GDC hearings: The imbalance of probabilities

Can we make the Regulators serve the Public and the Profession in foro conscientiae (the court of the conscience), rather than just a notion of what the regulations might say?

I have attended and been asked to make some input into a variety of cases recently involving several different Regulators.

It has become clear that there is a real danger that rules and regulations which may have been drafted for the protection of the Public and the guidance of the Profession are sometimes widely misinterpreted at best and occasionally deliberately corrupted and applied at worst.

How does this occur?

Whilst it might be considered that most regulation has been drafted to improve standards and reduce the risk of poor practice continuing; it is quite obvious that it can be applied in a manner to exert control or ‘manage’ the Profession. Sometimes this may occur deliberately and because it broadly serves the purpose of a government administration, it is allowed to continue at least as long as it serves a purpose. Sometimes it occurs at a much lower level and whilst not serving any particular purpose, it is allowed to continue because there is nobody at that level who is prepared to question it.

I’ve got nothing against shop assistants, however I wouldn’t be wanting them to draft the GDC Charge Sheet which might end a Professional career. There is a high turnover of staff at the GDC which I suggest leads to a poor understanding and there appears to be a low level of dental knowledge.

What this might mean if you are in the dock

One of the cases to which I refer involved a young colleague, and for whom funds were raised at very short notice thanks to the excellent GDPUK membership.

If you read the Charge Sheet, you would be forgiven in believing this dentist was a real danger to the Public. However I’m sure that you will all remember me reminding you to read between the lines whenever you are dealing with a Regulator. That is certainly necessary in this case.

Example appearing on a Charge Sheet

(i)            The use of a double cantilever (the bridge was fixed-fixed)

(ii)           Not adequately assess that a RCT was required (the tooth was root treated and had been a symptom free bridge abutment for 20 years)

(iii)          Fitted an inadequate post which was a) short of the apex, b) not extending to the apical third and c) was inadequate in width. (The post was temporary and deemed too wide).

If the Charge sheet is a nonsense, the solution is simple. The Panel changes it, strikes it out or substitutes different wording. In other words, it moves the goalposts. The Panel, which is independent by hearing both parties then asks its own questions of the witnesses. It is advised by experts and can choose which expert it ‘prefers’. The expert appearing on behalf of a registrant might then be warned by the Prosecution barrister that the GDC may take action against them. The prosecuting barrister is instructed by the GDC and regularly prompted by their expert witness.

In one of the cases to which I refer, four patient witnesses who had made a complaint were called. One of the witnesses was travelling to London and it was found that she intended to speak in favour of the Defendant and it was agreed therefore that this patient would not be heard.  

The Panel seemed to have some ability to read between the lines, but in the end ‘prefers’ the testimony of two patients. One of these patients produces a hand annotated diary of the treatment dates containing some dates that the defendant was actually not in the practice (a screen shot of practice diary was produced as evidence). The patient was receiving treatment from more than one dentist at two different practices simultaneously, but on the ‘balance of probability’ is to be believed. This patient was heard to say that she was seeking ‘redress’ on at least four occasions.

Our young colleague describes how he always uses rubber dam for RCT and yet on his last day in the practice he finds there is no rubber dam available. He admits that on this single solitary occasion, rubber dam was not used. The patient has pleaded that a temporary post crown be placed (the same inadequate temporary post that was short of the apex) and he accedes to the request of RCT and temporary post, since the broken tooth was within the patients smile. He uses rotary RCT instrumentation, floss on hand instruments and high volume aspiration. The patient is the same one who was not given the opportunity to give further evidence in support or denial of the registrant. Our young colleague is guilty therefore of serious clinical failures and therefore misconduct.       

Another patient gives evidence about never having received treatment he has paid for, but the Panel agrees that this evidence is just not credible, which it isn’t.

A fourth patient was having a long and complex treatment plan part of which had been incomplete and following a tooth fracture needed to be modified. The patient didn’t clearly understand the new treatment plan and for that our colleague was criticised.

It’s worth mentioning that there were NO PATIENT RECORDS available because there had been a burglary declared immediately following the practice change of ownership. This was highlighted to the Panel. 

Communication was a big word in this Hearing. Other significant words are ‘insight’ and whether or not the Panel consider that this is ‘embedded’ sufficiently. Our young colleague was supported by Sir Peter Bottomley in person who made a statement and also by the testimonials of 47 patients.

The GDC however do not need to give weight to the above in making their determination, although I noted that the prosecution barrister frequently returned to the GDC to ask for further instructions. I think it worthy of note that the Panel describe our young colleague within the Determination as follows ‘It is clear from all of this evidence that you are viewed as a competent and caring dentist, who will go out of his way to assist his patients.’

Do the GDC therefore need to apply Conditions, because that’s what they did? 

Please read the GDC Determination when it is published.

So what?

If you recognise any of the issues above, you are guilty of misconduct and your standards will be deemed serious failings. Approximately 1 in 7 dentists in the UK currently face some form of investigation which could result in imposition of sanctions either through the GDC, CQC or NHS and this number is growing constantly. This might mean that we have the worst performing Dental Profession in the World bar none or that we have the most disproportionate Regulators.

You may consider yourself lucky and are happy to cross the bridge with your indemnity organisation when your time comes; or you may be sufficiently confident to wade across the raging torrent alone when your indemnity organisation makes an unexpected discretionary decision against you.  

What type of indemnity organisation are you currently paying for?

How can it be legal?

You are required to have professional indemnity and it is considered a serious failure if you have ANY gaps in your cover period. Indemnity providers however do not guarantee to provide legal representation to you and if they exercise their discretion in favour of their balance sheet (or dressed up as other members interests) you will find yourself alone or facing a huge legal bill.

A recent Hearing which I attended over 7 days starts at £32,000 and it’s uphill from there.

Does anything need to be done about this?

You read the PSA report published 21^st Dec, I hope.  https://www.professionalstandards.org.uk/docs/default-source/psa-library/investigation-report---general-dental-council.pdf?sfvrsn=6

What exactly have we learned about whistleblowing from the Sir Robert Francis Report (Mid Staffs)?

And you can see how the whistleblower was treated, you can see what the PSA thinks about it and you have seen how the GDC are going to be dealing with your ‘serious failings.’

You tell me, do you need to do something about this?

So where are we now?

From a variety of recent cases we can conclude:

·         The GDC consider failure to use a rubber dam in endodontics to fall seriously below the required standards and therefore to represent IMPAIRMENT and worthy of sanctions.

·         In my view neither the CQC nor the GDC have a currently correct understanding of CONSENT which conforms with the recent Supreme Court judgement of Montgomery – v Lanarkshire Health Board. This needs to be challenged in the High Court.

·         The GDC will always use the ‘balance of probability’ in forming an opinion on which evidence it prefers. 

So where are we going in 2016?

The Profession must for once in its life join together. The issues regarding Consent and use of rubber dam will need to be challenged and this requires more than a well-intentioned individual or some crowd funding. It requires a strongly actioned move being taken by the BDA and the indemnity providers.

Image credit -Michael Coghlan under CC licence - not modified.   

In October 2012 a positive duty was placed on all employers to automatically enrol ‘eligible job holders’ in to a qualifying pension scheme. For most Dental Practices the relevant date for complying is likely to be early next year. If your Practice has not been given the relevant date yet, then you should expect notification imminently. A failure to comply with this duty can result in a penalty notice with a fine or enforcement action being taken against you. Enforcement action can consist of inspections being carried out on premises, which is yet another layer of bureaucracy for Dental Practices to comply with.

In this Blog we take a look at who is eligible for auto enrolment; what is a qualifying pension scheme; and what you must do to comply with the auto enrolment requirements. We also explain the continuing duty placed on employers to re-enrol eligible job holders.

Who must comply?

All UK employers must comply with the auto enrolment requirements, even if you employ just one eligible job holder. The only exception to this is if the eligible job holder is already in a qualifying pension scheme.

If you currently do not employ anyone but offer an eligible job holder a position following your relevant date, you will have an obligation to enrol them into a qualifying pension scheme from the start of their contract.  

Who is an Eligible Job Holder?

An eligible job holder is a worker who:

•       Is working under a contract;

•       Aged at least 22 and under State Retirement Age;

•       Earns at least £10,000 (in 2015/2016);

Therefore it’s not just employees who must be enrolled; it is workers, agency staff, apprentices, and could even extend to some self-employed contractors. It will also cover permanent and temporary staff and those on fixed term contracts.

Given this is a relatively new scheme, there is limited legal guidance as to what an eligible job holder, or worker, will be for the purposes of the Pensions Act 2008. However, the definition is similar to that found within the Employment Rights Act 1996. As such, we can look to existing case law to assist with the definition of a ‘worker’ under the new act.

Interestingly, in the case of The Hospital Medical Group Limited v Westwood [2012] EWCA Civ 1005 the Court of Appeal held that a GP working as a self-employed independent contractor for a private clinic was a worker.

Dr Westwood held three positions. He was contracted by the Hospital Medical Group Ltd to perform hair loss surgery for its clients; he was referred to in marketing material as ‘one of our surgeons’. He also had his own medical practice which he worked at, and finally, he had a contract to provide advice on transgender issues with another separate clinic.

When asked to determine whether he was a ‘worker’ at the HMG Ltd, the Court of Appeal held that there is a distinction between those who market their services independently to the world in general and those who are recruited by the principal to work as an integral part of the principal's operations. Whilst there was no requirement for the clinic to provide work and for Dr Westwood to accept it, the HMG Ltd had engaged Dr Westwood because of his skills. The patients were clients of the clinic not Dr Westwood. He was therefore recruited by the principal as an integral part of the principal’s operations. He was therefore considered to be a worker despite the flexibility of his role and the terms of his written contract stating he was a self-employed independent contractor.

The parallels between Dr Westwood’s position and that of most self-employed Associate dentists are clear. As such it seems extremely likely that for the purposes of pension enrolment legislation, Associate dentists will be considered an eligible job holder working under a contract. As such they will need to be included in Practice’s qualifying pension scheme, unless of course they choose to opt out. 

Practices will also need to consider their company structure when considering who is eligible for auto-enrolment. In the case of Clyde & Co LLP and another v van Winklehof [2014] UKSC 32 the Supreme Court held that a member of a Limited Liability Partnership was a ‘worker’ for the purposes of whistleblowing legislation. In this case Ms Bates van Winklehof was an equity partner receiving a profit-related element of remuneration and a guaranteed level of remuneration. Ms Bates van Winklehof made a complaint that a managing director had accepted brides. She was subsequently removed as a partner of Clyde & Co. Ms Bates Van Winklehof alleged this removal was due to a protected disclosure, a claim a worker is entitled to bring.

The Court’s reasoning for finding that Ms Bates van Winklehof was a worker was because she could not market her services for anyone other than Clyde & Co and she was an integral part of their business. 

The result of this judgment means Limited Liability Partnerships will need to enrol their members into a qualifying pension scheme if they meet the other requirements, including the minimum qualifying earnings. If the member received drawings based on the company’s profits there is a question as to whether these would be classed as ‘earnings’. Although the definition of earnings is wide and we would recommend automatically enrolling members in any event to avoid litigation.

The position would be different for partners in a traditional Partnership Agreement, as a partner cannot employ themselves and would therefore not been deemed a worker.

As most Dental Practices are Limited companies, it is worth bearing in mind that a Director of a company is a worker only if he is also employed by the company under a contract of employment and there is at least one other person employed by the same company under a contract of employment.

Exceptions

There are some exceptions to the requirement to auto enrolling eligible job holders and these are:

•       Job holders in their notice period within six weeks of the enrolment date;

•       Job holders who have cancelled their membership after being contractually enrolled;

•       Job holders who are receiving a benefit from a lifetime allowance;

•       Job holders who have received a winding up lump sum.

What is a Qualifying Pension Scheme?

A qualifying pension scheme is an occupational or personal pension scheme or a registered pension scheme that satisfies the quality requirements. You should talk to your current or proposed pension provider to get advice on this or you can find out further information here.

The Government’s ‘NEST’ scheme is an automatic enrolment scheme, as is the NHS pension scheme. However, if the eligible job holder is not able to register in the NHS pension scheme then employers are under an obligation to find another qualifying pension scheme for them. An example of this would be someone who has retired, but later decides to return to work. If they are an eligible job holder still they will need to be enrolled into a qualifying pension scheme.  

Non-Eligible Job Holders and Entitled Workers

A non-eligible job holder is:

•       Aged between 16 and 21 or State Retirement Age and 74 and earnings in excess of £10,000; OR

•       Aged between 16 and 74 with earnings between £5,824 and £10,000

Although they are not eligible for auto-enrolment, they must be made aware of the scheme and have the right to opt-in. If a non-eligible job holder opts into a qualify pension scheme the employer must make the minimum pension contribution, which at present is 2% of which the employer pays 1%.

Finally, there are entitled workers who are:

•          Aged between 16  and 74 and has earnings under £5,824

Similarly, these workers must be made aware of the pension scheme and their right to join. However, there is no obligation for an employer to make the minimum contributions for this class of worker.

What Next?

Once a practice owner is informed of their relevant staging date they will need to:

·         Find an appropriate qualifying pension scheme;

·         Provide workers with information about the pension auto enrolment before it takes place; and

·         Enrol any eligible job holder into a qualifying pension scheme if they do not opt out.

To find your relevant staging date, click on this link.

It has been suggested that the process can take up to 12 months to complete so we recommend preparing early.

You need to write to employees within 6 weeks of the staging date. For an example letter to send to eligible job holders and an opt out form, click on this link.

Ongoing Duty

There is an ongoing duty to auto enrol. Even after your staging date has passed you will need to be aware of the following re-enrolment dates:

• As soon as a job holder becomes eligible the employer must auto enrol. You have one month to make the necessary arrangements;
• After three years the employer must auto enrol any job holders who previously opted out;
• If a scheme no longer qualifies as a relevant scheme the employer must enrol the job holder into a relevant scheme.

Employment Protection Safeguards

The Pensions Act contains specific duties for employers to safeguard their workers’ rights in connection with auto-enrolment. It should be noted that these safeguards apply regardless of whether you have reached your staging date yet, and will apply to current and potential job holders. Below is a brief outline of the employment protection safeguards currently in place; a more detailed look at these can be found here.

Prohibited Recruitment Conduct. Employers must not ask questions or make statements as part of the recruitment process that indicate that an individual's application may depend on whether or not they opt out of auto-enrolment. This is enforced by the Pensions Regulator; it does not give rise to a separate claim in the Employment Tribunal by the individual.

Inducements. This is any action which has the sole or main purpose of inducing a job holder to either opt out or leave a pension scheme, or inducing an entitled worker to leave a pension scheme. An example of this would be re-negotiating contractual terms at a lesser rate if the sole or main purpose is to take into account the cost of implementing pension auto-enrolment for that individual. Again this is enforced by the Pensions Regulator; it does not give rise to a separate claim by the individual.

Right not to Suffer a Detriment.  A worker has the right not to suffer a detriment by their employer on the grounds that:

• any action was taken, or was proposed to be taken, with a view to enforcing a requirement under the auto-enrolment regime in favour of the worker; or
• the employer was prosecuted for an offence under section 45 of the PA 2008 as a result of action taken for the purpose of enforcing a requirement of the auto-enrolment regime in favour of the worker; or
• any requirement of the auto-enrolment regime applies to the worker, or will or might apply.

