A "Daily Clarion" call for Clarity

What ever happened to January being a dead month when we hunker down to pay all our Christmas credit card bills?  The CQC close a Salisbury practice facility [albeit for a month only]. [1]  The GDC’s CEO has written a feisty fob off letter to the BDA [2], revelling in the end of year report she produced .[3]

But the real January action comes from two directions.

What? Which? Again?

The Consumer organisation, Which? Have published a report on the lack of clarity of dental fees. The link [4]  below will allow you to read this.  Indeed follow the page and you will find many leading colleagues at Oasis and BUPA all shouting loudly in favour of clarity of fees [5].  Indeed across the profession, and for sure on GDPUK, there is agreement that charging a fair fee is not the problem, it’s about letting the patient know in advance and giving the patient a proper chance to consider the fee and their decision.

“Clean Up Dental Costs” is the clarion cry from Which?. They already have quite active assistance with understanding dental costs at [6] and [7]. 

A Mixed Game

Of course the problem seems in part to lie in that murky area of practice, where some treatment is NHS funded and some is not. Mixed practice, in which the sliding scale of gaming can be applied.

“If the patient pushes, I can do it under the Nash, but if they don’t object I will whack in a proper fee because they don’t REALLY need it …”

Which? state in their campaign “Mission Statement that

We're calling on NHS England and regulators to make sure all dentists comply with existing rules and make information on prices clearly available. Dentists need to explain the treatment options properly and make sure patients know whether or not their treatment is available on the NHS.

Here is my challenge:

How can dentists be expected to explain how much or what treatment is available under the NHS consistently across the country when NHS Choices states that “all treatment that is deemed necessary“ is wholly available and yet it is the soon to be ex-Chief Dental Officer himself  who has repeated that this decision of need is down to the individual dentist, in front of his or her patient.

Which? demand consistency, while the CDO [He of NHS England] espouses inconsistency.

Patently this cannot go on. Perversely, the Chairman of the GDC, being an OFT man ‘n’all that might be just the ally the profession needs.

As if by magic, albeit with ironic timing, the Department of Health’s long awaited Prototype Contract Document has emerged [8]

Nothing changes – the dentist decides “need”

Crucially, the suggestion is that nothing changes so far as the clarity that Which? and many others want.

The DH State

26. It is particularly important to be clear that nothing in the changes planned is intended to reduce or change the scope of NHS care available to patients. The changes are intended to ensure clinicians are supported to deliver the full range of care appropriate to a patient’s need. As with medical care, the NHS role is to meet clinical needs.

27. There is also no intention to end a patient’s ability to choose, if they wish, to have private treatment alongside their NHS care. As now patients will continue to be able to choose to have NHS care, private care or a mix of the two.

So contrary to what the Which? want,  the DH propose to roll out yet another way of delivering dental care in which the opportunity for mixed practice will remain, but the rules are decided by the treating dentist with his individual patient.

So, not one consistent rule for all to work to but 22,000 odd individual rules and utter confusion for the patient.  And more fodder for angry consumer organisations and patients “who know their rights”,

Is this really the best the DH can come up with?

The GDC are clear in their expectation – and this is COMPULSORY FOR ALL through their Standards for the Dental Team, [9],

PLEASE LOOK AT THAT WORD “PREFER”

1.7.4 If you work in a mixed practice, you must not pressurise patients into having private treatment if it is available to them under the NHS (or equivalent health service) and they would prefer to have it under the NHS (or equivalent health service).

2.3.7 Whenever you provide a treatment plan you must include: • the proposed treatment; • a realistic indication of the cost; • whether the treatment is being provided under the NHS (or equivalent health service) or privately (if mixed, the treatment plan should clearly indicate which elements are being provided under which arrangement).

Clear as Mud?

So the leading UK Consumer organisation are calling for the boundaries and costs of NHS and private dental care to be clear. Dentists and their LDC representatives are calling for the same thing.  The GDC has made it compulsory for there to be clarity, and breach of this clarity demand will result in you visiting London for an FtP day out.

