It has been a little while since I last wrote this blog. Various things have taken over as they tend to do in life, and the blog unfortunately was something that seemed to never quite get done. However, I’ve now found myself back in the writing frame of mind, and I still seem to have opinions that some will agree with and no doubt others will disagree with, so here we go with some more ramblings of a Yorkshireman.

I have still been keenly observing what has been going on with regards to the profession over the last few months, and there still seem to be the same old problems surfaces that always have. I shall be writing about all of these issues in the near future.

The GDC seems to still be a problem to many, and personally whilst it seems to be to have become more aware of its previous problems, I don’t think it can truly move on whilst the current chair is still at the helm. It is time for a registrant to be in charge again, and for Dr Moyes to be moved to some other Quango where he can’t oversee damage to the morale of an entire profession.

Social media is also still a hot topic, and the GDC have now issued a case study on this. Some of the profession are obviously of the opinion that social media is the real world, and seemingly lack the ability to see it in its true context. There is a lack of humility in the profession where social media is concerned, and huge damage can occur to people when they believe that all they see on their iPhone is the unadulterated truth. It isn’t.

The lack of a new NHS contract, or anything really concrete is also concerning. However, I have a fairly simple view on this. We must be deluded as a profession if we think for one moment that there is suddenly going to be a fantastic new contract that will give the patients and us everything we ask for. I will guarantee that any new contract will primarily be worded to the benefit of the DoH so that the dentists can be held responsible for whatever goes wrong with it.

I’ll write more on these subjects in the coming weeks. But for this blog I though I would concentrate on something that has seemed to be brewing for quite a time, and might actually be reaching a tipping point.

Indemnity.

Now, I can remember when my indemnity was about £1200 a year, and didn’t particularly change by much annually. But now, as a principal dentist working full time, it is £5800. This increase is over the period of about 10 years. We have seen an increase in both the activity of the GDC and especially negligence solicitors in this time, which it is claimed to account for the increase in our costs.

Indemnity is a little bit like car insurance in that you hope you will never need it, but it is a necessary evil to have. With the costs of legal representation being what they are, and the increase in the amount of cases being brought, it is not really surprising that costs rise year on year.

But how do we know how these costs are calculated individually? If you are a young driver with a fast car (which you will no doubt be flaunting on Facebook!) then you are likely to be a higher risk than an older person in a more sedate family saloon. This doesn’t necessarily translate to your dental indemnity though. It seems that the longer you are in the profession, the more likelihood you are to be sued and thus have higher premiums. Perhaps the reason for this is that when these practitioners retire, often the patients are found to have large amounts of remedial dentistry to be done. This may be the case, and I am aware of some dentists who have built up a good practice on rectifying this type of problem, especially when they perhaps encourage the patient to take some form of action against the previous dentist.

I’m not saying a wrong shouldn’t be corrected in that situation, but there do seem to be some dentists who are quite happy to throw colleagues under the bus in order to ensure they get the benefit of the patient charges to rectify the problems. Perhaps ‘There but for the grace of god go I’ would be an apt phrase to remind those considering this course of action. In addition, they will also find that their indemnity is going to increase also when this happens.

Because that’s how this kind of indemnity really works; the current members are paying for the claims that are currently being made and are going to be made in the future. In much the same way as the state pension works.  We can’t have an indemnity company suddenly have empty coffers, so they have a duty to ensure they assess the needs of the society to actively have the funds to cover their expenses. All of this is paid for by the membership.

However, this is where I spot a problem. There are some dentists who for what ever reason have higher indemnity costs. Whilst it always seems unclear why this is (as there is no apparent transparency in the fee structure when applied to an individual member), it is not unreasonable to consider that there might be an increased risk identified by the indemnifier. So they are basically saying there may be claims likely to be made against this person in the future. I have no problem with that in principle, but the issue comes when this person then leaves the society because the costs of indemnity have risen so high it is fundamentally unaffordable for them to keep paying.

What happens then? The costs of these future claims will be potentially met by the rest of the members who are maybe NOT doing the same sort of high risk dentistry as the member who has left. One can argue that this is a socially responsible and indeed professional manner in which a wronged patient can claim recompense. The problem occurs when there are more of the lower risk members paying for the expenses of the higher risk. Add into this situation that the societies offer ‘discretionary cover’, meaning that your claim only has the right to be considered by the society (and not actually guaranteed to be supported), then some people feel that they are paying an increasing amount of money for less than guaranteed and continued support in their time of need.