If a worker does suffer a detriment then this will give rise to a claim that can be pursued in the Employment Tribunal. As above, re-negotiating terms could be seen as detrimental treatment. Alternatively, offering new workers lower rates to take into account the direct cost of pension auto-enrolment for that individual could be seen as a detriment.

The situation may be different if pension auto enrolment causes your Practice financial hardship; this could potentially be seen as a valid reason to re-negotiate contracts. However, this will be fact sensitive depending on the circumstances of your business, so if you are planning to take direct action then you should seek specific legal advice.  

Automatic Unfair Dismissal. If you dismiss an employee and the main or principal reason for that dismissal is one of the three points highlighted above under ‘right not to suffer a detriment’ then that dismissal will be deemed automatically unfair and the employee can pursue an Employment Tribunal claim. This right only applies to employees; not workers.

Whistleblowing. Workers are already protected from detrimental treatment as a result of blowing the whistle on their employer. If a worker makes a complaint to the Pensions Regulator and suffers a detriment as a result of such a complaint, then they will have protection under whistleblowing legislation. In the case of a worker this could include their contract being terminated; so whilst they may not have a right to claim unfair dismissal they may have a claim for whistleblowing.

This is yet another financial burden being placed on small businesses. However, given the consequences of not complying with the law, it is important to know what you must do and when; ensuring you are prepared in advance will help take the stress out of implementing pension auto enrolment and help you plan for the future.

Pension Auto Enrolment is a vast area of law and as such this Blog gives an overview of your duties. For more detailed information you can visit the Pensions Regulator website here. 

This month is Mouth Cancer Action Month, a charity campaign set up by the British Dental Health Foundation (BDHF) to raise public awareness of mouth cancer. The campaign has been long running; spearheaded by the late Richard Horner, founder of Scope Group and well known among the dental media and trade, in 1998. He retired in 2003 and handed over the project to the BDHF, who have done much work to raise awareness of mouth cancer;  pushing through changes in legislation in relation to the tobacco industry, including a direct marketing ban and the smoking ban.

Over the last year concerns over the Nation’s oral health have hit the headlines; from concerns over children’s oral hygiene, the effect of sugar and proposals for a ‘sugar tax’, and more recently revelations regarding the poor state of professional footballers’ teeth. This article will consider the nations awakening interest in all things oral health, and what impact this has on the fight against mouth cancer.

Children’s Oral Hygiene

In 2013 the Health and Social Care Information Centre commissioned a survey in relation to Children’s Dental Health. This survey has taken place every 10 years since 1973 to track changes in the oral hygiene of children.  The results were published in early 2015 and found the following:

·         The nearly a half (46%) of 15 year olds and a third (34%) of 12 year olds had “obvious decay experience” in their permanent teeth. This was a reduction from 2003, when the comparable figures were 56% and 43% respectively.

·         The proportions of children with some untreated decay into dentine5 in permanent teeth have also reduced, from 32% to 21% of 15 year olds and from 29% to 19% of 12 year olds.

·         In 2013, nearly a third (31%) of 5 year olds and nearly a half (46%) of 8 year olds had obvious decay experience in their primary teeth6. Untreated decay into dentine in primary teeth was found in 28% of 5 year olds and 39% of 8 year olds.

·         In 5 year olds, the average number of primary teeth with obvious decay experience (dmft) was 0.9. Among 5 year olds with such decay, the average number of teeth affected was 3.0.

·         In 12 year olds, the mean (average) number of permanent teeth affected by obvious decay experience (DMFT) was 0.8. Among 12 year olds with any such decay, the mean number of teeth affected was 2.5.

The survey also looked at lower income families by assessing the oral health of children who had free school meals. The findings for this group were as follows:

·         A fifth (21%) of the 5 year olds who were eligible for free school meals had severe or extensive tooth decay, compared to 11% of 5 year olds who were not eligible for free school meals.

·         A quarter (26%) of the 15 year olds who were eligible for free school meals had severe or extensive tooth decay, compared to 12% of 15 year olds who were not eligible for free school meals

Around this time the Faculty of Dental Surgery at the Royal College of Surgeons of England (RCS) also published a report in relation to the state of children’s oral health. The RCS was seriously concerned about the state of oral hygiene in children and noted the regional inequalities in the results. The report confirmed that in 2013-14 approximately 46,500 children under the age of 19 were admitted to hospital with a primary diagnosis of dental caries.  The RCS estimated that 90% of dental caries are preventable.

Sugary drinks have been blamed for the poor oral hygiene in children, with many seeing sugar as the new tobacco. We reported on this in Issue 4 of our Dental Bulletin, at which time Tesco had banned sugary drinks from its shelves and Coca-Cola had funded research which down-played the effect of sugary drinks on teeth.

Since that Dental Bulletin the Government has come under increasing pressure to implement a sugar tax and for the food industry to have clearer packaging as to the amount of sugar in their products.

Jamie Oliver has been a campaigner for the sugar tax for a while, even implementing the tax in his own restaurants. He has a ‘five point sugar manifesto’, which includes the sugar tax and banning advertisements for junk food before 9pm. On 19^th October 2015 he also appeared before a committee of MPs to discuss the sugar tax, in which he asked David Cameron to ‘frankly, act like a parent’ with the food industry.

Meanwhile, Jeremy Hunt was accused of delaying Public Health England’s (PHE) report on the subject, which was meant to be published in July 2015. The report was finally published on the Government website on 22^nd October 2015; it appears his hand was forced after Dr Alison Tedstone, director of diet and obesity at PHE, went public with details of the report.

The highlights from the report are:

·         Treating obesity and its consequences alone currently costs the NHS £5.1bn every year;

·         Reducing the Nation’s sugar intake in the next 10 years to the recommended 5% (or 30g per day) could save the NHS £484m a year;

·         The influencers to buying sugary products include:

o   Advertising:

o   Food retail price promotions. Foods with higher sugar content are among the highest food retail price promotions on offer in stores:

o   Taxation on products:

·         Evidence shows lowering sugar in foods will help reduce consumption. This has a proven track record in relation to the reduction of salt in foods;

·         The report recognises that one single action will not be effective and a combination of changes will be needed to reduce the sugar intake of the Nation. Eight changes are recommended and these include:

o   A price increase of  a minimum of 10-20% on high sugar foods:

o   Reduce and rebalance price promotions;

o   Reduce opportunities to market and advertise.

What is evident from reading all the reports above is that children from lower income families are amongst the worst affected. Yet the Government is still reluctant to take action against the food industry. This is surprising as greater public awareness of the risks of sugar will surely help increase calls for change, hopefully resulting in similar action being taken against the food industry as has been achieved with the tobacco industry. 

Professional Footballers

On the opposite end of the spectrum, recent research has shown that wealthy professional footballers are amongst the worst culprits for bad oral hygiene.

Research carried out by University College London and published in the British Journal of Sports Medicine, found that nearly 4 out of 10 professional footballers have ongoing tooth decay; 57% have tooth erosion; and 8 out of 10 have gum disease, which in some cases was irreversible. Compare this with the national average, where 3 out of 10 adults suffer from tooth decay.

So why is it that professional footballers have such bad oral hygiene? Again, sugary drinks may be to blame, with the footballers drinking sports drinks during training sessions and games to help maintain energy levels. However, with appropriate oral hygiene, it has not been proven that drinking such drinks would harm teeth.

Similar research was carried out by the same study author, Professor Ian Needleman, on professional athletes during the London Olympics in 2012 and this report had similar findings in relation to the state of the athletes’ oral health.

Many people may be surprised at how oral hygiene can have an impact on one’s health and well-being in general. 7% of professional footballers and 18% of professional athletes said bad oral health had affected their training.

Dr Claudio Peru is a specialist endodontist and the principle at Chiswell Green Dental Centre.  CGDC have been working with Watford FC for the last two years, during their rise to the football Premier League. Dr Peru is responsible for the dental health for the players. His view on the importance of dental health in elite sports people is as follows:

“The importance of ensuring optimal dental health for professional athletes, including footballers, cannot be understated. By ensuring the dental health of players, they are able to train and perform during matches without being impaired by acute or chronic dental problems. There is an obvious economic advantage to the club. In particular we find that by addressing occlusal imbalances we are able to optimize neuro-muscular coordination and the postural balances. This is particularly important for the competitive performance of athletes.”

The studies did not give any conclusions as to why these professionals had such poor oral hygiene; many saying they visited a dentist regularly. With access to the best dentists and products surely there is no excuse for this.

Mouth Cancer Action Month

Mouth cancer is one of the few remaining cancers that is likely to increase in numbers in the coming years; the disease has already increased by a third in the last decade. In the UK last year 6,767 people were diagnosed with mouth cancer.

Mouth Cancer Action Month hopes to raise awareness of the symptoms of mouth cancer and the benefits of taking action early on.  The key message from this campaign is that early detection is key and it encourages the public to regularly visit their dentist.

The British Dental Association (BDA) has published an article highlighting the vital work dentists and their teams have in making the public aware of mouth cancer and early detection. It confirms that if detected early there is a 90% survival rate; compared with 50% where diagnosis is delayed. 

The BDA is also supporting HVP Action’s campaign for the HVP vaccination given to girls to be extended to adolescent boys (rather than just those between 16 and 40 who are having sex with men as recommended by the Joint Committee on Vaccination and Immunisation). It is thought that the HVP virus is likely to rival tobacco as the number one cause for mouth cancer in the coming years; the rate of mouth cancer is expected to double between 1995 and 2025.

If you want to get involved in Mouth Cancer Action Month you can visit their website here. We will be doing our part to raise awareness; look out for JFH Law’s #bluelipselfie.

Laura Pearce, Senior Solicitor

UCL Eastman Dental Institute is the largest postgraduate dental school in Europe and has a reputation as one of the world’s leading academic centres for dentistry. As part of UCL – London’s Global University – the Institute welcomes UK and international students.

With a focus on translational research, postgraduate education and training, the Institute offers a wide range of study opportunities – Master's degrees, specialty training, certificates, diplomas, research doctorates and CPD courses – from its twin sites in central London.

To find out more about our upcoming courses – including Microscopy, Implants and Restorative short courses running between now and Christmas - visit our stand at E210 or our website: http://www.ucl.ac.uk/eastman

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CPD Survey

Do you think CPD is valuable to you? Are you interested in having your say on CPD? Then you will be glad to know UCL Eastman is carrying out a nationwide survey to find out your views on the current state of CPD.

If you have an opinion and wish to complete the online survey visit https://www.surveymonkey.com/s/7YD9T9S.

Ward Hadaway is a top 100 law firm with offices in Newcastle, Leeds and Manchester. Its healthcare team is nationally recognized with leading legal experts supported by a substantial team of sector specialists.

Led by Damien Charlton and Alison Oliver, our healthcare practices team provides a range of specialist legal services for dental practitioners, including:

• sales and purchases of NHS, private and mixed practices
• preparation of associate agreements
• incorporation of practices
• advising on dental law and regulations
• preparation of partnership and expenses sharing arrangements
• employment law
• property matters
• dispute resolution

We look forward to seeing you at the NASDAL stand I175 at the BDIA Conference.

Damien Charlton is an experienced commercial lawyer who has been advising businesses on company and commercial matters for over 15 years. He is a member of NASDAL.

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

t: 0191 204 4265

Alison Oliver is an Associate Solicitor in Ward Hadaway's Commercial Department. She works almost exclusively with healthcare sector clients, and has been advising dental and medical practitioners for the last 10 years.

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

t: 0191 204 4240

Alison will be speaking on dental partnership and expense sharing agreements at the Conference – look out for details at the NASDAL stand.

What our clients say:

"We have recently completed the sale of our two large dental practices to a national corporate through Alison Oliver. The nature of the practices meant that there was a lot to consider, but Ward Hadaway provided an excellent service throughout and took a lot of the pressure off us as sellers. They clearly have a lot of experience and knowledge in selling dental practices, and were able to anticipate and prevent potential pitfalls. The sale completed smoothly on time, largely due to the close personal attention given by Alison Oliver throughout. Any queries were replied to immediately, and I could not fault anything in the whole process from our solicitor’s point of view."

Paul Blaylock, Former Dental Practice Owner

"We cannot recommend Ward Hadaway more highly....All [members of the team] completed their various roles calmly and efficiently, being the friendly contact at the end of a phone or e-mail almost immediately whenever we needed help and advice. I would not hesitate to recommend them to any other dentist who is contemplating the sale, or indeed purchase, of a dental practice."

Paul Winfield, Former Dental Practice Owner

What the legal directories say:

Committed to building long-term relationships with clients rather than just looking at immediate revenue opportunities.

Legal 500

Clients note that "the firm has an excellent cross-section of lawyers, the resources to cope with tight timescales and is excellent value for money – we trust it to come up with the goods on any legal matter".

Chambers Legal Directory

http://www.wardhadaway.com/your-sector/healthcare-practices/

NASDAL can be found on stand I175 at the BDIA Dental Showcase

NASDAL is an association of specialist dental accountants and lawyers all of whom have a deep expert, technical understanding of the key issues and challenges facing the dental profession.  Members regularly produce guidance and benchmarked data so that they can provide clients with cutting edge advice on complex issues.

www.nasdal.org.uk

Welcome back to the Indian Summer of tropical rain…

There was a time when those of use of a certain age [OK Old if you will, but take that tone out of your voice!] decided to pursue dentistry for many reasons one of which was the life time career of care which happened to be comfortably paid.  Professional life was stable, practice management was an ongoing process. Interestingly by and large we saw all the patients who wanted to be seen and managed their dental needs without any political calls for damage limitation of a crisis of “Access”. Those of us so inclined went home for a celebratory glass of cheap Chateau Rinse de Bouche over an FP17. [For those of our younger colleagues unfamiliar with such things, these were the old claim forms that allowed a course of treatment to be ‘claimed’]

Complaints were rare. The GDC were a body to whom one looked up in awe and respect, and yet who played little part in day to day practice. Indemnity was low cost as was the ARF.  At some point in one’s career one would make the decision to up the standards of ones work and seek to change the way one practiced. It was a cycle of professional life.

Meetings [long before CPD became a fashion statement] were a cacophony of chit chat about practice matters.

Morale I would be so bold as to say was always, broadly, high

So what on earth has happened? How do we find ourselves at the edge of a perfect storm of change for the worse?

The GDC are a runaway train of high cost complaints handling and we are all paying through the nose and other orifices too, I should think.  The persistent arrogance and lack of accountability of the GDC and its leadership remain a real cause for concern.  A worry in part because they affect us but we do seem to be able to affect them, nor can the PSA, it seems.

Just look at Indemnity as an example. On the one hand it is a significant chunk of income on an annual basis, now being compulsory [so the lawyers can REALLY get their teeth into you]. On the other hand, despite reassurances, there is a pervasive sensation that they will dig you out of a shallow pit of excrement, but if you are truly up to your neck they may simply leave you to flounder. A worry in part because they affect us but we cannot affect them.

Now we have news of the falling away of dentist incomes.  In a separate and apposite piece of Government news, even that respected statistical body HSCIC, thinks morale is a worry amongst dentists. Now incomes falling is hardly news because most of us have noticed this in the last 5 years.  How? Well, we run these efficient Micro-Businesses, Minister and produce the annual accounts.

Practice Plan’s latest Confidence Monitor is hardly an advert for happy campers under the Governments clinical cosh that is the UDA.  The vast majority of the NHS dependent sector must be feeling very uneasy.

