Image by rakka_pl

Dear Mr Brack,

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

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

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

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

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

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

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

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

Kind Regards,

Simon Thackeray

Image credit - Rakka_pl under CC licence - not modified.

Lookout: Image by Dave Bleasdale

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Image credit - Dave Bleasdale under CC licence -  modified.

Employed or self -employed?

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

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

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

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

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

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

Pimlico Plumbers Decision

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

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

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

Personal Service

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

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

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

Business Undertaking

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

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

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

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

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

Conclusion

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

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

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

Laura Pearce

Senior Solicitor

Branding on the gazebo where the screening is based

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

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

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

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

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

Amongst the health checks made in the small branded gazebo    

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

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

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

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

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

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

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

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

​

Links:

http://boundariesforlife.co.uk/

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

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

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

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

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

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

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

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