But the DH produce a Prototype Contract that suggest maintaining the present confusion.

Aside from it all beggaring belief, it is also now time for our Regulator to earn their spurs and take on the DH.

Calling Mr Moyes, calling Mr Moyes

It is time for the GDC to lay down to the DH in one hopes clear terms that lack of clarity for dentists and patients as to what is on offer under the NHS simply is not acceptable.  It is no use asking the GDPC to achieve this for the DH simply bounce them.

This needs a man of words, in a position of influence, perhaps ideally with Consumer based experience,  to deliver a Clarion Call for Clarity on what the NHS expect dentists to do, not for the dentists, but for the patients, whose very protection the GDC under your Chairmanship is charged with.

Come on down, Mr Moyes – time to play Dental Regulation for real.

Your time has come.

LINKS – THE NEWS

1 http://www.salisburyjournal.co.uk/news/11739251.NHS_suspends_dental_practice_following_inspection/

2 https://www.gdpuk.com/news/latest-news/1812-gdc-remains-defiant-over-jr

3 http://www.gdc-uk.org/Aboutus/Documents/FTP%20Improvements-Dec2014-MA-FINAL.pdf

LINKS – WHICH? CAMPAIGN

4 http://www.which.co.uk/campaigns/dental-treatment-costs/

5  http://www.which.co.uk/campaigns/dental-treatment-costs/2015-01-19-Dentists-respond-to-Clean-Up-Dental-Costs/

6 http://www.which.co.uk/home-and-garden/bathroom-and-personal-care/guides/get-the-best-from-your-dentist/private-and-nhs-dental-charges/

7 http://www.which.co.uk/home-and-garden/bathroom-and-personal-care/guides/get-the-best-from-your-dentist/dental-treatment-checklist/

LINKS – DH DOCUMENTS RE PROTOTYPES

8 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/395384/Reform_Document.pdf

9 http://www.gdc-uk.org/Newsandpublications/Publications/Publications/Standards%20for%20the%20Dental%20Team.pdf

Geneva, 19 January 2015 – As World Oral Health Day (WOHD) 2015 approaches, FDI World Dental Federation is advising people to consider the impact of frequent sugar consumption on their ‘Smile for Life’.

Dental caries is the most common non-communicable disease in the world. Research has demonstrated that sugars are the main cause of tooth decay (holes in your teeth).

When you eat or drink something sugary, the bacteria in the plaque (the sticky film that keeps forming on your teeth) feeds on the sugar and releases acid that attacks teeth for about one hour. Frequent consumption of sugar allows prolonged acid ‘attacks’, weakening the protective outer layer of the teeth.

Speaking about this process, Dr Jaime Edelson, Chair of the FDI World Oral Health Day Task team, commented: ‘Sugar reacts with bacteria in the mouth, which together form an acid that damages the enamel. When this keeps happening, a hole is formed in the tooth, which then requires filling and may over time lead to an extraction. By paying close attention to how often we are consuming sugary foods and drinks, the number of acid attacks on our teeth can be reduced.’

WOHD is an opportunity for FDI to draw attention to proven oral care behaviours that people can adopt to protect their teeth –for life. These include brushing twice a day with a fluoride toothpaste, cutting down consumption of sugary¹ foods and drinks between meals and chewing sugar-free gum after meals and snacks when on-the-go and brushing is not feasible.

FDI President Dr Tin Chun Wong commented: ‘World Oral Health Day 2015, “Smile for life!” and has a double meaning - lifelong smile and celebrating life. Smiling implies self-confidence and having fun, as people only smile if they are happy and have a healthy life. Please take the time to consider your oral health and bring a smile to everyone around you.’

FDI supports the World Health Organization’s guidelines on reducing sugar consumption, based on evidence of its association with dental caries and obesity.

WOHD is celebrated throughout the world on 20 March each year with a wide range of awareness-raising activities organized by dentists, dental students and National Dental Associations (NDAs).

About FDI

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

For more information, visit: www.fdiworldental.org

About World Oral Health Day

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

For more information, visit: www.worldoralhealthday.org

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.