What has caused this change of circumstance?  Why are all the pointers suddenly running the wrong way?  If morale is a precarious state of mind, all this news must surely cause the spiral of decline to turn more quickly unless something is done?

Can morale fall, like the rain, in stair-rods?

Now hold on Dr Prism … Dentists are a resilient bunch – we get by, we generally don’t moan, and we take the rough with the smooth because, let’s face it, there are many worse off than us and despite what the Daily Fail et al may say, we do have a social conscience.

In our day to day work, we [you me and all the other GDPs] take personal responsibility for our situation. It is up to us to be happy … or not as the case may be.  It is up to us to run our businesses. All good so far.

But for the bigger external problems we rely upon an external body to do our work for us.  We reply upon our Academic colleagues to lay out the ground for evidence based clinical practice. Not some random bunch of Red Braces in Wimpole Street who would not know a dental practice if it hit them on the head! We rely upon a representative body to keep the bad news at bay – to fight off the bad guys as it were.

Where are the BDA as our ‘Union’?

Perhaps they themselves experiencing a decline in morale as time and again they fail to make an impact against the onslaught of Government regulation and initiative?  Not so long ago there was the change of subscription system and I seem to recall there was a ‘bit of a fuss’.  Even on a professional matter such as obesity and the sugar debate, it was the medical fraternity that snatched the victory, and the BDA were left to issue a “told you so” PR statement which barely caused a public ripple.  

Perhaps the lesson of influence here was that we need strategic alliances to amplify our voice and our influence.

Why is the BDA so effective on so many levels of “back office” matters and yet on the “Front Line” of headline influence and involvement, it is abjectly falling short. Why is it that as a body of 20000 dentists, they are neither first to be thought of in the media domain nor are they regarded with respect by our political masters?

Incomes … the UDA system …  the Prototypes … the CQC … the GDC and its quisling Dental members …  the GDC and it expansionist ambitions … FtP … more FtP … Professional Morale  … a vision for UK dental care …  Children’s Dental Health … Young dentists and early training...  Planning for Tiers ...   the list goes on where as members [and non-members] we cry out for some serious bloody Bolshiness – and time and again we feel they fall short. Too busy having ‘polite meetings’? You might say that, but I could not possibly comment.

By and large of course those who are in private practice are able to manage their lives and rise above the challenges of NHS practice.  This indeed is reflected in the consistent theme of the HSCIC, Practice Plan and others: their findings relate to NHS practice

So if the NHS GDP is the poor bloody infantry, who are their Generals? 

Well certainly not the new CDO, ironically Colonel [Retired], who is happy to discuss the present and future problems on the same stage as the very man who was their architect, now relishing his role as a non–exec director for a leading Corporate.

The sign of poor morale in an organisation can be its collective ineffectiveness of leadership.

Perhaps the problem of spiralling morale in GDPs is in part due to a perception of low morale at the BDA?

For sure as profession we need a dose of Feelgood Salts and a good kick where it hurts. 

The season is underway.

The BDA need to start scoring some goals.

It’s not like the ball is not in the open, and for sure the net is wide open.  The NHS GDP needs its leaders, its “Generals”, to start doing more than limply waving a PR flag.  I suspect members would prefer one action over the hundred words of a glossy Press Release.

Can it really be a year since we and the BDA all went up in arms over the ARF change?  A fine campaign of action but has 2015 seen it followed through?…  It’s a sad reflection that, as no doubt predicted by Madame Gilvarry and Dr Moyes, the ARF is now seen as small beer – have you looked at your Indemnity bill?

Get a grip BDA.

Start earning your members fees.  Before a large part of the profession withers under your watchful gaze. 

The signs are out there. How many more hints do you need?

Weblinks:

New report looks at motivation and morale of primary care dentists  http://www.hscic.gov.uk/article/6675/New-report-looks-at-motivation-and-morale-of-primary-care-dentists

Dental Earnings and Expenses - 2013-14  http://www.hscic.gov.uk/catalogue/PUB18376

The first NHS Confidence Monitor  https://www.practiceplan.co.uk/dental-plans/the-nhs-confidence-monitor

BDA Current Press Releases  https://www.bda.org/news-centre/press-releases

New CDO to speak at therapists conference  https://www.gdpuk.com/news/latest-news/2004-new-cdo-to-speak-at-therapists-conference

Here is a campaign in which GDPUK can be the leader and get the whole profession to change their thinking, and from there spread outwards.

I believe dentists, their teams and dental company offices and dental events must lead the way by being sugar free.

When we visit a dental organisation offices, or we go on a dental course, a conference, an exhibition, any event at all, we must demand that the organisers make the catering sugar free. As well as the granulated white stuff, we must banish the biscuits and the cakes, put out fruit and other snacks. Our chefs can conjure up delicious sugar free creations - let's make dental events the showcase for them.

I have found it weird that for years we would go to dental events and find white sugar, brown sugar, but we cannot find artificial sweeteners.

We need to banish the sugar from OUR events and encourage hotels, venues and offices to do the same. After dentistry, we must campaign for the NHS events to do the same, there must be hundreds of those every day. Minister of Health?

There are multiple alternatives to sugars for drinks, there are many sugar free options amongst soft drinks

In terms of table top sweeteners, there are intense sweeteners such as saccharin, and there are bulk sweeteners such as sorbitol or sucralose.  Some people cope with artificial sweeteners in drinks, some dislike, we can accept that.  At the premises of dental companies, and in our dental practices the law demands no smoking in the workplace, let dentistry take the lead and encourage adoption of sugar-free to trickle down to all food outlets, all hotels, all workplaces, and from there into homes. It does not have to be forced on anyone, no legislation, just a gentle change.

The larger dental organisations need to change their policies, and shout this from the rooftops. It would be good PR. Give journalists packets of sugar free sweets when the story is launched.

Let's do it, colleagues - we can take the lead and start the change to help our nation's health.

Main blog Image credit - Moyan Brenn under CC licence - not modified.

When an oppressive situation arises develops over the years as the one we have with our current regulator, it is natural initially, to think this won’t directly affect me. Gradually, though, it becomes apparent from the people you hear of who are affected, and then those you personally know that becoming involved, you start to think a little differently.  When its people the calibre of Colin Campbell and ‘Microdentist’ (to name a couple whom I know personally) then as I’ve said before in my previous ramblings, there’s no hope for any of us.

So if this happens to us, we need to know we’ve got the support and help of organisations that can back us to the hilt. The backing of our indemnifiers is our lifejacket; they take our money and promise to help us keep afloat.

But it is becoming apparent that the support we need to rely on might not always be a given. An increasing number of colleagues seem to be being told by their indemnifier that they wont be supported, or they are supported up to a point and then dropped. No smoke without fire? In reality I’m sure there is a degree of this in these situations. Social media is often full of discussions involving this subject, with some of the participants almost wearing a badge of pride that they’ve used their indemnifier multiple times. I’m left thinking in those cases that the problem here isn’t the indemnifier, but the way these individuals are practicing dentistry and not learning from what appears obvious to others. After all, if you keep on crashing your car into the same wall every time you drove to work, perhaps its about time you either drove a different route, learnt where the wall was, buy a slower car you can control, or just give up driving. In these cases the indemnifier is probably absolutely right to start loading the costs of representation.

Is this always the case though? There seem to be so many rumours flying around that suggest if you ring for advice this counts against you, or that if you settle a certain number of times you’ll see your premiums loaded or even cover withdrawn. There is a definite lack of public clarification from the indemnifiers about the decision processes involved in these situations. One of the indemnifiers has said that ringing for advice does NOT load the premium or count towards a risk analysis. But what about a letter that immediately closes a case or offers a refund (which is usually out of the pocket of the practitioner and not the indemnifier). We don’t know what their process of risk assessment is. We need to.

I’ve been aware for a long time of the discretionary nature of much of the indemnity, and the fact it can be withdrawn, and I’m surprised more dentists aren’t. But I’ve never heard of so much of this discretionary withdrawal actually happening as recently. A good part of this is probably due to the unprecedented increase in complaints, but is this the only reason? There isn’t any public explanation usually as to what discretionary cover is, because it’s at their discretion, which is a fantastic catch all, but that doesn’t help us. We don’t actually know what the criteria are, so we don’t actually know if we are going to be helped when we need to be. Some practitioners will be higher risk that others, but that is not necessarily their fault either. Some of those will work in environments that are naturally more hostile than others, such as prisons, and it is not their practicing style that brings the risk to them or the indemnifier but the nature of the patients they treat. I would also strongly argue that there are certain demographics of patients and even geographic hotspots that increase the risk of complaint and claims, and perhaps we should be made more aware of that in order to mitigate the risk to us. We need to know.

I can see the point that if we don’t know what the reasoning is we wont construct our practice around it. A sort of Indemnity Gaming if you like; if you know the criteria that are used then you know what you can get away with and just stay within the margins (if you are a dodgy practitioner that is). But this is what risk assessment should be about. I’m talking about the risk to our livelihood and careers here. We can lose our home due to a regulator that we accept is not fit for purpose, so we need the security that our indemnifier is going to be transparent and fair with us.

I don’t see any profits warning or indications that their membership reserves are running terminally low from any of the indemnifiers which suggests that they are in reasonable financial health. Given the beautiful offices that many of then operate out of confirms that indemnity is big business. Which leads me to where I think part of the problem lies.

The bigger a business, the more it loses its personal touch. There is a immediate personal contact with the advisors who do so much valued work, but they are not going to be the party that decides if support is withdrawn or not. That is likely to be made at a higher level, lacking in the emotive connection with the dentist. There is so much litigation going on now that the indemnifiers have to be large, and have to have the resources necessary to run such organisations. The costs of the support network in order to run the core business are huge. The cost of the legal representation for its clients is also huge, and shows no apparent sign of getting any less. As more patients complain via the medium of ‘No Win No fee’, or direct through the GDC, then the need for the indemnifier grows symbiotically as does the drain on its resources. With the demand to stay in business, then the indemnifier needs to ensure it is financially solid enough to survive to protect its clients. Its survival then becomes the prime reason for its existence, and it becomes even more risk averse. Thus affecting the very clients it is there to protect. Is this why some dentists are finding themselves without a lifejacket? Will there eventually be a multi million pound business protecting the one or two clients who are so risk averse themselves they will never need the indemnifier as they never see a patient?

This symbiosis is no different to any other supply and demand industry. The more the GDC presses ahead with what appears to be the UK’s largest complaints handling business, the more the indemnifiers will grow on the back of the legislative need for us to protect ourselves. The more they need to protect the finances of the business it becomes.

But we need to know they will be there for us when we are walking the plank. Perhaps the indemnifiers should publically reconnect with us, be more transparent, and show us their human side once more. After all, it’s not all about the money….

It’s about saving lives.

Did you read Part 1 of this blog? If not, click here

Image credit -Ian Armstrong under CC licence - not modified.

Readers may or may not have experienced the delights of going on a cruise. So how does a voyage on a Dental Cruise sound?

You join your ship with lots of other passengers and set sail. What is vitally important though is that you’ve been told before you sail you have to provide your own lifejacket. You notice that there are quite a few different sorts and colours. Some are ones that only inflate whilst you have them with you, and some are inflated all the time, even when you get off the ship at the end of your journey. Some passengers even have special coloured expensive ones that some of the lifejacket manufacturers don’t even supply. We’ll come back to those later. The industry is getting bigger and bigger, so more and more life belts have to be made for all those going cruising.

Initially it’s all really nice, the food’s ok, and the accommodation is too. However, there’s something not quite right. The crew seem to be openly hostile to you, and the officers never seem to speak. The captain of the ship and the 1^st officer never come down to speak to the passengers. You’re actually suspicious that the direction the ship is headed isn’t the one you signed up for. Not all the islands you visit are as welcoming as others. After a couple of ports you also start to see the numbers of passengers dwindling a bit and you hear a lot of splashes at night.

You do a little research and you find out that the crew is in better quarters than you are, and your money has gone to pay for that. You have to tip the crew more and more even though the service is rubbish, and then you find out the way they worked out the tips was illegal. More worryingly you hear that the captain orders the crew to round up passengers who might be a danger to those who live on the islands the ship has visited or might visit yet. The captain orders the islanders to report anything they don’t like about the passengers to the bridge. The captain also allows spies to be put ashore to trap some passengers if the locals themselves don’t report the things that are done ashore. Passengers who have committed some sort of infraction are invited to visit the Bridge for a tour. Its not an option. You hear rumours that some of the officers don’t speak as the 1^st officer has ordered their tongues cut out, possibly to prevent mutiny. You laugh at this, but you start to get a bit worried. You realize the crew doesn’t trust the passengers at all. Some of the passengers even report other passengers, or get the islanders to report them, or even join the crew.

Then you see why the passenger numbers are dwindling. Every night, the crew makes those passengers who’ve had the bridge visit walk the plank. They are allowed to take their lifejackets though. Sometimes the crew let the passengers off before they get to the plank, although there isn’t always consistency as to who will be let off or not. Some even get halfway down the plank before they are allowed to come back. Usually that’s because the lifejacket manufacturers send their best machinists and repairers to make sure of the buoyancy of the jacket whilst its owner is on the plank. This costs the manufacturers lots of money, so it’s better if the lifebelts never get used in the first place. But you’ve already paid for the service when you bought the lifejacket.

Most of those that do fall off the plank therefore obviously have their lifejackets to help them. These keep them afloat until the rescue boat picks them up and puts them back on the ship. Sometimes some are thrown overboard before the captain has heard the case and they might be allowed back on board, or they might be put ashore until the case has been heard, then they get to walk the plank all over again.

However, there’s a problem with some of the lifejackets. Not all of them are going to work. Most do, but not all. Any you might be wearing one that isn’t going to work when you need it.

Now some of this is because the passenger has done something so bad that Mercenaries employed by the crew are allowed to puncture the lifebelt. Some of these passengers drown or swim to shore, but either way they never get back on board. Occasionally the crew or even a mercenary punctures a lifebelt through their own incompetence and hope they don’t get found out. The lifejacket repairers sometimes throw a spare lifejacket to them. But sometimes the sharks get them first.

But sometimes its because the maker of the lifebelt has decided not to put the flotation device in a lifebelt because of something you’ve told them or you’ve walked the plank before. It looks the same, and you certainly paid the same for it, but its only when you try to use it that you realize its not working. Remember those with the special coloured expensive lifebelts? They’re really expensive because the normal lifejacket makers wont supply normal ones to these passengers because they keep being made to walk the plank, or just keep jumping overboard because they do stupid things and don’t seem to learn from it. In fact, some of the lifejacket makers wont supply them at all but don’t always say why. Strangely, some of these passengers seem to arrive at the ship in fast cars and occupy the biggest and best passenger suites.

Occasionally there are times when a passenger is walking the plank and the manufacturer of the lifebelt actually takes it off them, either just before they walk, when they’re in the water, or when they get back on board having survived the ordeal. The rules say passengers can’t stay on the ship without a lifejacket, but they now can’t get one to fit, the manufacturer wont sell them another, or they don’t have enough holiday cash left to buy another one. They either have to stowaway for which the penalty is immediate plank walking, or they have to get off at the next port.

The captain no longer answers to the ships owners, but they don’t seem bothered, and the captain and 1^st officer decide they’re going to expand their little seafaring enterprise as a result. There’s a ship right behind with loads of passengers that go ashore and always paint the islands white and harm the natives, and occasionally the captain makes one of them walk a plank, but doesn’t seem that bothered by the harm they’re doing. They don’t have any lifebelts on that ship either.

