composites.  Paul Bachelor will explore the topic of dementia-friendly dentistry and Bob Cummings will explain some of the HMRC challenges associates face.  There will also be some business-focused presentations.  Frank Taylor & Associates will take delegates through the journey of a practice sale, including advice on finance.

Innovation Theatre

Those who’d rather attend shorter lectures, offering snapshots and practical advice, should visit the Innovation Theatre.  The application of technology is core to these lectures and this year the event will utilise revolutionary new technology, introducing an interactive element to the live demonstrations taking place each morning. The afternoon sessions will allow you to peek into ‘tomorrow’s world’, with discussions and reviews of the latest technology accessible to dentistry.  Pioneers and practitioners will talk you through its evolution and application.

Core CPD

There will be a specific learning opportunity for those wanting to meet their core CPD.  The GDC recommends five core areas in which dentists and DCPs should carry out CPD. The Core CPD lectures will bring the whole dental team up to date on the latest developments in these key areas and ensure you are well on the way to satisfying the GDC’s requirements for verifiable CPD.  New radiation regulations, medical emergencies and safeguarding of children and vulnerable adults will all be covered in this forum.

Learning Through Discussion

How many times have you wanted to “have your say” when it comes NHS dentistry?  Well, Dental Showcase is delighted that the Office of the Chief Dental Officer (CDO) has chosen to use this event as a platform for you to do just that.  Sara Hurley, CDO for England, will be talking each morning about the development and provision of dental services.  The Thursday morning session will be available to dental societies only, but Friday and Saturday are open to all on a first come, first served basis.  It is anticipated that these briefings will engender much debate which can be continued at the CDO Zone, where panel discussions will run throughout the three days. This is your opportunity to engage directly with the decision makers.

To register, or for more information, visit http://www.dentalshowcase.com/

By @DentistGoneBadd


This is where I stand.

A few years ago, before David Cameron adopted the foetal position and waved the white flag to the advancing UKIPS, giving them the Brexit referendum, I was stopped by a ‘kipper’ in the high street of my adopted home city. I was asked if I wanted to forever remain ‘dominated’ by some ‘faceless European bureaucrat who would force us to consume straight bananas and live in dimly lit buildings powered by puny Dutch lightbulbs, or put the ‘Great’ back in Britain.

I answered thus:

“If I were the Prime Minister and had unlimited funds, I’d build a motorway bridge from here (the Midlands) directly to Paris.”

It was a nonsense answer – the sort that Donald Trump would have given – but I thought it got my point across. I am, and always will be, a European - a citizen of the world. I think Brexit is madness, and at a time when the world is becoming more and more fragmented, I strongly feel we need unity.

In the past couple of weeks, two of my closest dental friends – both from the EU, have indicated that they are thinking of returning to their countries of origin, having worked in UK dentistry for several years. Both were worried about the uncertainty surrounding their rights to residency – an issue still not absolutely clarified by the UK Government.

Another East European friend has recently left my corporate practice to go into independent dentistry, unable to cope with the madness of the NHS, UDA system. This has left the corporate practice critically short of clinicians and attempts to bring in either a permanent dentist or long-term locum has failed. (OK, fair enough, it IS a corporate after all). Many foreign dentists I have met have all been working for a UDA rate much lower than their home-grown counterparts and it is them in the main (it appears to me) that are prepared to work at a rate UK-born dentists would turn their noses up at.

One former corporate practice manager told me recently that she was told to offer prospective dental associates different UDA rates – foreign nationals being offered two pounds per UDA less than their UK counterparts.

Associate Shortages

I know of a number of NHS practices locally, which are currently struggling to find fully qualified associates of either UK, EU or other origin and this of course contributes to the lengthening of waiting lists and reception desk grumbling. With unattractive salaries on offer, particularly from the corporates, it is no wonder some practices are struggling to recruit. I once put myself on a few dental jobs websites and despite pleading to be taken off, am daily bombarded with all manner of associate jobs, from part-time to ‘whatever you can manage.’

Besides EU nationals going home as a result of Jacob Rees-Mogg, in 2017, a private Freedom Of Information request obtained from the General Dental Council showed that foreign dentist numbers dwindled in 2016, since nearly 40% of dentists who were found to have impairment of their fitness to practice originated from the EU or outside the UK and EU. This represented just over 3.7% of the total ‘foreign’ dentist workforce as contrasted to the 0.2% of naughty UK dentists based on 2018 registrant figures.

A search of the number of dental therapists in trouble with the GDC finds no such comparable statistics. Apart from one therapist in 2005 who was erased for performing a filling without a dentist prescription and one in 2013 who forgot to pay her Annual Retention Fee, there has been an exceptionally low rate of fitness to practice cases brought against therapists.

These days, since I work in a corporate, I meet very few therapists, but I have a very high opinion of them from personal experience. I will admit, I was forced into it because I couldn’t find an associate to move out into the sticks where my practice was located, but I employed a dental therapist in my own practice for a while a few years ago and her work was very good - providing a top-notch client service as well as taking patient appointment pressures off me. Her employment was also economically, a ‘no-brainer,’ being cheaper than employing an associate at 50% renumeration. I also trained with a mature dental therapist in the early 80’s. She flew through the dental course with ease, knocking spots of her classmates.

A Solution?

With many practices searching fruitlessly for fully-qualified post-vocational training dentists to replace fleeing dentists (for whatever reason), I wonder if we are missing a trick? Why not put these underutilised dental professionals to full use? Even the corporates haven’t caught on to this yet – presumably because they haven’t done the sums fully. Dental therapists can perform a wide range of tasks that can leave the corporate associates more time for searching for materials or stabbing the practice manager in the back. The only fly-in-the-ointment would be the stroppy associate who resents writing a prescription, but they can always be blackmailed with ‘OK. Do you want to do a radiograph audit after 5.00pm?”

In independent/NHS practice, remuneration would be a simple matter of a salary or hourly rate. In corporates, a nod to the associate’s prescription input would have to be acknowledged, so that he can get on to providing Band 3 mouthguards for someone who may have heard a vague click in their left TMJ in 1998.

Having said all that, I WILL miss my European colleagues if they do decide to go.

When I first met her, one of my EU friends was trying to pick up some British colloquialisms, mainly taught to her by her dental nurse, a girl with a mischievous sense of humour.

I arrived with my wife at the new house she was occupying with her now (British) husband. We had a lovely traditional meal from her home country, but then she apologised for the lack of furniture, and although we were perfectly comfortable at the dining table, she pointed to a couple of ample beanie’s in the lounge area and asked “Or would you prefer sitting on the douche-bags?”

David Cameron, what did you do?

Dr Chet Trivedy at Old Trafford last year.

Following the sponsorship success of 2017, Simplyhealth Professionals has announced today its continuation of support for Boundaries for Life at this year’s cricket season.

Founded in 2010 by Dr Chet Trivedy, a dual-qualified dentist and doctor with an interest in emergency medicine and dental emergencies, Boundaries for Life offers free health checks at major cricket fixtures throughout the UK, and is supported by the European Health Stadia Network.

Currently the only free comprehensive health check initiative that includes an assessment for mouth cancer, Boundaries for Life aims to promote health awareness through high-profile cricket events. The health checks include blood pressure, cholesterol, blood sugar (diabetes), dental (mouth cancer), obesity and dementia advice.

Henry Clover, Chief Dental Officer at Simplyhealth Professionals, said: “We’re delighted to support Boundaries for Life once again and help to promote the messages of good oral health and general health to thousands of spectators across the UK this summer – and potentially save lives. Our commitment to the programme has been further strengthened by the support of our member dentists, several of whom have volunteered to carry out mouth cancer checks as part of the Boundaries for Life team, as well as raising awareness of good dental health and the links to general health.”

With a health professionals team comprising of dentists, doctors, nurses, and medical students, the health checks take no more than 15 minutes and are offered to spectators and ground staff. Since its launch, Boundaries for Life has carried out over 3,500 free health checks and diagnosed several cases of suspected mouth cancer, or pre-cancer, and many other health concerns, and given thousands of cricket fans specialist advice on how to improve oral and general health.

Boundaries for Life is also an award-nominated initiative, and has received recognition after being shortlisted for Best National Smile Month Event at The Dental Awards 2018, taking place this May.

Dr Chet Trivedy said: “We’re looking forward to another cricket season and utilising the sport to reach as many people as possible. Cricket is an ideal vehicle to discuss health, particularly as our key demographic for health checks are men aged 45 years and over, and those who might not be regularly visiting a dentist or GP. This target audience are thought to be increasingly vulnerable to a range of health conditions, and our health checks offer the opportunity to identify people who might be at risk of future health problems at an early stage. The health checks are easily accessible and provide instant feedback to guide people on any next steps that they should take regarding their oral or general health.”

The current Boundaries for Life fixtures are:

• Saturday 16^th June – England v Australia – Cardiff
• Sunday 17^th June – Warwickshire v West Indies XI – Edgbaston
• Sunday 24^th June – England v Australia – Old Trafford
• Saturday 30^th June – Domestic One Day Cup Final – Lord’s
• Saturday 7^th July – Kent v India – Beckenham
• Tuesday 17^th July – India v West Indies – Headingly
• Sunday 22^nd July – Kent Cricket Festival – Kent
• Thursday 2^nd August – England v India – Edgbaston
• Saturday 1^st September – England v India – Ageas Bowl
• Sunday 2^nd September  – England v India – Ageas Bowl

For more information, visit http://boundariesforlife.co.uk/

www.simplyhealth.co.uk             www.simplyhealthprofessionals.co.uk      

A couple of months ago I stopped part way through a presentation and asked what words of advice the audience of dentists, of varying ages and experiences with the vast majority over 40, would give to a group of 25 - 30 year old dental graduates.

I have been mulling over their responses and the subsequent post-meeting discussions since then and sharing them whenever I can.

“Emigrate” was the first shout out. When I asked why, there were a number of answers, which set the tone for the mix of the realistic, but slightly miserabilist attitude, which can tend to dominate groups of dentists. “Because this country doesn’t appreciate dentistry, nobody values what we do, it’s better elsewhere”. This attitude harks back to my last post for GDPUK, “Nobody loves us every body hates us” and I believe that dentists should come to terms with the fact that people do like their dentist but don’t enjoy dentistry.

Next response was, “Say No”. On exploration this was the heartfelt plea to be left alone to do the very best for their patients. Constant interference from government bodies and the imposition of repeated layers of untried, untested and mostly unnecessary compliance have done little or nothing to improve the condition of patient care.

There was a feeling that dentistry had been caught napping about many of the changes and that the British Dental Association could and should have been more proactive in defence. (This was not a BDA section meeting). I teased this out a little more and the mood was that the BDA should lead, rather than react to change, that they should be the early adopters instead of worrying about the laggards.

“Go Part Time,” said an associate who shared how she had just reduced her working week to 3 days. My suggestion that all dentists especially practice owners should work no more than 4 clinical days a week (preferably less) was greeted with a certain amount of suspicion - no change there. Often I find that many dentists have such a “high maintenance” lifestyle because they can borrow highly that when they do want to consider reducing their hours they are so wedded to a treadmill of their own construction that it is hard to slow down.

The words of advice started to get more measured then and the group were clearly focussing on the target group rather than their own discomfort.

“Continue with Post Graduate training.” The awareness that in many areas therapists are replacing associates, who had not developed their skills and training beyond BDS, is leading to a growing realisation that you must bring something unique or special to the party. I do meet associates who cannot see the wall ahead of them and still believe that a few local meetings a year is all they need to stay current.

“Choose the right practice.” Said with some emotion by one dentist who shared some familiar stories of promises made and not kept by several principals with whom he had worked. The nods in the room showed that was a common experience.

“Get the balance right.” Bearing in mind that the subject of my talk was the causes and signs of burnout it was no wonder that this was in delegates’ minds. Unfortunately for too many it seems that balance is something that has to be restored in their lives after a problem or two rather than being established as a matter of course.

“Good financial advice, ASAP” This contributor was keen to encourage all young dentists to start planning for their financial future sooner rather than later. Their experience it turned out had been of needing to stay working rather than wanting to because they were not going to be as well off in retirement as they had believed.

“Look after yourself, physically and mentally.” In every group where I speak, especially about the topic mentioned above, someone comes and speaks to me at the end and shares their experiences of breakdown in some shape or form. This was no exception, except there were three of them who had not taken care and suffered from the consequences. The sometimes macho culture of (UK) dentistry can certainly take its toll with life altering consequences in some cases.

“Don’t be afraid to leave.” The world of dentistry is split into two groups it appears, those who have no idea of the value that they can to deliver to the world away from the dental chair and those who have walked away and been successful. The former camp may have self-esteem problems in my opinion and possibly never thought themselves good at dentistry in the first place. It could be that having aimed at dentistry from the age of 15 or 16 they can’t comprehend a life away from it.

“Choose your company wisely.” I thought this was particularly good advice, unfortunately the Internet is full of bad stories about “things” that have happened to dentists. If you are so inclined you can spend hours wallowing in websites, Facebook groups and bulletin boards where individuals try to out do each other with either misery or boasting about their success. All these of course are exaggerated and do little or nothing to help. If the old adage, “you are the sum of the people you spend your time with” is true, and I believe it is, then be selective and stay away from doom mongers and atmosphere hoovers who celebrate misery.

Finally came this gem:

“Don’t listen to old gits who tell you how good things used to be.” This was the view of the people who were really enjoying their lives in dentistry, who had control of their own destiny and could see opportunities in the future. They knew that there have been, and would, always be challenges and that was the way that life is. The “old gits” are the same people who moaned about the 1990 contract, the move to wearing gloves, and changing burs between patients. They were probably the ones who in their day missed vulcanite (look it up), daily “gas” sessions and the inevitability of full dentures. They were the gang who were suspicious that dental hygienists would take the bread from their mouth, believed that the relaxation of advertising was the death knell of professionalism and said that they would never get rid of their upright chairs.