It seems to me that many of the members of the traditional membership societies are becoming increasingly worried about the inexorable rise in costs, and the discretionary nature of the support offered. I am aware of much conversation about the pros and cons of moving between the societies, and I’m also aware of the increase in membership of the Insurance based companies as a result of the concerns about this. One of the advantages of insurance based cover is the presence of a written contract, and the ability to make a complaint to the Insurance Ombudsman, which doesn’t exist with the discretionary membership. In addition, the insurance companies are also heavily regulated by the likes of the Financial Services Authority; the traditional indemnifiers however seem to have no regulator at all. The counter to this argument is that with discretionary cover the traditional indemnifiers can cover those who are not indeed members at the time of a claim, and for the benefit of the profession. I can recall this publically happening at some point in the past, and if I am not mistaken it was a human rights issue that became clarified as a result. However, just how many times has the discretionary cover been used in that manner, and not just to refuse cover?

The way I see it, we will reach a tipping point if something is not done soon to clarify more robustly the stance of the traditional indemnifiers, especially where their discretionary powers are concerned. I want to know that I have the support of the indemnifier in assisting me in my time of need, and not that at some point they decide to pull the plug due to a disagreement or just because it is easier and cheaper to settle (despite it being morally, ethically, and clinically wrong to do so). Does writing a blog of this nature give them grounds to refuse cover? Your guess is as good as mine since there is no real published criteria to know where you actually stand.

I can see there becoming a tipping point at some time in the future where all the good clients of the protection societies are no longer willing to put up with the uncertainty and the lack of transparency about the decisions made about any individuals’ costs and especially the discretionary element of support. These clients will leave, and since it is a requirement to have appropriate indemnity, there will be no shortage of new style companies happy to disrupt the market place and offer an alternative.

For example, what if the indemnifier needed a million pounds to cover its expenses and it had 10,000 clients? The cost per client is obviously £100 per client. But what if this indemnifier then starts to haemorrhage clients until it only has 1000? The cost per client is then £1000. These remaining clients are not necessarily going to be the high risk ones either, as it’s probably the case that those higher risk clients will have changed society much sooner in order to keep their costs down.

This is probably a gross oversimplification, and I’d actually welcome someone putting me right over this, especially from any of the defence societies. However, fundamentally what I see is an ever increasing demand on the resources of these societies, with a potentially decreasing number of members footing the bill, and those members not actually knowing if they will be fully supported by the society due to the discretionary nature of the membership. This is a prime situation for a tipping point to occur that changes significantly the whole model this operates under. This might be practitioners leaving, or it might be a re-evaluation of the business model to take things into account. However it is not something that can remain the unchanged as it appears to me unsustainable in the long term.

Before anyone says this couldn’t happen as the societies are so big and have so many customers, all I have to remind you of is Kodak not identifying the digital camera revolution, Encyclopaedia Britannica not recognising the  threat of the internet, and finally the inexorable rise of Uber in its disruption of how we utilise taxis.

All indemnifiers are also reliant on the need for legal cases to continue. By this I mean there is a symbiotic relationship between the defence and prosecution of dental cases, as without one side the other cant really exist the in the same way. Once a case is begun, then costs accumulate on both sides, and the legal profession feeds from this accordingly. These adversarial sides become dependent on one another, and in particular the defence side of negligence does not necessarily work under a no-win, no-fee basis in my experience and gets paid regardless of winning or losing (by our indemnifiers). Cynically, one would say it is therefore in the financial interests of those in the legal profession to have the current highly litigious situation in dentistry to continue, because there appears to be no shortage of work for them. The practice of dentistry becomes the raison d’etre for the existence of both the societies and those legal firms feeding it until we do something to stop it.

There may be protests from the indemnifiers of the tome of this blog; certainly I have taken no account of some of the truly awful issues that result in harm befalling patients by some practitioners. I am definitely of the opinion that we as a profession most certainly still need to put our house in order, and there is probably no room within it for some of the practices that some of our colleagues routinely feel are acceptable. However, unless you are part of the solution, then you are actually part of the problem, and I feel that there should be much more clarity evident in the world of indemnity, so that the profession can practice with the confidence that our patients need us to have when caring from them.

Otherwise, what’s the point in us continuing to serve our patients? That may well create a further tipping point…..of no one in the profession left to care.

Image credit - Guiseppe Milo under CC licence - not modified.

Oral-B has released the dates for their next series of Up-To-Date seminars.  Each of these popular evening sessions will be comprised of two 45-minute lectures.

Louis Mackenzie’s presentation is entitled ‘How to make fillings look like teeth!’  He will discuss the challenges in shaping posterior composites and carving amalgams and how restoring the complex optical properties of anterior teeth can be even more difficult. Detailed practical tips will be given for the easy, predictable anatomical shaping of posterior composite and amalgam restorations, using a unique step-by-step system designed at Birmingham Dental School. The lecture will also outline the fundamental principles of aesthetics, enabling delegates to optimise all clinical stages of direct anterior composite restorations.