The passengers frequently get together and talk to one another, but no-one ever has the bravery to arrange a passenger mutiny even though they keep having the cost of the planks added to their tips. Most of the passengers are too busy trying to protect themselves to look out for the others. The senior officers of the crew don’t talk to one another as they haven’t any tongues, and those passengers that become part of the crew and can still talk don’t want to resign as they say they’re the ones that keep the bridge visits and plank walking fair. The happiest are the mercenaries that get to puncture the lifebelts as they get a bonus especially if they can make it take longer. The manufacturers seem to want to really only give the lifebelts to those that will never use them as they don’t have to spend money readying them for plank walking or repairing the punctures. But their top repairers are happy because they get paid more when they have a puncture to repair.

What a silly story…. No one in their right mind would get on that ship if they read that, or stay on it a moment longer than they possibly could once they found out what was happening.

Read Part 2 of this blog by clicking here.

Denplan is urging the British public to go sugar-fee for September, following the results of its latest survey of over 2,000 adults¹, which has shown a desperate need for better sugar education as Britons think chocolate, sweets and fruit juice contain no sugar.

It appears the public are clueless when it comes to sussing sugar in foods, as one in five (21%) don’t believe chocolate contains sugar, with the same amount (22%) thinking biscuits are sugar-free too. Drinks are not immune from sugar ignorance either, with almost half (47%) of respondents believing that neither wine or beer contain sugar. Perhaps more worryingly, over a third (38%) of people asked did not know that fruit juice contained sugar, despite warnings from Action on Sugar that many juices contain at least six teaspoons of sugar - more than cola².

Other food and drinks which respondents believed were free of sugar included the below:

-      Sweets (20%)

-      Hot chocolate (30%)

-      Fruit (40%)

-      Spirits (58%)

-      Fizzy drinks (20%)

-      Sports drinks (26%)

-      Energy drinks (28%)

This worrying lack of knowledge could be reaping havoc on the nation’s teeth. Many patients are not aware that each time sugar is consumed, teeth are under acid attack for up to one hour, producing harmful acids and increasing the risk of tooth decay. Some are also unaware that fizzy drinks could be just as harmful to the teeth and that carbon dioxide gas is used to create bubbles in fizzy drinks, which then turns into a very dilute acid in the drink. This exposure to dilute acid can lead to the dissolving of tooth enamel if consumed on a regular basis.

The new results also showed a clear need for more clarity on labelling of products, as 54% admitted that they wanted to reduce their sugar consumption, but just one in five respondents could decipher whether a product contains sugar by reading ingredient labels. 80% said they don’t always check the list of ingredients before buying or eating food, and over a third of respondents (38%) said they didn’t know the difference between ‘sugar-free’ and ‘no added sugar’. 

Whilst this low level of knowledge may seem surprising, it’s now harder than ever to avoid sugar, even in unexpected foods such as bread, sauces, flavoured water drinks and canned soups. And looking at the labels for sugar content isn’t always straightforward, as there are over 30 different names for sugar – including fructose, lactose, glucose, and dextrose. 

Although a range of diets have advocated a low or no-sugar approach over the last year, in reality, less than half of respondents had tried to quit sugar, and less than 10% have successfully done so for more than a year, with a quarter lasting less than a month.

Henry Clover, Deputy Chief Dental Officer at Denplan said “With sugar ‘hidden’ in so many unexpected foods and drinks, managing our daily sugar consumption can be a challenge. Not only is this detrimental for the nation’s general health, it can also significantly affect our oral health because the frequency at which we consume sugar is a huge factor in tooth decay. However, there are so many simple changes people can make on a daily basis to cut back on unwanted sugar and still enjoy a healthy and tasty diet, leaving them with healthy habits that their teeth will thank them for.”

Worried about the lack of knowledge surrounding sugar consumption, Denplan are urging Brits to go sugar-free for September. Logging on to www.sugar-free-september.co.uk will give patients access to information on hidden sugars, reveal the health risks of too much sugar consumption, provide tips on how to cut back on sugar and explain the importance of regular dentist visits and a better oral health regime.

References

¹  A Onepoll survey of 2,000 participants conducted in May 2015

² http://www.bbc.co.uk/news/health-29986012

It’s just two months until BDIA Dental Showcase, the UK’s premier dental trade show, opens its doors for business, so make sure you have registered at www.dentalshowcase.com 

At the NEC in Birmingham between 22^nd and 24^th October, around 350 exhibitors, many launching new products and offering incredible show deals, will be on hand to demonstrate to you and your team the latest innovations in technology, products, techniques and services.  Whether it’s specialist manufacturers, dental suppliers, professional service providers or global brands, the most significant and innovative companies in the dental world see BDIA Dental Showcase as a must-attend event, providing an unparalleled opportunity to ‘See it, try it and buy it’. 

It’s also not just the latest products that you’ll find at BDIA Dental Showcase.  With a comprehensive programme of over 100 mini lectures, seminars and on-stand demonstrations, industry experts and thought-leaders will be sharing their knowledge.  Take a look at the lecture programme and discover the diverse range of subjects covered, from learning new techniques and procedures through to helpful and hands-on business advice that could bring you greater success.

In keeping with the BDIA’s pledge of ‘putting innovation into practice’, there is always something new at Dental Showcase.  For example, this year sees the inaugural Dietary Zone, sponsored by The Dairy Council, which reinforces the link between diet and oral health.

BDIA’s Executive Director Tony Reed said: “Every year BDIA Dental Showcase continues to deliver what attendees want – new products, good deals and an opportunity to broaden knowledge in the CPD verifiable mini lecture sessions.  Many of our visitors come back year after year and use BDIA Dental Showcase as a platform to see new products and learn about what’s new in dentistry.”

So why not join more than 10,000 dental professionals and come along to the dental event of the year!  Registration is simple, just go to: www.dentalshowcase.com, call 01494 782873 or email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Check out the website for a complete list of exhibitors and the updated lecture programme, you can also download the Showcase app to help you make the most of your visit.

The BDIA represents and supports manufacturers and suppliers of dental products, services and technologies, to the benefit of members, the dental profession and the public.

BDIA members gain access to a range of services designed to benefit them and promote the wellbeing of the industry as a whole and the profession gains the reassurance of dealing with like-minded individuals who are committed to providing a high quality standard of service.

BDIA is a non-profit organisation which means that we dedicate our funds solely for the purpose of developing dentistry for the benefit of our members, the profession and the public.

For further information on BDIA Dental Showcase, follow @dentalshowcase on Twitter or like our Facebook page, ‘BDIA Dental Showcase’.

Contact: Dianne Gettinby, Marketing Manager:

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

For more information on the BDIA, please call 01494 782873 or visit www.bdia.org.uk

Institutional Arrogance

Many of you will be reading this from the sneaky preview of your ‘mobile device’ while on holiday so I will keep my mumblings brief. Don’t want the present Partners or Spouses to my dear readers getting a holiday stress on!

Holidays are of course the time when you re bond with the family, and past troubles diminish in their significance such that when you return, the sun still shines and the daises are growing. Holidays allow a new focus on the real issues such as the performance of the many Premier League teams.

If you are single of course holidays can be a “fun” time, strangely challenging in some respects. The STO or Short Term One-nighter relationship can lead to some interesting morning conversations.  Matters of Validity of Consent can raise their head.

And so it is, in your professional area of work.  

I do, I do I do …

You will return from holiday to a focus on your note taking and records like never before. For some time this has been defensive, and a recent case [1] now confirms that it is not enough to record what treatment you undertook. You must now have a discussion with your patient about the risks or proposed treatment, and you must know your patient sufficiently well to apply context to those risks, and the end result will be that the patient should be able to agree to a course of action of their own free will.

GDC Standards for the Dental Team was of course ahead of the consent game by stating in 2013

3.1.2 You should document the discussions you have with patients in the process of gaining consent. Although a signature on a form is important in verifying that a patient has given consent, it is the discussions that take place with the patient that determine whether the consent is valid.

3.2.2 You must tailor the way you obtain consent to each patient’s needs. You should help them to make informed decisions about their care by giving them information in a format they can easily understand.

This of course all takes time. As busy GDPs in mixed practice, that is the one thing that most of you will lack. The threat of an FtP case against you however focusses your mind.

Welcome back to the Autumn of un-squareable circles, as the GDC in their lofty arrogance see no reason why you should have a problem, that body being out of touch with reality.

OK …  Talking of that body the GDC  …

If you have not heard, the problems have officially been fixed. Hurrah!

The Professional Standards Authority issued a report [2] being most unfair & critical of the GDC. The GDC Press release [3] in response was beautifully dismissive – a masterpiece in Institutional Arrogance. Taking arrogance to a new level. Real Premier League stuff

We have already instigated a significant programme of change within the GDC which will help us to support dental professionals to deliver high standards of care and maintain public confidence in the profession.  

You would never guess that the PSA were critical in the extreme, the GDC being a long way below the standards of other regulators. Someone has to come bottom of the class but the GDC take that ‘achievement’ to a new level. You hear the PSA sighing in frustration.

Constantly we hear the mantra from the Executive Suite in Wimpole Street that a new Parliamentary Section 60 order is needed. And yet we read in Fitness to Practice rules [4] as follows:

Initial consideration by the registrar.

The registrar shall consider a complaint or other information in relation to a registered dentist or a registered dental care professional, including a dentist or dental care professional whose registration is suspended, and shall determine whether a complaint or information amounts to an allegation

So the reality of the GDC’s crisis is that it is entirely in the hands of the Registrar to create a system to sort out the wheat from be chaff in letters of allegation received.  Instead of picking true FtP cases, the Registrar operates a set of rules in which it seems that any allegation is considered seriously.  Good grief, the Caseworkers are in some cases a contracted company. 

The GDC has descended to the role of a commercial Complaints Handling body.

Standards is being used as stick to beat the profession and not as a level of practice to which to aspire.

Fitness to Practice is not a Regulatory function in hands of Ms Gilvarry, it has become a commercial operation of immense cost, be that financial to the wider profession through the ARF, the financial cost to a dentist under investigation, or of course  the emotional cost to dentists.

The way that Ms Gilvarry operates demonstrates that she has mastered the delivery of Institutional Arrogance. In the Chairman, Dr Moyes,  she has a willing partner who has revoked his role of oversight.

Who will rid us of this rotten leadership? The summer may be over but the need remains.

Coalescence

It is time for the six registrant members of the GDC to seriously consider their positions. I assume even they were shocked at the GDC’s Press Release.  The BDA and FGDP, perhaps with DPL, & DDU, and perhaps with Denplan, Practice Plan et al, have a massive role here through the BDJs editor’s concept of Coalescence[5]. Action is needed to grab the attention of both the Minister and the Council.

Unless of course they have all caught the Institutional Arrogance disease

 [1]The Montgomery case - Montomery -v-  Lanarkshire health Board Scotland 2015

[2] PSA link

[3] http://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/General-Dental-Council-response-to-the-PSA%E2%80%99s-report-%E2%80%9CRethinking-Regulation%E2%80%9D.aspx

[4]  http://www.gdc-uk.org/Aboutus/Thecouncil/Meetings%202006/Items%208%20and%209%20FtP%20Rules.pdf

[5]  BDJ leader Vol 219  No 2 July 24^th  “Coalescence”  Stephen Hancocks OBE

Is there anybody out there?

These words introduce the beginning of my favourite song, Pink Floyd’s ‘Comfortably Numb’, the title of which has always struck me as a particularly apt song for dentists.

Several times in my career different parts of the song have resonated with me for various reasons, but this is perhaps the first time the whole song in its entirety relates to dentistry at the moment. For those that don’t know the song, it’s about a reluctant performer who is made to keep going on stage by the various influences and promises of those who seek to benefit most from him, without any consideration as to how the performer is actually feeling inside. Sound familiar? Give a performer a new drug (the continued promise of a new contract??) and that’ll keep you going through the show….(despite the eventual catastrophic effects).

However, I’m not going to muse about the wider issues of dentistry that are analogous to the lyrical musings of Roger Waters otherwise this will be a very long blog.

So, in particular given the recent Professional Standards Authority paper looking into the rethinking of regulation, one has to ask if there is indeed anyone out there who is actually listening to what this paper suggests.

Here we have what is effectively a toothless organization in the PSA (show me precisely what it has actually done to rein in the GDC given its publicized failings over the last few years?) that is suggesting a completely new way of thinking with regard to the regulation of the professions. Its worth a read as there are many things that have been mentioned within the pages of GDPUK.

However, it’s one thing suggesting this radical rethink, but who with the power to actually instigate change is listening to what the PSA have to say? The Health Select Committee still seem to be getting their diaries in order after the election, and with no apparent repeat hearing for the GDC in the offing one has to wonder if other more pressing health matters will take priority over our issues. There appears to be no pending Government Bill in the offing to set up a super regulator (which is what I personally think will happen eventually) or rewrite the outdated legislation of the current regulators. It is obvious that the PSA sees radical failings in the current scheme of regulation, and we all know the opinion it has of the GDC in particular. However, we need to be careful about thinking the PSA is our knight in shining armour riding to the rescue; one of its remits is to review all the decisions of the GDC FtP process and if it feels they are insufficiently protective of the public (i.e. not a harsh enough punishment) then it can order further action against the registrant via a re-hearing. So they are no particular friend of the regulated, but I would counter that by suggesting they are at least an organization with the ability to actually understand what modern regulation requires. They, after all, they keep referring to the paper written by them for the Council for Healthcare Regulatory Excellence on what ‘Right Touch’ regulation means, and it doesn’t appear to always be the touch of the executioner’s sword.

There was a suitably robust call from the BDA for the government to take action as a result of the PSA paper, and whilst this is the sort of thing we need to see and hear from the BDA, once again I have to ask if there is anybody out there to listen? We are unlikely to ever get any press sympathy like the GP’s do; when the Daily Mail is happy to run a story asking if we are all Natural Born Killers as a result of the recent Lion hunting episode then we really are going to lose that battle before we begin. As a profession we already know the issues, so really the BDA is only going to be preaching to converted. How they get the message out to the wider public is the key to getting the regulatory change we so desperately need. That is going to require an awful lot of positive PR and I don’t see much evidence of that. Even the fact we have been harping on about the perils of refined sugar for years seems to have fallen on deaf ears until our medical colleagues woke up to it.

The PSA paper recognizes that over-regulation costing more offers no additional benefit to the patients, or the fact that healthcare has inherent risks that cannot be regulated out without a disproportionate amount of money and time, and that attempting to do so only serves to not only stifle the beneficial innovation that can help the patient, but also the general benefit to the patient overall. None of this will be news to any ethical practitioner reading this; but it’s not us that needs to take heed of this, we need to be listened to by the people who can instigate change and actually have a desire to do so.

The PSA also admit that one of the problems with the current outdated regulation mechanisms is that the action or words of a registrant last lasts only a mere moment or so but can result in serious damage to not only their careers and lives, but the lives of their families too; often having a serious and lasting effect. Again, not news to us particularly, but at least it is being recognized by the PSA. The disproportionate effect of a minor, spurious, or downright vexatious complaint should not be able to carry this threat, and indeed never used to; but more recently seems to be something that we must all be prepared to bear as an occupational risk no matter how diligent we are in our care and dealings with patients.

