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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We hope to see you there!

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

Let me start with an apology ...

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

One Week to go, Eight Weeks from certainty, 

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

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

Long live the GDC

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

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

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

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

Tiers of Tears?

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

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

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

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

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

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

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

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

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

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

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

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

Valedictum

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

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

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

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

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

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