Prof Trevor Burke’s lecture is provocatively entitled ‘The rise and rise and rise of toothwearology’.  Tooth wear, in the past, was treated by gross destruction of teeth using a turbine drill for crown preparations – a strange way to treat teeth which were already compromised! However, advances in bonding techniques have enabled the use of minimally invasive treatment using composite resin bonded to worn surfaces. Trevor will discuss the optimum bonding agents for this treatment, how to achieve an aesthetic improvement where needed – the concept of pragmatic aesthetics, and will indicate the rates of success which might be expected.

Clinical dental professionals are invited to attend this complimentary CPD accredited evening event at one of six locations:

London – 28^th September 2017 – Hilton Hotel (Watford)

Newcastle - 12^th October 2017 – Hilton Hotel (Gateshead)

Bristol – 2^nd November 2017 – Aztec Hotel

Manchester – 9^th November 2017 – Village Hotel (Cheadle)

Birmingham - 16^th November 2017 – Crowne Plaza (Solihull)

Leeds – 23^rd November 2017 – Village Hotel (South)

As well as two and a half hours of verifiable CPD every delegate is invited to enjoy a complimentary meal at the beginning of the evening. 

Registration and buffet is from 5.45pm with the first lecture starting at 6.30pm. The evening will finish at 9.00pm. 

Register online at www.dentalcare.co.uk/uptodateseminars.

For enquiries please email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 0870 2421850. 

The British Academy of Cosmetic Dentistry (BACD) Annual Conference will be opening its doors to delegates in November. In its fourteenth year, the BACD Annual Conference is, without a doubt, one of the most highly anticipated events in the professional calendar. This year focusing on ‘FAB: Function, Aesthetics, Biology’, the fully-filled, three-day event will be bringing together delegates from across the country for some of the most exceptional learning opportunities dentistry has to offer.

This includes a schedule of exclusive lectures, exciting presentations and inspiring hands-on sessions – all led by some of the profession’s leading lights. The line-up this year is better than ever and includes such names as Dr Nikos Mardas.

Nikos qualified in dentistry from Athens University and completed first a three-year postgraduate MS in periodontology and then a PhD at the Royal Dental College at the University of Aarhus in Demark.

He has experience in private practice as a specialist periodontist and has been appointed a senior lecturer at the Periodontology Unit at UCL, Eastman Dental Institute, as well as Senior Clinical Lecturer/ Honorary Consultant  in Periodontology at Bart’s & The London School of Medicine and Dentistry at the Queen Mary University London. He is also The Educational Delegate for the ITI UK & Ireland section. All combined, this means Nikos is one of the most knowledgeable periodontists working in the field today, and he will be bringing this wealth of understanding to the Academy’s Annual Conference in November.

Giving a lecture entitled Periodontal Plastic Surgery: myths and reality in gingival recession coverage, Nikos will be giving delegates an insight into the advanced concepts of modern periodontal plastic surgery. He says, “Periodontal plastic surgery refers to a great variety of procedures designed to restore form and function, and improve cosmetic disturbances around teeth and, increasingly, dental implants. Various flaps designs, soft tissue grafts and substitutes, together with micro-surgical techniques have been applied to correct different muco-gingival defects in a variety of clinical scenarios, ranging form gingival recession coverage to extraction socket management.

“My presentation will provide a summary of the evidence on the predictability of current treatment protocols for gingival recessions, utilising different techniques and biomaterials. I will be showing delegates different case examples and discussing the pros and cons of each to evaluate the clinical effectiveness of different techniques in every day clinical practice.

“I hope that delegates will be able to go back to their practice and diagnose different recession defects, understand their predictability and the difficulties encountered in their management and guide the motivated patient towards the most appropriate therapeutic approach, based on an estimation of local and systemic factors.”

With such a compelling topics, Nikos’s lecture will undoubtedly be one of the highlights of the BACD’s Annual Conference and will give delegates the knowledge and insight they need to go away and improve their daily practice.

Of course, the BACD Annual Conference is not simply one of the best opportunities for dental professionals to learn more about the modern profession, it is also a chance to see what the dental industry has to offer. Delegates will be treated to a three-day trade show throughout the conference, where they can get information on the latest technology and products on offer.

What’s more, there will be plenty of time to network with like-minded colleagues at any one of the BACD’s planned social events, meaning delegates will have a chance to let down their hair and reignite their passion for beautiful dentistry in a more relaxed environment.

Make sure you book your place today to ensure you do not miss out!

The BACD Fourteenth Annual Conference 2017

‘FAB – Function, Aesthetics, Biology’

9th – 11th November 2017

The Hilton London Metropole Hotel, London

For further enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com.