More interestingly for the GDC though is that the PSA warn against the expanding of the boundaries of regulators and the lack of clarity and tensions this then produces. It’s no secret that Mr. Moyes has said he would like to develop the role of the GDC and broaden its remit. It is already apparent that this seems to have begun, as the GDC is no longer just the upholder of Standards within the profession but has become the de-facto complaints service which will happily look into every single issue it is made aware of. A stop to this ‘mission creep’ as the PSA call it must come sooner rather than later, but again, the PSA has little power to prevent it at the moment.

Yet the GDC in its latest press release once again refuses to acknowledge that responsibility for regulatory failings are in any way its responsibility, choosing to blame once again the legislation that constrains it, and actually indicating it doesn’t go far enough currently. I think most registrants would be of the opinion that when a single complaint can have you in front of a committee that can end your career, then there isn’t actually an issue with the legislation not going far enough. The GDC is also apparently putting in place a series of ‘measures’ to help support the profession in delivering high standards of care and maintain public confidence in the profession. What these measures are we don’t know yet, but of course one way of doing this would be to make sure there are less people able to meet the standards they enforce, either my repositioning the interpretation of standards to make them virtually unattainable, and then ‘help’ by removing the registrants who fall short via the FtP process or by just driving them out of the profession by fear. Maybe this is too cynical a view but it’s hard not to have such thoughts in the current environment.

More and more I hear of dentists leaving the profession due to the immense pressure placed on them every day. Despite their best efforts to remain positive, it is increasingly difficult to not think that the next patient could be the one that ends their career, despite not having done something bad enough to justify such a draconian result. That makes the risk of practicing dentistry increasingly difficult to justify. It would be interesting to see if you are likely to have a longer career these days in the field of professional bungee jumping or crocodile wrestling than clinical dentistry. In what way does this help patients when good practitioners decide to leave our profession?

I remember a satirical comment a few years ago that eventually there would be 100% employment in the UK. Only one person would actually have a job doing something, but all the others would be employed to regulate them. I can see the dental profession going this way if someone in power doesn’t start to listen soon, as there will be less and less people electing to remain in or join our profession. We as individuals therefore need to unite and show the public that the pressures on our profession will directly affect them. Only when the voting public is affected will the situation come to the attention of those in power and change can be made. Although how this will pan out if the supposedly unelectable Jeremy Corbyn takes control of the Labour party and renders the opposition as toothless as the PSA remains to be seen.

Getting back to the title of the song then, the problem is that too many of us are (un)Comfortably Numb with inactivity. So we are reaping the rewards of our complacency and intransigence and will continue to do so unless we unite to do something positive. If we were as vociferous and active as dairy farmers have been recently when things finally got too much to tolerate we would have arranged some form of peaceful and professional group action. Perhaps we should round up a few hundred small cats (lions would be too difficult to risk assess and probably attract the wrong type of dentist) and release them into the General Dental Council chamber at the next meeting. Trying to herd said bunch of cats into Wimpole Street is likely to be simpler than getting dentists to do anything en masse. We could then say not all dentists have a desire to hunt cats (including small ones), and given that social media these days seems to be obsessed with the antics of cute kittens then surely this is guaranteed to get positive press interest. A flock of sheep might be easier to manage, but we don’t really want them in the Council Chamber do we? Tongue in cheek maybe, but food for thought nonetheless.

In all seriousness though, whilst it appears the public at large don’t appear to have a clue what damage over-regulation and the current litigious and complaining environment is doing to the ability for dental professionals to care for them appropriately, these are the same people who in their chosen fields are also likely to be suffering from similar threats. Speak to many of your working adult patients and you’ll find we are not alone in suffering the pressures we are currently under. Admittedly there might not be the same degree of threat to their career and livelihood, but certainly anyone in one of the professions and the emergency services have very similar issues as we do. ‘Guilty until proven Innocent’ is not unique to dentistry.

This is the message that needs to be conveyed in no uncertain terms to the public by both our professional leaders and us as individuals. Only when the public has empathy with us will we have their support. If nothing changes then the profession will dwindle more and more as a lack of morale grows.

For it is they the public as patients who will then suffer most when there are no longer any of us out there.

Image credit -Samuel Rodgers under CC licence - not modified.

Committed to providing innovative technologies and ensuring you receive all the training you need to maximise on the benefits, Carestream Dental is running FREE seminars for the CS 3500 intraoral scanner.

The seminars will demonstrate the simple transition from conventional impressions to digital modalities, offering a wealth of practical advice for you and your whole team.

An ideal platform for the sharing of ideas and experiences, you’ll also hear success stories from other dentists, technicians and patients and discover how the CS 3500 can save you time and money while ‘wowing’ your patients.

Confirmed dates:

• 22nd Sept - Derby
• 6th Oct - Cheltenham
• 7th Oct - Haydock
• 8th Oct - Oxford
• 28th Oct - Norwich
• 29th Oct - Kent
• 11th Nov - Bath

Completely free to attend and with 0% interest free credit details available at the events, can you afford not to come along?

To book your place please call 0800 169 9692.

For more informationabout  Carestream Dental call

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

Or follow us on Twitter @CarestreamDentl and Facebook

BDIA Dental Showcase is the UK’s premier dental trade event because it’s the show that has something for every member of the team.

This year’s event, held on 22-24 October at the NEC in Birmingham, will host over 350 exhibitors demonstrating the latest in products and services, an extensive programme of CPD mini lectures and presentations, plus the opportunity to find out about new initiatives and developments affecting the dental industry.

Try and buy

With hands-on access to the latest innovations and a great range of exclusive show offers, Dental Showcase is the perfect event to make the purchases you need to enhance and grow your business.  In fact, 73% of visitors made purchases during, or as a direct result of attending, the event last year. 

Many companies use the event to announce the launch of exciting new products and services.  Whether it’s global brands, world-leading manufacturers, local suppliers, or companies exhibiting for the first time, if you want to be up to speed with what’s happening in the dental world, you need to be at BDIA Dental Showcase.

It’s not just products and services

In addition to experiencing the latest in technology and techniques, there’s a whole lot more to Dental Showcase.  This year, for example, sees the launch of the Dietary Zone.  Sponsored by The Dairy Council, this dedicated nutritional section recognises the impact of diet on dental health and provides a wealth of information and resources for team members involved in talking to patients about the effect of diet on oral health.

The Association of Dental Implantology will be presenting taster sessions of their highly regarded Introduction to Implantology course, and on Friday 23 October, the BSDHT will be hosting a day of special lectures, awards and CPD for their members.

Catch up and converse

As the UK’s best attended dental trade show, Dental Showcase gives ample opportunity to meet up with friends and colleagues.  Many associations will be holding special events and many more will be exhibiting, so you can discuss the latest developments in your particular field.  Among the associations in attendance will be the Association of Dental Administrators and Managers, the British Academy of Cosmetic Dentistry, the British Association of Dental Nurses, Dental Fusion, the National Examining Board for Dental Nurses and the Orthodontic Technicians Association.

With so much to see and do – start planning now!

Because there’s so much happening at BDIA Dental Showcase, you’ll want to make the most of your visit.  Start by registering now for tickets for you and your team, by visiting www.dentalshowcase.com.

The website can help you decide which exhibitors you’ll want to visit and the lectures or demonstrations you won’t want to miss.  You can even download the new Dental Showcase app to help your visit go smoothly and to share your thoughts and comments whilst you’re there!

For further information and a link to register can be found at www.dentalshowcase.com

Anthony and Sue Inman, Principal Dentist and Practice Manager of Beechwood Dental in Bournemouth, were among the 7,908* delegates attending The Dentistry Show 2015.

“This year, we saw another huge increase in the quality and variety of CPD available throughout the two days, as well as many more trade stands among the exhibition.

“In particular, we were keen to find out more about the various orthodontic systems and facial aesthetic training courses available, as well as new marketing ideas and effective use of media. We were delighted to find everything we wanted and a whole lot more!

“The key benefits of The Dentistry Show for us is the easy to reach location and the opportunity to network and share ideas with like-minded people.

“We would highly recommend The Dentistry Show to anyone looking to enhance their practice – we have already saved the dates in our diary for next year.”

Free to attend for the whole team, The Dentistry Show offers a wealth of information, advice and inspiration for all. Make sure you don’t miss out in 2016!

The Dentistry Show and DTS 2016 will be held on Friday 22^nd and Saturday 23^rd April, NEC in Birmingham. For further details visit www.thedentistryshow.co.uk call 020 7348 5270 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

• Exploring new horizons – presented by mydentist
• Exciting innovations that will change the way you practice dentistry –presented by DirectaDentist
• Quick, straight smiles from Cast and SmileTRU – presented by SmileTRU/Cast
• Producing and maintaining a perfect finish on anterior restorations – presented by Oral B
• Cerezen clinical trial overview – presented by CerezenTM
• Better understanding of how banks assess lending propositions – presented by Lloyds Bank
• Ergonomic sitting in dental practice – presented by Salli Systems

The Chancellor of the Exchequer, George Osborne, delivered his second Budget of 2015 today, 8th July 2015. Following the promises made in the election campaign the main focus was, unsurprisingly, on cuts to welfare spending. Nevertheless, there were items of interest to dentists as Jon Drysdale explains.

Two tax measures will benefit most dentists

First, the higher rate threshold will increase from £42,385 in 2015-16 to £43,000 in 2016-17. This will undoubtedly benefit many dentists as the majority are higher rate taxpayers. The amount people will have to earn before they pay tax at 40% will increase from £42,385 in 2015-16 to £43,000 in 2016-17.

Second, the tax-free Personal Allowance will be increased from £10,600 in 2015-16 to £11,000 in April 2016. The tax-free Personal Allowance – the amount people earn before they have to start paying Income Tax – will increase to £11,000 in 2016-17.

Buy–to-let landlords lose tax break

Many dentists invest in buy-to-let property – a strategy that is already under pressure from decreasing yields. Landlords who currently receive tax relief at 40% and 45% on their costs – including mortgage interest – will be restricted to claiming 20%. This is to be phased in by April 2020 and puts further pressure on buy-to-let yields.

Incorporated dentists: dividend tax rates reformed and corporation tax reduced

The dividend tax credit (which reduces the amount of tax paid on income from shares) will be replaced by a new £5,000 tax-free dividend allowance for all taxpayers from April 2016. Tax rates on dividend income will be increased and are likely to affect those dentists who take income in the form of dividends. However, Corporation Tax will be cut to 19% in 2017 and 18% in 2020.

Pension reform

A major 'root and branch' reform of pensions was announced with a Green Paper for consultation to be published shortly. The implication is that tax relief on pensions may be reduced and tax-free access to pension pots further eased.

Those dentists with incomes over £150,000pa will be restricted to claiming tax relief on no more than £10,000 of pension contributions. This may make the NHS pension significantly less viable for dentists with this level of income.

Comment

Jon Drysdale, an independent financial adviser from Chartered Financial planners PFM Dental, says: “This budget didn’t contain too many surprises, although dentists who have incorporated will need to consider their remuneration strategy carefully due to dividend tax reform. Landlords were hit with the withdrawal of some tax relief and this may see buy-to-let yields fall significantly.

Jon Drysdale is an independent financial adviser for Chartered Financial Planners PFM Dental. He specialises in pension and wealth management advice exclusively for dentists.

For more information visit www.pfmdental.co.uk

At GDPUK towers we love to keep an eye on the statistics that the site creates. We want to make sure we are still doing all the right things to attract an audience that stays engaged with the site and of course interacting on the forum.

Below are a few stats we would like to share, we are very proud of these and they show that GDPUK is constantly used for news, views, opinion and information.

These stats are up to date, as of 30th June 2015.

• In June 2015 alone, we have had over 100,000 opens of our daily digest emails (sent 3 times a day)

• We published a news story on Friday 26th June called “GDC labelled worst of all regulators”. As of Monday afternoon we have had over 4500 readers. This shows the reach of GDPUK news by using various social media platforms and our daily digest email.

• This year, the site averages 32,000 unique visitors a month

• Users continue to join the site, membership is now getting close to 9000 people, who are all members of the dental community.

• The forum attracts just over 1000 different contributors a year.

• Whilst on the topic of the forum, it continues to attract readers and plenty of engagement. Since our present site went live (late 2008), there have been 18653 topics created and 209771 posts. An average of 11 replies a post. This definitely demonstrates the amazing amount of discussion and activity that takes place on the forum.

By sharing these stats we want to demonstrate the reach of GDPUK and how we feel we get important dental news in front of thousands of readers daily. Thanks for sharing, engaging and reading the site, we appreciate the great dental community that continues to support us.

If you would like to join the forum (it’s free) and get a feel for what is happening in UK dentistry in 2015, please follow this link. If you are already a member, keep spreading the word and telling your colleagues about the site :)

Thanks for reading, please get in This email address is being protected from spambots. You need JavaScript enabled to view it. with me if you would like further information on GDPUK.

Jonny

The Hired Gun with a smoking gun….

We all know the GDC has spent the last few years on its own little self-righteous planet, and even given its recent pitiful showing in front of the Health Select Committee there appears to be no sign they are planning to return to normality in the near future.

Indeed, this week, what can only really be described as damning evidence of the GDC’s utter and complete contempt for the process of Justice in its most fundamental form has been revealed.

A case in front of the Professional Conduct Committee this week has revealed that it is not only the initial stages of the disciplinary process that are woefully inadequate which resulted in their huge backlog of cases; but that the basic legal requirement of full disclosure of the case against a registrant may be riddled with horrific inefficiency and contempt for the fundamental tenets of justice. Not only that, the GDC is not following the rules set out for its registrants and flagrantly flouting them in order to pursue its own agenda of what now appears to be a persecution of the profession via its individual registrants. The PCC themselves described it as an ‘Offence to Justice’.

In this particular case, amongst other things, the GDC had 9 different versions of its expert witness report, and failed to submit many of them in a timely manner for the defence case to be prepared. It was still submitting them to the defence on the day of the scheduled hearing. Not only that, but it would appear that evidence the GDC held was not submitted to the defence at all, which may have helped the defence case. Thankfully the outcome has been for justice and propriety to be upheld by the members of the PCC. (who have for some reason remained anonymous)

With the facts that have come out about the way this case has been handled, the GDC has now plumbed new depths it seems. I didn’t think we could be treated with any more contempt that we already were; but this is jaw-droppingly bad. By what definition do the GDC expect us to have fair trial if they don’t submit the evidence as per the rules? They fail by their own standards throughout this case. Where is their duty of candour? Where is their transparency in their dealings with the registrant?  Have they actually read the Human Rights act? I refer them particularly to Article 6, the right to a fair hearing, which quite obviously would not have occurred in this case had it not been for the integrity and the strength of the members of the PCC.

For the PCC to accuse the GDC of being egregious (or outstandingly bad) is an extremely strong and unusual stance for them to take. Whilst this occasionally happens in the criminal and civil courts when a judge or jury might take exception to the conduct of one of the sides, for a committee funded by one of the sides to effectively take a swipe at its paymaster is highly unusual. I know the PCC is made up of independent members, but don’t forget, despite this independence, they are funded by the prosecuting side, the GDC. I am not for one minute casting any doubt on the integrity of any of the members of these panels, and in this particular case nothing could be further from the truth. But one has to wonder how much of a culture of fear is being instilled that pervades throughout any process the GDC is remotely associated with including these committees. How many other cases have been similarly dealt with by the GDC and the PCC not spoken up in the same way? We know now that this is an organization that doesn’t seem to apply the rules of law and justice properly to those it pursues, and even think these rules don’t apply to itself, and then show no insight whatsoever into its failings. Even the GDC solicitor involved in the case appeared to have had an inappropriate contact (not contemporaneously noted incidentally!) with the patient witness in order to ask leading questions and to coach them which also a big no-no.