There’s a lot of wisdom in dental audiences, it’s a shame it isn’t shared in dental schools.

At this year’s Dental Awards hosted by Purple Media during the British Dental Conference and Dentistry Show 2018, Dental Elite was thrilled to sponsor not one, but two of the prestigious Awards.

The first, Website and Digital Campaign of the Year, was presented to Narberth & Herbrandston Dental Practices in Pembrokeshire, while Practice Manager of the Year was awarded to Lesley Holden from Sharoe Green Dental Practice in Preston.

Presented by none other than Dental Elite’s Director of Recruitment Services, Luke Arnold, the leading practice sales, acquisitions, valuations and finance agency is pleased to have once again been able to be a part of the Awards. He says:

“It’s always a pleasure to sponsor and present an Award, and we’re extremely happy to have been able to do it again this year. Congratulations to all the winners and category finalists.”

For more information contact Dental Elite. 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 British public could be putting their oral health - and even their general health - at risk as new research reveals that millions are overlooking the basic oral health essentials such as brushing, flossing and visiting the dentist.

The annual survey[i], conducted by YouGov on behalf of Simplyhealth Professionals, revealed shocking statistics including that only two thirds of adults brush twice a day (69%), and two percent admitting that they never brush.

Flossing is also frequently ignored, with one in three adults (37%) admitting they never take the time to floss, despite the fact that 63% know that it helps to avoid gum disease. When questioned why they don’t floss more regularly, 27% said they couldn’t be bothered or find it boring.

Furthermore, almost one in 10 (7%) are avoiding the dental chair and said they never visit the dentist.

Commenting on the figures, Henry Clover, Chief Dental Officer at Simplyhealth Professionals, said: “With the busy lifestyles that people lead, it’s tempting to skip brushing or flossing, or delay visits to the dentist. A good oral health routine is an essential everyday activity that helps to protect against tooth decay and gum disease. Moreover, with studies increasingly finding links between poor oral health and conditions such as heart disease, strokes and diabetes, looking after your oral health is important for your general health too.”

Those adults avoiding the dentist could also be setting a bad example for the younger generation, with over a fifth[ii] (22%) of parents of children aged 18 or under saying their child only brushes their teeth once a day or less, and 2% saying their child never brushes.

Childhood tooth decay continues to be a huge issue in the UK, and remains the number one reason why children aged five to nine years old are admitted to hospital in England[iii]. 19% of parents surveyed said their child had at least one filling and, shockingly, 46% saying their child had their first filling when they were seven years old or younger.

Worryingly, the survey also revealed that 83% of adults said they never check their mouths for signs of mouth cancer. With recent figures[iv] showing that cases of mouth cancer are up by a third in the last decade, and with around 18 people being diagnosed with the disease every day in the UK, the implications of not self-checking could be serious.

“Regular visits to the dentist can help to spot the early signs of mouth cancer, but it’s important to be aware of the symptoms and any changes that you see or feel in your mouth between dental appointments,” explains Henry. “These can include unusual lumps or swellings in the mouth or head and neck area; ulcers that don’t heal within three weeks; and red and white patches in the mouth.”

[i] All figures, unless otherwise stated, are from YouGov Plc, on behalf of Simplyhealth.  Total sample size was 5,264 adults. Fieldwork was undertaken between 12th -19th February 2018.  The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+).

[ii] All figures, unless otherwise stated, are from YouGov Plc. Parents of children aged 18 years old and under were surveyed; and if there was more than one child in the family, we asked parents to answer based on the child whose birthday fell next. Total sample size was 4,294 adults. Fieldwork was undertaken from 9th to 16th February 2018. The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+)

[iii] The Faculty of Dental Surgery at the Royal College of Surgeons of England, The state of children’s oral health in England report, January 2015.

[iv] Oral Health Foundation – www.mouthcancer.org

Simplyhealth Professionals is the UK’s leading dental payment plan specialist with more than 6,500 member dentists nationwide caring for approximately 1.7 million patients registered to a Denplan product.

Simplyhealth Professionals provides the following range of leading Denplan dental payment plans under the Denplan name:

• Denplan Care: all routine and restorative care + worldwide dental injury and dental emergency cover
• Denplan Essentials: routine care only + worldwide dental injury and dental emergency cover
• Denplan for Children: routine and other agreed care + worldwide dental injury and dental emergency cover
• Denplan Membership: registered with the dentist + worldwide dental injury and dental emergency cover
• Denplan Hygiene: A dental payment plan without dental insurance for all types of practice from NHS, mixed and private to support patients commit to a consistent hygiene programme.
• Denplan Emergency Insurance: worldwide dental injury and dental emergency cover only

Simplyhealth Professionals also provide a wide range of professional services for its member dentists and their practice teams, including the Denplan Quality Programme and Denplan Excel Accreditation Programme.  Plus regulatory advice, business and marketing consultancy services and networking opportunities.

Dentist enquiries telephone: 0800 169 9962.

For patient enquiries telephone: 0800 401 402   

www.simplyhealth.co.uk

www.simplyhealthprofessionals.co.uk       

Oral-B’s campaign to support parents & help kids develop a lifetime of good oral care habits

Shocking research findings have revealed that 23% of 5-year-olds^[1] and nearly half (46%) of 8-year-olds in the UK² have obvious tooth decay in their primary teeth. Also, it was found that sadly, 35% of 12-year-old children are too embarrassed to smile or laugh⁶ due to the condition of their teeth. These issues are particularly prevalent in UK children due to many factors, including poor oral care habits and nutrition. Also, Oral-B knows that using the right products, at the right frequency, with good supervision can have an impact on the oral health of children.

Help through research & education: For parents – for children

Oral-B is on a mission to support UK parents / carers adopt appropriate home-based oral health behaviours and thereby reduce the number of children with toothache and dental problems – all through its #StrongTeethMakeStrongKids-campaign. The oral health experts from Oral-B and the University of Leeds, have launched a research and education programme to give dental professionals and parents the right support to prevent these dental health issues from now on. Peter Day, Associate Professor and Consultant in Paediatric Dentistry at the University of Leeds, about the research: “Our research explored how dental teams can best support parents of young children to adopt appropriate oral health behaviours at home. We have examined the literature and undertaken qualitative interviews and focus groups to identify the challenges parents and dental teams face. These findings have provided the blueprint for Strong Teeth oral health intervention.” 

Why a healthy mouth is so important for UK kids

Asked about the situation in the UK Peter Days adds: “In my clinic, I see far too many young children with dental decay. Unfortunately, many will have had toothache, sleepless nights, disturbed eating patterns and time off school and nursery. We know children with decay in their baby teeth are much more likely to develop decay in their permanent teeth. Establishing toothbrushing and healthy eating habits in early childhood is a strong predictor for oral health in adult life.” In response to this, Oral-B is on a mission to support UK parents adopt appropriate home-based oral health behaviours and thereby reduce the number of children with dental problems.

Oral-B launches #StrongTeethMakeStrongKids campaign

Oral-B’s “Strong Teeth Make Strong Kids” programme aims to educate and support parents on how they can help their children develop the right habits, as well as lay down a strong foundation for good oral health – for a healthy and confident smile for life.  “We are working closely with the UK’s Dental Professionals by aiming to provide up to 20,000 dental professionals this year with simple and engaging educational materials for parents and their children during routine check-ups. Oral-B is committed to take on this challenge to sustainably improve the situation in the UK”, says Jane Kidson, Oral-B Professional Team Leader UK & Ireland.

Combined with the right dental care products, these positive oral health messages are designed to encourage parents to lead the way, so they can see that these oral health issues are mostly preventable with simple changes to their families’ daily oral care routine.

Here is a snapshot of the brand’s educational materials that dental professionals can use to support the conversations that they are having with parents / carers. Such materials include:

1. Brushing from 1^st tooth to 5 years
2. Friends & Family can support healthy habits
3. Make brushing fun for children
4. Healthy Eating can help protect teeth

There’s more to good oral care than meets the eye:

Maintaining good oral health and establishing the right healthy habits early on will help children progress along the key ‘Strong Teeth’ milestones. They include their first dental visit, the arrival of their first tooth or teeth, and then the first time they use an electric power toothbrush (from age 3 onwards). Having a good oral health habits results in a healthy smile and that smile drives confidence, and that confidence is usually a key contributor to a better future for children.

About Oral-B
Oral-B® is the worldwide leader in the over $5 billion brushing market. Part of the Procter & Gamble Company, the brand includes manual and electric toothbrushes for children and adults, oral irrigators and interdental products, such as dental floss. Oral-B® manual toothbrushes are used by more dentists than any other brand in the U.S. and many international markets.

About Procter & Gamble

P&G serves consumers around the world with one of the strongest portfolios of trusted, quality, leadership brands, including Always®, Ambi Pur®, Ariel®, Bounty®, Charmin®, Crest®, Dawn®, Downy®, Fairy®, Febreze®, Gain®, Gillette®, Head & Shoulders®, Lenor®, Olay®, Oral-B®, Pampers®, Pantene®, SK-II®, Tide®, Vicks®, and Whisper®. The P&G community includes operations in approximately 70 countries worldwide. Please visit https://www.pg.co.uk/# for the latest news and information about P&G and its brands.

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About the University of Leeds Study

Oral-B wanted to understand the fundamental and systematic issues which brought about the UK’s child dental health situation, and funded an extensive study with the University of Leeds, analysing the how dental teams can best support parents of young children to adopt appropriate oral health behaviors. Leeds has a strong research expertise in the design and evaluation of complex oral health interventions (i-ii) . The findings from the Oral B funded study provided the blueprint for the Strong Teeth oral health intervention, including the creation of vital ready-to-use educational materials that Oral-B will provide to Dental Professionals across the country.

1. 1. 23.3% had experience of dental decay with one of more teeth that were decayed to dentinal level, extracted or filled because of caries. Source: Public Health England. National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2017.
2. 2. In their primary teeth. Source: National Health Service Child Dental Health Survey 2013.
3. 3. Due to tooth decay. Tooth extracted under general anaesthetic. Source: Public Health England Health Matters: Child Dental Health 2017.
4. 4. Children with decay waiting for dental treatment In hospital. Source: Public Health England Health Matters: Child Dental Health 2017.
5. 5. Children with decay waiting for dental treatment in hospital. Source: Public Health England Health Matters: Child Dental Health 2017
6. 6. Due to tooth decay or missing teeth. Source: National Health Service Child Dental Health Survey 2013 

References for University of Leeds complex intervention studies:

(i). ESKYTE, I., GRAY-BURROWS, K., OWEN, J., SYKES-MUSKETT, B., ZOLTIE, T., GILL, S., SMITH, V., MCEACHAN, R., MARSHMAN, Z., WEST, R., PAVITT, S. & DAY, P. 2018. HABIT-an early phase study to explore an oral health intervention delivered by health visitors to parents with young children aged 9-12 months: study protocol. Pilot Feasibility

(ii). GRAY-BURROWS, K., DAY, P. F., MARSHMAN, Z., ALIAKBARI, E., PRADY, S. L. & MCEACHAN, R. R. C. 2016. Using intervention mapping to develop a home-based parental supervised toothbrushing intervention for young children. Implement Sci, 11, 61.

Five dental business consultants are taking on their ultimate challenge, cycling almost 1,000 miles in fifteen days to raise funds for three wonderful charities – Cancer Research, Bridge2Aid and BrushUpUK. Chris Barrow, Les Jones, Sheila Scott, Simon Tucker and Ashley Latter have set themselves an ambitious target; between them they’re hoping to raise £50,000. The team has been sponsored by four industry stalwarts – Practice Plan, Dental Sky, Wesleyan and Dental Focus.

Explaining why they chose these three charities, Ashley commented, “We will all be touched in some way by cancer in our lives, so supporting the work of Cancer Research is something everyone can get behind.  We’ve also chosen two special charities within the dental sector.  Bridge2Aid does amazing work in Africa training local medical officers to carry out basic dentistry and, as a result, helps thousands of people out of pain and suffering.  BrushUpUK is a charity that believes that everyone should have the knowledge and skills to access and maintain a good standard of oral health and works with professionals within the sector to provide education and guidance to vulnerable groups in society”.

A fundraising page has been created for anyone who would like to support the challenge. 

Additionally, you may like to challenge yourself and join the five for a leg or a day of the journey. Dust off your cleats, dab on your chamois cream and join the team! There are five places available for each day. For more information, or to make a donation, visit www.fivegoforth.co.uk.

#GDPR [Image by Jon Worth]

Roger Matthews further examines the EU’s forthcoming General Data Protection Regulations and its potential impact on dental practices. Have you drawn up your privacy notice yet? Are you up to speed on how you can lawfully process the data you hold on patients?

In the first two articles in this series (part 1 and part 2) I’ve taken a look at how the new Data Protection Bill – incorporating the EU’s General Data Protection Regulation (GDPR) - is coming along. I’ve highlighted the importance of preparing by taking a good look at all the personal data you currently hold in the practice (a Data Audit). Where does it come from? With whom do you share it (or might disclose it to)? How long will you keep it? Do this as a practice team, because ultimately everyone is responsible for good Data Protection.

The Data Protection Bill is still working its way through the parliamentary system and further amendments are still possible, although unlikely to impact dentistry. We will continue to watch this progress closely and to update Simplyhealth Professionals practices as we move towards the implementation date of 25th May 2018.

Fees

I gave some clues as to future Data Protection fees payable by Data Controllers last month, and now we have a clearer idea, although still subject to Parliamentary approval. As predicted there are three ‘tiers’, but some careful thinking may be needed to know which one you fall into.

Firstly, if you do not do any electronic processing (at all – that includes computers, tablets, smartphones, CCTV or any form of digital equipment) – and that’s pretty unlikely I would say in 2018, or if you only use a computer for the purposes of staff employment, PAYE, business administration, and payment processing (i.e. only basic personal details) it might appear you are technically exempt from paying a fee. But, the ICO has stated that any personal data processed for the purposes of ‘healthcare administration’ you will still have to pay. (See The Data Protection Fee – A guide for Controllers at ico.org.uk)

If you have a small practice, with 10 or fewer staff (every part-timer counts as ‘one’ and that includes the cleaner, gardener, and self-employed associates, hygienists etc), and if your annual turnover is less than £632,000 then you are in Tier 1. The fee will be £40, or if you pay by direct debit, then £35. Yippee, no increase! You will get a reminder when your current registration runs out, and an opportunity to set up the direct debit then.

(A little complication: if you have an NHS contract, then you are regarded as a ‘Public Authority’ in respect of processing and fees from that contract only. Public Authorities are exempt from the turnover threshold above, so if your NHS contract turnover is more than £632,000, then you are rated only according to your sGDPRtaff numbers. So a very big NHS contract but low private fee income might keep you in Tier 1.)

Larger practices, who do not fall within the above criteria, will pay a Tier 2 fee of £60 (again presumably with a direct debit discount of £5). This covers Data Controllers with 250 or fewer staff and a turnover of less than £36 million. Large Corporates may need to do some calculating, but otherwise this Tier will cover just about every other large-ish practice or small chain.

Tier 3, at £2,900 annually, is probably not an issue for dentists!

If you are currently registered (‘notified’) with the ICO – as you almost certainly are – there is no need to take any action until you receive your reminder to renew after 25 May 2018.

Your fee level will, in most cases, be accurately anticipated by the ICO but you should check to make sure it is correct and either call or e-mail them if not. It seems likely that if your renewal date is shortly after the implementation of the new law, there will be significant delays in getting changes made, but so long as you can show you took all reasonable steps then this should not disadvantage you.

Remember that Associates will only need to register – as now – if they act as Data Controllers in their own right (see the ICO’s Information Governance in Dental Practices, September 2015).

Action Stations!

Between now and 25th May, practices will need to:

• Complete their data audit (as above, if not already done)
• Check where back-ups are stored (ask your software provider/s)
• Consider how to present Privacy Notices to patients (see more below)
• Consider revising their Data Protection and Information Security policies
• Update their Cookie policy if they have a website
• Carry out and document a Legitimate Interest Assessment
• Draw up a Data Breach policy and procedure (if not already done)
• Appoint a Data Protection Officer

Whew!

Helping Member dentists

To help with preparation, Simplyhealth Professionals will be publishing further guidance for members on all the above, including templates for the necessary policies and assessments. However, in every case, it will be necessary to consider how these templates should be adapted for your own particular circumstances and practice.

This information will be published on the web portal for member dentists to access and it is hoped that all the necessary policies will be in place by the end of March. However, the new law is still Parliamentary ”work in progress”, so you should keep aware of any updates in monthly newsletters and e-mails.

Although ICO has said they will take a “proportionate” approach to enforcement in the early days of the new legislation, we cannot be sure the healthcare regulators (or NHS Commissioners) will take a similarly sympathetic approach. So preparedness is necessary!

A Lawful Basis

As noted when writing about Privacy Notices in previous articles, a Data Controller can only process data under the new legislation if they have a Lawful Basis to do so. Sounds reasonable, and GDPR gives six options to choose from.

Consent sounds like a good idea and as dentists we are well versed in this topic. However, remember that consent can be withdrawn at any time, and whilst you might simply and rightly stop treating a patient who decides, for whatever reason, to exercise this ‘right’ it would make life difficult for all concerned.

Necessary to fulfil a contract would apply in the case of self-employed staff members, such as associates, hygienists and so forth, so is appropriate for those cases.

Necessary for a Public Task is actually appropriate for all processing to do with NHS Contracts, since if you have one, you are regarded as a ‘public authority’ and are carrying out processing as required by legislation. So that ticks off the NHS patients and their care.

Legitimate Interests of the Controller is really the catch-all that would be appropriate for most of your private patients’ care and treatment. A ‘legitimate interest’ is really any self-evident need that an organisation has in order to function, and where a ‘data subject’ (patient) would ‘reasonably anticipate’ that such processing is necessary, provided it does not undermine any of their rights.

In order to use Legitimate Interests as your Lawful Basis, the legislation requires that you complete a Legitimate Interests Assessment (LIA). This is not too difficult provided you follow the detail of the law: firstly do you need the information? Secondly is there any alternative? Thirdly can you balance your need against the patients’ rights? And finally what actions do you take to ensure the security and confidentiality of the data? There will be a template for an LIA provided on the member dashboard during March.

Why the fuss about ‘Lawful Basis’? The legislation requires that your full Privacy Statement, freely accessible to all those persons whose data you process, specifies clearly what this basis is. On a website this must be clearly signposted (not buried in the small print), and in the practice its availability can be pointed out within a brief statement given verbally or, I would suggest, added to medical history forms and updates.

Finally…

A few odds and ends.

If your practice software provider stores or backs up your data, you should have a fully documented contract showing where the data is kept, and if it is overseas (especially if outside the European Economic Area) does it conform to GDPR requirements?

If you use patient data for marketing purposes, and also if you routinely contact patients by e-mail or text message, you will need to have specific marketing consents for these activities. Again, simple messages about forthcoming appointments can be consented with specific ‘opt-in’ boxes to be ticked and signed for. The medical history form is a good place for this too. ‘Opt-outs’ or other non-explicit methods will no longer be acceptable.

Do you need a Data Protection Officer? If you have an NHS contract (however small) the answer is “yes” as you are considered a ‘public authority’. However, authoritative guidance (from an EU Working Party) states that although ‘large scale’ processing of ‘special’ (e.g. health) data, such as by a hospital, does require the appointment of a DPO, processing of patient records by ‘an individual physician in practice’ does not. You may however feel that it is worth appointing one anyway: note that their identity will be shown in a public register held by the ICO. They are not ‘responsible’ for compliance (that remains with the Data Controller), but may be a source of expertise and advice, and may, if desired, be an external appointment.

Check your website cookie policy and make sure it is compliant (a template is on the way!)

Finally, make sure everyone in the team is aware of the changes coming up, of their increased responsibilities around data security (no more passwords on Post-It notes!), data breaches, and confidentiality, and review your training at regular intervals!

Part 1 of this blog

Part 2 of this blog

Errata - Postscript by Roger Matthews

A quick note before you read through my blogs on GDPR (or if you’re reading them again). The complexities of this new legislation (and the amendments taking place at the eleventh hour in Parliament) mean that my commentary has been “on the hoof” so to speak and based on available knowledge at the time of writing (starting last December). So there are a few points I now need to clarify and correct.

In Part 1 ‘GDPR - The New Millennium Bug?’ I mention specific consent from patients for processing data. It’s now clear that this is a bad basis to use since patients can withdraw consent. I correct it in Blogs 2 and 3. Oh, and the new law will be the Data Protection Act 2018 (not 2017).

In Part 2 'GDPR - Privacy Notices and Consent' I refer to patient consent possibly being needed for referrals. This arose from some EU commentaries on GDPR (The Section 29 Working Party if you must know) whose advice was rather vague. I now think that this is unnecessary by virtue of exemptions in the Act. I also got the new ICO fees wrong – but those were the ones she was suggesting to the Government at the time… plus ça change…

Finally in Part 3 'GDPR and Data Protection', written as recently as March, we have again been overtaken by events. It seems the ICO will ‘assume’ everyone is in Tier 3 for fees, so unless you want (or need) to pay £2,900 a year, make sure you correct her when your renewal notice comes around (on the anniversary of your current notification fee). The Report stage of the Data Protection Bill happened on Wednesday 9th May when there was a whopping 138 amendments to be considered. One of those of particular note was an amendment to exempt primary care providers with NHS contracts from appointing a Data Protection Officer. Sadly for NHS providers, the Government rejected this amendment.

The Bill now returns to the House of Lords for the final stages.

Roger Matthews

GDPUK thanks SimplyHealth Professionals and Roger Matthews for their permission to reproduce these three blog articles.

Image credit - Jon Worth under CC licence - not modified.

Part of GDPR blog by Roger Matthews

Roger Matthews further examines the EU’s forthcoming General Data Protection Regulations and its potential impact on dental practices. Have you drawn up your privacy notice yet? Are you up to speed on how you can lawfully process the data you hold on patients?

Hopefully you’re reading this after digesting the first part of this GDPR blog. If so, then even more hopefully, you will by now have done a “data audit” as recommended by the Information Commissioner’s Office (ICO).

You haven’t? Then you should: it won’t take too long. Work out all the personal data you hold: on patients, staff and contractors (Associates etc.), where do you get it from? And with whom do you share it? If you export data to a third party (a laboratory, patient referrals or cloud storage for your Patient Management Software maybe), do they have good data security (can they describe it or have a policy you can see?) and where is it stored or backed up? In particular is cloud storage in the EEA or in another country?

When you’ve completed your audit, the next thing is to consider “why” you hold the data – the “purpose of processing”. For the vast majority of practices, this is blindingly obvious – to you at least! You process patient data in order to provide safe and effective dental healthcare, you process staff data for employment law purposes, and you process contractor data to maintain effective financial and performance records. Simples!

A few practices may undertake forms of marketing which go beyond those simple purposes. They may buy in mailing lists to attract new patients, or may offer additional services to existing patients. If you undertake direct marketing in this way, you should look at the advice given by ICO (Google: ’ICO direct marketing’).

One of the relatively few (for dental practices anyway) major changes that the General Data Protection Regulations (GDPR) will introduce is that ‘data subjects’ (i.e. living individuals) whose data you will hold, store, process and ultimately delete, must be given prior notice about the data you hold, the reason/s you hold it, who you disclose it to and what their rights under the new Data Protection regime will be. This is called a Privacy Notice.

If that sounds like a complicated document, it is! At least in the sense that it needs to be drawn up carefully. It must not read like a complicated document, since you must, by law, be transparent and clear in your communication.

The ICO helpfully suggests that you do not need to spell out the full details of your Privacy Notice when patients (or staff, or contractors) first engage with you, but you must signpost it to them so that they can easily find it. That’s easy on a website (“click here for further details”), but perhaps a little more difficult when patients telephone or present in person.

You could, for instance have a short Privacy Notice at reception, or on a practice information leaflet, and either display a full version on the premises or laminate one that is available for patients to read. However you do it, a Privacy Notice is a must!

Again, you can read about Privacy Notices on the ICO website, and/or you can sign up (for free) to www.dpnetwork.org.uk which is an open access website for small businesses and charities. They have good legal opinions backing them.

Now let’s have a closer look at “consent”. Don’t confuse this with the professional and dento-legal term: in this case, it is defined as one of six ways in which you can lawfully process personal data. I have seen it rumoured that you will need to have explicit, clear and unambiguous consent from every patient/employee/contractor before you can even access the personal data you already hold! Whilst possible (maybe), that’s a very big ask.

Fortunately, the GDPR allows other ways for organisations to lawfully process data. One of these is the “legitimate interest” test. Essentially, this means that if the data subject would reasonably expect you to collect, hold, etc., their data for, effectively, self-evident purposes, and you only collect and process data for such essential purposes, and you are not contravening or infringing their rights to privacy in the process, then that’s OK.

Well, it’s sort of OK!! It is recommended that in order to validate your choice of “legitimate interest” as a lawful basis for processing, you should carry out a Legitimate Interest Assessment (LIA). This would set out firstly, what those essential interests are; secondly,  identify the necessity for processing the data; thirdly, to balance the needs of the organisation against the rights of the data subject; and finally, what actions will be taken to ensure that processing is not excessive or invasive. 

Again, the ICO and DPNetwork have excellent advice on how to carry out an LIA and it’s strongly recommended that you do this before relying on this basis. But it does avoid the need for a blanket consent exercise.

All that having been said, it remains true under the new legislation that health-related data about an individual is regarded as more sensitive (“special” in GDPR-speak). Thus article 9 of the GDPR states that processing health-related data (and other categories, similar to the existing UK Data Protection law) is prohibited, unless one of a number of exceptions apply. One of these is ‘…medical diagnosis, the provision of health or social care or treatment …pursuant to contract with a health professional’. So again, that seems OK, but… the EU Working Party looking at consent still hasn’t produced its final guidance and in its final draft it gives an example which suggests that explicit consent is required, for instance, when transferring a patient’s health data to a referral practitioner or specialist.

So for caution’s sake, when getting updated medical histories, having patients sign treatment plans, or submitting treatment claims, it is probably advisable to get patients to clearly indicate that they consent to the use of data as in your Privacy Notice (which should be available to them to read if they wish). And refreshing that consent (e.g. at medical history updates) is a good idea too. The use of pre-ticked boxes, inaction or silence on the part of a data subject can no longer be relied on, either.

It’s anticipated that generic templates will be available for Privacy Notices, LIAs and other key components of the new Data Protection legislation in the coming months, but it’s a good idea to have some drafts in your mind now to stay ahead of the game.

In the third and final part of this GDPR blog, we’ll look at Data Security, dealing with Subject Access Requests and complaints, and an update on how the new Data Protection Act is going through Parliament.

PS: Annual Registration Fees with the ICO

Parliament hasn’t yet approved a new fee-scale for registering with the Information Commissioner after the new Data Protection Act becomes law in May 2018. But the ICO’s draft guidance to the Government has suggested a three-tier approach. Very small, or new dental practices which process fewer than 10,000 personal records will be Tier One with a fee “up to £55”; but those with larger patient bases will fall into Tier Two: “up to £80”. It’s likely that existing annual notifications will be valid until their expiry date. Watch this space!

Part 1 of this blog https://www.gdpuk.com/blogs/entry/2123-gdpr-the-new-millennium-bug

Part 3 of this blog https://www.gdpuk.com/blogs/entry/2125-gdpr-and-data-protection-part-three

Errata - Postscript by Roger Matthews

A quick note before you read through my blogs on GDPR (or if you’re reading them again). The complexities of this new legislation (and the amendments taking place at the eleventh hour in Parliament) mean that my commentary has been “on the hoof” so to speak and based on available knowledge at the time of writing (starting last December). So there are a few points I now need to clarify and correct.

In Part 1 ‘GDPR - The New Millennium Bug?’ I mention specific consent from patients for processing data. It’s now clear that this is a bad basis to use since patients can withdraw consent. I correct it in Blogs 2 and 3. Oh, and the new law will be the Data Protection Act 2018 (not 2017).

In Part 2 'GDPR - Privacy Notices and Consent' I refer to patient consent possibly being needed for referrals. This arose from some EU commentaries on GDPR (The Section 29 Working Party if you must know) whose advice was rather vague.  I now think that this is unnecessary by virtue of exemptions in the Act. I also got the new ICO fees wrong – but those were the ones she was suggesting to the Government at the time… plus ça change…

Finally in Part 3 'GDPR and Data Protection', written as recently as March, we have again been overtaken by events. It seems the ICO will ‘assume’ everyone is in Tier 3 for fees, so unless you want (or need) to pay £2,900 a year, make sure you correct her when your renewal notice comes around (on the anniversary of your current notification fee). The Report stage of the Data Protection Bill happened on Wednesday 9th May when there was a whopping 138 amendments to be considered. One of those of particular note was an amendment to exempt primary care providers with NHS contracts from appointing a Data Protection Officer. Sadly for NHS providers, the Government rejected this amendment.  

The Bill now returns to the House of Lords for the final stages.

Roger Matthews

GDPUK Thanks SimplyHealth Professionals and Roger Matthews for their permission to reproduce these three blog articles.

Roger Matthews looks at the significance to you of the EU’s forthcoming General Data Protection Regulations.

If it hasn't already happened to you, it will! Over the next few months you'll be approached with numerous offers to guide you (for a fee) through the 'demanding processes' of compliance with the EU's General Data Protection Regulations (GDPR).

"Aargh," you may say, as you read the doom-sayers' predictions of harsh fines and imprisonment (or both), here comes yet more compliance pressure on my overworked dental team!

However, you should be reassured by the Information Commissioner's statement that anyone (or any organisation that complies with the existing Data Protection law, is already well on the way to achieving compliance with the new requirements.

New Data Protection Act from 25th May

GDPR was issued by the EU in May 2016, giving all member states two years to comply. It's provisions will apply in the UK from 25th May this year. However, each country has some freedom to amend a few details and the UK Government has also decided to 'tidy up' and 'tighten up' on the existing law, the Data Protection Act 1998.

so, on 25th May there will be a new Data Protection Act 2018. This will encompass the GDPR requirements and the draft legislation is currently lumbering through Parliament. The

House of Lords has been debating it since October and it probably won't get the Royal Assent until sometime around Easter.

While we don't absolutely know what the final version will look like, we do know most of it, given that much of the discussion will not really be relevant to dentistry in particular, or primary healthcare in general.

12 step guide

The Information Commissioner's Officer (ICO) has already issued a '12 step guide' to the GDPR which is a useful start to check your current status. As a responsible practice you'll already be registered ('notified') with the ICO (don't be fooled by the earlier news that GDPR will abolish notification or annual fees!) Plus, you'll have a Data Protection Policy and an Information Security Policy (Information Governance compliance too, if you're an NHS contract-holder).

It is worth checking some things at this early stage, however. Do you obtain 'specific and explicit' consent from your patients to store their data? Do you have a privacy notice that tells patients (and prospective patients, for instance on your practice website) exactly what data you hold and who you share it with?

Data flows

It may seem simply - you keep their personal details and health records and because you know all about professional confidentiality, you

keep it all to yourselves. But what about your IT system? Is it backed-up in-house? Is it held in ‘the Cloud’? And if so, where exactly? Do you send patient information to any third

parties, such as insurance companies or Simplyhealth Professionals, for instance? You can be certain that Simplyhealth has rigorous security, but do others? Do you? Is any data taken home or stored on USB sticks or personal computers? It’s worth thinking it through and conducting an audit to look at all the data inflows and outflows.

When you know exactly where all your patient and staff data comes from and where it goes, you can rest assured that you’ll have ticked off one important stage in preparing for the 25th May deadline.

Read Part 2 of this blog

Read Part 3 of this blog

Errata - Postscript by Roger Matthews

A quick note before you read through my blogs on GDPR (or if you’re reading them again). The complexities of this new legislation (and the amendments taking place at the eleventh hour in Parliament) mean that my commentary has been “on the hoof” so to speak and based on available knowledge at the time of writing (starting last December). So there are a few points I now need to clarify and correct.

In Part 1 ‘GDPR - The New Millennium Bug?’ I mention specific consent from patients for processing data. It’s now clear that this is a bad basis to use since patients can withdraw consent. I correct it in Blogs 2 and 3. Oh, and the new law will be the Data Protection Act 2018 (not 2017).

In Part 2 'GDPR - Privacy Notices and Consent' I refer to patient consent possibly being needed for referrals. This arose from some EU commentaries on GDPR (The Section 29 Working Party if you must know) whose advice was rather vague. I now think that this is unnecessary by virtue of exemptions in the Act. I also got the new ICO fees wrong – but those were the ones she was suggesting to the Government at the time… plus ça change…

Finally in Part 3 'GDPR and Data Protection', written as recently as March, we have again been overtaken by events. It seems the ICO will ‘assume’ everyone is in Tier 3 for fees, so unless you want (or need) to pay £2,900 a year, make sure you correct her when your renewal notice comes around (on the anniversary of your current notification fee). The Report stage of the Data Protection Bill happened on Wednesday 9th May when there was a whopping 138 amendments to be considered. One of those of particular note was an amendment to exempt primary care providers with NHS contracts from appointing a Data Protection Officer. Sadly for NHS providers, the Government rejected this amendment.

The Bill now returns to the House of Lords for the final stages.

Roger Matthews

GDPUK Thanks SimplyHealth Professionals and Roger Matthews for their permission to reproduce these three blog articles.

Attendees at this year’s Henry Schein Digital Symposium were left in no doubt about the exciting opportunities and mind-expanding innovations that are already transforming dentistry and are set to continue in the coming months and years.

On 27^th and 28^th April, digital advocates from all areas of dentistry gathered in London to talk technology and discuss the latest developments and trends in areas such as predictive treatment, diagnosis, management, treatment and prevention.

This year’s Keynote Speaker was the Medical Futurist Dr Bertalan Mesko, a self-confessed “geek physician” with a PhD in genomics and an acclaimed author, who challenged the audience with his predictions on the way in which digital heath technologies are set to impact on the future of health care.

Dr Mesko was joined by a first-class line-up of speakers including, Rune Fisker, Sinead McEnhill, Colin Campbell, Adam Nulty and Josef Kunkela, as well as renowned technicians Petr Hajny, Vicken Hatsakordzian, and many more. Topics were wide-ranging and included the importance of retaining the human element in digital dentistry, the rising influence of digital dentistry apps and how dentists can drive patient engagement through the use of digital technology.

Henry Schein ConnectDental was a pivotal part of the two-day event, showcasing a comprehensive range of digital solutions, which can help practitioners harness the efficiencies of digital workflows and benefit from the economic impact of offering single-visit dentistry. The pace of change in digital is already being felt by the profession and improvements in aesthetics, guided implant surgery and digital shade matching is quite breath taking, and the rise in 3D printing and digital dentures is now taking treatment options to a whole new level.

There was much interest in the many innovative digital solutions on show and five in particular caught the profession’s imagination:

The 3Shape TRIOS® MOVE

This mobile HD touch screen is the ultimate communication tool that enables dentists to involve and engage patients in their treatment. Compatible with all TRIOS 3 scanners, it has an adjustable arm and swivel screen enabling the clinician to position it exactly where needed and facilitating vastly improved patient engagement and treatment acceptance.

The 3M™ True Definition Scanner

Available in mobile or cart edition, this scanner offers excellent accuracy, ease of use and affordability for making fast, precise digital impressions. The 3D-in-motion video technology generates a true replica of the patient’s oral anatomy – improving visibility right from the start. The innovative design ensures fast, comfortable intraoral scanning for greater patient comfort.

The Dentsply Sirona Chairside Solution

The original chair side solution, CEREC makes it possible for dentists to offer patients genuine same-day dentistry – from fast and accurate digital scanning, to versatile and intuitive digital design to in-house milling, sintering and glazing. Catering for patients’ increasingly busy lifestyles CEREC maintains excellent quality and functionality, but with the speed and precision now so much in demand.

The 3Shape X1 4-in-1 CBCT scanner

This CBCT scanner offers low dose scanning and high image quality with its innovative motion compensation and dynamic field of view (FOV) technology. Its sleek design and no requirement for head fixation provides a comfortable scanning experience for the patient. Ease of operation and intuitive workflows, combined with full integration with 3Shape treatment modules for orthodontics and implant dentistry, makes this digital equipment extremely versatile.

Formlabs Form 2 3D printer

The Form 2 3D printer, which is now available from Henry Schein Laboratory, provides high-resolution 3D printing, featuring laser-sharp prints and stunning surface finish. It can deliver both large, solid parts, and small intricate detail and has a small desktop footprint. The Form 2 has wireless connectivity and touchscreen control and integrates seamlessly with 3Shape and other dental software systems.

The 2018 Henry Schein Digital Symposium did not disappoint, and delegates came away with their heads full of new ideas and genuine excitement about the possibilities that digital dentistry is opening up. As billed, it truly was “the ultimate digital experience”.

To find out more about all Henry Schein ConnectDental’s digital solutions, email This email address is being protected from spambots. You need JavaScript enabled to view it. or visit hsdconnectdental.co.uk.

henryschein.co.uk

Twitter: @HenryScheinUK

Facebook: HenryScheinUK

Healthcare Markets Intelligence

In partnership with LaingBuisson, the Association of Dental Groups (ADG) recently hosted a roundtable event to discuss current challenges facing dentistry and identify possible solutions that might help to ensure the long-term sustainability of NHS dentistry.

Chaired by former Deputy Chief Dental Officer at the Department of Health Sue Gregory OBE, and attended by a number of principal figures in the profession, the roundtable addressed a number of key issues that are threatening to undermine the delivery of dental care.

Education and training, regional variations in the supply of dentists, dwindling numbers of EU dentists, and the greater demand for skills mix in the dental practice were among the topics discussed. As the stakeholders identified at the roundtable, changes will be required in a number of areas to get to grips with the problems that lie ahead – including greater involvement from the government and NHS commissioners.

The roundtable was a huge step forward for dentistry, bringing together most of the key organisations for the discussion, but there is still a lot of work to be done. The Association of Dental Groups will therefore continue to work closely with key stakeholders from the profession as well as senior government and NHS figures moving ahead.

For more information please visit http://www.dentalgroups.co.uk/dentists/HealthcareMarkets_May_2018_ADG_Roundtable.pdf

By Chris Tapper

One working day in April 2018, precisely at 4.50pm, ten minutes before the unseemly scramble by the dentists to get out the door to avoid the dry-retching of the nurse’s as they clean the filters out, I was presented with a sheet of paper.

A nurse delivered the A4 sheet with a flourish and the warning that our corporate practice manager required my signature before five, since she was going away for a few days.

A space had been left for me to make my mark and I noticed all my colleagues had already signed the sheet, with that day’s date. My colleagues had all apparently attested to the fact that they had completed in-house training in needlestick injuries, they had all read the practice policy on needlestick injuries, and they had then participated in a ‘facilitated practice discussion’ about needlestick injuries. The top of the sheet stated that all the training and accompanying requirements had to be completed by the end of January 2015.

I certainly hadn’t completed the in-house training in question personally and definitely hadn’t noticed a facilitated practice discussion, unless I missed it because I was engrossed in Facebook at the time, doing a fun quiz on ‘is your line manager a homicidal psychopath?’ (My answers were probably of great value to Cambridge Analytica and the ‘Leave’ campaign).

More interestingly, three of my colleagues hadn’t even been employed by the corporate around the date mentioned and I figured that two of them couldn’t possibly have done the training since they are new trainees, though they MAY have read the policy during induction. One of them admitted they had only signed the policy sheet “To avoid a lot of hassle.”

I dismissed the nurse with an “I can’t sign it since I haven’t done the training,” to be met a few minutes later by a text from the head nurse with a link to a video on, presumably, needlestick injuries.

The upshot was that I actually went online and found the subject on the website of a training organization I occasionally use, and produced a CPD certificate before six and signed the form anyway.

Yup, I wimped out rather than be met with the ‘I’ve Been Bagging Angry Wasps Into A Sack With My Bare Hands Face’ of my corporate practice manager.

Of course, the nub of the above was that someone in management (I don’t know at what level) had fouled up and had realised that CQC requirements had not been met. In order to meet requirements, staff had been browbeaten into fraudulently signing a statement that would give the authorities the impression the company was complying with regulations.


And the reason I have outlined the above?

Corporate Bullying

At this time of year, independent dental providers are bidding for contracts against the corporates and increasingly, they are being undercut by the latter, who use their low wage, high trainee workforce ratio and dubious interpretation of NHS regulations to undercut independent practices.

NHS commissioners are desperate people. They need to secure services at the lowest possible rate and the corporates present them with exactly what they need to satisfy the number-crunchers at the Department of Health - high numbers at low prices. To quote from a popular 70’s sitcom, “Never Mind The Quality, Feel The Width.”

It’s a subtle form of bullying, but it’s bullying nonetheless. The Independent practices cannot possibly hope to compete on an equal footing with companies that run their practices on trainee nurses and (largely) EU dentists willing to work for £8 to £9 per UDA until Brexit is put into effect.

It’s the equivalent of being elbowed in the face by the school thug as he pushed into the lunch queue.

I have worked for a corporate for over five years after selling my own practice, and during that time we have had a huge turnover of nursing staff. As nurses qualify, they leave within months for the independent sector - not once has a qualified nurse been replaced with a qualified nurse. The company just takes on another trainee, and often the £9-per-UDA associate finds him/herself providing the in-surgery training.

The playing field is definitely not level. Low quality materials, poorly maintained equipment and restrictions on which laboratories can be used all contribute to the ‘Poundstretcher’ mentality. At one point last year, we had absolutely no x-ray facilities while head office sourced the cheapest scanner possible.

Unfortunately the commissioning Area NHS Teams are either oblivious to what is happening in the corporates, or are turning a blind eye. And by no means is my corporate the worst offender - I’ve seen worse with my own eyes. As corporates go, mine is considered to be one of the ‘good guys.’

So what is to be done? Your guess is as good as, although I would LOVE to see widespread and coordinated unannounced CQC inspections nationwide at 9.00am. Or else a mass walkout of the Nash by the independents? The corporates definitely wouldn’t cope - few of them hit their contracts annually anyway.

As for me, I’m off to Poundland.

HMRC has written to dental associates

On the 20^th April 2017 HMRC updated their ‘Internal Status Manual’ regarding the employment status of dentists. This made clear that where dentists are practicing as associates in premises owned and run by another dentist and are subject to a BDA or DPA approved associate contract, and the terms are followed, then the associates income will be assessed under ‘trading income rules’ and not as an employed income. In short, associates are self-employed and as such will be liable for Class 2/4 National Insurance, not Class 1 National Insurance. Despite changes bought into effect by the NHS General Dental Services Contract, which changed the way that dentists were paid, allowing for less fluctuation in income, HMRC were of the view that as long as associates continued to pay their share of laboratory fees and follow the terms of their associate agreements, then they will remain self-employed.

So what has changed?

Over the last 6 months there have been a number of landmark legal cases before the UK courts. Laura Pearce of JFH Law wrote in June last year that the tide was turning for dental associates following the Court of Appeal decisions in the cases of Pimlico Plumbers and City Sprint, which were hot on the heels of the earlier decision in the Uber in October 2016.

These cases all revolve around the ‘gig’ economy, where companies have traditionally relied upon casual or flexible labourers, who get paid for the work they do, rather than a weekly or monthly agreed salary. These people are often categorised as independent contractors, but the legally reality can be very different.

The Court of Appeal has ruled that despite the fact that the individual’s contracts defined them as self-employed, and certainly in the case of the Pimlico Plumber, they had benefitted financially from the arrangement for many years, they were in fact ‘workers’ not ‘self-employed contractors’. This means that they are entitled to the national living wage, holiday pay and statutory sick pay and the right to pension auto enrolment.

One of the key definers for whether an individual is a worker or self-employed is whether they have an unfettered right to send a substitute. If a dental associate is obliged to undertake the work personally, and can only send a substitute in the event that they are unavailable (for example when they are unwell or on maternity leave), or the right to send a substitute is dependent upon the consent of the practice owner, then it is highly likely that they will be defined as a worker by the employment tribunals. Pimlico Plumbers have appealed the judgement to the Supreme Court and judgement is currently reserved.

However, could an associate dentist go further and argue that they are an employee; thus obtaining all of the benefits of employment, including the right not to be unfairly dismissed? As no associate dentist has yet challenged the status quo within the Employment Tribunal it is not possible to answer this categorically. It will depend on the nature of the working relationship, the mutuality of the obligation between the parties; i.e. is the dentists obliged to offer work to the associate? Is the work done within fixed hours at a price fixed by the Principal? Finally, is the associate obliged to undertake that work themselves? If the answer is yes to all of these questions, the dentist could well be an employee.

What does this mean for tax purposes?

To date, if an individual is defined as a worker by the Employment Tribunal, that has not automatically affected their status as ‘self-employed’ for the purposes of paying their taxes. Indeed there have even been circumstances where the Tribunal has determined that an individual is employed for employment law circumstances, but self-employed for tax purposes. As such a ‘worker’ and an ‘employee’ can be exempt from PAYE and pay Class 2/4 NI contributions.

In 2017, HMRC had clearly taken the view that regardless of the personal nature of the services offered by dentists, they were content to allow them to continue as self-employed. However, the indications are that this is likely to change in the not too distant future. There is little benefit to HMRC under the current arrangement, and they are likely to see a change in associate dentist’s status as an opportunity to increase NI contribution and tax revenues. Furthermore, with the Government’s current focus on shifting responsibility of pension provision away from the state onto third party employers, it is likely that the writing is now on the wall for many associates self-employed status.

This has major implications for practice owners. Whilst any change in status for the purposes of HMRC is unlikely to be retrospective, bearing in mind their current guidance, this may open the floodgates for claims from associates against their principals before the Employment Tribunal. With the tax benefits of self-employed status gone, associates may think it’s worth arguing that they have been workers or employees for years. They can then claim back unpaid holiday since the commencement of their employment and demand enrolment in workplace pension schemes.

If you are concerned about your employment status or want to discuss the content of this dental bulletin contact Julia on This email address is being protected from spambots. You need JavaScript enabled to view it. or call us on 0207 388 1658.

Julia Furley, Barrister and Partner

by Nina Cartwright Carestream Dental - Product Manager

A recent survey found that there are over 42 million smartphone users in the UK.[i]. This number is only going to keep increasing, and reliance on apps and other digital technologies is likely to rise with it. A recent survey concluded that average UK smartphone owners use 30 apps per month and 10 apps regularly each day, showing how deeply the technology has integrated into our lifestyles.[ii]

Why do people use apps?

The main reason people have adopted apps and other digital innovations is because they add a high level of convenience to our lives. They can be used to shop online, pay our bills and keep track of our eating and exercise habits.

Furthermore, social media and other communication technologies allow people to speak to one another in a variety of new and instant ways, broadening how we connect with one another.

Digital access for patients

In light of this, all industries have developed apps and other digital presences in order to stay relevant. Dentistry is no different, and there are now hundreds of apps and other digital programs that patients and professionals alike can download to streamline their daily lives.

From digital oral hygiene guides to apps that help patients overcome any dental phobias, the range of apps available is extensive. These platforms can even encourage patients to communicate with dentists, as some of them will raise awareness or give them the information they need to inspire them to seek out professional attention.

Technology in the dental practice

As the digital lifestyle is now so prominent, it makes sense to invest in technology that means you can communicate with patients in a way that appeals to them.

Digital products help you communicate with your patients on a more accessible level when you’re treating them in the practice. New systems are very visual and can show them graphs and detailed explanations of the treatments you are suggesting, delivering information in a way that the patient understands.

Cutting-edge visual graphics are just one of the many benefits of the CS R4+ practice management software from Carestream Dental. Functioning at the heart of your practice, the system can streamline your patient care routine by acting as a tool to educate patients and communicate their treatment plans in an appealing, visual way.

Implement the technology that works best for your patients

By implementing apps and other digital technologies into your professional workflow you can communicate with patients in a way that’s easier for them to understand. This leads to better patient care, as they feel more comfortable and informed.

For more information, contact Carestream Dental on 0800 169 9692 or

visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Twitter @CarestreamDentl and Facebook

[i] E-marketer. UK Digital Users: The eMarketer Forecast for 2017. Link: https://www.emarketer.com/Report/UK-Digital-Users-eMarketer-Forecast-2017/2001988 [Last accessed March18].

[ii] App Annie. Spotlight on Consumer App Usage. Link: http://files.appannie.com.s3.amazonaws.com/reports/1705_Report_Consumer_App_Usage_EN.pdf [Last accessed March18].

During 2017, an increasing number of practices successfully transferred their existing payment plan patients with another plan provider to a practice-branded solution with Patient Plan Direct (PPD), cumulatively saving hundreds of thousands of pounds in costs.

This trend continues in 2018.

PPD asked the practices that made this transition in 2017 to explain their primary reasons for making the move, which are shared below.

Do any of these reasons resonate with you and your practice?

Would you like to find out more about how PPD can help you to significantly improve your practice’s profitability by making this move, whilst still benefiting from a first-class, award-winning service?

If so, you can book an exploratory call by emailing or calling the PPD team:

Tel: 0844 848 6888      Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Here are the five primary reasons practices that made the move to PPD from their previous plan provider in 2017 expressed…

1. Huge Cost Savings – Increasing Practice Profits

PPD’s administration fee (only £1.28 per patient per month, including Worldwide Dental A&E Cover) can prove to be up to over 65% lower cost than other plan providers administration charges.

Visit the PPD cost saving calculator to see how much your practice could save CLICK HERE  

2. Their previous plan providers branding

Some practices commented they were left feeling confused about their previous providers branding / re-branding, opting to make the move to not only cut costs, but take control of their own payment plans and patient relationships in the future.

3. A First-Class Worldwide Dental A&E Cover for Patients

(Included in PPD’s £1.28 admin fee)

The Worldwide Dental A&E cover* for patients included with PPD’s service includes cover for the placement, repair or replacement of implants following an accident at no additional cost to patients (This is only an option with some other providers at an additional cost to patients).

PPD’s cover also includes:

• Treatment following an accident
• Emergency treatment whilst away from home
• Emergency out of hours call out costs
• Mouth Cancer diagnosis, fixed benefit payment of £2,500
• Contribution towards plan costs following redundancy

4. Hands On Support with a Simple Transfer Process

Patient retention and/or extensive administration needn’t be a concern thanks to our fully supported and refined process, which makes the transfer quick and simple for both your practice and your patients.

5. Professional and Personable Service

PPD is not a huge corporate organisation. Your practice will not just be another fish in the sea when you opt to work with PPD. Our passionate team of field-based managers all have past experience of working in practice, both in clinical and management roles, ensuring we can relate to your everyday challenges and support, train, and advise your team to reach your practice’s payment plan objectives.

We encourage you to watch our transfer success video, documenting one practices positive experience of making the move from their previous provider to PPD.

Visit:  www.patientplandirect.com/success-story-video

If you’re heading to the Dentistry Show at the NEC in a few weeks’ time on either the 18^th or 19^th of May, you can visit the PPD team at stand H74.

* The Worldwide Dental A&E Cover for patients included with Patient Plan Direct’s service is underwritten by Hiscox – one of the UK’s leading insurers. The full policy wording, terms and limits are available from www.patientplandirect.co.uk

If you’re a practice principal you’ll no doubt be familiar with the term ‘exit strategy’. What you may not know is that your plan should be in place at least five years before you actually intend to leave. This gives you time to get all your accounts in order, identify the appropriate exit strategy and identify your personal goals for the future. Not to mention that it will help you secure a smooth exit and gain maximum return on your practice.

If you plan on selling the business as a way of securing monetary funds for retirement, then that time can be used to implement strategies that will help to maximise turnover and profits. Advertising and branding can help with this, as can having a dental practice valuation from a specialist valuations company.

As part of your exit strategy you should also decide whether you want to sell the practice outright or stay on part-time as part of a deferred consideration deal. Admittedly the eventual outcome may be outside of your control, but it’s definitely something to give thought to and plan. Especially if your intention is to depart immediately and settle for a smaller sum, as you may need to start your exit plan even earlier.

Of course, the better the planning, the more likely you are to achieve your personal and business goals. So if your heart is dead set on walking away from the practice and avoiding being tied into a part-time contract for several years after the sale, you’ll need to plan in advance to make that happen. Naturally, it’s best to contact a specialist dental acquisitions and sales agency that can help you to establish the most appropriate exit strategy that matches your objectives.

They will also be able to warn you of potential pitfalls to avoid. For instance, don't make the mistake of taking on fewer patients and reducing working hours too soon. All too often practice principals make this mistake, resulting in stagnation of growth and loss of income. As your profits decrease, so will the practice’s attractiveness to potential buyers and banks.

In regard to your staff, be sure to look at the way in which your associates are remunerated in your exit strategy to create an accurate overview of your practice’s performance and potential. Official associate agreements will be needed as well to protect the goodwill of the practice and assure potential buyers that the clinical team plans to remain with the business for the foreseeable future.

If retirement is on your mind or you’re thinking of moving on, then it may be time to start thinking about an exit strategy. Call Dental Elite for a free valuation, healthcheck and expert advice that will help you to achieve your long-term goals and realise your practice’s potential.

For more information contact Dental Elite. 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

By Chris Tapper

Six years ago, I attended a two-day residential course. It was a CPD course I hasten to add, not the usual anger management or ‘appropriate behaviour in the workplace’ type of thing I used to have to attend before they found the right tablets for me.

Anyway, it was very interesting, although I freely admit I never put a single thing I learned into practice – mainly because the dental corporate I work for wouldn’t shell out for the equipment I needed unless I could produce a business plan that proved I could earn them at least a tenner for every quid they invested. But that is by the by.

On the evening of the first day (a Friday if I recall correctly), the ten participants plus the lecturer and two representatives of the sponsoring company, enjoyed a meal in the hotel where the course was being held. After a very pleasant starter and main course, I moved to where a gaggle of four youthful dentists were sitting and enquired as to where they were in terms of their careers. It transpired that all four had graduated from the same Northern dental school and had all been qualified roughly two years. They were all general dental practitioners and had all taken up associateships in NHS practices.

As the most experienced dentist on the course – actually, why mince words, the oldest – I was interested to see if the youngsters were enjoying their chosen profession so far. I think I was trying to vicariously re-establish myself with my early enthusiasm for dentistry.

I posed, what I felt, was a fairly innocuous question to the group:

"How’s it going?"

One female dentist confessed that she cried every night when she arrived home from work, and sometimes did it during surgery sessions. One of the males said he was so anxious about work that he threw up most mornings and that brushing the lingual aspects of his teeth was impossible, while the other female said she had trouble sleeping and had been put on antidepressants six months earlier.

Perhaps the most troubling response was from the other male, who confessed that he had on a number of occasions, thought of ‘ending it,’ having realised that he had made a dreadful mistake in going into dentistry, and couldn’t see any way out. My concern for him diminished a little when I saw that he had an incredibly healthy appetite, demolishing his own rhubarb crumble and a female colleague’s lemon sorbet in less than three minutes.

When I questioned them more closely, the reason for their universal despair was not down to the pursuit of ridiculous UDA targets or the student debts they were saddled with, but the fear of dental litigation.

All four were constantly worried that they would see their careers end either in a GDC meeting, or more likely, through the bad publicity and financial ruin brought about as a result of a civil action facilitated by a dental litigation firm. They felt that the chances of those events happening to them were high, since one of their fellow students had already found himself in the middle of litigation as a result of an NHS root-filling having not worked.

Now that was six years ago, and I would argue that since then, the UK dental profession has slipped into a febrile anxiety that I have never previously witnessed in the 30 years or so that I have been working in dentistry.

Never have I seen dental colleagues (and even strangers) so jaded and so preoccupied with fears of dental complaints and ‘the dreaded letter’ from a certain Northern dental litigation firm.

I will freely accept that I have no scientific evidence for my observations and that my views are based purely on the empirical, but I personally know of no dentist who has not recently entertained thoughts that a patient might ‘turn legal’ if the wind blows the wrong way.

Over the past 18 months, I have been offering support to a close young colleague, being pursued by an extremely aggressive young solicitor (she IS young, I looked her up) who is alleging ‘negligence’ after her client developed dry socket after a routine extraction of an upper first molar. Rightly or wrongly, my colleague decided she did not want to consult her defence organisation and so I have been (rightly or wrongly) equally aggressive in demanding expert witness or consultant reports in support of their absurd claim. So far, the solicitor has failed to provide any evidence of negligence or give any reason why an expert assessor’s report has not been provided. All I know is, it has been fun ‘having a go’ back, but it to me illustrates a sad fact – nobody in the UK-based dental profession is safe from opportunistic punts from patients who want to make a quick quid from the no-win-no-fee mob.

A few months ago, a solicitor I know told me that during a local meeting of his legal colleagues, a speaker said that a lucrative and growing new source of business was dental litigation and that it was “something to think about” since the clampdown on spurious ‘whiplash’ claims and ‘Benidorm Belly’ – where package holiday tourists claim compensation for stomach upsets caused by dubious calamari and fries - had resulted in less opportunity for successful claims.

Recent experience has taught me that dental litigators are a tenacious and avaricious species and are unlikely to give up easily on an area of medical law that they consider to be easy pickings. Certainly, according to my legal friend, lawyers see it as a much easier area to be successful in than medical litigation.

Soon, the cost of dental defence subscriptions will be prohibitive to viable practice, and the profession, once all our European colleagues go back home, will find itself unable to cope with patient demand. What is the answer? Your guess is as good as mine.

Until then, I am going to have a rhubarb crumble and some sorbet.

Ahead of the impending Soft Drinks Industry Levy on 6^th April, one in five UK adults (21%) say that potentially paying a little bit extra won’t bother them if they want a sugary drink.

According to survey figures* released today by YouGov and Simplyhealth, the experts behind Denplan payment plans, just over half of the nation (59%) supports the new tax, but a significant number of people would not be deterred by potential price hikes of sugary beverages. In the same survey, 20% of adults admitted they are addicted to sugar.

Nicknamed the ‘sugar tax’, the Soft Drinks Industry Levy is a completely new measure that comes into force on 6^th April 2018. Plans for the tax were announced in the Government’s 2016 budget in response to the nation’s alarming levels of obesity and poor oral health.

The tax primarily targets manufacturers and importers of sugary soft drinks and encourages them to adjust their recipes and reduce the levels of sugar in their drinks, thereby avoiding the tax or paying a lower level. However, consumers could also be affected and be forced to pay more for sugary drinks if manufacturers decide to not reformulate their recipes and pass on the tax to consumers.

Under the new levy, drinks with a sugar content over five but below eight grams per 100ml will see 18p added to the price of the drink per litre, and drinks containing over eight grams of sugar per 100ml will face an increase of 24p per litre. 

“It’s encouraging to see that the majority of people support the new levy and understand the urgent need to address the alarming levels of obesity and poor oral health – particularly those of children - in the UK,” said Henry Clover, Chief Dental Officer at Simplyhealth, the experts behind Denplan payment plans. “However it’s concerning that one in five people say they would not be deterred by potential price increases of sugary drinks, suggesting that sugary beverages are seen as a staple item in some people’s daily diets. Sugary drinks are a leading cause of tooth decay and acid erosion and offer little to no nutritional value.”

Encouragingly, 53% of respondents in the survey claimed they don’t drink sugary drinks, and 17% would consider choosing less sugary and potentially less expensive options, of which 10% didn’t like the thought of paying extra and 7% who definitely don’t want to pay extra.

“It will be interesting to observe consumer buying behaviour over the next year as well as seeing how many manufacturers have adjusted their recipes,” says Henry. “Reducing access to high sugar drinks options and encouraging people to choose less sugary options is likely to have a positive effect on the nation’s oral health, particularly in children and young adults. Sugary drinks should always be seen as an occasional treat and only drunk as part of a meal. Water and milk are far more tooth-friendly options.”

The survey also revealed that one in four adults (25%) admit to struggling to understand the sugar content on food and drink packaging labels, highlighting that many people may be unwittingly consuming much higher levels of sugar than they realise. Worryingly, amongst these, only 56% of 18-24 year olds knew that honey is a sugar, and only 41% of the same age group knew that molasses, fruit juice concentrates (44%) and maltose (50%) are also types of sugar.

“Confusion over food and drink labelling and a lack of awareness of the recommended daily limits almost certainly contribute to the nation’s high sugar consumption,” says Henry. “It’s important that manufacturers and retailers make it as easy as possible for consumers to know what they’re purchasing and are transparent with their ingredients and labelling. There is also a role for dental teams and other healthcare professionals to help patients understand the effects of a high sugar diet on their health and help them make more informed choices.”

*Online survey conducted YouGov on behalf of Simplyhealth. Total sample size was 5,264 adults. Fieldwork was undertaken between 12th -19th February 2018.  The figures have been weighted and are representative of all UK adults (aged 18+).

About Simplyhealth:

For 145 years we’ve been helping people to make the most of life through better everyday health.  In 2017, Simplyhealth and Denplan united under one Simplyhealth brand and today we’re proud to be the UK’s leading provider of health cash plans, Denplan dental payment plans and pet health plans.

We help over three million people in the UK access the health and care products, services and support that they need, when they need them and at a price they can afford.

• 1m health cash plan customers
• 1.5m patients with a Denplan payment plan
• 6,500 member dentists
• 1,900 member vets
• 879,600 animals covered
• 11,000 corporate clients

We’re proud to donate 10% of our pre-tax profits to health-related charitable activities every year, and this amounted to over £1 million in 2017. Our Simplyhealth Great Run Series partnership raised an additional £42.6 million for charity.

Simplyhealth is a trading name of Simplyhealth Access, which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

www.denplan.co.uk

www.simplyhealth.co.uk       

Implants & Beyond Symposium 2018

Friday 20th April

Double Tree by Hilton Hotel, 2 Bridge Place, London, SW1V 1QA

FREE TO ATTEND (5 CPD Hrs)

 Further details on the website.

To register for this free event, just fill out the form on the website

http://www.implantsandbeyond.org/

Carestream Dental is delighted to announce that Mark Garner is its new national sales manager, based in the UK.

Mark has over 20 years of experience working in the dental industry having previously managed large sales teams at other companies. Based in Leicester, he brings with him a wealth of dental knowledge and business leadership experience, with a strong focus on meeting and exceeding standards.

Carestream Dental is committed to delivering an exceptional standard of customer service to every dental practice it works with. Building a highly experienced and skilled sales team is part of this, ensuring all its customers receive the information, advice and support they need.

For more information please contact Carestream Dental on

0800 169 9692 or visit www.carestreamdental.co.uk

For all the latest news and updates, follow us on Twitter @CarestreamDentl and Facebook

Carestream Dental is delighted to announce that it has been shortlisted in two categories for the National Sports Technology Awards 2018.

This is an internationally-recognised accreditation that celebrates technology-led innovation throughout the world of sport.

It is thrilled to be a finalist in the following groups:

• Best Participation Technology

• Most Innovative Sports Equipment or Apparel

In collaboration with the mouthwear suppliers and dental laboratories involved – Forcetech Mouthwear, Rhino Mouthwear, Fairbanks Dental Laboratory and Wessex Dental Laboratory – the company has also been shortlisted in the Most Innovative Sports Partnership category.

We look forward to the awards ceremony and are hopeful for a win!

For more information please contact Carestream Dental on

0800 169 9692 or visit www.carestreamdental.co.uk

For all the latest news and updates, follow us on Twitter @CarestreamDentl and Facebook

Simplyhealth Professionals has produced a range of templates and draft policies to support its practices in preparation for meeting the enhanced data protection requirements, coming into force on Friday 25 May 2018. The company has also been providing detailed information and guidance on the implication for practices of the new data regulations with a three part blog written by Roger Matthews, Honorary Life President and former Chief Dental Officer (https://www.denplan.co.uk/dentists/blog).

Between now and Friday 25 May, the recommendations are that practices will need to:

• Complete their data audit (as recommended by The Information Commissioner’s Office (www.ico.org.uk/gdpr)

• Check where back-ups are stored (ask your software provider/s)

• Consider how to present Privacy Notices to patients

• Consider revising their Data Protection and Information Security policies

• Update their Cookie policy if they have a website

• Carry out and document a Legitimate Interest Assessment (in simple terms how you lawfully process personal data)

• Draw up a Data Breach policy and procedure (if not already done)

• Appoint a Data Protection Officer

To help with preparation, Simplyhealth Professionals has published several templates for members on their web portal in a GDPR toolkit.  There are templates available for a Legitimate Interest Assessment, a Privacy Notice and a Data Breach. However, in each case it will be necessary for practices to consider how these templates should be adapted for their own particular circumstances and practice.  Further resources will be published on the portal in the coming weeks in the form of a Cookie policy, a Data Retention policy, a Data Protection policy and an Information Security policy.

As the new law is still a Parliamentary ‘work in progress’ and subject to some further amendments, Simplyhealth Professionals intends to keep members fully updated on any further developments.

Henry Clover, Chief Dental Officer at Simplyhealth Professionals, said: “We shouldn’t forget that confidentiality, consent and security of sensitive information – to name but three factors – have already been an integral part of dental practices for a long time. This is the embodiment of data protection in our professional lives, so much of this is not actually new.  

“However, there is still some preparation required by practices and they will need to become familiar with some different language.  Similar to the support we provided with regards to CQC inspections, we have again attempted to simplify the complex and make generic data protection requirements relevant to dental practices.”

About Simplyhealth Professionals:

In February 2017, Denplan rebranded as Simplyhealth Professionals.

Dental

Simplyhealth Professionals is the UK’s leading dental payment plan specialist with more than 6,500 member dentists nationwide caring for approximately 1.7 million patients registered to a Denplan product.

Simplyhealth Professionals provides the following range of leading Denplan dental payment plans under the Denplan name:

• Denplan Care: all routine and restorative care + worldwide dental injury and dental emergency cover

• Denplan Essentials: routine care only + worldwide dental injury and dental emergency cover

• Denplan for Children: routine and other agreed care + worldwide dental injury and dental emergency cover

• Denplan Membership: registered with the dentist + worldwide dental injury and dental emergency cover

• Denplan Hygiene: A dental payment plan without dental insurance for all types of practice from NHS, mixed and private to support patients commit to a consistent hygiene programme.

• Denplan Emergency Insurance: worldwide dental injury and dental emergency cover only

Simplyhealth Professionals also provide a wide range of professional services for its member dentists and their practice teams, including the Denplan Quality Programme and Denplan Excel Accreditation Programme.  Plus regulatory advice, business and marketing consultancy services and networking opportunities.

Dentist enquiries telephone: 0800 169 9962.

For patient enquiries telephone: 0800 401 402   

For details of all of our products, visit www.denplan.co.uk

Adam Christie the CEO of CALCIVIS was interviewed by BBC Scotland this week. He spoke comprehensively about the development of the CALCIVIS imaging system and told viewers how this innovative new dental device is helping to revolutionise preventative dentistry.

Filmed at a dental practice in Edinburgh, Adam showed how the CALCIVIS imaging system works and explained:

“Using a recombinant photoprotein, the CALCIVIS imaging system identifies free calcium ions released from actively demineralising tooth surfaces.”

Viewers saw how the CALCIVIS imaging system produces a very short, low-level flash of light that is detected by an integrated intraoral sensor and presented as a glowing, digital map at the chair side. It was agreed that CALCIVIS offers dental practitioners an early detection device to identify enamel demineralisation in the earliest, most reversible stages, which enables them to plan prompt management to prevent dental caries.

In addition, the non-invasive CALCIVIS system helps patients to understand their risk of dental caries more easily and motivates them to improve oral hygiene levels.

As Adam Christie explained to the BBC, “CALCIVIS is a first for British Dentistry. Never before has it been so easy to detect areas of active demineralisation so efficiently.”

If you would like to know more about this remarkable technology, contact the CALCIVIS team today.

To find out more about CALCIVIS visit www.CALCIVIS.com

or call 0131 658 5152

A recent Court of Appeal judgment has criticised the fairness and scope of the former Parliamentary and Health Service Ombudsman’s procedure for investigating clinical complaints against healthcare professionals. The GPs in the case were jointly represented by the MDU and another medical defence organisation but the judgment will also have positive implications for dental professionals.

The court considered exactly how the Ombudsman applied her discretion to investigate a complaint. It found an investigation should not begin where a complainant has another legal remedy open to them (other than complaining to the Ombudsman) unless the Ombudsman “is satisfied” that it was not reasonable to expect the complainant to use the alternative legal remedy. The Ombudsman must obtain and analyse information related to the complainant’s particular circumstances and not simply refer to general criteria. 

The court also provided welcome clarity on the standard applied by the Ombudsman to determine whether or not the exercise of clinical judgement was reasonable.

The judge commented:

“The standard chosen by the Ombudsman is beguilingly simple but incoherent. It cannot provide clarity or consistency of application to the facts of different cases. There is no yardstick of reasonable or responsible practice, but rather a counsel of perfection that can be arbitrary. It runs the risk of being a lottery dependent on the professional opinion of the advisor that is chosen. It is unreasonable and irrational and accordingly, unlawful.”

John Makin, Head of the DDU said: “This judgment will have positive implications for dental professionals. When their clinical judgement is criticised, the Ombudsman can investigate what happened, reach conclusions and make recommendations if service failure is found. It is essential that the standards used by the Ombudsman to judge the clinical care provided to a patient are appropriate. Dental professionals should not be held to unreasonably high standards. It is also important that the Ombudsman stays within its legal powers and does not investigate exactly the same facts as a court would consider as this could present double jeopardy for dental professionals.  

“Those facing an investigation into their clinical practice should have reassurance that the processes being followed by the Ombudsman are fair and just. This judgment is good for healthcare professionals, and will also benefit patients who can be assured that the investigation was properly and fairly carried out.”

The DDU, the specialist dental division of the MDU, is a not-for-profit organisation wholly dedicated to our members’ interests. Our team is led and staffed by dentists with real-life experience of the pressures and challenges faced in practice.

We offer our members expert guidance, personal support and robust defence in addressing dento-legal issues, complaints and claims. Our customised services range from legal assistance to indemnity to appropriate CPD.

theddu.com

Carestream Dental’s Application Specialist, Kirsty Morrison, was one of several lucky people to receive a ‘Golden Envelope’ from Practice Plan at the BDIA Dental Showcase last year. It contained a £20 note and a dare – make it count!

Kirsty decided to use her £20 to help a gentleman who had battled and overcome his fight with alcoholism. He was honing his technology skills on a tablet with his social worker, but was devastated when it broke and he was unable to replace it.

The story inspired the whole team in the Carestream Dental Head Office, who decided to donate to the cause as well. The amazing £230 raised enabled Kirsty to buy the gentleman a brand new tablet, as well as a cover and other accessories, enabling him to continue working on his skills from his own home for the very first time.

This is just one example of how a little incentive like the £20 from Practice Plan can really make a difference to someone. Thank you to everyone who donated!

For more information please contact Carestream Dental on

0800 169 9692 or visit www.carestreamdental.co.uk

For all the latest news and updates, follow us on Twitter @CarestreamDentl and Facebook 

One year after taking ownership of the UK’s third largest dental group, Zurich-based Colosseum Dental Group unveils a £5M comprehensive modernisation programme focused on clinical excellence and best practice.

Southern Dental, the nation’s third largest chain of dentists, is now known as Colosseum Dental UK Ltd. The name change coincides with the first anniversary of Zurich-based Colosseum Dental's acquisition of Southern Dental, which made it not only Europe's fastest growing dental group, but also the only one with a network spanning the continent.

With a patient base in excess of 500,000, the majority of Colosseum's 80 practices in the UK will undergo an extensive refurbishment programme, introducing a new look and feel to waiting rooms with upgraded treatment areas and clinical facilities as part of a £5,000,000 investment in the company. Peter Keegans, CEO, explains, “Our new owners have a long-term, 20-year vision which is enabling us to invest in upgrading our clinics to be state-of-the-art practices offering the highest standards.” Colosseum Dental Group’s ambition is to be Europe’s leading dental provider within five years.

LOCAL PRACTICES SERVING THEIR COMMUNITY
One of the pillars of Colosseum’s recipe for success in the UK will be embedding each practice as a “good neighbour” in its local community. Peter continues, “We want to break with convention from other dental chains. Each of our 80 practices will be known by the local name patients have always referred to it. If, for example, ‘Hollybush Dental’ is how a practice has always been known colloquially, we've no intention of simply re-badging it as ‘Colosseum Dental’. In this way, each practice will retain its connection as an integral part of its community."

In addition to being a good neighbour, Colosseum has two other refreshingly simple cultural values; to be a provider of exceptional patient care and to be a great employer. As Peter explains, “Our name change marks a new era: a renewed energy and focus, an opportunity for cultural change and to align ourselves with the values of our European colleagues. Armed with a long-term vision, we can now invest in our practices and staff with confidence, knowing our patients will be the ultimate beneficiaries. Everyone wins.”

EUROPEAN SCOPE FOR PROFESSIONAL DEVELOPMENT AND PATIENT CARE
Being part of a European group means dentists have the chance to provide best practice based on the ability to observe long-term clinical outcomes in a huge, European-wide patient base. Treatment protocols, guidelines and KPIs are currently being developed across the group to provide highly informed patient care, and present the best possible treatment options to patients. Ravi Rattan, Clinical Director at Colosseum Dental UK, who joined in 2016, is excited to be part of these changes: “At Colosseum Dental, we’re committed to raising clinical standards and offering more advanced treatment options and procedures to our patients. Our new specialist referral centres in Kettering and Kingston offer private as well as NHS treatments such as orthodontics, implants and facial aesthetics. Patients there will benefit from 3D CBCT scanners to enable better, safer treatment planning. Having new investment means we can continue to set up such centres: Our European colleagues are highly experienced in managing large referral centres, and we are learning from their success.”

The group’s aim is for no differences to exist between treatments available at, say, a practice in Switzlerand, and those available at one in Southern England. Lars Armbäck is Chief Dentist at Colosseum Dental Group. Armed with 30 years’ general practice and a special interest in prosthetics, implants, quality and treatment strategy, his focus is on best practice, dentist development and quality assurance. He’s excited by the addition of the 80 English clinics, noting, “Patients everywhere should be able to benefit from digital technologies that enable them to make informed choices about their care. Hence, as a group, we recently chose to invest in intraoral scanners for all patients, and our size means we can negotiate to help keep diagnostic and treatment prices affordable.” He adds, “Dentists at our UK practices will benefit from committees we have set up to examine best practice in treatment planning and workflow. With time, we’ll be able to compare patient outcomes across Europe, and thereby identify best treatment strategies and best practice overall. It’s this type of sharing which sets us apart from any of our competitors.”

COMMITTED TO PROFESSIONAL DEVELOPMENT
Career choices at various levels are being made more flexible, in line with changing lifestyle requirements such as increased female and part time dentists in post. Samaneh Nezamivand-Chegini, a dentist who practises in Central London, having joined in 2012, now sits on the Clinical Board. She says, “It’s great to see my suggestions have been noted, despite my being relatively newly qualified. Peter [Keegans] and his team have listened and acted, which is in turn inspiring my clinical colleagues. On a personal level, I’m being supported to further my career and income via training in implantology.”

Sharyn Wilson, HR Director at Colosseum Dental UK, notes, “Our improved ways of working and communicating are being appreciated by all our staff, from receptionists to dental specialists.” Career progression for non-clinical staff is also being strengthened. For example, the new Advanced Treatment Co-ordinator has progressed from earlier roles as nurse, Practice Manager, then Resourcer. As a sign of its commitment to professional development, Colosseum Dental UK will hold its first Annual Conference on 20th April, where keynote speakers will include Seema Sharma, an expert in transforming dental practices, Joe Bhat, a Fellow of the International Team for Implantology and Jas Gill, who was voted in at No.12 in the Top 50 most important people in UK Dentistry.

ABOUT COLOSSEUM DENTAL UK LIMITED
Colosseum Dental UK Limited is the third largest chain of dental practices in the UK, with 80 clinics spanning 19 counties. The company supplies high quality general dental care, as well as specialist services for NHS and private patients. It has more than 900 employees and Associates, including over 250 dental professionals, serving more than 500,000 patients. Its mission is to be the ‘best in class’ dental group in the South of England by providing modern, quality dentistry services for the benefit of patients, dentists, employees, shareholders and striving for continuous growth and excellence. www.colosseumdental.co.uk

Michael Lansdell is a founding partner of specialist dental and medical accountants Lansdell & Rose and a chartered accountant. Here, he gives an overview of Philip Hammond’s first Spring Statement, and the key points for dental practice owners…

We had two Budgets and three Financial Bills in 2017, which for many, was more than enough! The Spring Statement lasted a grand total of 25 minutes, and was essentially a review of the public finances. It was also an opportunity to publish consultations before any announcements in the Autumn Budget.

So, nothing headline grabbing, but here’s a glance over the Spring Statement and how it may relate to your business.

VAT

From April, the VAT threshold will remain at £85,000 for the next two years, as per a previous announcement. Mr Hammond said he would consult on whether growth could be incentivised by looking again at how VAT is structured.

Digital payments

Payments/settlements systems (including the Bank of England’s) are to be renewed in order to harness the power of the latest technologies. The government pledged its support to these changes, and it will be consulting on them.

On a related note, views will also be sought on how online platforms could help users comply with their tax obligations.

Entrepreneur’s relief

If an individual now owns less than 5 per cent interest in a company, because the company has issued trade to raise capital, they should be able to claim Entrepreneur’s relief, says the government.

Business rates

Views had previously been sought on this topic. It was announced that the first of more frequent, three-yearly revaluations for business properties would be in 2021.

Self-funded work-related training

Have you – or a colleague – undertaken this? Well, the government is going to look at how tax relief can be extended and how the system can be both simplified and protected from misuse.

Coming up in April…

No new tax measures were introduced, but some previously announced changes are coming into force in April. The personal allowance is rising to £11,850 (for basic rate, to £34,000 and higher rate, £46,350). This excludes Scotland, who will have five new tax bands for 2018/19. If you are on a higher rate in Scotland, this isn’t great news as the threshold is going to start at £2,920 below the rest of the UK. As previously announced, the dividend tax allowance will be reduced to £2,000.

The national insurance contributions (NICs) threshold is also increasing by 3 per cent and Class 2 NICs will now be phased out for 2019/20.

If you have a company car, tax will rise for all by the highest emission vehicles.

The residence nil rate band for Inheritance tax (IHT) will rise; the main rate band will remain unchanged. There could be changes afoot by the Autumn Budget, however, a review of IHT conducted by the Office of Tax Simplification is due to report around then.  

As for pensions, the minimum contributions for workplace pensions under automatic enrolment will increase. The lifetime allowance will rise in line with inflation (it’s been on a downward path since 2012).

Finally, both income tax and NICs will apply on all payments in lieu of notice (PILONs) in 2018/9.

If you want specific data, or clarification, contact Lansdell & Rose. We can help your practice to stay ticking away efficiently and profitably during the next financial year and beyond.

Other dental accountants also available. Nasdal.

Lansdell & Rose on 020 7376 9333,

Or visit www.lansdellrose.co.uk

On 29^th November 2017, the European Court of Justice (ECJ) handed down its decision in the case of King v Sash Windows. It is another case in a long line on holiday pay and has opened the flood gates for workers to claim unpaid holiday dating back 20 years.

Why is this relevant to dental practices?

At present most associates are working under a self-employed contract and as such will not be paid holiday pay. However, there is a risk, especially for those associates employed by a dental corporate, that in fact the reality is that associates are workers and therefore entitled to holiday pay.

Mr King’s case does not change the legal test for establishing who might be a worker. However, prior to this case, it was thought that workers could only claim up to two years back dated holiday pay. This meant the risk to dental practices if an associate was wrongly classified was fairly limited.

Now a dental practice is at risk of having to pay anyone found to be a worker unpaid holiday from the start of their contract or from 1998, when the Working Time Regulations came into effect, if the contract began before then.

Definition of a Worker

Before looking at this case in any detail, it is important to understand what the definition of a worker is. This is another area of employment law that has had a number of high profile cases in recent years. In essence the test is as follows:

1. Must the person personally provide the service or can they send a substitute?

            Most associate contracts contain a right to send a substitute. However, if the right is fettered this 

            could result in the associate being found to be a worker.

2. Is the company obliged to provide work and is the person obliged to accept it?

           If you have an NHS contract, you need to ensure that the associate meets their UDA targets. This 

           therefore could infer into the contract a mutuality of obligation. 

3. Was the status of the ‘employer’ under the contract that of a customer?

            No; the customer is the patient. The associate is providing their services for your customers.

Facts

Mr King was a self-employed window salesman. He began working for Sash Windows in 1998 and was paid on a commission only basis. He never asked for holiday pay and he never received it. On average Mr King took fewer holidays each year than a worker is entitled to. Just before his 65^th birthday Mr King’s contract was terminated on the platform of Victoria Station due to his age.

Mr King pursued various claims including unfair dismissal and age discrimination. Here we will just deal with his holiday pay claims, of which there were three, namely:

1. Claim 1 = holiday pay due on termination of employment, namely in the final year;
2. Claim 2 = holiday pay due in respect of days off taken but not paid for;
3. Claim 3 = holiday pay due for any days he did not take from the annual leave entitlement.

The employment tribunal found Mr King to be a worker and all three holiday claims were successful. He was awarded £27,257.96 in total for this element of the claim.

The case was appealed and there were cross appeals in relation to various aspects of the findings. The issue in relation to the holiday pay claim was ultimately referred by the Court of Appeal to the European Court of Justice. 

Holiday Pay Claim; Legal Arguments

Firstly, the only holiday pay claim subject to appeal was in respect of claim 3 – holiday pay due for any days not taken from the annual leave entitlement.

Sash Windows’ main argument was the ‘use it or lose it’ principal, which in essence states if a worker does not use his annual leave entitlement in the applicable holiday year he will lose it entirely. This is because there is no automatic right to carry holiday entitlement from one leave year to the next. They also suggested that a worker would have ‘double recovery’ if they received pay for holidays that they in fact worked and were paid for.

Mr King argued there were circumstances beyond his control that meant he could not take the annual leave and so it should roll over. In this case it was argued that the circumstances beyond his control were his employer’s intentional failure to pay him holiday pay.

Decision

The Working Time Directive was enacted to ensure the health and safety of workers; to allow employees sufficient time away from work to ‘recharge’.  Therefore workers should not be deterred from taking their annual leave entitlement. Given this underlying principle the ECJ found that:

An employer who does not allow a worker to exercise his right to paid annual leave must bear the consequences.

Therefore whilst there may be double recovery, that is a risk the employer takes in not granting a worker his paid annual leave.  The ECJ felt it was for the employer to correctly categorise staff and ensure they are given their employment rights, as workers are in a weaker bargaining position.

The case has been referred back to the domestic courts for a final decision. However, the Court of Appeal will no doubt follow the ECJ’s decision.

This means that an associate can continue to claim they are self-employed and then on termination seek to argue they were in fact a worker and claim back dated holiday pay. There would be no down-side for the associate, as employment tribunal fees have been abolished and there is no costs regime. Also as the test for employment status is different for HMRC and the tribunal, a retrospective change of status would have no bearing on this. The risk is therefore all on the dental practice.

Further, the definition of a worker under the Working Time Directive is wider than the UK law, which an associate may be able to rely on when pursuing their claim.

Practical Tips

First and foremost, make sure you correctly categorise your workforce from the outset and provide a contract that reflects the true basis of the relationship. Whilst this means front loading time and costs, it is likely to save you a hefty legal bill later down the line.

This decision only affects the 4 weeks annual leave granted by the Working Time Directive. Not the additional bank holidays given by UK legislation. Consider amending your contracts to state that UK bank holidays will be deemed to be taken last. You would not need to add this to associate contracts, but if it is in your employment contracts you will be able to rely on this as evidence should a claim be pursued against you.

When buying a practice do your due diligence on the workforce. Make sure the old practice is complying with the Working Time Regulations. Ensure the sale agreement contains indemnities in case staff have been wrongly categorised. Consider implementing your own contracts that are genuinely self-employed, time limits for presenting a claim against you would then start running from the date of the sale.

When selling a practice be careful what warranties you give to the buyer. You would not want to be liable for the entire claim, especially if the new practice has also continued with a contract that was not genuinely self-employed.

If you need advice or assistance in relation to employment status and protecting your position, please contact Laura Pearce on 020 7388 1658 or email her at This email address is being protected from spambots. You need JavaScript enabled to view it..

Laura Pearce

Senior Solicitor

In endodontic therapy, the complete removal of microbes from the root canal system and prevention of reinfection is essential to the overall outcome.

The most effective means of eradicating infection is a combination of chemical and mechanical debridement, because when irrigation is introduced alongside instrumentation the chance of removing inflamed and necrotic pulp tissue, microbes and debris is significantly higher.

As it stands, there is little evidence to prove that certain irrigants are more effective than others, but research has shown that no single irrigant on its own holds all the required characteristics needed to effectively eradicate and prevent infection.[i] Only a combination of two or more solutions in the appropriate sequence can predictably obtain safe and effective irrigation.[ii]

Perhaps the most commonly used irrigant is sodium hypochlorite (NaOCI) in concentrations varying from 0.5 to 6.00%, as this can dissolve organic tissue and has a broad antimicrobial spectrum allowing it to effectively kill biofilms adherent to the root canal walls.[iii] For those who prefer to use sodium hypochlorite, it is worth bearing in mind that a high concentration NaOCI has demonstrated better results than 1% and 2% solutions. [iv] In cases where NaOCI has been used but has been ineffective, it may be that the strength of the formula – or lack of – has compromised the success of the outcome.

The downside of NaOCI is that it does not remove the smear layer. This can be overcome, however with subsequent irrigation with Ethylenediaminetetraacetic acid (EDTA), as it can dissolve inorganic material, including hydroxyapatite. Importantly, EDTA is also biocompatible, able to condition dentine and has shown positive effects on the root canal seal.[v] Nevertheless, it is important to remember that EDTA must be used as a final rinse, not as an alternating rinse with NaOCI.

Another possible irrigant is chlorhexidine digluconate (CHX), which has good antimicrobial activity and is biocompatible. As it is incapable of dissolving organic tissue it cannot replace sodium hypochlorite. One could also opt for hydrogen peroxide, but again, this lacks antibacterial activity when used alone and cannot dissolve tissue.

Whichever combination is used, it is important to choose quality irrigation products from a trustworthy manufacturer of endodontic solutions. At COLTENE, all products are designed and produced using the latest materials and technology to guarantee optimal results. The range of solutions includes CanalPro NaOCI in 3% and 6% formula, CanalPro EDTA 17% and CanalPro CHX 2%, providing all the characteristics needed for effective irrigation. For best results, use alongside HyFlex EDM NiTi root canal files, also available from COLTENE.

The role of irrigation and its impact on the overall success rates of root canal treatment is clear, so be sure to consider your choice of irrigants.

To find out more visit www.coltene.com, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 01444 235486

Once again the new patient charges have been announced for the NHS, and once again they have gone up far more than the amount dentists will get for their UDA’s. The third consecutive inflation-busting rise in patient charges means that an ever increasing number of dentists will find themselves as unpaid tax collectors for the government, with the added pleasure of having to continue to practice in a hostile environment where the threat of litigation and GDC involvement is ever present.

So what will it actually take for dentists to wake up and smell the coffee? Patients are paying an increasing amount for their care, and as they do so, direct their annoyance as ever to the dentists. Its unlikely that they will understand or accept the explanation given that the charges are in effect a taxation, as they are too closely linked to the provision of a service.

Why do many of the dental practices seem to forget that they are in truth independent contractors within the NHS, and as such only have to refuse to contract to the NHS in order to retake a degree of control of their own future once again? It can’t be that working within an NHS contract is too easy; we increasingly hear of the demands on the practitioner’s time to fulfil the contract requirements. This time of year is full of comments on social media about the increased flurry of activity in order to hit the UDA’s targets once again or suffer claw-back.

By raising the patient charges, the government is contributing less and less each year to the cost of dental provision. The population of the UK isn’t reducing, and the cost of providing dentistry isn’t either. But for less and less contribution the government is still dictating the terms of the contract, and dentists continue to accept it.

Will it actually take the government to raise the patient charge to £30 for an exam (whilst still paying £25 for the UDA) for dentists to realise that they would be better off just charging the patient £30 and sticking two fingers up at the government? Or is it the NHS pension that people are holding out for? Or the continued chance to pay an associate £10 per UDA when they are really getting £30?

Practice owners (and particularly the bigger practices and corporates) definitely have the whip hand here. I can remember the times when associates were few and far between. It appears that the reverse is now true in many areas of the UK (particularly in metropolitan areas), which allows the principal to reduce the unit price of a UDA paid to an associate. An increase in patient charges will likely bring a drop in the number of patients visiting practices, and in one fell stroke this will reduce the PCR, and reduce the chances of the UDA targets being met, and therefore a claw-back occurring. I know of many associates that are made liable for the gross amount of any claw-back due to their individual underperformance (rather than the net amount they have been paid per UDA). Add this to the NHS pension of the principal that is effectively enhanced by paying a smaller percentage of the UDA value, this hardly puts the principal under any immediate pressure to withdraw from the NHS system they are still aligned with. However, I suggest that it is now causing a much greater ‘Us and Them’ situation with associates than ever before.

So why is it ok to make money out of the associates and not charge the patients a decent amount for their care? Whilst a business has a duty to its shareholders and owners to keep its costs low, with the introduction of the minimum wage this means they don’t tend to be propping up their bottom line by charging their staff for the privilege. They tend to charge their customers for it with the increase in the charge for the product.

Unless you happen to be in a fixed price system…so the only way money can be made (let’s forget upselling to patients using the NHS as a way to get them in the practice for now) is by reducing the costs of the workforce and investment in the business. However the government expect more and more for less and less (look at the next round of orthodontic commissioning that is going on) and it becomes impossible to square the circle unless someone actually pays for it. That certainly isn’t going to be the government.

Given that some patients will not be able to afford the hike in charges does not mean that many others would not pay for a decent service if they had to. Surely having fewer patients (but of the sort that don’t sue and complain) that are being charged a fair amount for the service provided, with no third party dictating targets has to be better for the stress levels of both dentists and patients under their care?

Will it take associates to actually walk away from the profession and retrain? With the current environment of stress due to the GDC, threat of litigation, and the real time reduction in associate income, then this has never been more possible than it is now. And that will lead to a reverse in the associate market again, especially if the (currently unknown) effect of Brexit results in European dentists returning to their home countries – and who wouldn’t if it meant avoiding the GDC and Litigation!

So what will it take for the profession to see the light? That we need to realise the government would still wish to control us if they only contributed £1 in every £100 charged and only then will we react? Or do we need to remember that everyone who owns a practice is a private practitioner already and they should just tell the government:

‘No More’.

Image credit - Pascal under CC licence - not modified.

Are you dealing with Flexible Working Requests Properly?

Employers should be aware that they are required to consider a request from an employee for flexible working hours. A request of this nature must be made in writing, setting out details of the request, the date it is made and disclosing the date of any previous request. A request must be dealt with and responded to within three months of the request being made.

What many employers are probably not aware of is what can happen if that request finds its way to the bottom of a pile of everything else a practice owner has to deal with, and the practice owner fails to consider and deal with the request.

Providing an employee has 26 weeks of employment with the employer, the employee has a statutory right to request flexible working hours. If the employer fails to consider the request, it is possible for the employee to bring a claim in the Employment Tribunal and assert this statutory right. The claim that would be brought by the employee is a breach of statutory rights.

If the employment tribunal were to make a judgment in favour of the employee, they could do one of the following:

• Make an order that the employer reconsider the request for flexible working; OR
• Award compensation for up to a maximum of 8 weeks statutory pay.

The statutory maximum for this type of award is £4,064 from 6 April 2018.

As with all statutory or contractual breaches, discrimination claims could be tagged on to claims such as this which could have grave financial implications, as well as unfavourable publicity exposure for an employer.

Where a request is rejected, a record of this should be kept and reasonable business justification should be set out when confirming the rejection. Where a request is accepted, a variation to the contract of employment should be issued and signed by both parties to note the variation to contracted hours.

It is important to have policies and procedures in place to deal with flexible working requests in a compliant and efficient manner, in order to avoid ending up in the above situation.

It is also worth noting that an employee may only make one request in any 12 month period.

Latest on the Taylor Report – Extension of Employee Rights?

As we have already touched upon, any changes in employment legislation are likely to take longer than usual, whilst the political landscape is dominated by Brexit-related legislation.

However, last month, the government issued its response to the Taylor Report. The points to note in this response are that none of these proposals are guaranteed to happen and will be subject to legislation. Moreover, these proposals will certainly not be implemented before March 2019, save for the issue of payslips.

There is a suggestion that employees could benefit from new ‘day one’ rights that give workers the right to being provided with payslips from the commencement of their employment, which would have to include the number of hours that the employee is being paid for where the employee is not salaried.

What else is being proposed?

• A new tier/definition of worker in the mould of the ‘dependent contractor’ following on from the landmark Uber case;
• A universal right for everyone in the workforce (employees, workers, agency workers, zero hour contract workers) to ask for a variation to their contract. This would, of course, not go so far as being able to demand a variation and it remains to be seen the nature of variations which would be asked for;
• The right to be provided with a written statement of employment particulars from the first day of employment (at present, this is within 2 months of employment commencing and only applied to employees).

Whether these proposals are going to make it into law and regulations will depend upon if trade unions have an appetite for these concessions, if they will be rejected in the pursuit of more far-reaching protections and rights for employees, or whether employers and business groups are willing to accept such changes – given some of their considerable practical hurdles and, arguably, increased bureaucracy.

Statutory Sick Pay – the Facts

The issue of when, how much and for how long statutory sick pay (SSP) is payable by the employer is often a point which is misunderstood or simply ignored. This has the potential to be financially detrimental to a business and/or in breach of the law.

Without going into extensive details, here are some of the common misconceptions:

1. Not everybody is entitled to SSP. You must be an employee, have carried out some work for your employer and earn no less than £113 per week (i.e if your employee works 8 hours per week at £8 per hour, they are not eligible).
2. From the minute they are off work, employees are not entitled to SSP due to illness/sickness absence. The employee must have been ill for at least 4 days – which includes non-working days – before an employee is eligible.
3. SSP is not payable for an indefinite term. It is only payable for a maximum of 28 weeks;
4. Once this 28 week period comes to an end, the employee is not necessarily left without any money to live on thereafter and may be able to apply to the state for Employment Support Allowance;
5. That isn’t to say you don’t do anything at the end of the 28 week period. If it is a reasonable expectation that the employees’ sickness absence is going to pass the 28 week period, then you should obtain an SSP1 Form (available from www.gov.uk) on the 23^rd week of the 28 week SSP period. This should be completed and given to the employee so that they can access the government funded allowance at the end of their 28 week period.

The increase in SSP rates which were announced in December are due to come into effect from 6 April 2018 and from which date will be £92.05 per week.

Ben Williams (pictured below) of Goodman Grant Solicitors – contact on This email address is being protected from spambots. You need JavaScript enabled to view it.

For more information visit www.goodmangrant.co.uk or contact your nearest office:

London: 0203 114 3133

Leeds: 0113 834 3705

Liverpool: 0151 707 0090

Below you will find an infograph we have created from a recent thread on GDPUK which was titled - help me with end of year spending....

Simplyhealth Professionals has announced today the launch of a new flexible payment plan for both its’ member practices and non-members which will help patients to spread the cost of both dental and facial aesthetic treatments.

The new Flexible Payment Plans will make treatments more accessible and affordable for all patients as they can set the price and payment length with their dentist so it suits individual budgets. Patients can opt for treatments that they might have previously thought were unaffordable.

Dentists will agree with each patient how much they pay each month and how long their treatment will take. They can offer the patient an ongoing monthly plan for more regular treatments, or a choice of three to ten monthly payments for a one-off treatment, helping the patient to spread the cost of treatment and make it more affordable for them.

This is the first time that Simplyhealth Professionals has created a payment plan that can be tailored to support dentists providing an increasingly diverse mix of cosmetic dental and facial aesthetic treatments in their practices.  Flexible Payment Plans will encourage patients to opt for new or higher cost treatments which they previously might not have considered due to the price.