Just as strident but more worryingly to my eye is the criticism the GDC’s expert witness comes in for at the hands of the committee. I have not seen this amount of criticism of the expert in any case before. It almost seems like he has gone out of his way to act as some sort of private investigator in order to help the GDC secure its desired conviction. There have been a couple of cases recently where the GDC’s expert witness has come in for criticism, but not to this degree.

Expert Witnesses are required to be independent and objective. It is an enormously privileged position to be in as they alone are allowed to give opinion-based evidence to a court and not just statements of fact. They are not and should never be seen as a Hired Gun to destroy the defendant. For whatever reason it would appear that in this case the expert has gone beyond his remit in such a way that one could seriously question that if this were a civil or criminal case whether serious charges against him would be the result of such a deviation from the accepted role. All the expert witness training I’ve done (and I’ve done a lot) has stressed the importance of never being a Hired Gun. I’ve had solicitors request I change parts of my reports to better serve their cases; and the answer has always been an immediate refusal. An expert witness has a duty to the court and to no-one else. We are not Magnum PI no matter how much we might want to be.

But by acting as a hired gun, this expert has now turned this case into a smoking gun.

Experts are no longer immune from prosecution, and given the evidence in this case, one has to wonder if the abuse of process by the GDC and its expert means that this should now be taken further by the defence team in order to recoup their costs. Ironically, the expert could well be professionally covered by the same indemnifier involved in the defence, but then I’d have thought that might be an appropriate time for any discretionary support for the expert to be withdrawn since it appears he acted in such an unusual manner. Its also rather hypocritical of an expert who appears to be acting far outside his remit to feel he can stand in judgment of a practitioner who may or may not be acting outside his sphere of expertise. Unfortunately Expert Witnesses are not regulated in any way other than by their profession; but this behavior has to be close to bringing the ‘profession’ of expert witnesses into disrepute. I know a good many experts who are aghast at the revelations in this case.

I’m sure the acquitted practitioner will probably now want the whole thing to go away, but I really hope that he doesn’t take this lying down; the GDC should be massively on the back foot with this revelation, and the profession’s moral (and legal) advantage should be well and truly rammed home now.

The BDA should also now get very vocally involved again, and if they don’t they are going to miss a huge opportunity. If they approach it through lobbying MP’s they should broadcast this loudly to the profession so we can hear their voice.  Some have said they should call for a complete halt to the GDC investigating process; but this would leave the public open to the risk of any truly dangerous individual being left free to practice. However, in my opinion they should press for every case both this expert and this particular GDC team been involved in to now be independently reopened, re-examined and all at the cost of the GDC. The costs of this should then be made exceptional from the annual GDC budget so they cannot then charge the profession for this. I’m sure they’ve got some indemnity insurance kicking around somewhere they can use. In addition, every pending case that involves just a single patient complaint should be now be suspended until a full independent inquiry (and I don’t mean by some equally flawed organisation like KPMG) into the above cases has been completed. There should be full and complete disclosure, and compensation paid to any registrants if the GDC are found to be in the wrong. Any employees of the GDC found to be in breach should feel the full weight of any legal process, and not be allowed to hide behind the corporate protection of Wimpole Street.

The GDC are quite obviously in breach of the Human Rights Act. There was no way this registrant was going to get a fair trial, and the GDC were quite obviously unconcerned by that. How many times they have done this before now needs to be made public. If we persistently did the same to our patients we would lose our careers, our livelihood, and our professional integrity. They should pay the same price and their executive should now be held vicariously liable if the law has been found to be broken (again…)

Resignations of individuals at the GDC are no longer enough for confidence to be restored in our regulator. The profession should demand the highest powers possible now decide their fate. Whether this should be up to individuals crowd sourcing an opinion from a barrister as to whether the GDC are breaching our human rights; or our indemnifiers taking their own legal action to seek redress for the expenses incurred in cases like the above;  and whether the Health Select Committee recall the GDC Executive to be given the coup de grace; or the BDA continue their lobbying of MPs whilst we keep filling those same MP’s mail sacks with letters. It needs to be all of the above and simultaneously. We need to unleash a veritable storm that cannot be ignored.

Enough is enough. We need to keep taking firm action.  Is the entire profession listening? It’s time to hit back again.

One of my early posts to my digital dentistry blog was entitled “4 A * Reasons Email Marketing is still Alive!” and I looked at the reasons behind why email marketing was still so important.

Nearly 2 years later, this is still seems to be the case. One could argue it is more important than ever. In the recent eConsultancy Census, it was found that revenue from email marketing increased proportionately by 28% in 2014, and was ranked as the number 1 channel in terms of return on investment, with 68% of companies rating the channel as ‘good’ or ‘excellent’.

Email has become part of mobile marketing, it is estimated that mobile can account for up to 70% of all email opens. The banner ads or message on these emails still need to be clear and well positioned, although it’s not just the creative that is important, the sales funnel must also be fully mobile-optimised, with every page working so that they are mobile optimised and keep your customer engaged. A well designed landing page is still always an important part of the process.

We forget that with emails you are often reaching an audience that already knows you, if you have them on your list, they want to hear from you. Email requires a deeper level of engagement and trust. That is the reasons our daily digest emails remain popular. Our members are expecting them.

Therefore advertising on the GDPUK daily digest emails (sent 3 times a day) remains incredibly popular because so many people receive these daily emails to their inboxes and thousands of eyes look at the animated banners on the emails. We use these daily digest emails ourselves as an accidental marketing tool. What started as a way of communicating the latest posts on the forum to our members, has instead become a way for our members to be constantly engaged with the site and what is happening within UK dentistry. We know that not every member reads every thread or email but there is always a subject that appeals to a number of our members and that keeps our site busy and the banners receiving impressions. This means email remains incredibly important for GDPUK plus of course every big business that is online and looking for customers.

So two years after I wrote the blog piece linked above, email marketing remains an important tool for businesses of all sizes and needs to be treated as an integral part of your marketing plans, whether you are looking to reach dentists or members of the public for your practice.

We are all looking to generate leads and gain new customers, is email marketing still something you use to reach these goals or do you find other methods more effective? We look forward to hearing your thoughts, on what works for your business and what doesn’t.

Hope you enjoyed this follow up blog. Thanks!

With opportunities to learn from some of the world’s most talented and renowned clinicians, the 12^th Annual Conference from the British Academy of Cosmetic Dentistry (BACD) is not to be missed.

With outstanding education on a vast range of topics available, attendees will also get the chance to network with like-minded professionals over a packed three days. Titled “The Aesthetic Equilibrium”, the conference aims to address challenges the modern dental professional faces, balancing all the needs of the patient as well as finding harmony between biology, science, technical aspects, aesthetics and mechanics.

Part of this year’s exiting programme is a full-day, limited availability course, “Practical Crown Lengthening Techniques”, delivered by Hatem Algraffee and Zainab Malaki.

Working out of private practices in London and Kent, Hatem dedicates his time to periodontics. Zainab is a part-time consultant at Guy’s Hospital.

“We are going to cover theory in the morning, and then the afternoon will be a practical hands-on session on animal jaws,” says Hatem. “We will show attendees how to master crown lengthening techniques, what to look for, what to avoid and also give them some cases which they can plan themselves. By the end of the day, delegates will be able to assess cases with confidence so they can apply practical knowledge to their practice.

“Some practitioners try to avoid any kind of gum involvement because they are worried about raising flaps and suturing, and we will go over all of that with them too.

“If people are interested in this topic, this session will be a good place for them to start. Zainab and I are going to provide a list of all the dos and don’ts they will need to get going, what instruments to use, what instruments to buy, the information to give patients and potential pitfalls. Our course is suitable for entry level, as well as being comprehensive and thorough.

“When I was approached about presenting, I was told that every year BACD delegates always want practical sessions and our course fits the bill perfectly. Also, if you are doing certain cosmetic work, you will need to learn how to crown lengthen and adjust teeth accordingly, to some extent.

“It will be intense, challenging yet enjoyable and attendees will really get a lot of out of it. There are only 14 places on our course and we expect them to get filled fast!”

Whether you are a student, newly qualified, a highly experienced clinician or a dental technician, the BACD Annual Conference will have something for you. Other sessions will cover minimal veneer preparation, photography, implant aesthetics and there will be a lively occlusion panel. Book your place today and enjoy three days that will help you to raise standards, refine your technique and challenge yourself in every single aspect of your work.
 

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

Acronyms should be catchy in dentistry, shouldn't they? Surely that's a rule? GDC, BDA, DPL, CQC, NVQ, CPD . . . It also seems to be a rule that they have to be three letter acronyms but maybe the exception proves the point!

I have been puzzled by the newer demand to note non-verifiable education. GDC call it "General CPD".

In my mind non verified means it cannot be defined nor denoted as a specified event in time.

I feel if written down, this act of noting the time spent means it is verified. Expressing this the other way, the act of writing, noting the activity, makes it no longer non-verifiable, to my mind. I therefore offer you 2 minutes of recorded general CPD for reading this article on a dental website, and of course, closing your eyes and reflecting on it.. There you go. Only 174 hours 58 minutes to go and RECORD!

I propose, if the GDC insist we must continue to note this time spent, and they do, this part of recorded CPD has now become not-non-verified and must be renamed as "self verified personal study time".

I'm off to do some SVPST!

Now that's bound to catch on.

Image credit - Moyan Brenn  under CC licence - not modified.

On Wednesday 27^th May the dental industry came together to launch The Implant Hub, a unique and exciting new online resource for dentists looking to grow their dental implant business. 

This brand new digital hub, at www.theimplanthub.com, provides information on topics that will directly impact profitability for both GDPs and specialists, supporting the business of implant dentistry.

A venue where you can gain valuable insight into growing your dental business, The Implant Hub delivers exclusive support and advice in implant dentistry through articles and blogs to Google Hangouts, as well as LIVE Q&As from our three top coaches: Chris Barrow (Business Coach), Mark Oborn (Marketing Coach) and Dr Nav Ropra (Inspirational Coach).

Speaking about The Implant Hub, Ken O’Brien, General Manager of BioHorizons UK, the team behind this new offering, said:

‘Always mindful that we provide unparalleled support for our clients in the business of implant dentistry – and beyond the sale of implants – The Implant Hub was the natural development in our offering to this industry. We are delighted to launch The Implant Hub and, together with our three coaches, our aim is to provide a resource that helps our clients develop their practices from a business perspective.’

Recently added content includes:

- White Paper Marketing in Implant Dentistry

- How to differentiate yourself from the practice down the road

- Why online marketing is more powerful than conventional marketing techniques.

To see for yourself what The Implant Hub has to offer your implant dentistry business, please visit www.theimplanthub.com. 

The Implant Hub is currently available free of charge to all BioHorizons customers. For  those who are not BioHorizons customers, please register your details on the website to find out how you can gain full access.

 

Dear Colonel Hurley,

The profession would like to congratulate you on your appointment to the post of Chief Dental Officer. As someone with a reputation for professional change management, then your appointment is seen as a welcome one by many.

The profession has not recently been blessed with a CDO who it can feel it truly relates to, and many may feel that the last few years have been detrimental to the quality of dental care available in the United Kingdom. Whilst the position of CDO will always be to do the will of its paymaster, Her Majesty’s Government, I am sure you will continually keep your professional responsibility to the profession at the forefront of your mind.

At a time of unprecedented change and pressure within the profession, you will have the opportunity to rebuild the bridges that have been lost over the years. One of the ways of doing this would be to listen very closely to the concerns of the profession, and most importantly do not be afraid to tell the truth of the problems we are experiencing. After all, you are a member of our profession first and foremost, and what is bad for the profession is bad for patient care.

A New NHS contract will no doubt be a priority; but in whatever incarnation this takes, it needs complete and total clarity as to what treatment is available for patients under the rules. There should be no room for abuse by those who use a lack of definition to perpetuate the problems of the current system. Contract negotiations based on honesty are a must; and if the government cannot afford what it wants, then it should be told in no uncertain terms that this is impossible to achieve. Not only do our representatives the BDA have this responsibility, but so do you. Only by listening to and working with the profession in a fully engaged and mutually respectful manner can this be secured. If this means a core service for the NHS, or a new way of thinking that benefits both patients and teams alike then it should be piloted properly and not forced on the profession in the manner it has before; please don’t forget that the success of dental care depends on those delivering it. You have a track record in delivering high quality change within a budget; but do not underestimate the suspicion of the profession as to how government will treat them.

The inequities of dental care must be addressed; and the continued lack of a joined up policy on dental health in the nation is still something that makes dentistry a poor cousin to other health issues. When dental problems are the number one cause of admission to hospital for children, can nobody actually see it would be cheaper to fight the problem at source rather than wait until the problem occurs? There would be no better long term legacy for a CDO than to have truly changed the face of dental health in the UK for the better. A public face of the profession that is prepared to stand up for the patient and not hide behind government spin and empty promises is what the profession requires if faith in the position of CDO is to be renewed. A clear message is what the public need.

The situation with our young practitioners having to play some kind of bizarre lottery to gain a job on graduation is another aspect of the profession that you must turn your attention to. At the very beginning of their careers, we have an increasing number of them considering whether or not they have made the right choice for their futures; and by association this is the future of the profession too. Whilst part of this lack of morale lies at the door of our failing regulator, to then heap on the uncertainty of a tiering system will eventually result in the profession being devoid of is youngest talent, without which it will wither.

So, as you approach the start of your tenure as CDO, the profession can only really ask one thing of you.

After years of obfuscation, spin, and confusion;

We need clarity.

Yours Sincerely,

The Profession.

Image credit - Jason Dean  under CC licence - not modified.

I have been reading coverage and watching interviews about the latest book by Steve Hilton. Apparently, he is the favourite political guru of David Cameron and therefore his ideas are ones we might expect to be implemented in the next five years. You might find a perusal of @stevehiltonguru on Twitter to be interesting, his TV appearances suggest he has been coach to “Call me Dave” in the way Chris Barrow has been a polarising national coach to the UK dental profession.

Our profession has massive frustrations with our daily lives and the restrictions which are all around us, reaching out to almost affect our pattern of breathing. Steve Hilton argues that what has happened, as our information society has developed, is that it has become easier and easier for systems which we must follow to be written and then codified. I believe our dental profession has been trapped by this codifying of systems, almost trying to make every dentist work and behave in the same way, with the same paperwork, the same records. The words I am using here could be used for every field in the UK, ask your spouse, your friends, professional colleagues, business people, all are being stifled by the weight of the state's hefty duvet of regulation.

In the 20th century, Hilton argues, due to the way communications worked, only the people in the centre were able to make decisions, and these rippled out, in some cases enforced. Before the Industrial Revolution, decisions were taken locally as the communications of the times meant a distant ruler in the capital city may impose large scale decisions such as war and taxation. The King in the castle could not micro-manage the daily actions of subjects hundreds of miles away, the local lord, or sherrif imposed their version for their area.

Can the philosophy of applying those systems allow us to be trusted again with making our own decisions, our own leadership, rather than being force fed by the nanny state?

Nationally, this broad idea encompasses powerful, executive, city mayors. This concept is being taken forward, we will see this as more and more city mayors take office across the UK. The benefits will be a translation of what may be a well meaning law or regulation emanating from a Whitehall Minister's desk, into what this means in a locality, where a well argued, seemingly sensible, national edict may be counter intuitive to the situation on the ground.

If there are to be more and more local mayors, or decision makers, could this idea be applied to dentistry? Many agree that the whole profession is frustrated daily by the national edicts which do not fit in with how we run things on the ground, in our own practices, or in our own areas?

In oral health provision, the needs of differing areas do vary widely. Truly local decisions will help people on the ground, the providers of healthcare working together with the recipients of this care. How can we move the profession away from political control, away from the politicos who are able to speak publicly and utter soothing platitudes, but when devising and enacting changes, they seem to be regularly and plainly wrong? But our decision makers must be of the people, possibly elected, and definitely not from the present Dental Public Health elite who continue to drive change in their narrow eyed image.

Decision making for the future of our profession needs to be more human, more involving, and not just showered onto dentistry from the top down. This itself will mean different things to different people, but will allow concepts from grass roots to flourish, we have many mechanisms for communication, to set the agenda, and make the changes. The age of imposing change must now be over.

My call now is for our largest trade union, the BDA, to take this forward to this new Government on terms that fit in with their style, their politics, their understanding,  in order to make a change to the top down mindset. This is about freedom, modern politics, and a move away from the paternal style of the last century, using modern coimmunications but not only in a single direction.

John Grant Director from Goodman Grant Solicitors discusses the importance of bespoke written associate agreements.

If you were to study the legal test into whether someone is an employee or self-employed, you might quickly conclude that most dental associates are employees. The dental profession has quite frankly always enjoyed what can only be called a special dispensation from the Inland Revenue. In other words, the Revenue have not, as yet, challenged dental associates’ self-employed status. Although there is little sign of this changing at present, that is not to say it never will and it is certainly better to do what one can to protect oneself – not only against the Revenue, but also against claims of unfair dismissal by former associates

If there is no written associate agreement and a practice principle decided to terminate an associate’s contract, that associate could seek legal advice and if it was deemed that they were an employee, they could pursue a claim for unfair dismissal. This could then culminate into a sizeable compensation sum.

In addition, not only are there the risks of compensation claims, there are also tax implications. If the Inland Revenue were to pursue the case, it would be entitled to ask the principle to pay all tax that the associate should have paid as an employee over their entire period of employment. This is regardless of any tax the associate may have already paid.

Consider the criteria of the legal multiple test that is used to determine if someone is an employee or self-employed:

Personal service – does the servant have to perform the service personally or can someone else carry it out

In most associate’s agreements, the right to appoint a locum is provided – however in the vast majority of cases, it is limited and may only apply if the associate were away ill and even then, the appointment of a locum is usually subject to the practice owner’s approval.

Mutuality of Obligation- An obligation to do the work and an obligation to be paid for it.

The overall reality of a dental practice is that the principle or owner does introduce patients. Whilst many associate agreements state there is no obligation, the reality is that such an obligation does exist – otherwise principals would quickly find associates giving notice to leave the practice. When the work is complete, there is the obligation to pay the associate.

Control – how much control does the employer exercise over how the servant carries out their job?

Not only are there controls imposed by CQC, the NHS and the GDC, but in addition many written agreements stipulate that associates must comply with the practice policies and procedures – even to the extent of requiring associates to participate in practice appraisals.

Similarly, most large dental corporates go into great detail within associate contracts to explain exactly how the individual should perform the work, which I would submit is entirely contrary to the notion of associates being self employed. If they are required to attend team meetings and have to attend out of hours emergencies, this too suggests a degree of control that is most commonly found in an employee/employer relationship.

John Grant of Goodman Grant Lawyers for Dentists - a Past Chairman of ASPD

For more information call John Grant on 0113 834 3705 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk
 

ASPD MEMBER

If you want to stand out from the crowd, think about joining a professional academy. This shows your patients your ongoing commitment to education, an outstanding quality of service provision and dedication.

The academy that you choose will depend on the education avenues available, so ensure that you select one that suits your learning needs.

A worthwhile academy should offer the latest in education, career support, assistance to find more patients and value for money. The larger academies will hold an annual conference, featuring internationally recognised experts in the field so you can find out about techniques and developments from all around the world, but close to home.

It’s not what you know, but who you know

Another important aspect of attending annual conferences is networking – you can meet with old and current acquaintances and catch-up on their news. But, you also get to the chance to connect with new contacts and opinion leaders that have similar professional interests, too.

It is at some of the better conferences that you can get access to the speakers on a one-to-one basis. This allows you to seek valuable career advice, clinical case counsel, get suggestions on specialist courses to attend and hear their experiences with particular products and materials.

The most talked about conference of the year!

The most influential conference in the aesthetic dentistry calendar is no doubt the British Academy of Cosmetic Dentistry’s (BACD) Annual Conference in November. As always, the 2015 event it is expected to be one of the most talked about conferences of the year! For the last 12 years, the BACD has staged professional educational conferences that have attracted the most eminent of dental professionals offering their insights into their specialist topics.

This year the conference is titled, ‘The Aesthetic Equilibrium’ and it seeks to achieve harmony between biology, science, technical aspects, aesthetics and mechanics, as well as balancing the patient’s emotional, financial and clinical needs. By using the finest national and international speakers, the BACD hopes the topics will inspire you and offer an insight on how to achieve this balance.

There is something for everyone at the BACD Annual Conference – technicians as well as clinicians will find something to interest them on the programme, which has also been carefully designed to be relevant to all levels of experience.  

As a dental professional, you will never stop learning, or training to be the very best that you can be. As well as honing your skills, keeping up-to-date with the latest research, equipment and materials is essential. When you join an academy, its programme of events can offer you all this and more. Contact the BACD to find out more about Annual Conference, and the other education opportunities it offers its members. 

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

Dr Adyl Asani, principal dentist at TwentyOne Dental Clinic in Hove, has been using Impregum Impression Materials from 3M ESPE for over 15 years. “As far as I am concerned, it is the most superior impression material on the market,” he says. “I use it for all my indirect restorations and implant work.

“Currently, I am using Impregum Penta because I feel it reproduces the detail I need in my indirect preparations most accurately. Of course, I have used a variety of other impression materials over the course of my career, though none have provided me with the stability, accuracy and level of detail that Impregum has.

“It has ideal flow properties which means I can ensure the first impression I take is the only one I need. The flowability reproduces even the most minor details and the hydrophilic properties exhibited by Impregum guarantee excellent accuracy every time. In addition, I don’t experience drags or airblows in my impressions.”

Dr Asani uses the Pentamix Automatic Mixing Unit from 3M ESPE to ensure an efficient process. “It allows ease of mixing and handling,” he says. “Messy hand-mixing is now something from a bygone age.

“While the setting time of the Impregum is slightly longer than others, my patients readily accept that if I am to give them extremely accurate and stable restorations, a couple of extra minutes in their mouth is insignificant.

“I would have no hesitation in recommending Impregum to other practitioners if they are looking to provide their patients with the best possible accuracy and marginal fit of their indirect restorations.”

Discover the qualities of Impregum Penta Impression Material and the Pentamix Automatic Mixing Unit from 3M ESPE for yourself today.

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

The one thing that has been a constant in my entire career so far, and has been the fundamental guiding force to everything I do, has been my ethical compass.

Where it came from originally I suppose was my upbringing, but then further refined by exposure to teaching (particularly clinical) of such a style it helped me to understand what an important position we as professionals hold, and the huge responsibilities we have to other people, primarily our patients.

Whilst clinical experience and techniques have doubtless changed through my practicing career as it does for all of us, the ethics of how and what I do have remained a fundamental baseline that cannot be compromised in my opinion.

I’m sure for the majority of the profession this rings happily true. So much so I have wrestled with even submitting this blog for publication. After all, none of us know anyone in the profession who could do with taking a good look at themselves and thinking about what I’ve written here…..

There are times when I have had to wrestle with what the right course of action is clinically, but these dilemmas have always been fairly straightforward when put in the perspective of how other medical professionals might have to act, and I’m actually quite grateful that for the vast majority of us our day to day decisions are rarely likely to have life changing impacts on our patients, especially when compared to the huge responsibilities of cardiac surgeons or oncologists for example.

But….

If our ethical compasses have become somehow magnetized by a malign influence that we fail to see, ignore, or indeed we positively allow to affect us in some way, then our actions will have potentially life changing impacts on our patients. Ok, so maybe not as severe as for the medical professionals mentioned above; but certainly at odds with the ‘First do No Harm’ principle we swear an oath to.

I am purposely NOT going to go into the potential malign influences of the NHS contract and how it might be abused or gamed; I leave readers to draw their own conclusions about this after reading this piece. What I will say is that my examples below probably only scratch the surface of what might be happening in our profession.

There is huge increase in the cost of indemnity, and whilst we have a GDC that is not fit for purpose causing at least part of this increase, it surely cannot be solely due to that alone. We can blame no win-no fee solicitors to a degree, but don’t forget that cases have to have some merit to be paid out, even if only on the balance of probabilities. Otherwise, they are defensible.

So, consider the parallel increase in availability of orthodontics and implants in recent years. This blog incidentally is NOT aimed solely at the orthodontic aspect although it may seem so; it is purely written from my personal experience of one aspect of our profession that I have experience in so feel able to comment on a bit more.

These treatments are by their very nature high value items, and potentially have a higher profit margin that some of the more routine treatments offered. The courses maybe expensive, as is the equipment needed to carry out the treatment. Being the principal of a practice that offers both these treatments, I am pretty well placed to know the financial aspects of them. What is worrying is that there seems to be a section of the profession that immediately has a new direction on their ethical compass when they start to offer these services, sometimes after only a weekend course. Admittedly this might apply more to the orthodontic side of things as I think it is now more recognized that implants are not quite as simple as Meccano to install.

But with the increase in availability (or is it an increase in higher pressure marketing and selling??) we see the parallel, and often steeper rise in litigation and Fitness to Practice associated with these treatments. Personally, I think a good chunk of this is due to the magnetism that potentially affects the compass of some of the profession after being exposed to these treatment modalities.

It’s one thing coming away from a weekend composite course having learnt what is likely to be a refinement of an existing technique, to actually introducing a whole new treatment modality to your patient base that wasn’t taught at all at undergraduate level. The ethics of such a situation are different in my eyes. When at least some of the course is given over to how to sell the new treatment to your patients on some courses (rather than spending it further exploring the ethics, assessment, case selection etc) it is not surprising that magnetism is already starting to alter the direction of the needle on your compass…

There is nothing wrong with a return on investment, but it’s how you go about getting that return that might be the problem.

Let me give you some background with regard to my orthodontic experience to put into perspective where I am coming from.

I was fortunate to work as a clinical assistant in the mid 90’s in orthodontics. One morning per week I treated patients under the supervision of a consultant in a regional hospital, and this continued for about 4 or 5 years. By that time I had seen and indeed treated some pretty advanced cases under very close supervision. I was also treating simpler cases in practice as an associate. Along with another general practitioner, we estimated this experience prepared us to treat perhaps 30% more of our orthodontic patients in practice, but more importantly it had taught us how to identify what we definitely couldn’t or shouldn’t treat. The ethics of what we could now do was drilled home all the time since we often got to see the slightly more ‘random’ orthodontic treatments that had failed in the hands of practitioners with experience only of removable appliances at undergraduate level.

We had begun to Know what we Didn’t Know.

Since then I have also been on the courses for commercially available appliances of different types, and had the advantage of my previous experience in looking at the systems and the teaching a little more objectively than perhaps some of the other delegates.

The problem comes when some of our profession don’t have these limiting factors in their internal ethical system. Some are possibly not enough motivated by the desire to always only do the right thing by their patient, but by their own financial and even egotistical drives. There have always been those in our profession who seem to have a sliding scale of principles, and are more driven for their own gains (and the patients may or may not gain as a result). I actually don’t feel that there are any more truly ‘bad guys’ in dentistry now as a percentage than in the past despite what the GDC think; but I think the potential for damage to our patients has increased because perhaps the fundamental ethics we should all have in place, in some are allowed to erode.

Combine this with the further issue now that with a lack of experience at undergraduate level for some aspects of dentistry, the starting point for not knowing what you don’t know is now much lower than perhaps it was in the past. This is where the ethics should come in to play, and whilst I applaud the efforts to fill a gap in the treatment needs by offering training in fields not covered by the undergraduate training, there doesn’t seem to be an ethical ‘lock’ in place with some practitioners to prevent them seeking their financial gain over that of the patient.

More controversially with regards to their ethical direction, perhaps they Don’t (want to) know what they Don’t Know about ethics?

So when the treatment goes awry because of not knowing enough about what wasn’t known, and the ethical direction was slightly (or massively) off, the profession has a HUGE potential for life changing impacts on both patients and its members.

This brings me on to the thorny subject of ‘selling’ in dentistry. Now, I have absolutely NO issues with dentistry as a retail environment, offering services to patients. Indeed, in order to keep a viable business in this ever competitive age, you have to consider how best to let your patients know the services you can offer them. I certainly do, and I feel it is another method of protecting ourselves from criticism that we are not offering a full range of options to our patients.

But ‘selling’ has to be fundamentally and overwhelmingly in the patient’s benefit, and not ours. I worry about some of the techniques I know can be used by some industries that if (or should that be when?) used in ours would exert an influence on the patient designed to get them to agree to treatment whether that is the right thing for them or not, or even more worryingly, whether the practitioner is truly capable of providing the treatment correctly or not. The pound signs appear, the ethics can get completely switched off, and it becomes a one sided benefit.

But what if you actually CAN’T solve those issues? (and are either aware you can’t, or just bite off more than you can chew?). The classical ‘Over Promising and Under Delivering’ is a guaranteed route to problems for patients and the reputation of the profession.

This is where the huge problem occurs. The practitioner that doesn’t know ENOUGH about what he/she doesn’t know, having been blinded by clinical and other courses that seem to offer all the answers to patients problems and get them to agree to treatment, with an underlying anaesthesia of the ethical values (if they ever had one in some cases) for what ever reason is not doing the best for their patient.

At all.

Without the ethical compass pointing in the correct direction, then there are those in the profession who cannot with their hands on the hearts say that they are truly driven by doing the right thing for patients. Take the ego and the financial aspect out, and their direction is quite possibly completely lost.

Until we make sure all our ethical compasses are calibrated properly, I’m afraid the GDC (in whatever guise it takes) will continue to be on our backs, and our Indemnity will continue to rise. The press will see us in the wrong light, and so will patients.

We need a return to the fundamental values of what we do and what that means to us and the patients.

And to do that, The Only Way is Ethics.

Image credit - Paul Downey  under CC licence - not modified.

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

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

The definition of the word revolution includes this:

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

The 8th May - the day things changed

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

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

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

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

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

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

Dentistry... why, is there a problem?

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

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

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

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

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

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

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

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

Perhaps dentistry will feature during the post-election negotiations?

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

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

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

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

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

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

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

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

The Clock is Ticking

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

Who remembers the HSC?

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

Dentist in Politics

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

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

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

You ARE political influence

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

What should it be?

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

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

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

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

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

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

Unclear Prototypes & Mixed Practice

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

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

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

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

If McEnroe had been a dentist ...

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

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

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

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

“Will you ensure Clarity of NHS Dental Treatment?”

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

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

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

That’s half a million confused patients per day

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

If not, why not?

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

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

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

[1]          http://may2015.com/

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

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

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

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

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

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

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

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

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

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

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

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

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

Friends and Family Test [FFT]

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

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

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

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

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

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

Other suggestions for free text questions have included:

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

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

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

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

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

So what should you do?

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

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

So what should the profession do?

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

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

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

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

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

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

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

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

 Image credit - Glyn Lowe  under CC licence

Measuring patient experience in NHS Dentistry

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

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

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

The Dental Quality and Outcomes Framework (DQOF)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let me start with an apology ...

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

One Week to go, Eight Weeks from certainty, 

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

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

Long live the GDC

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

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

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

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

Tiers of Tears?

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

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

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

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

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

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

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

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

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

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

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

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

Valedictum

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

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

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

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

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

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

By Rebecca Allen of Initial Medical

As part of the dental team, needlestick safety is something you should be acutely aware of in your day-to-day role. A survey conducted in association with the British Association of Dental Nurses* in 2014, found that 51.2% of respondents had received a needlestick injury at some point throughout their career, with 60% of those saying they’d received more than one. When you then consider the risk of infection following a needlestick injury is estimated to be 1 in 3 for HBV, 1 in 30 for HCV and 1 in 300 for HIV**, it is vital that safety procedures are put in place in all dental surgeries.

Following the introduction of The Health & Safety (Sharps Instruments in Healthcare) Regulations 2013, all healthcare facilities must ensure that:

(a) The use of medical sharps at work is avoided so far as is reasonably practicable;

(b) When medical sharps are used at work, safer sharps are used so far as is reasonably practicable;

(c) Needles that are medical sharps are not capped after use at work unless— (i) that act is required to control a risk identified by an assessment undertaken pursuant to regulation 3 of the Management of Health and Safety at Work Regulations 1999 (a); and (ii) the risk of injury to employees is effectively controlled by the use of a suitable appliance, tool or other equipment;

(d) In relation to the safe disposal of medical sharps that are not designed for re-use— (i) written instructions for employees, and (ii) clearly marked and secure containers, are located close to areas where medical sharps are used at work.

Health and safety law has always placed general responsibilities on the employer to provide their staff with a healthy working environment. However, this legislation now puts further emphasis on prevention. In reality it would be difficult, if not impossible to remove all sharps from a dental practice, so the next best thing is to assess the risk correctly, use devices which limit the risk of injury and dispose of all sharps in a safe manner.

Key tips that all dental clinical staff should follow to help reduce needlestick injuries are:

·         Cease recapping of needles

·         Ensure the correct type and size of sharps disposal unit is in place

·         Make sure your sharps disposal units are assembled and closed correctly

·         Place all sharps disposal units in a safe, secure location

·         Dispose of your sharps at point of use

·         Report all sharps injuries immediately

·         In the case of a needlestick injury follow your health and safety protocol immediately

It’s important to remember that when it comes to hazardous and infectious waste, such as syringes and other sharps at a dental practice, the cradle-to-grave rule applies. The producer of waste will always be held responsible for the safe and legal disposal of it, even after it has been passed onto the waste carrier collecting it. This is why it’s important to work with comprehensively trained sharps waste disposal experts who will safely and securely dispose of it and advise on the correct products that comply with both the UK and EU legislation.  Health and safety law is criminal law and healthcare organisations can be subject to enforcement action if they fail to comply with the legal requirements. There is also always a threat of civil law action if an employee is injured due to insufficient practices and technologies being in place.  

Everyone has a role to play in the prevention of sharps injuries, from trainee staff who are learning the ropes, to practice owners who will hold legal overall responsibility for the wellbeing of their staff.

*For healthcare workers worldwide

**1216 British Association of Dental Nurses responded to the survey in August 2014, from across the UK and the Republic of Ireland.  99% of respondents were from the UK and 1% from the Republic of Ireland.

About Initial Medical Waste Experts

Initial Medical is an expert in healthcare waste management, providing a complete collection, disposal and recycling service for hazardous and non-hazardous waste, such as offensive waste produced by businesses and organisations within the UK. The safe management of healthcare waste is vital to ensure your activities are not a risk to human health.  Initial Medical’s healthcare waste services ensure that all of your waste is stringently handled in compliance with legislation and in accordance with Safe Management of Healthcare Waste best practice guidelines, providing you with the peace of mind that you are adhering to current legislation.

For further information please visit www.initialmedical.co.uk or Tel 0800 731 0802.

Rebecca Allen, Category Manager, Initial Medical

Rebecca has worked in the Healthcare sector for the past 13 years and was a Research Chemist with Bayer Cropscience prior to joining Rentokil Initial in 2003.  She keeps up to date on all developments within the clinical waste management industry and is an active member of the CIWM, SMDSA and BDIA.  

As a digital company, we are always interested in digital innovations and improved efficiency, especially in the dental sector. One area of dentistry that this is particularly apparent, is in the booking of dental appointments online. Although this is a relatively new sector, there are a number of companies who are improving access, customer service and ease for patients.

Toothpick who are one of the leaders of this revolution, shared some amazing numbers from 2014, which they have given us permission to share. The infograph below gives a great indication of the growth of the sector, can dental practices afford to miss out on offering this service?

A few stats that caught our attention:-

• The fastest time from booking to seeing a dentist was 23 minutes
• 56 per cent of bookings were made in evenings and weekends
• Peak booking time for appointments is Monday and Tuesday mornings, when a booking is received every 30 seconds!
• Over 60 per cent of visitors to Toothpicks website are accessing via a mobile device

We believe this sector will continue to grow over the next few years. Dentists are always looking for new ways to gain patients and offering 24hr online booking seems a great way of doing this. The general public are increasingly familiar with doing many things online, so why should booking a dental appointment be any different? The service seems to benefit all involved. The continued growth of smartphone usage, plus the introduction of dental practice apps or mobile webpages will also fuel the growth of this sector in 2015.

It will be interesting to see how this sector evolves over the next few years but our suspicion is that it will soon be an expected feature on the majority of dental practice websites, mobile sites or apps. 

Please enjoy looking at the infograph and you can find some further information on Toothpick below. 

1. What do we do about the General Dental Council? 

2. What do we do about NHS dentistry in England? 

3. What can all dentists look forward to in the next parliament? 

The Health Select Committee will be holding an accountability meeting with the GDC on the 3^rd of March. It’s about time too, as they haven’t been asked to account at all to anyone but the judiciary recently (and they lost). It will be interesting to see if they try to spin that meeting in the same way as they did in the press release just after the decision in the high court in December.

It looks like the GDC have finally got to face the only people who they are answerable to. I wonder if they are going to try to wiggle out of the unavoidable truths?

I presume everyone reading this is going to submit his or her evidence to the HSC through this link before the deadline of 19^th February.

No?

Why not?

Are you scared?

Well actually, that is probably extremely close to the truth. I am personally quite worried these days that a GDC letter will arrive on my doorstep for some reason or another (and that is not because I know I have something to fear – my inherent belief structure tries to ensure I do the right thing by patients at all times, but I have also been openly critical of the GDC, which I’m sure they do not like – and they get to decide what is deemed as professional or not).  All someone these days has to say (even in jest) is “I’ll report you to the GDC for…” or ‘I bet the GDC have their eyes on you” and it feels like a letter from Wimpole Street is already winging its way to you starting the process of investigation and a potential loss of livelihood.

The lack of proportionality that has been written about previously means that a situation like this could be an increasing possibility for all of us. It’s why the ARF had to go up according to the GDC for goodness sake. To put a few figures on this, if you reckon on 40,000 dental registrants having about a 40 year career, and the current data from the GDC is that there were 1700 complaints in the first 6 months of 2014, then the maths shows that each registrant will have 3.4 complaints in a career. (3400 complaints x40 /40,000). Some of these complaints are against DCP’s, ok, and not all of them will go to the full Fitness to Practice hearing,  (but 40% of them currently do) but I’m sure you get the overall idea. Is it right that if this way of dealing with complaints continues, on average, every single dentist will have to face this career-wrenching possibility more than once? This alone tells the general reader that the regulator is going the wrong way about it.

Since the GDC are the initial arbiters of our standards and decide an investigation will run to see if there are any grounds to an allegation, and there is currently the interminable wait for a hearing, then I don’t honestly think I could mentally deal with that kind of pressure for that long with the fear of loosing all that I have put into patient care, this profession, and that of my livelihood and ability to provide for my family. Even if an investigation goes all the way to a hearing, is there any guarantee that there will be an understanding of the pressure we are now practicing daily under from the committee, especially when it is made up of so many lay persons?  Tony Jacobs wrote an excellent blog on this subject.

Some of you will have no doubt read the very eloquent and erudite blog written by Colin Campbell, a very well thought of colleague in my locality and indeed nationally. Colin is one of the most ethical and conscientious practitioners I have ever met. If you haven’t read it then it is a ‘must read’, because Colin is a person who wears his heart on his sleeve and this series of blogs are likely to be a wholly authentic and personal view of how HE felt during the process he went through.

There are many (most of us?) out there that fear the GDC, and not for the correct reasons. We need to respect our regulator, and know that whilst it absolutely MUST act to protect the public, it is not effective ‘right touch’ regulation to do this by ruling the profession with that kind of fear. Using a methodology akin to continuing the beatings until the morale improves is not how it works these days.

Mistakes happen; I was once told right at the beginning of my dental career by an older practitioner the reason he was more experienced than me is because he had made more mistakes than me. Nobody is ever going to excuse the type of mistakes that are so dangerous they have to be dealt with swiftly and appropriately. But if we are to be perpetually living in the fear that one minor transgression will bring the full weight of our regulator down on our backs then that is wrong.

There are also bad people in our profession; nobody is denying that, and I will certainly make no excuses for them. But the climate of fear that pervades the profession at the moment is no way to prevent mistakes from happening, and it certainly wont do ANYTHING to stop that minority who are out to damage people because  they probably don’t have the emotional or ethical values to allow them to feel the fear those of us that practice ethically and responsibly (and fearfully) do.

So at the moment I remain scared. But I will still be submitting evidence to the Select Committee because I cannot, and will not be made to feel this way for the rest of my practicing career. We care for patients every day, but we also have to care about our future health for the sake of our families. After all, we too are human, just like the public the GDC must protect.

We have to stand up to the GDC and now show them the true and high calibre of the vast majority of Dental Professionals.

Blog image Edvard Munch [Public domain], via Wikimedia Commons 

Its becoming very apparent that there is a distinct lack of transparency where some practitioners are concerned with regard to what is and isn’t available on the NHS. This has been going on from the beginning of the new contract, and has caused much heated discussion over the years.

When you consider that not even the CDO was prepared to give an actual list of NHS treatments, instead relying on the ‘All that is Clinical Necessary’ definition that is deliberately intended to obfuscate, then it isn’t really surprising there are almost as many different interpretations as there seem to be contract holders.

We can argue amongst ourselves as to when something should be, or can be provided on the NHS, but the end consumer, the Patient, is stuck in the middle of this unsatisfactory situation, and that should be our prime concern.

The GDC are now starting the come down on those practitioners who they feel have been misleading, or even dishonest in their definition of what is available, and since the balance of probability legal test is used, the weight of evidence does not have to be as high as a criminal issue to find a practitioner guilty, and then suffer the consequences.

However, until recently, the difference of opinions as to what is legitimate and what is ‘gaming’ has largely been discussed only within the dental profession itself. This is NOT intended to be a blog about what gaming is; it’s sufficient to say though that we have to acknowledge it exists within the profession.

This week, Which? have now waded into the argument, with a campaign to ‘Clean Up Dental Costs’

It would appear that they have found this distinct lack of transparency in the pricing of dental care, and in particular the differences between private and NHS care. Not only that, they appear to have also found that about a quarter of those surveyed were unsure of the differences between NHS and Private.

More worryingly, 40% of respondents were unaware that all treatment that was clinical necessary was available on the NHS. This lack of awareness plays right into the hands of those practitioners who have been guilty of perhaps ‘massaging’ the NHS contract to their benefit and not that of the patient. One question it asks is who is responsible for the overall education of the general public as to what is available to them; it is accepted that expert opinion and advice is needed when the general public seek the aid of a professional, so they can perhaps not be held completely responsible for not knowing the ins and outs of dental treatment. On the other hand though, is ‘All that is Clinically Necessary’ too difficult a concept for the Government via NHS England to convey to the populus in some way? The lack of this clarity has lead to varying degrees of confusion, alternative interpretations of the contract (not tested in law to my knowledge) and downright dishonestly and misleading behaviour at the expense of the patients.

Whenever gaming rears it head in discussions on this and any other forum it polarizes opinion hugely, and usually ends up in a slanging match of NHS vs Private. As I’ve said this is not the aim of this blog, but merely to get people to think about the consequences of what we in the profession have begun to create for ourselves and our patients.

It’s one of the huge elephants in the room in our profession at the moment.

There is no doubt that gaming is rife amongst some practitioners. Not all of them, but I would wager that there will be a fair number of mixed practices that are operating at the very edge of what is actually the correct definition of ‘Clinically Necessary’ throughout the country. The fact this aspect of the contract has not been tested in law is probably somewhat fortuitous for all concerned.

Of these practices, I think there will probably be some of them actually deliberately seeking to maximize their financial advantages over those of the patient. This is in direct breach of the GDC standards relating to putting a professional’s needs over that of the patient. It wont be an excuse to use ignorance of the rules of the contract to defend this either, or the continued financial survival of a practice. The continued ignorance of the patients in knowing what is and isn’t available themselves, and the plausibility of the explanations given (‘its isn’t available on the NHS’ is a difficult phrase to argue against for a majority of patients) mean it is simple for some practitioners to pull the wool over the eyes of the public.

If we want to take a stance against the way the GDC is acting at the moment, but there is sufficient evidence that some practitioners are being more ‘flexible’ with the interpretation of clinically necessary, then we can hardly take the moral high ground against them, as individuals are misleading the public the GDC are tasked to protect. How can we protest at that? When we have a Chairman of the GDC who has a background in the Office of Fair Trading it is not beyond the bounds of thought that his wish to broaden his remit has the tacit approval of the powers that be, and will include any future tests of NHS vs Private provision. Incidentally, Which? are not calling on the profession to clean up their act; they’re calling on our regulator and NHS England to do it for us.

In addition, if the Big Lie is to be exposed in all its glory, we as a profession can’t then be seen to be obscuring the failure of the contract by blurring the treatments that patients are receiving on the NHS and Privately. By misleading patients as to what is and isn’t available, to the benefit of the practitioner, is never going to expose the lack of funding inherent in the system.

Lack of transparency of fees has always seemed to be a problem with our profession. The artificially low NHS prices when compared with private means a significant number of the population have no understanding of the real costs of dentistry, and I think we really as a profession don’t go far enough to explain this to the public. Couple that with the confusion now as to what is and what isn’t available on the NHS then it is no wonder Which? have waded into the fray on the side of the consumer.

I personally don’t think it will be long before some form of disclosure along the lines of that seen by Independent Financial Advisors will be compulsory. With the GDC being final arbiters of our professional conduct, any lack of transparency in financial issues are already taken as being as serious as those of clinical errors. We will therefore reap what we sow where it come to financial misdemeanours.

We are in an ever increasingly consumer driven society, and we have to get our house in order if we are to retain the professional status we think we deserve. If we don’t, then we only have ourselves to blame for what is then enforced on the profession in the future. We can resist consumerism and try to hang on to the last bastions of professionalism, but if some of our profession are less open with their dealings with those consumers, then we will all pay the price.

The consequences of gaming are coming home to roost whether we like it or not.

Personal Liberalism:

Political Liberalism: 

Economic Liberalism:

Social Liberalism: