By the time you read this it will be less than a week before the Judicial Review hearing over the GDC’s setting of the ARF, and after the Special Meeting of the LDC’s unanimously held a Vote of No Confidence on the GDC. That vote was excellent timing in my opinion, as it was the last piece in the jigsaw of No Confidence coming right before the Judicial Review.

The thought of having to appear to defend yourself legally when you don’t think you’ve done much wrong (or indeed anything wrong) is an increasingly familiar feeling amongst our profession, judging by the sheer increase in the number of our colleagues having to go through a similar adversarial situation. I truly hope there is now some realization amongst the higher echelons of the GDC of how it feels to have your career under threat.

After all, no matter what the result, its not a great addition to your CV when you have to add you were in charge when an entire profession voted No Confidence in your Leadership, and you headed up the first regulator to be taken to court by those it regulated. I wonder if the (unfortunately fictional) General Quango-crats Council ever impose conditions like the GDC do to make you inform future employers aware of what cases are pending or have been found against you?

The difference of course though is that if we showed the same degree of arrogance and lack of insight then that would be held against us by the regulator. They continue to show no insight that they might be doing something wrong; a vote of No Confidence from the LDC’s is the latest in a long line of similar votes and their response to that was as predictable as usual; once again failing to acknowledge the levity of the issue, that they were surprised, and repeating the mantra of saying they want to work with us to improve patient safety.

Unfortunately the judiciary are not going to be able to take into account these votes of no confidence; their remit is only to see if the correct legal process has been taken by the GDC in setting the ARF, and will not be influenced by our opinion of the regulator. Win or lose though, Pandora’s Box has now well and truly been opened by the BDA’s action.

Next Monday’s decision is critical in many ways, but almost irrelevant in others. Let me explain why I think that. In my opinion, if the BDA lose, then all that really happens immediately is we pay the increased ARF. Nothing else was going to change with a regulator with leadership that will not accept it is wrong. It does mean that the GDC will continue along the path it has chosen with renewed vigour, but that actually won’t make much difference to the registrants who live in constant fear of falling foul of the GDC’s interpretation of the law.

And what if the GDC lose? Does anyone really expect the current leadership to resign or admit they are wrong? One thing that has become apparent over the past few months is the lack of accountability and insight that organizations like this display, so my bet is that the current management will retire to lick its wounds if it is defeated, but not fall on its swords as would be the honourable thing to do.

So that’s why the result is almost irrelevant as whatever the decision, the fight must continue to bring the GDC to order. That is only likely to be done by putting them under ever increasing pressure no matter what happens next week.

So, on the other hand, the decision is critical in that it has to be the beginning of the tipping point against the GDC. This feeling within the profession will NOT and must not go away, because the fear that the GDC is instilling in all practitioners that the slightest infraction will lead to a draconian and disproportionate response is ruining patient care. When we practice so defensively that our first thought is to protect ourselves, then we cannot truly be acting in the best interests of the patient. Why can’t they grasp this concept? Is our profession really so bad that 15% of us deserve to have a fitness to practice case against us at some point? No it is not.  And this injustice is what we should continue to fight.

The GDC is also going to be subject of an Adjournment Debate this week, and whilst MP’s are usually conveniently unaware of dental problems in much the same way as our patients unless something happens to focus their attention, the fact that this issue has now appeared on their horizon is notable. Traditionally the profession doesn’t tend to get the kind of hearing they would like in Westminster due to the influence of the Department of Health. This debate might be different however as it is not about contracts and the NHS for once.

This is why it is now so important that the recent votes of No Confidence and the Judicial Review in particular are broadcast to a wider audience. Never has a regulator been so roundly condemned to such a degree as this before, and the MP’s must now be made aware of the strength of feeling in profession. This is the kind of pressure that brings change. Some might say that change could bring in a worse situation to the one we are not in. Really?? Could it get much worse when you already live in the fear of losing your career over a single patient complaint?

One wonders if the GDC Christmas party will be on hold this year; one of my previous blogs suggested the GDC would be running out of cash round about now, and given the tone of the ARF reminder emails that many of us have received this week, there seems a desperation to get some cash into the coffers fairly swiftly. I don’t think for a minute there is any compassion or helpfulness behind those emails to remind us to pay our ARF; if they had either of those virtues they would have come up with solutions to help registrants pay monthly, or not act so swiftly to erase for non-payment, and not continued blindly on the course they have chosen. No, this is a cashflow issue in my opinion, and possibly quite a desperate one.

Its perfectly possible they’ve run their reserves so low this time that they won’t be able to spend as much on the Christmas party as previous years – which a recent freedom of Information response reveals was about £80,000 of our money between 2007 and 2013 (including summer events). I know they are currently having a laugh at our expense, but should they be having a party funded by us as well?

So I think the GDC’s ship is heading into a perfect storm this week; starting with Questions in Parliament, then the Judicial Review, and finally the starving of its cashflow by our cancellation of direct debits, means now is not the time to sit back and wait for something to happen, but to continue to exert pressure on the beleaguered Executive and Council. This need not only be via organizations like the LDC’s and the BDA, but also by registrants as individuals taking whatever action they can professionally, ethically and legally.

After all, a ship sailing through a Force 10 Hurricane isn’t likely to appreciate a few well-aimed torpedoes is it?

In this weeks "digital dentistry" blog, we would like to look at comments we regularly encounter about gdpuk.com. We have provided answers to those statements in the blog below, that we believe will bust the myths about our site and change your perception of gdpuk.com.

"The same people use the forum"

We agree that a number of people post regularly (true of any successful community) but in 2013 we had 958 different contributors to our forum discussions and in 2014 we expect to have over 1000 different contributors from all over UK Dentistry. We believe that such a huge amount of expertise, information and opinion is unbelievable! This varied interaction makes the forum vibrant, controversial and inspirational, everything you want in a successful community.

"The forum contains arguments and negativity."

Yes the forum does contain arguments and disagreements but a bit of controversy keeps the community moving forward and our members logging onto the site! Overall, our threads receive positive feedback, encouragement or helpful information. The site is professional (helped by members using real names) so information can be shared plus opinion or outrage can be discussed in a secure environment (CQC, GDC etc).  This helps to create a credible, thriving and growing community. The majority of our users find the site an incredible and positive medium.

"Dentists don’t go online."

We heard this comment recently at a dental exhibition from someone who shall remain anonymous. They believed that dentists prefer to read trade magazines and books and don’t use the internet. Dentists are no different to the rest of the UK population and use the internet to book holidays, buy clothes and interact on social media. GDPUK is a major part of thousands of dentist’s daily lives; we have thousands reading the daily digest email or forum on a daily basis. We believe dentists are using online dental websites on an increasing basis, especially because they can use social media to interact with each other on a regular basis. Using dental sites means that friendships can be formed with colleagues across the country.

"Banners on the site aren’t noticed"

We have just under 8000 members, a number we are extremely proud of.  Our members are constantly logging in and out of the site all day long, often between patients or during lunch breaks. This means our banners often receive tens of thousands of impressions on a daily basis. At the start of December 2014, we started running a campaign for a company that helps practices with their CQC visits. As part of their advertising campaign they are running a survey on gdpuk. Link here. In the first 8 days , the survey has received 65 completed responses, which we believe is a fantastic response. The company have used a simple campaign of email and forum banners, which have received 126 clicks and just fewer than 54,000 impressions in 8 days. We believe that this is an amazing example of banners being noticed and with the right message, action being taken by our readers.

Thanks for reading. We hope you enjoyed this short blog. We hope you can look at GDPUK.com as a positive influence in UK Dentistry. If you would like further information on how to work with the site, please get in touch. 

A pantomime in so many parts, so many ways  …

Opening Sing-a-long

T’is the season to be jolly
Fa-la-la-la-la, La-la-la-lah
GDC have got your lolly
Fa-la-la-la-la, La-la-la-lah

Enter Widow Cockcroft, the ghost of Dentistry past

Ah, ladies and gentlemen, boys and girls, will you just look at that Christmas tree – and who’s that on the top I see?  Is that little Angel Evlynne? My that spiky tree looks painful… and she’s no angel, children believe me.

What a pantomime this is.  Welcome to our very special Dental Land of Panto [DLP … grown up joke …. Never mind ]

Dr Mick – are you out there – yes children, look – there he is going into that nice big Law Court. Wave him goodbye will, you. Wish him luck Good Luck Dr Mick. A big cheer now … HURAAAAAAH! 

He’s going to fight that nasty Baron Moyes and his henchperson the Wicked Witch

Do you know the story of the bad Baron? He was such a weak Baron that he failed to see how he was hurting the people who lived in Dental Panto Land. He taxed them and taxed them to the point where all they could do was…   well, in the end children, they did pay their taxes otherwise they would lose their jobs and starve. It was very unfair especially on the young members of the Dental Panto Community. It was unfair on the old as well, and any one with children – actually, it was unfair on everyone!

It was all the fault of the Wicked Witch really. She was a Lawyer at heart - - do we have any Lawyers here children? A big boo for all lawyers shall we ?

1  …  2  … 3   … BOOOOOOOOOO

Ooh that’s better.  Lawyers use the law that their friends made to take the Dental money too. Isn’t that nasty and spiteful children? BOOOOOOOOOO. We all know a bunch of baddies don’t we children? They are called the Dental Law Partnership. BOOOOOOOOOO!!

Things got so bad that an emergency council of Local Dental Committees was called.  All the brave souls, they all got on their White Chargers [ Well, GNER , Cross Country Trains and the odd Porsche mainly] and rode to a secret meeting place – well actually a nice gaff in Cavendish Square conveniently underneath the offices of that nice Dr Lewis at Dental Protection.

He will look after you children.

The second half children is going to be very exciting. Shall we all giver a big cheer for Dr Mick and the LDC Merry Gentlemen and Ladies ? 

1  …  2  …  3  …  HURAAAAAAH

Shall we all sing another carol?

God rest ye, merry gentlemen
Let nothing you dismay,
The G D C have done you over
for it’s cut your pay

[All]
Oh tidings of penury and Moyes
Pen’ry and Moyes
Oh, tidings of the ARF, Oh joy

Stage note:  The pantomime continues until … well for ever, really!

Pantomime season with a Grimm warning   

I’ve had a busy couple of days and upset some applecarts; perhaps I should apologise if I have bruised any fruit?

On Friday the 21st, I spent an interesting day in Corpus Christi College, in Cambridge with my fellow NADA (National Association of Dental Advisers) colleagues as well as a selection of the great and the good and quite a few of our younger dental colleagues who had come along for the verifiable CPD and to find out what sort of profession they were entering into.

Sarah Rann (assistant medical director East Anglia Area Team NHS England) kicked off proceedings by asking us and then telling us what we should be doing as National Dental Advisers. The only aspect that she missed off her list was influencing the Regulators, (aka upsetting the established applecart by proffering an expert opinion).

We were then treated to a relatively complimentary double act between Barry Cockcroft and John Milne’s views on Contract Reform. There was a large amount of agreement even concluding with synchronised retirement from their respective roles early next year. Barry emphasised that ‘access’ was less of a political hot potato now than it had been and he saw this as one of his successes during his tenure. John talked about the impact of pilots and possible implications.

A little local difficulty about a dental practice not far from Nottingham was briefly mentioned.

A question regarding access to certain less privileged groups was aired and this is where I must apologise. I raised the question of ‘access to what quality of care?’ And I then asked ‘who was responsible for the World Class Commissioning of such ludicrously large and unmanageable contracts?’

Well there was a stunned silence and poor Barry looked like he had been stabbed in the chest. Fortunately John was on hand to ride to his rescue and acknowledge, although not answer the question and then draw stumps on this part of the meeting.  

We were treated to some joined up thinking from David Geddes (National head of primary care commissioning) who discussed intelligently and without too much smoke and mirrors what the future 5 year plan may mean to dentistry, please read this if you haven’t: http://www.england.nhs.uk/ourwork/futurenhs/

Amanda Crosse (consultant in Dental Public Health) went a little off piste with her unguarded comment regarding perhaps planning to have dental NHS commissioning overseen by CCG’s. An interesting idea which seemed to irritate the level headed David and which he was forced into backtracking a little.

David Behan was cut short, the previous part of the agenda having overrun by 50 minutes meant that David only had 10 minutes to get his message across about the new CQC. He did it very well I thought and was only sorry that it was necessary to tell the gathered throng of dental advisers that he was disappointed in their union attitude to pay and perhaps we would like to put something back into the profession. He was having no more of discussing an inflationary fee. Actually I agree and am happy to spend my time for free advising the CQC.

This is where all of you come in…...’Efficacy and the CQC inspection, on the right path now? ‘It’s your opportunity to get the message across and its coming to GDPUK soon.

 Poisoned apples for ‘afters’………..,

The afternoon was devoted to a Brother’s Grimm pantomime about a dodgy dentist with decontamination and NHS gaming tendencies, played brilliantly by Bryan Harvey (DDU), who was frighteningly good at getting into Character.  We were assured that this was not based on any recent situation and I pointed out that it couldn’t have been, since they failed to notify the Press or recall 22,000 terrified patients…., Oops!

The GDC on this NADA inspired day was represented by Mike Ridler (Head of Hearings) who displayed distressing figures on FtP hearings.  Mike expressed his inability to understand the reasons since in his experience there had not been an associated decline in professional standards. Somebody in the audience mentioned that it might have something to do with National advertising?!! Mike did not wish to be drawn further on this.

He obviously didn’t feel inclined to join in with the GDC pantomime either and suggested that if anyone wanted to talk about other ARF type issues they could do this individually later, although it wasn’t his ‘field.’ He then failed to answer the other questions, since they weren’t his field either.   

The meeting closed with another unplanned shedding of apples just as stumps were drawn and flat hats were on; Jason Stokes leapt up on stage and shouted that if the younger members of the audience felt slightly dismayed by opinions voiced by the demobbing great and the good; NOW is the time to make their voices heard. Oyez, oyez!

Keith Hayes

Right Path Ltd

As we approach the final month of 2014, people start to wind down for the year and we all start looking at the year ahead. We focus on setting targets, goals, wishes and budgets for the year ahead.

Before you start looking too far into the future we thought we would let you know, that we have a small number of advertising opportunities on GDPUK in December.

Do you have a course you are looking to promote in early 2015?

A new product you have launched and you would like some extra promotion?

You may have December offers of your own that need a push?

Whatever your reason, we have a few spaces left on the site in December. Please This email address is being protected from spambots. You need JavaScript enabled to view it. and we may even surprise you with a festive price!

Did you know?

December has always been one of the busiest months on gdpuk. Dentists constantly use the forum and share expertise throughout the holiday period, which even includes Christmas day for some!

No one with anything to do with dentistry could have escaped from the news in Nottinghamshire this week about the cross infection standards at a practice there over the years. This is my neck of the woods, so I can perhaps write with a little more insight than others who are out of the area.

The complete facts have yet to fully come out, but it seems clear there was enough of an issue perceived by the powers that be to recall 22,000 patients, and in doing so scare the living daylights out of a fair number of them.

But given the facts that are available, and not in any way condoning the actions of the dentist involved (whatever they may turn out to be), this brings up a more sinister undercurrent to the whole matter the really should be exposed.

It’s in the public domain that this practice had a UDA contract of 29,000. The last update of the NHS Choices website in 2010 for the practice shows a single performer at the premises where the contract was held.

29,000 UDA’s for a single-handed practitioner? Who in their right mind commissioned that number? That’s like contracting your dental nurse to do a 240 hour week and then washing your hands of the problem when it all goes horribly wrong. She’s either stupid or greedy (if its paid hourly) for accepting, and you’re an idiot for thinking its possible. Even if she gets a mate to help out, its NOT POSSIBLE.

It sounds like this has been going on for some time as well. It’s entirely possible this has been the case since the beginning of the contract.

Ok, the rumours flying around are that there was also a part time associate, but even so, it is still not an achievable number to do with any degree of quality, safety, and ethics.

The person(s) who commissioned this at the PCT, and latterly the LAT, and continued to do so over the years remains anonymous and unanswerable at the moment.

Because they have to take a share of the responsibility for this situation. Its one thing if a dentist decides to act in a certain way; there is the ultimate sanction of our regulator the GDC erasing us, but its another thing when the Unanswerable and Untouchable contract managers in their PCT/LAT towers make decisions solely based on targets being met and box ticking. As I have already said, if the registrant has brought patient safety into jeopardy then there should be the full and appropriate weight of our regulators applied to protect the public.

But how can it be remotely possible that SOMEBODY at the contracting level didn't think there was something odd about such a small practice having such a huge contract? Did they knowingly turn a blind eye in their quest for access? If so they surely are culpable to some degree for what has happened. If they were blissfully unaware that 29,000 Uda’s is a ludicrous target for that practice, then they should be given a job more suited to their skills. May I suggest if that is the case then an audit into how many paperclips the PCT/LAT have used in 5 years would be more the level of their ability.

This is our Mid Staffs. Clinical staff being driven by targets, (which may or may not in this case have a personal motive by the dentist from a financial point of view - we can only speculate) which are quite frankly unachievable with any degree of quality, and patient care therefore suffers.

Unfortunately, the managers commissioning would appear to have gone blind for a period of time and will probably get away with having any culpability attached to them. Their lack of vision and insight is ironic when you consider they are also usually responsible for optical contracts too. (Perhaps they have no teeth when it comes to problems with those contracts!)

However, Mr. Moyes at the GDC wants to broaden their remit to regulate even more.

Might I be so bold as to suggest that ANYONE involved with dental contracting has to be registered in the future with the GDC from a patient safety point of view.

From the Assistant Deputy Assistant Manager’s Deputy to the Assistant Manager (have you noticed how long these names get for people employed in LATLand?) right up to the Directors, they should all be included. The BDA should press for an addition to the Dentists Act whilst the Section 60 order is going through consultation and get these people included on a register. Charge the LAT a flat rate, (How about £890 for Directors and £116 for the others to start off with?). Then, when something like this hits the fan, THEY can be held responsible at least in part for the damage to patient care that results. Sanctions to them can be the same as us, suspension, or erasure. In one fell swoop you would then solve the employment issues that means some people can’t be got rid of in the normal manner. Not registered? Can’t work. End of.

Some will argue it is the dentist and only the dentist who is unilaterally responsible for issues such as we see here. If so, then these people have nothing to fear from registration. However, I think you find most of those who think this at the moment will probably be doing it from the comfort of a nice office somewhere in LATLand or some other associated organisation.

And what of the whistleblower? If someone has been party to the goings on at this practice for a period of time and has only reported it lately, why are they not implicated in the failure prior to the whistleblowing? Is this a negotiated immunity from implication in the problem? If it is, I’ll bet the Rottweilers at the GDC won’t see it that way if their name ever comes out and they are a registrant. If they don’t, then they the GDC are guilty of double standards. Given some of the recent charges levelled at registrants and how spurious they seem to us, I’d have thought any professional remaining in a practice as bad as has been made out for more than 20 minutes on their first day would have to be implicated just by continuing to work; a tacit acceptance of poor standards with the intention of whistleblowing at some point in the future wouldn’t be much of a defence I’d have thought.

And if its only been so bad recently that the whistleblower has only just had grounds to report and is therefore exonerated, then why say it has been going on for 30 years and involves 22,000 patients?

Which means Public Health England and the CQC shouldn’t escape criticism either; The CQC report on their website doesn't fail the practice at the level of needing immediate enforcement action, and closing it, but at the level of requiring improvement, which allows an action plan and to remain open. So should the CQC have gone further and sanctioned a close down if there was such a huge risk of viral transmission? Either the inspector is wrong in not closing it down, or the PHE/LAT have blown it out of proportion. Between them all they remind me of Corporal Jones from Dad’s Army running round in circles shouting ‘Don’t Panic’, whilst simultaneously causing the local population to do just that.

To reiterate, I am not in any way defending or condoning the actions the practitioner involved, and do not know him. If there has been a breach in safety and patients have suffered an increase in risk at the hands of one of our profession we should do the right thing and deal with it swiftly and publicly.

However, I suspect once again there has been virtually no real dental input into this situation, and its probably the Untouchables who have set all the balls in motion as a result of the whistleblower’s video.

So, Mr. Moyes, you want to broaden your remit? Might I suggest you clarify the definition of regulation (since your recent answers at the Parliamentary Committee meeting suggests you aren’t very sure about what regulation is) and get your remit broadened?

When you do, you could do worse than look at this case for some names to get you started.

What a great testament to the powers of humanity is the Rosetta comet chaser and viewing project. Not only a great success for the co-operative that is the European Space Agency, but for mankind., and an advertisement for human teamwork. Launched way back in March 2004, this craft has used a few slingshot manoeuvres around planets to gain speed on its 4 billion mile journey to reach Comet 67P at the planned time, travelling at the same speed as the spinning, irregular lump of rock.

The concept must have been dreamt up way back, maybe ten years before its launch, and the thinking and planning must have been so detailed. Then the team working from MUSC in Koln must have had  a seemingly endless ten year wait for this week to arrive.

But consider the team work, design, manufacturing, planning, mathematics and forethought that must have gone into this project over the best part of two decades. The distances involved, the risks of failure were massive, yet this team have got the craft to land on the planet, and even though it has bounced around in the micro-gravity there, it is communicating electronically to the base, where witty tweets are being posted in many languages. https://twitter.com/philae2014

And just think - Twitter wasn't a twinkle in anyone's eye when Rosetta was launched!

Even though now the lander is under the shadow of a cliff, and has lost battery power, it might get some daylight and re-charge itself. 

The comet itself is larger than one might think, around 3 kilometres by 5 kilometres, it rotates around each 12.4 hours, and takes around 6.4 years to orbit the sun

The goals of the mission are to look at the structure of the comet's core, its chemical and mineral composition, measurement of the comet's other phyical properties, an observation as the comet approaches the sun.

Let's congratulate the ESA team, hope for more successful results and images from Philae whilst anchored!

http://en.wikipedia.org/wiki/Rosetta_(spacecraft)
http://en.wikipedia.org/wiki/Timeline_of_Rosetta_spacecraft
http://dlr.de/dlr/en/desktopdefault.aspx/tabid-10394/

Disastrous events have and will still occur in dentistry, despite being, in the UK, the most over-regulated profession. But my question in this "open-letter" blog is not just about the right touch of the regulators, but about who runs and who controls the regulators.

In the good old days, the regulators of the professions were drawn from the professions themselves, people of good standing who were willing to put themselves forward, possibly by election or appointment, and it was the case that many good people did indeed come forward.

During the last twenty years, or less, political theories developed suggesting greater and greater roles for the lay members' control of regulators, and my strong contention is that the pendulum is proven to have gone too far away from professional input and control. In other words the regulators have visibly and clearly lost touch.

Regulators insist that professionals show insight into themselves. As professionals, do we educate ourselves correctly, probe our own weaknesses and failings, educate ourselves away from those weaknesses?

But have the regulators shown any form of insight? I also contend, in a very short time frame, the lay element just do not have insight of the profession. How it ticks, how practitioners think? Do they know? How new professional problems are viewed and solved? Intelligent people, as professionals, are put into the rapidly shifting sands of a hightly regulated and inspected system, how do the professionals respond to all those influences, and how do they cope? Do the lay regulators pick this up? How? GDC regulators, the people making the policies have now become so detached from this they have no idea at all. That detachment has been so vividly apparent this summer and autumn, with the GDC remaining with its' collective head deeper and deeper in the sands of 37 Wimpole Street.

Dentistry is also regulated by the Care Quality Commission [CQC]. The CQC early engagement with dental profession was disastrous. In many ways the initial relationship between the CQC and the English dental profession could have served as a case study in how not to engage, a manual on how to alienate. Even in 2014, when CQC have pronounced that dentistry in England carries a low risk for patients and inspections will be made each 5 years, the early alienation created by CQC remains at the forefront for the profession.

The style of CQC speakers, tasked with communicating to dentists in around 2010, was bullying, harrassing and when they saw the dental audience was visibly angry, they invoked the Health and Social Care Act 2008, and said they will do what they want, the law says they can. No negotiation, no compromise, no concept of listening to the senior dental people they were visibly insulting.

They got it wrong then and things may be improving [with added DENTAL input] but the D'Mello case shows how the CQC were getting it wrong. The report on that Mansfield practice shows an inspection was passed, but the main concern was that the mops were the wrong colours. ^[1] [For those who do not know, a system exists, which all dental practices must follow - mops used for the floors in each room must be the right colours, and cleaners educated and make tick charts of the use of the mops in differing areas.]  ^[2]  However, the lay CQC inspector did not note other more worrying aspects, such as, this dentist was seeing, to meet the demands of that particular NHS general dental contract, around 55 patients per day.

Even assuming a full 8 hour day, and knowing all professionals flag after a long day of executive processes and clinical decision making, that is close to seven patients per hour, an average of less than nine minutes per consultation. And we know some of those visits must have been for treatment, not just examination. And dear reader, think about the time it really does take for a patient to enter a room, take off their coat, say hello, be quizzed about their medical history, examined, explained, full informed consent given, explanation of costs, then final greetings, rinse, stand, coat back on. Could you do this in around 8 minutes? This is without allowing for the natural breaks in the day. Even if this dentist worked 10 hours every day, that only gives 12 minutes per patient, including treatment, day after day, hour after hour.

I omitted one thing here - time for cross infection control, several minutes each patient - and this was the thing D'Mello is now notorious, having been proven to have cut this essential aspect out.

But the lay inspector missed this massive aspect of how this practice was being run, something a dentist might not have picked up, but it is much more likely a dentist would have seen in a long, detailed, inspection visit.

So my words for politicians, civil servants, British Dental Association negotiators, and Department of Health; reforms of dental regulation are needed again, and do not cut the corners this time. We need appropriate intellectual and professional input at all levels of new regulation processes that urgently need re-specifying.

Tony Jacobs.

[1] see appendix 1 p15 

[2] CQC report updated at time of suspension of dentist.

Image credit - John Morgan   under CC licence - not modified.

Many people do many extraordinary things in the name of charity. From the tried and tested classic of soaking in a bath of baked beans, to pouring a bucket of freezing cold water over their head, the lengths people will go to in order to raise money and awareness for worthy and deserving organisations are in every case commendable.

Often the more extreme the feat, the more exposure and recognition the charity receives. Whether it’s a group of celebrities climbing Mount Kilimanjaro, or a well-known comedian completing 43 marathons in 51 days, we are all aware of those who have gone the extra mile in support of a good cause. However, these immense charitable challenges are not solely limited to those in the public eye.

On the 16^th November 2004, Bobby Grewal, Chairman of the India Association, embarked on a colossal and formidable task to raise money for a number of well-known charities. His incredible fundraising endeavour saw him trek 2,556 miles from Amritsar in the north-western tip of India to Kanyakumari, in the extreme south.

Described as ‘The Great Charity Walk’, over five months Bobby trekked across 10 states, covering an incredible 30-35 miles each day. Although the walk was both physically and mentally challenging it was completed on 14^th April 2005 and the India Association raised over £100,000, which was donated to Northwick Park Hospital for Cancer and AIDS research.

Now, Bobby has decided to return to India, embarking once more on an immense journey that will see him go ‘Full Circle’. Setting off from Kanyakumari, where he concluded his previous walk, he will make his way up the east coast via Chennai and Calcutta to his final destination in Delhi covering an unbelievable 2,600 miles.

Now in his 79^th year (Bobby will celebrate his 80^th birthday during the challenge), this will be no mean feat. He will have to endure extreme weather conditions and exacting terrain, while completing 20-25 miles every day in order to meet his targets. Along the way, Bobby will attend various publicity and fundraising events to help raise awareness of his task.

Each day begins at 04:30 as he aims to cover 12 miles by 09:00, he will then take a break until the late afternoon to avoid the hottest part of the day and complete the day’s walk by the early evening. Throughout his walk, he will be accompanied by only a single support vehicle and small team. His crew of four consisting of a PR manager, a driver, a chef and a physiotherapist, who will attempt to ensure he stays fit and healthy throughout the five months.

Completing this gigantic task, Bobby hopes to raise £1,500,000 for Save the Children and the India Association who will distribute the funds to other charities here in the UK and abroad.

A West London based charity, the India Association is committed to helping raise funds for worthy causes. The charity’s committee is made up of 300 volunteers who all share the same aim of ‘providing relief from poverty, sickness and distress to those in need’. Bobby has been Chairman of the India Association since 2001 and has so far helped the charity raise over £300,000 for a number of deserving charities including Help the Heroes, St Mark’s Research Hospital and Northwick Park Hospital. This next challenge looks to be his most impressive to date and has backing from a number of well known faces, politicians and organisations.

The Sterling Dental Foundation is part of the Sterling Dental Group and is proud to be one of those supporting Bobby’s Walk Full Circle.

The Foundation will provide practices and clinicians across the profession with support, advice and networking opportunities. The group is committed to supporting the dental industry through working closely with charities and other professional associations.

The Sterling Dental Group is fully supportive of Mr Modhi, the Prime Minister of India’s initiative to raise awareness levels of Oral Hygiene and Dental Education amongst people, especially children living in rural areas. We welcome dental practitioners to visit the new satellite centers whilst also supporting Save the Children.

The Group invites UK and Indian dentists and hygienists to walk alongside Bobby for this very worthwhile cause. Join the charity in supporting underprivileged children by raising Oral Health awareness in the various states in India. You can join at various legs of the walk, adding smiles, lighting up beautiful faces and having lots of fun along the way!

Show your support for Bobby’s momentous challenge by attending the Sterling Dental Foundation Charity Ball at the Radisson Blu Portman Hotel, London on 13^th December 2014. Book online early to avoid disappointment at www.sterlingdentalgroup.co.uk

Amongst our distinguished guests, our Guest of Honour is Professor Ian Hutchinson, BDS, MBBS, FRCS (Eng), FRCS (Edin), FFD RCSI, Consultant in Oral & Maxillofacial Surgery, St Bartholomew's and The Royal London Hospitals and Founder of Saving Faces Charity.  www.savingfaces.co.uk. 

To find out how you can help or to volunteer, visit www.sterlingdentalgroup.co.uk and register your interest online.  

To sponsor Bobby’s Walk Full Circle, please email Cara Williams at This email address is being protected from spambots. You need JavaScript enabled to view it. or call 07985593147, or visit

www.indiaassociation.co.uk/bobbys-walk-full-circle

The Sterling Dental Foundation is linked to the Sterling Dental College.

For details of the hands-on courses, seminars and CPD events that the college provides visit the website, www.sterlingdentalcollege.co.uk

Sterling Dental Foundation, registered charity: VB/5042656/RTN

I wasn’t going to write any more GDC related blogs for a while, as I don't want to be seen as a one trick pony, but the situation with the GDC is the singular most important thing to have affected our existence as a profession, and continues to have more twists and turns than a white knuckle roller coaster, so my apologies for writing about it again.

Seriously, was anyone surprised by the GDC’s decision to increase the ARF to £890 on the 30th October?

After the sham of a consultation, it’s not entirely surprising that this should be followed by what was probably a sham of a discussion at the Wimpole Street Lublyanka (for those unaware, that was the name of the HQ and prison of the KGB), and an ARF of £890 has been set.

Nothing has really changed though; despite now slightly reducing the amount for DCP’s (the majority being nurses who I suspect have that actually paid for by their practices), this would appear to have been the classic “give ‘em 3 choices and they’ll pick the middle one”.

The BDA is now set on its path for Judicial review; and this will be heard before the 17th December. The BDA stops short of recommending what its members can do up to this point, but If I may suggest the one thing that absolutely everyone can do now is cancel their direct debit, and write themselves a reminder to pay the GDC before the 31st December. That way they CANNOT take the money early, and whilst it may only be three or four weeks more before they can get it, at least if the BDA win the Judicial Review then people wont have to be waiting for a refund from a regulator that has no sense of respect for the profession. You will not be acting illegally, just stopping the GDC from getting its hands on your money sooner. Incidentally, according to a recent freedom of information request, the decision to engage KPMG was a decision taken by the Executive of the GDC and not by the council. One would have thought that engaging a company like KPMG with its associated costs would have been something put to the Council to vote on. Anyhow, the GDC will need even more money to pay for the services of KPMG, and guess what? We get to pay again.

This brings me to the point of this blog.

Civil Disobedience.

What would happen if every one of us rang the GDC between Christmas and New Year to pay? If a few thousand registrants rang over that 3 day period it means hundreds of calls would need to be taken every hour by the GDC if they had an 8 hour working day. What if their systems collapsed under the weight of having to take so many online or telephone payments? Apparently they are so arrogant they do not have the facility to take payment in cash, so the very press worthy images of a few hundred dentists turning up with buckets of £1 coins in order to pay are not going to hit the pages of the Daily Mail anytime in the future.

So what’s wrong with paying £10 on each of 89 cheques, and requesting a receipt for each one?  Or making multiple credit card payments of the same amount? Given that it is also legal to write a cheque on just about anything, may I suggest that a few 6’x4’ pieces of chipboard, properly filled out with sort codes etc delivered to the GDC in Mid-December from registrants wouldn't go amiss. How about arranging a mass payment in between Christmas and New Year, and on the days that the LAT’s insisted we should all be open for normal business? If just 100 of us turned up and wrote cheques out on pairs of boxer shorts (new ones obviously!) that might get some press attention. All at the same time as they're manning the phones taking the card payments above. One idea being floated on Facebook is getting the GDC’s bank account details and paying them directly by BACs. Its actually quite difficult for the GDC to trace who has paid at their end, but we will all have documentary proof at our end that it has been paid.

All a bit tongue in cheek admittedly, but with a serious side; if the judicial review fails, then we will have to pay this ARF. The BDA will continue the fight I know; but this particular avenue will then have closed, so a little bit of civil (legal) disobedience would show the GDC we are still up for a fight, but just looking for the next opportunity to open up a chink in their armour.

I also think that with Thursday’s decision the position of the remaining dental registrants on the GDC has now become untenable. I’ve stopped short in my past blogs of directly levelling any personal criticism at any members of the council, including the Chair and the Chief Executive. But with the emasculation of the profession so effectively by this council structure and those at its head, and the lack of any PUBLIC individual vocal defence of the profession by those who are members of it on the council, then they can no longer use the excuse of trying to change it from the inside. Thursday’s outcome should surely have delivered that message resoundingly to them. If they were against the ARF rise then they cannot now remain in the council; if they were for it, then they are not representatives of the profession. Either way, that makes their positions untenable. They look to be completely sidelined in the council processes that seem to be railroaded through at the whim of those who appear to be building a personal fiefdom with the seeming remit to destroy the entire profession it regulates. Indeed, they don't appear to write their own articles, as those published recently in the dental press which purported to be from them were 80% similar to one another when run through anti-plagiarism software. I also understand a large amount of the council business is now held behind closed doors, and only lip service is paid to the public aspect of the meetings these days which generally give the appearance of being stage managed for those observing.

As a Yorkshireman from the Loxley valley now living in Derbyshire, and working in Nottinghamshire, one legend that has been very close to me throughout my life is that of Robin Hood. I was brought up a stones throw from one of the reputed birthplaces of Robin of Loxley, am now living near the reputed burial place of Little John at Hathersage, and work close to the Major Oak near Mansfield, and I can see a huge analogy in this story.

We have a Sheriff of Nottingham, collecting taxes from the downtrodden masses, ruled over by a King John figure who’s got no real chance of a proper throne. The peasants don't like either of them but they don't care and keep finding more and more reasons to persecute the peasants whilst charging them for the privilege. This makes the remaining members of the GDC the barons at the table of the Sheriff with no real power whilst paying lip service to the Sheriff and King.

We've then got our Little John and Friar Tuck rolled into one, (ok, so its actually Fat Mick but the sentiment’s the same), and the BDA collectively as our Robin Hood (probably the Errol Flynn one rather than the Kevin Costner one given the size of its cojones recently!). That makes the profession the downtrodden peasants (metaphorically), some of whom became the Merry Men and Women. GDPUK is a collective Will Scarlett as the mouthpiece of a storyteller and bard. Hopefully the righteous King Richard is going to be the judiciary who will hear the BDA’s case.

Robbing the rich to give to the poor? How much money has the GDC had from us over the years? Having enough money to spend on QC’s and £78,000 Fitness to Practice cases over silly matters that should dealt with locally at lower cost to the profession shows it has no respect for the money it is given. It has become like a like a rich man who knows the cost of everything and value of nothing. Whilst its remit is to protect the public, this does not mean it should have the sort of reserves it wants. It should have enough to function effectively and no more.

Legend or not, every version of the story ends the same; good always triumphs over evil; a disorganised band of individuals becomes a force to be reckoned with after starting out with a bit of Civil disobedience and brings down a brutal Fiefdom that sees its subjects as legitimate source of money for its own ends, and for summary punishment at its whim.

At first the people can’t see how they will defeat the Sheriff. But up steps a leader and a small number of supporters. The impetus grows and grows until eventually a tipping point is reached. They eventually win by sticking together and keeping up the pressure. King Richard steps in and justice is restored.

Only we can decide if we let the Sheriff and King try to divide and conquer us. It’s still up to us to unite the profession against the GDC.

So to coin Moyes’ phrase of yesterday; ‘Are We Comfortable with that?’

I am.

* Image from Wikimedia Commons.

But last chance for whom?

Good morning worker bees. Get you cheque books ready.  It looks like £890 is the scrap of ARF meat being fed to the lambs that are called the Council, led by Cruella deVil’s partner in professional fur-fights, Chairman Bill.

You should have all received yet another patronising diatribe from ‘er up top in which the choices are summed up as “Ignore your dentists and their fiscal stakeholder role in the GDC and keep the DCPs on side”.

You have three days. If you cannot be bothered, pay the price.

If you cannot afford this before Christmas, get lobbying NOW.  You can see the GDC Council Members on line – mail them, let them know your feeling, for all things being equal, on Thursday you wallet will be shoehorned open by a large amount.

The Council must act with courage reject these options and simply ask that the Executive come back with a more acceptable solution.

Incompetence carries a price and it appears to be the order of £900. 

Of course how you pay is up to you. There is a general feeling that you should cancel your DD.

I saw a comment that £576 by cheque and any increase by Postal Order, each sent separately and by Royal Mail Special Delivery which caught my eye.  Mind you don’t get caught speeding; if the Magistrate hears it you will be up to the GDC for an FtP Party.

Ironic really that of course next year’s increase will have to cover the admin costs of this year’s collection.

How do you feel?

The word “shafted” comes to mind.

Will Contract Reform cover this additional cost, allied to the Medico Legal cover increases?  Quite.

Can you imagine the medics letting the GMC do this?  Quite

BDA Judical Review

So the BDA driven Judicial Review is all the profession has. Guess what? Cruella has palmed it off it seems in a manner a rugby player wold be proud of.

Do not dismiss the BDA efforts - this may yet turn into the professional gunfight at the Wimpole Street Corral

Let’s think positively. What shall we get Cruella for a leaving present? 

Spooky how Haloween is here at the same time.  Kee-eep dancing :)

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We have put together an infographic which shows how UK Dentists are using the internet. We have included some of the stats that were produced from the recent August 2014 GDPUK Survey. Thanks to all that took part. We have also added in some statistics from We Are Social which shows how addicted we are becoming to our smartphones  and social media in general! Thanks for reading.

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So who is going to admit having read the draft Statutory Instrument to that is going to change the Dentists Act so the Fitness to Practice process can be streamlined?

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/358328/Draft_Order.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/358765/Consultation_document.pdf

It may well have gone unnoticed due to the smoke screen of the ARF rise, but creeping in under the cover of darkness to be installed as part of the Dentists Act is a draft amendment that changes the Fitness to Practice proceedings. This has long been asked for by the Registrar, and also the profession, but having read it, whilst I think it is a step in the right direction, it is a potentially worrying device in the hands of a regulator that is acting in its current manner.

Once you translate the legislation speak into plain English, it becomes apparent the Registrar is being given quite a few new powers. Whilst in principle these powers look like they will streamline the Fitness to Practice procedure, that is only if they are used proportionately, which we all know at the moment it isn’t necessarily the way the things are at Wimpole Street.

One of these powers will allow the Registrar (or any other officer of the Council) to ‘exercise the functions of the investigating committee’. This will basically remove the Investigating Committee from the process of Fitness to Practice and replace it with Case Examiners.

Great, the removal of a tier of costly committee system to allow the streamlining of a process. That is one of the reasons the ARF is so high and the process takes so long. That can’t be bad. Get rid of an entire layer of the process, and speed things up for less money. You’ll not see many registrants complain about that. Giving the Case Examiners some powers to issue warnings which are binding is also a step forward.

 If you read the consultation document, you will see that there will be 2 Case Examiners, one lay, and one from the registrant’s own field of practice. But that’s only one less than the panel of 3 on the Investigating Committee. Read a bit further, and you’ll see if they can’t agree then the case goes to the Investigating Committee anyhow. We’ve now got Case Examiners to fund, and still got the Investigating Committee to pay for as well by the looks of it. I can’t see that costing much less that it does already, especially given the GDC’s skill with figures that the BDA have already pointed out.

More worryingly though is the addition of powers to the Registrar to review a decision of the Investigating Committee or Case Examiners not to be considered by a Practice Committee, and subject to ‘Rules’, then unilaterally take action despite this decision. There’s no official definition of what the procedural rules are yet, but the GDC will be running a consultation in November about them. I don't think any further comment is needed on what the profession currently think of GDC Consultations…..

This amendment effectively brings in the possibility of a registrant going through an Investigating Committee or Case Examiner process, being found there is no reason to refer to a practice committee, (which is in effect a not Guilty verdict), and then the Registrar deciding that they should be referred after all, which might even be some time after the original decision has been made - again depending on ‘the rules’. Two years is the time mentioned, but in ‘exceptional circumstances’ could be longer.

To me that looks like we now have double jeopardy entering our professional regulation. The prospect of registrants found ‘not guilty’ by the Investigating Committee then living under the spectre of not knowing if they are going to have that decision overturned by the registrar and proceedings restarted is now very real. In addition, since the rules governing this are not yet written, we don't even know over what period of time the registrar can look back at these decisions and reverse them. Does this mean old cases earlier in a registrants career will be resurrected in order to support the ‘No smoke without fire’ policy the GDC seem to have? Who decides the exceptional circumstances, as theres no talk of a committee being involved in that decision. Talk about a Sword of Damocles hanging over those (un)lucky enough to be exonerated by the Investigating Committee.

All these changes are all well and good if the regulator has a degree of proportionality though, and that what its so worrying about these changes. Given the current stance of the GDC and in particular its refusal to listen to reason, do we have any faith that this fundamental change in the statute will improve the system, or will it make it a more streamlined, swift, and cheaper way of eventually getting all of us in front of a Fitness to Practice committee? It requires us to trust that the legislation will be interpreted appropriately by the GDC. Given the that the GDC are the most disproportionate of UK regulators according to Dental Protection, then is giving them a bundle of new powers necessarily a good idea at the moment?

Disappointingly, there is absolutely nothing whatsoever in the draft that indicates a change in the approach to what happens to cases at the earliest level. This is where the real problem is. The inappropriate referral of cases by the NHS and the abdication of responsibility to sort them out, and the advertising of the DCS are all doing nothing to stop the tide of complaints. Yet it a dentist encouraged or felt obliged to take on a clinical workload such as this, he or she would rapidly fall foul of the very regulator that is in effect unable to say ‘No’ to the same thing.

So rather then reducing this flow of cases by putting requirements in to exhaust local resolution first, or require cases to be heard by the appropriate NHS body, and bounce them back pending this, there’s now a mechanism to deal with them faster by fewer people.

At the moment this is only a draft our for consultation. I am fairly sure that both the BDA and the Protection Societies will be responding to this consultation on our behalf, along with other key stakeholders, but we should all individually read it and voice our opinions as this is the legislation under which we are going to be regulated.

http://consultations.dh.gov.uk/ftp1/gdc-proposed-amendments-to-ftp-processes

As I have already said, I happen to think this is the step in the right direction that Fitness to Practice needs; but only if we have a GDC we trust.

With the contempt the dental profession is so obviously held in by our regulator at the moment, we need to ensure that we do everything in our power to protect ourselves against a potential modern day McCarthyism descending on our profession.

“You can’t manage what you can’t measure.” (Peter Drucker)

On a number of blogs I have written over the last few years, I have mentioned one huge benefit of advertising online and that is accountability and the fact that transparency can be seen as a huge advantage to the marketing team.

Having the ability to track or getting feedback from your ads is critical. Other advertising forms can be hard to track; using display ads means you can receive weekly or even daily updates. This kind of information tells you whether your advertising/marketing effort is succeeding or you need to tweak it. Feedback reports can guide you to better strategies and more successful marketing.

Experienced marketers say that one of the greatest benefits of online advertising is its measurability and the information it provides about your audience. It is a win-win situation, you can learn about your visitors while they are getting to know you. This means you are getting instant input about the effectiveness of your campaigns which can then be quickly modified to increase conversions and sales.

Online marketing is wildly more measurable than offline marketing but it is still marketing, as we are all aware humans are complicated and unpredictable, I just think it appeals to the marketer’s brain and budget constraints that there is a huge benefit to receiving reports and statistics to show for their marketing spend.

We have just returned from the BDIA Dental Showcase, it was great to catch up and chat with a range of people in the Dental family. When it came to the subject of online marketing, they kept coming back to accountability and the fact that since they had embraced digital advertising; they were increasingly getting a better idea of which campaigns worked and which media platforms to use.

It is still too early to make a final judgement but I believe the appeal of greater measurability and accountability in online marketing is beginning to pick up further support from the dental marketing community. What do you think? Is it true that you cant manage what you can't measure? Look forward to hearing your thoughts.

The season has started ...

Autumn has arrived, as has the rain.  Time to close those curtains a while, light the fire and catch up with reading maybe?  The fall is with us and that refer’s to Man U’s fortunes …. 

Recently publicity should not have escaped your notice. Barely a week has passed since Public Health England, under the leadership of Dr Sue Gregory & Dr Sandra White went public on what many of us have known for a while.

12% of 3 year olds have tooth decay

Now … is that a scandal? You bet it is.  But it is also an inconvenient truth that has been long ignored by Dr Gregory’s superior, the erstwhile Chief Dental Officer at the DH, Dr Barry Cockcroft. His new role has moved him downwards and outwards to NHS England of course. But it was on his watch that this problem both developed and was ignored. But it was on his watch that this problem both developed and was ignored. Was it not our illustrious CDO who hawked the Adult Dental Health Survey around as a triumphant scalp over the ne’er-do-wells, in full knowledge that he was ignoring the cries of ‘Fire’ from the coal face of children’s dentistry? 

Just consider this secondary fact:

This is the first national survey of the oral health of 3 year old children in England.

Well that’s two scandals in consecutive soundbites– firstly the ignorance of the problem and secondly the lack of enquiring minds in the first place. What exactly have the DH been doing with taxpayers money might one ask?

The state of children’s teeth is now officially and very publicly worrying [1]. It was headline news on the BBC and even took lead coverage in the "Today" priogramme.  The Public Health England report is found via the at the PHE website [2]

Now call me irritating, call me inquisitive. My wife uses other words. OK dear, just coming ...

Do I not recall that much of all that we GDPs feel is wrong with the 2006 Contract is the  UDA system of perverse incentives?  The result of 10 years of perverse incentive is borne out by this report.

The Guardian highlighted the GA Admissions scandal in the early summer. [3]. This is quoted fromn The Guardian:

The number one reason for primary-school-aged children being admitted to hospital is to have multiple teeth taken out, newly released figures show….Provisional figures for the period 2013-14 show that 25,812 children from that age group have been admitted to hospital to have multiple tooth extractions, up from 22,574 three years previously.

RESULT ...   DH & NHS England 0  -v- Public Health England  3  [Att. 100 000, dentists and teams]

Now it seems to me that Dr Cockcroft has wilfully presided over a collapse in children’s dental care with the 2006 contract and simply failed to undertake any attempt to resolve the matter.  And believe me, he has been told many times.

We are to be thankful to Dr Gregory for her persistence in examining the problem. One wonders if there is a fundamental difference of professional approach to the job. On the one hand, Dr Cockcroft, riding the Dept of Health Fiscal Horse called Austerity, and on the other Dr Gregory’s role demonstrating true caring about the problem?

To any outsider there is a self-evident split, nay a cavernous gulf, between the opinions of the CDO England and the Head of Public Health England.

The rumours of efficiency drives allied to prototypes of Contract Reform abound. The GDPC is playing its cards close to its chest, whether rightly or wrongly. I for one think that they need to empower the whole profession with openness and transparency to call their MPs to account. Closed doors are a defunct way of acting as the profession's negotiators

What Sue Gregory has done, whether by intent or not, is give the GDPC an Open Goal to aim for!

If ever there is a problem that requires proper funding for dentists and their teams to work effectively, this is it.

The DH are now out on a limb, Dr Cockcroft has proved himself an anachronism, and Public Health England under Dr Sue Gregory has given reason and energy to the GDPCs position.

The GDPC must make their case without fail, and without shrinking from what can now be described openly as a 21^st Century scandal of gargantuan proportions. 

Like all football matches, the GDPC need us cheering them on - please open your doors, GDPC, and tell us your strategy. Let us know who is playing where, keep your fans on side.

Children’s dentistry in General Dental Practice is in a mess, and it is Dr Cockcroft and his political masters who shoulder the responsibility.

But it is dentists who can deliver the solution.

The GDPC know what they have to do now for negotiating a rejuvenated Contract Package and with it money to solve the scandalous problem of children’s teeth.

The result should be an assured 3 points.

Shouldn't it ? ... 

[1] http://www.bbc.co.uk/news/health-29413906

[2]  https://www.gov.uk/government/news/new-phe-survey-finds-12-of-3-year-olds-have-tooth-decay

[3] http://www.theguardian.com/society/2014/jul/13/teeth-problems-children-hospital-decay-extractions

“If we’d asked people what they wanted, they would have said faster horses”, Henry Ford is famously quoted as saying.

And this week we have news reports about the car insurance industry being subjected to further “market reforms” in order to deliver cheaper end-consumer prices.

But this is a fundamental misunderstanding of the markets.

If you look at the résumé of our first appointed chair of the General Dental Council [GDC], Bill Moyes, you will see that he has led several market-driven initiatives in various roles, and it wouldn’t be a leap of the imagination to consider that he has been appointed into the GDC to fulfil a “market-driven” reform. Dentistry has long suffered an image problem; consumers feel that prices (and pay) are too high, that dentistry delivers poor value to the consumer and that there is a conspiracy of the profession against the public – it is only necessary to have the briefest of reads through the comments section on any newspaper that publishes a dental article to see that the accusations of “rip-off” rear their head at a very early stage.

But this premise is entirely wrong. The problem with a free market is that the results are entirely unpredictable. Economic journals are full of perfectly logical explanations as to why markets behaved in a certain way – crucially, behaved and not behave. That is, the analysis of the markets and the rationality of them is done post hoc.

One of the most fundamental problems I can see with the approach of trying to manipulate markets in order to deliver a specific outcome is that it rarely works, or often, even where it does work, often this is not what the consumer demands or buys, although they may insist at the outset that that is what they want.

In our particular dental industry, I would hazard a guess that many people (of a non-dental nature) believe that market reforms will deliver cheaper dentistry, through increasing the supply of the dental workforce. I would suggest that this is unlikely to work for a variety of reasons. Firstly, costs represent some 60-70% of the price that the patient pays. Given that the average pay for dentists has been declining in real terms for some time, if we were to cut pay for dentists by 10%, then this can translate into only a 3-4% price saving for patients. And I don’t believe that we can cut pay much further without running into another economic problem – that of a shortage. If you pay too little for something, you create a shortage. In this case, how many dentists do you think would leave the profession if average pay drops below a certain point? (I would suggest £50,000 for associates, on average, and £75,000 for principals)

So if cost savings are to be made for the end consumer prices, this will have to come from reduced costs. And here we already have an idea of what happens from another industry – the British car industry. Throughout the 60s and 70s, the British car industry suffered a slow and agonising death over many years, selling outdated cars, with poor workmanship and a reputation for declining quality, and in some cases, with cars selling at less than the cost of manufacture. Do these problems sound familiar?

Of course the British car industry eventually collapsed, superceded by German and Japanese competitors who were operating on free market conditions, and produced innovation and rapid improvements in delivering things people wanted rather than what they told government-led focus groups that they wanted. The eventual death of Rover marked a turning point and renaissance of the British car industry, and now we have world class manufacturing and design, but for this to happen we had to see the government leave the industry and several companies to go under.

I sincerely hope that dentistry has its “Rover moment” soon. I believe in the free markets, but a belief in the free markets also means accepting when they don’t deliver quite what you thought they would. And that doesn’t always mean that what will be delivered will be cheaper: sometimes, what is delivered is “better” rather than “cheaper”. I believe that health and dentistry falls into this camp.

After all, when was the last time you saw a car maker advertise how cheap they’d made the braking system?

Free markets tend to deliver better healthcare, by and large, which is often but not always cheaper. I would therefore issue a challenge – if this is truly the purpose of Mr Moyes’ appointment, I would suggest that he can best serve the public by completely withdrawing any government interference in the market, but only on the proviso that he and they MUST accept that prices will almost certainly rise, but also must accept that this may result in longer term reduction of cost. Otherwise we run the risk of delivering the cheapest horses in the world when the rest of the world has moved onto cars.  

Image credit - Coen Dijkman  under CC licence - not modified.

Appropriate Bedfellows?

It looks like the submissions by the BDA and Dental Protection have finally struck a chord with the GDC. Between them, these 2 organisations represent a huge majority of dentists in the UK, and DPL, by virtue of the therapists and hygienists memberships plus the associate indemnity of dental nurses, a fair chunk of the DCP’s as well. Given the scale of representation we see here, whilst  I don't think we’ll see a intimate liaison between these 2 organisations, it certainly appears they are appropriate bedfellows to take on the GDC.

The GDC response to the DPL reply has been to defend its position by coming up with a list of improvements it has already made; a list of blindingly obvious ‘improvements’ which should be the bare minimum it should have already been working to. Things like obtaining clinical advice at an early stage of the investigation it sees as an improvement in its process.

Excuse me, but aren’t you a regulator of Clinicians? You don't have to be a brain surgeon to work out a clinical complaint needs a clinical opinion immediately, so the fact it is seen as an improvement shows your system is unfit. You cant go blaming the lack of a section 60 amendment or order to get a CLINICAL regulator to take CLINICAL advice. There’s also been the introduction of a triage process. Which in itself is an admission that many of the cases going through the system haven't been triaged. So the GDC haven't a clue whether they are spending money appropriately or not in these cases, especially if they haven't got the clinical input.

The GDC also asks DPL and other organisations ‘to contribute to the development of more effective complaint resolution systems”. Perhaps the profession should now start to use the medium of interpretive dance in order to convey its message to them, since the GDC doesn't appear to be listening to any of the words said or written by any of the stakeholders in this affair. Anybody fancy a mass Haka outside the GDC at their next meeting on Thursday 18th September?

In addition to this press release, we learn that, now, instead of making a decision on the ARF this Thursday, the GDC has decided to have their figures looked at before any decision is made. We won’t know until October now what the results of this review are likely to be.

One would think they wouldn’t need to do this if they were confident in their calculations, so the very fact that KPMG have been engaged by the GDC for this assessment means they are now worried about the information presented by the BDA, which looks fairly damning. The firm instructed by the BDA would apparently ONLY take on the instruction if they were to remain utterly and completely independent, so any report commissioned by the GDC should surely spot the same things if they are engaged on the same basis.

I do believe that whilst there is a realisation from the GDC that this affair is now really serious, I do think they will try to defend their position by using KPMG to counter the arguments put by the BDA’s forensic accountants.

The choice of KPMG seems another appropriate bedfellow; this time for the GDC. KPMG do not exactly have a glowing reputation with regard to their auditing standards; indeed, they are currently under investigation over their part in the Co-Op banking problems, and prior to that the Public Company Accounting Oversight Board in 2012 found a failure rate of 34% in KPMG’s audits ¹, up from 22.6%. That looks very familiar to the position the GDC find themselves with the PSA from where I'm sitting.  Admittedly, it will probably be a different department of theirs looking at the GDC figures, but if there is inherent inefficiency in one part of an organisation, it tars the rest with the same brush as it’s a symptom of breakdown in communication and leadership right from the top tier of the organisation.

In that respect then, having KPMG look at the GDC seems to be a bit like one failing student marking other failing students’ exam papers. In fact it has actually been said that using KPMG as an auditor is ‘like a chicken farmer asking a fox to count the chickens in the farmyard, find the holes in the fence, and then trusting the fox when he promises not to tell his mates outside ² . Will anyone be surprised therefore if this report shows the GDC figures are correct? On the other hand, would a GDC stuck in its current ‘not listening’ mode believe it if KPMG point out the same issues, or even discover something else more damning? Perhaps they would then commission more reports until they get the answer they want.

But this recent development now brings a different aspect of the situation at the GDC into focus. Do we actually know if the Council themselves approved this recent move? Or is this the Executive acting independently of the Council in making this decision before the meeting of the 18th? It seems to have been a knee jerk reaction judging by the speed with which it was announced, so has it been fully ratified by the council? One would hope so. But since the Council doesn’t meet until Thursday the 18th, unless there is in place a facility for remote decision making by the council (and if there is then why do they need to still meet in expensive London?) then is it possible this decision might have been taken by members of the executive? If so, surely when the Council meet this week, in their oversight role the council must look at this move, and question robustly the need to have to now instruct an expensive firm of accountants to look at the figures used for calculating the ARF. Yet again registrants will pay for this further move, thus draining the GDC of further resources which they’ll ask us to pay. I can see the FOI requests winging their way to Wimpole Street asking who actually made the decision to instruct KPMG.

If it is indeed the Executive that have acted to bring in KPMG, then if the Council do not consider whether this is appropriate use of funds, and bring the Executive to task over the situation, they further illustrate just how toothless and out of touch they are with that is going on at Wimpole Street. It must bring into question what the actual point of the Council is if it doesn't exercise, or indeed have, an oversight role. If the executive is making the decisions about the running of the GDC then surely this is not obeying the statutory role the GDC has. Its a General Dental Council we have in law, not a General Dental Executive Committee.

On the other hand, if the Council have been involved in the decision to get KPMG in, does that mean the Council didn't question the ARF figures robustly enough before they were released as part of the consultation? In which case it brings into question the suitability of the Council itself to oversee anything.

Which ever of these two scenarios is the right one, the GDC still aren’t covering themselves in glory, and their actions raise further, and more searching, questions every time there is a new development as to the suitability of the organisation to properly regulate the profession.

1.    http://www.complianceweek.com/blogs/accounting-auditing-update/kpmg-pwc-2012-inspection-reports-list-more-failures#.VBbfzkue_aQ

2.   http://www.thenews.coop/83091/news/general/kpmg-faces-embarrassing-questions-role-co-operative-bank/                        

The DH & GDPC – Bedfellows Or Bedfoes?

Take the Dept for Health [DH].
Add in an ineffective General Dental Practice Committee [GDPC] at the BDA
Keep the vociferous Local Dental Committees [LDCs] at arm’s length…
What do you have?

General Dental Chaos?

The other GDC and “The Referendum” are not the only kids on the dental block. The chaos of Contract Reform is still lurking in the periphery of our vision, and really ought to be a full on crisis for shouting about.

To those of you of a Gaelic disposition North of the border, good luck for the forthcoming shenanigans. By the time you read this Scotland might be heading toward independence if YES prevails – or toward much reduced dependence if the NOES have it. In some respects, our Scots colleagues have the best of all worlds – they have retained Fee For Service, and have a relatively user friendly Government. Any changes frankly are less than likely to cause great change or disadvantage in the short to medium term.

English [and Welsh] dentists on the other hand … From where I sit, the DH heads are still in the sand as we head out to a 9 year old discredited Contract with so many problems, it is laughable.

What with the GDC imploding and Scotland commanding our attention [the irony of a UK wide GDC trying to set an ARF on the day that Scotland may break away is not lost] it is easy to forget that in the background NHS England and the DH are trying to blag the next Contract Reform package
Increasingly, if you keep your ear to the ground, it appears that a Train Crash in slow motion is a suitable mind-set.

2015 not long now …

2015, people …. it is only next year – and what have we to show? Discredited pilots, great suspicion that the Corporates are trying to wedge the DH door open for personal gain, and a weak GDPC who continue to fail to nail down the critical issues.

The LDCs it has to be said are populated by wet fingered dentists who understand the issues. It is the LDCs who supposedly guide opinion at the BDA’s GDPC. Is that not what the LDC Conference is all about? Trickle-up democracy and all that?

And yet after all these years there is a feeling that the BDA’s GDPC is simply not taking the DH to task.
While opinion varies, there is a mood that the LDCs are passing water into wind when trying to influence the GDPC. If you would care to get that special ‘under the counter’ view of those in the know, you will find that there is a feeling that the GDPC are so desperate to see the present contract replaced that have forgotten all the headline issues that plague the current fiasco, overseen by the late PCTs and now NHS England’s LAT gate guardians.

Ask anyone, you all know it. The current problems abound. Whether it be the massive and unfair discrepancy in UDA values. or fairness in dealing with high needs patients – there are serious issues of finance. The clinical disaster of Endodontics is mirrored in the back office with HTM 01-05 and its fictional evidence base. What about Nurses and their enhanced professional status – no funding and no pensions! Status, indeed!!

Never mind the matter of practice sales or incorporation difficulties and how the CQC cope with it all.

Wake the GDPC up … NOW!

Now that the ARF is a matter closed in all but the detail, [OK so the GDC have gone running to KPMG in a panic and put the decision back 6 weeks – but are we fooled?] and while your antennae are still vibrating, why not turn some of your energy to the GDPC and their effectiveness in making sure YOUR contract is beneficial to you in 2015.

After all, if you want to pay your ARF and not simply take a pay cut to do it, you need Dr Milne and his GDPC colleagues to pull their collective bloody fingers out and to do so a bit quick. This next month or two is the last chance saloon before the Civil Service wrap it up for the election.

Time for the swarm of dentists to move along Wimpole Street. Even if you are NOT a BDA member – it is the GDPC who are gambling away your heard earned fees with their laziness and ineffectiveness at dealing with the DH.

You called the GDC to account.

May I suggest you ALL now call the GDPC to account. It’s your wallet that will pay for their failure.

What happens when an Immovable Object meets an Irresistible Force?

Impasse. And so it would appear to have been for the last couple of weeks after the initial thrust of the BDA’s threats, and the parry and riposte of the GDC’s response.

However, I always thought it was going to be right at the end of the ‘consultation’ process that the BDA would make their next attack, and as we have seen yesterday, Mick Armstrong has told the GDC in no uncertain terms ‘ it’s 1 minute to midnight’. Waiting until the last minute has made sure the Judicial Review can’t be halted or paused to allow the consultation to finish, had it been launched prematurely and has made sure the GDC don’t get to see the BDA’s hand of cards early.

But this hasn’t actually seen the announcement of the BDA taking legal action to go to Judicial Review, and as such I bet a lot of people will be disappointed if they just look at this video superficially. I can see the posts on GDPUK forum that this is just BDA posturing again, and they haven’t the guts to carry out the threat.

But if you read the full press release as well as watching the video, and especially take time to look at the additional information within the release regarding the figures in the consultation, it is obvious the BDA are actually giving the GDC a final chance to back down. The GDC will suffer a humiliating loss of face if they do, but we as registrants and members won’t then have to foot both sets of legal bills.

I don’t get the impression Mick Armstrong is messing about when he says the BDA are committed to following this through. But as a fellow Yorkshireman I appreciate the sporting nature of letting your opponents know you’re going to hit them, hard, and give them a final chance to back down. But you only do that once you know you have the upper hand. The BDA might not have a Royal Flush, but it seems like the GDC only has a pair of Jokers at the moment. Reading the documents attached to the BDA’s submission leaves one in no doubt of the intention of the BDA to go to JR.

By engaging the services of a FORENSIC accountancy company the BDA appear to have pulled off a masterstroke; utilizing the skills of professionals specializing in detecting high level fraud, regulatory scrutiny and anti-corruption, and then publishing a précis of the findings publically must surely send the a big signal to the GDC that the BDA is not playing brinkmanship here, but actually means business. This is serious stuff now, and the BDA have now shown their cards to the GDC by revealing financial inconsistencies are what the JR will probably be based on.  

The forensic analysis of the accounts has apparently shown the GDC’s own published figures for the ARF hike are somewhat contradictory. These inconsistencies not only call into question the validity of the need for the ARF increase by questioning the basic level of evidence, but the inconsistency of the figures must surely now call into question the bigger picture of the integrity of the GDC in all of its financial matters. Whether this is part of the Judicial Review or not, the financial matters of the GDC must be impeccable, and they appear not to be.

The analysis of the figures would appear to go beyond the fact insufficient and inconsistent information has been given to registrants so they can’t actually make an informed response to the consultation. It seems to confirm the GDC is actually so contemptuous of us as intelligent people that they feel they can knowingly release confusing figures, expect us to then swallow the ARF rise, (after what we have all agreed is a sham consultation) and carry on as before. If a dentist were to confuse a patient in that manner, it would be cause for a registrant to be hauled before the GDC. Alternatively, it suggests incompetency and a lack of communication in the organizational structure of the GDC. Once again, they are grounds for a registrant to appear before the regulator. Whichever way you look at it (and it may be a combination of the two), our professional association appears to now have more robust evidence of the failings of the regulator and is prepared to act on it.

However since the GDC’s regulator is the PSA, and they seem to be about as threatening as a periodontally compromised 3 legged chihuahua with trismus and a sore throat, and as much use as a pair of waterproof sandals then you can’t really blame the GDC for not being too worried about the consequences of their actions.

Judging by the interview with Ms Gilvarry in Dentistry magazine, she doesn’t have appeared to understand what the profession is finding such a problem with. The penny certainly hasn’t dropped with her; perhaps this is because there aren’t actually any spare pennies left to drop at the GDC since their accounts seem to be in such a tangle.

But surely there must now be a realization by at least someone in power at the GDC that the BDA and the profession as a whole just might have a point. It would be useful if it dawned on them simultaneously that they have picked a fight with what seems to be a quickly developing Irresistible Force.

And they as the Immovable Object appear to have some ominous cracks developing, which wouldn’t do them a lot of good if they continue on the course they seem hell bent on taking…….

Image credit - James Cridland  under CC licence - not modified.

1. Let someone know you are outside their house waiting in the car. Just send them a "Yo".
2. Thinking of that special someone, send them a "Yo".
3. Your chinese takeaway is ready, you receive a "Yo" and go to pick it up.
4. Tell a patient in your surgery that you are ready to see them now! Or is that taking things to far?

• 30000 angry letters to MP’s WILL count.
• 30000 angry letters to the GDC WILL count.
• 30000 angry letters to the PSA WILL count
• 30000 angry dentists arriving at the GDC on a chosen day to pay their ARF WILL really get their attention
• 100,000 letter from dentists and DCPs – now THAT will really get attention!

The revelations of a recent FOI request showing the cash reserves and short term access assets of the GDC potentially raise questions of the financial fortitude of our regulator.

If indeed the figures supplied by the GDC are correct, and represent the full and correct answer to the question asked, then it would appear they have access to about £11.9million of funds within a 5 day period. (I’ve got that figure from 10.5m less 4.8m at 22/7/14 added to the 6.2m at 1/8/14)

Given that the GDC costs £104,000 per day to run by their own admission, then this sees us with a regulator that looks like it is going to have no more cash by the end of November 2014. Coupled with the £7.1million that it is spending on refurbishing its HQ on Wimpole Street, it doesn’t seem all that surprising now that the GDC is threatening the BDA with its losses if the judicial review fails (if it goes ahead).

The GDC usually takes its run of Direct Debits for the ARF in the first week of December, so this would then have the effect of restoring its cashflow straight away.

However, what if all the registrants cancelled their direct debits? What if the BDA were to lead a concerted effort to get us to do this? It won’t fall foul of the legality of having to pay the ARF, it’s just that the GDC won’t be able to actively take it to help their cashflow; we will give it to them when we decide. As long as it is paid before the end of that month, then we cannot be erased for non-payment of the ARF. Wouldn’t it be great for the BDA to suggest ALL registrants cancel their Direct Debits with the GDC?

If this is the case and the GDC is running out of money, then in all likelihood they will just delay the FtP cases and other hearings until the cashflow looks better. Since these equate to the majority of their expenditure this would be a fairly easy way to massage the situation swiftly;  but this then becomes even more intolerable to those stuck in the ever increasing queue for the March to the Scaffold. That means that yet again there will be  practitioners that indeed represent a danger to the public still unpunished and still working, along with those in the queue probably because they used the wrong grade of soflex to polish a composite. Is that any way to protect the public?

But what happens if a regulator is effectively insolvent? Has this ever happened before, and if it is boracic, will it get bailed out by the Government?  What happens to the role of protecting the public if this happens, and how does this square with the requirement in the Dentists Act to have a regulator? If it does indeed become insolvent and is bailed out by HMG, then this shows us that it is indeed a wholly owned subsidiary of HMG, so if they want it to remain solvent , then they and not us should fund it.

Many a profitable business has gone bust in this and the recessions before due to a cashflow problem, so why should any other type of organisation be immune from this when it gets its sums wrong or experiences an increase in its expenditure?

Would the duty of the GDC then be better served by the CQC instead? After all, the CQC now realises dentistry isn’t that bad, and that it recognises the need for experts to be involved in its inspection processes. It appears to have grown a pair of ears more recently. If we are going to have a super-regulator foist upon us, wouldn’t we rather have one that whilst it still seems a bit dim, does  appear to be learning from its mistakes, or continue with one that treats us with arrogance and contempt whilst (possibly) overspending its funding? That’s discussion for another day.

This is all probably hypothetical and the figures have been interpreted incorrectly and they don’t include the contingencies for the refurbishment etc;  if so the GDC isn’t going to run out of money .

But if this IS the situation, the GDC isn’t just Broken, it's Broke.

So, the GDC has responded to the BDA’s challenge at the 12^th hour with the response we probably all expected. Basically it’s a legalese version of a ‘la la la we’re not listening, and my dad’s bigger than your dad ‘cos he’s going to take all your money when you lose’.

The problem we have with that is that the BDA needs funds to take the GDC to Judicial review which comes from its members, us,  which the GDC will fight using the money it gets from its registrants, also us.

Great. We get to pay for both sides slugging it out in court. That’s like getting the kids to pay for both sides in a divorce out of their own pocket money.

One could argue there will be no winners in this case other than the legal bigwigs who, should the BDA carry out its threat to start the Judicial Review process, will start to cost considerable amounts of our money on both sides. If the BDA wins, then this will only be one of the issues with the GDC dealt with, as the JR will only deal with the Consultation process, and not the greater failings of the GDC we are pointing out left right and centre. Given that the arrogance of the GDC throughout the whole process so far has been astounding, it wouldn’t be beyond the realms of possibility for the GDC to lose the JR, and STILL continue in the same manner as before, asking for even more money to replace that spent on the legal profession, and leave us with merely a pyrrhic victory, and an even bigger ARF increase. They even comment today that they are pleased to have received 4000 responses to the consultation. It shows they probably haven’t read them as I’m sure the vast majority of them wont be supportive ones.

If the BDA lose, and then have to pay the costs and losses of the GDC then this could spell the end of our professional association financially, and with it probably the last real chance of taking on a bullying and out of touch regulator. That’s why it needs as many members to support it financially by joining up in a show of solidarity.

We have this chance to take a stand as a profession, and I’m sure the legal team at the BDA have considered the implications of not winning the Judicial Review. But if the BDA backs down now, what message does that send to the GDC? I’d wager things would then get even worse from a whole load of other angles, not least from the DoH regarding the new contract. The BDA press release this evening in response to the GDC is possibly quite telling in that Mick Armstrong promises to put the interests of dentists first, and not just those of its members and the association.

So are the BDA going to play Chicken with the GDC?

I think they should.

That is indeed a question!!

Phew, what a scorcher. 

If you think the meteorological heat is oppressive, you want to try working in Wimpole Street. AirCon does nothing to relieve the heat of the pressure the GDC should be feeling.

What interesting, perhaps desperate times we live in.

The world is awash with wildfire wars with all the suffering that ensues.  The state of children’s teeth of those who do not ‘get’ the dental health message in this country remains an unresolved scandal.  Contract Reform of NHS Dentistry in England has become a fictional event of the future. The CDO England must be playing a lot of golf these days because there is naff all else going on. Dento-legal indemnity has started to rise in cost alarmingly as  the GDC and it’s woeful Fitness to Practise regime comes off the wheels.

But it takes a proposed rise in ARF to really galvanise the profession in a unanimous outpouring of anger.

Well directed anger?

This is being expressed in many ways – letters to MP’s, the professional Standards Authority, letters to the GDC allied to Freedom of Information requests to name but a few.  At meetings, the conversation is grim and consistent – it’s the GDC innit?

Even our old muckers the BDA have bared some teeth which, to judge by their public statements, are finally sharp enough to threaten injury.

What is happening so far can be summarised as a collective professional rant.  There is nothing wrong with that.  This process of ‘ranting’ is a precursor to something much more effective

It is well know that RANT is actually an acronym

The RANT acronym

• Review your position

• Analyse your options for Action

• Notify interested parties of impending Action

• Take action

Where are we?

I think we are heading out toward the last element, if only driven by the timescale.

A request for legal review, a BDA driven legal challenge, and protesting by payment in cash at the front desk of the GDC are just some of the actions being proposed.  What about resignation of a significant cadre of the dentists they need to make the processes and systems function?

What about calling for the resignation of the Dental Professional GDC members en masse?  It certainly seems to have merit.

Will the ARF be less than proposed? My money says “yes”

Will we see heads roll at the GDC?  The CEO, Ms Gilvarry for example? Its hard to see how her position can possibly remain tenable.  She certainly has lost our confidence, but I would imagine the GDC staff are pretty low as well.

What about our new appointed Chairman, Mr William Moyes?  His condescending e-mail to registrants allied to his Pendlebury Lecture suggest a level of isolation and ignorance that make you wonder how he ever got the job.  Based on his utterances so far, he simply does not get it.  Based on the lack of communication by the GDC’s Dental Professional members, I thinks its safe to assume the GDC has battened down the hatches and GDC Council Members are prevented from public comment. So much for transparency.  The ARF was not even an agenda item at the GDC Council meeting of 24 July.

Problem?  What problem?

The GDC have absolutely lost the confidence of the profession.  The have proved themselves to be the most incompetent of Regulatory bodies, and they are asking us to pay for their ineptitude.

The short answer Madam Chief Executive and Mr Chairman is “NO – NOT ON OUR WATCH”

You fix your problems first and we might talk then .

Until then, we will continue with the biggest professional RANT seen for many years.

Once again I profess my grateful thanks for the GDC’s role in uniting the profession, finally.

Enjoy your break people. Be assured, the heat will still be turned up when you return.

Yours, rantingly :)

Having just read the response from the GDC to the BDA’s questions about the Telegraph advert, it would appear that there is a distinct tone of avoiding answering the legitimate questions posed.

Coming from the Chair of the GDC, with his background at the Office of FAIR Trading, this again seems to be at odds with a desire to be open and transparent, and indeed with his recent comments about ‘doing the right thing’.

The admission that the cost of the advertising campaign cost over £27000 should now start a new round of questions to the GDC, since we as registrants are funding this exercise in awareness (the adverts were in Saga Magazine and The Guardian) to a demographic who are largely likely to already know of the mechanisms available to them to complain. In addition, in order to justify any money spent on advertising, this requires some form of review as to its success, so there will be yet more expense following this, otherwise it will have been a total waste of our money. Even if it is reviewed by salaried members of the DCS, whilst doing this pointless analysis, the time spent on this would be better utilised elsewhere.

But more importantly, how would we be treated by the GDC if we avoided answering their questions?  We have a regulator who now seems to run itself by a different set of values to those it expects its registrants to adopt.

Far from allaying any of the concerns of the profession, I feel the response from the chair has once again shown the contempt dentists are held in by the GDC. 

Cometh the hour, cometh the man?

That phrase may be a cliche but where does the profession go from here? We have seen careful reaction in the form of a press release from GDC defending themselves against criticism, showing they are not totally thick skinned.

There has been action on all the UK dental websites, GDPUK has been busier then ever, and response to GDPUK on Twitter has increased by 1061% within the last week.

Vereen Gupta's petition has over 11,500 signatures at the time of writing 

Prem Pal Sehmi's Facebook group has over 4000 likes, and many more are now "liking" the GDC's Facebook page. there must be several more strings of anger, please let me know and I'll add them to this blog.

GDPUK forum has several threads ongoing on this topic, with over thousands of readers and over 350 dentists posting.

But . . . . I think the binding together of all the strings of anger into a rope of action is where the profession is still lacking leadership. We need a person or a body to emerge which has great respect on all sides, and there needs to be practical leadership, not pie in the sky. This leadership has to take on the GDC, warn them or provide proof which makes the PSA or DH take serious action to regulate this out of control regulator.

Cometh the hour, cometh the man?

Grateful thanks

Like many I am grateful for the services of the GDC. I pay the ARF secure in the knowledge that my patients are safe and the money well spent.

Presently though I feel I have more to thank them for than usual.  I hope my readers understand irony ...

Professional disunity?

Just when the state of the dental profession cannot look more perverse, the GDC have achieved something that the last 8 years of the DH and their man at the helm of the 2006 UDA disaster has failed to cause.

Numerous LDC Conferences calling for this and calling for that – the ever calm and serene profession of dentistry has just adapted and carried on.

Implosion at the BDA and barely an extra glass of claret was supped at the ripples on the water of our profession as calm discussion took place about politics.

A raft of daft changes came along such as the UDA system, the HTM document, the OFT report you all now the form – and we ranted for a few months but quietly took another blow to the body, absorbed the costs and “moved on”.

The public acknowledgement that the Contract Pilots have been a sham and that any changes to come will be merely prototype in nature and at least 2 years down the line.  Dentists have had a bit of a cough to their colleagues and carry on, “being busy”.

The dreadful farce of Foundation Dentists lacking places allied to their debt and many were heard to comment widely and indeed care deeply, but the rump of the profession have likely returned to their skate-like lying on the bottom.  “They’ll get by” we all thought. “Wouldn’t recommend it to my chidren” we muttered. Next please.

The CQC came over the horizon brandishing a large bill and a lot of empty folders and by and large we have paid the charge and filled the folders, only to carry as before doing what we do – meeting, greeting, interacting with & treating patients with their range of ailments and fears.

Incoming, incoming ...

But the GDC, in their proposed hike of the ARF to £945, allied to a comical  consultation so pre-determined as to be reminiscent of a past communist regime have caused the profession to both awaken and threaten to unite in a way never seen before.

Just when it was looking very interesting, the satellite of the GDC, the Dental Complaints Service fire their own salvo at the profession. The DCS may be “at arm’s length” and independent or so they claim – but they are wholly funded by the GDC, ergo our ARF’s – so how independent they are is, shall we say, somewhat debatable.

What effect was intended, I wonder when the DCS took a full page advert in the weekend colour magazine of the Daily Telegraph claiming to act on anything less than COMPLETE satisfaction for every patient.

I have a three letter acronym of my own - FFS!!

Professional unity?

Never in 35 years have I seen such united sentiment and anger, perhaps however more importantly associated with individual response and action. The electrons are red hot with e-mails, complaints and letters to MP’s and these bodies.  How ironic that when a patient complains about us, we are always assumed to be in the wrong. When we complain about these bodies, they are always correct and indeed learning. Is it just me? 

So, what now?

Well this is an unprecedented time, and it will call for unprecedented action.

Perhaps a mass sentiment requires a big organisation to coordinate a big response. There seems to be a widespread sentiment that the GDC has lost completely any confidence it may have had with the profession. Of course they will blandly point to some piece of biased research they did to show how well regarded they are. 

They may not realise but the rules have changed and the gloves are off. Big boys games demand big boys rules. And it is the GDC and the DCS who started this.

Who will rid us of this poison organisation, who will deal it a fatal blow, for it is a big monster and well protected by the armour of politics?

We must thank the GDC & DCS – the profession appears to have finally awoken, and if I am not mistaken, this time it is getting to its feet.

Interesting times with a little smoke of excitement.  Who will wager what we see next? I won’t!!

Have a good week, worker bees. Tootle pip.

 

Social Media outpouring from UK dentists, against GDC ARF rise, July 2014.

Since news emerged at the very end of June that the General Dental Council [GDC]  was planning to raise its annual retention fee [ARF] from £576 to £945 per year for all dentists in the United Kingdom.  This coincided with an announcement of a consultation on the matter of this fee, yet the fait accompli of the rise proposed was publicised.

GDC maintains a register of all dentists working in the UK, and it remains illegal to practice any form of dentistry without this registration. This monopoly held by the dental profession is there to protect the public from imposters, and despite this serious registration process there are always queues of impending prosecutions of people who feel they can practice forms of dentistry without a degree, training, nor the proper registration and indemnity cover.

Dentists are livid and united about this unprecedented rise in costs by an increasingly out of touch, unjust body.

It appears the large rise has been caused by the exponential increase in complaints against dentists administered by the GDC, a very stressful process for dentists who remain innocent until findings are proven. GDC accepts cases, investigates, and will proceed with a risk to the professional future of a dentist even if there is a single incident of complaint. This wall of actions has led to delays and blockages in the GDC processes, something dentists are finding unacceptable, and this is one of the factors behind the social media congregations in the last 48 hours.

GDPUK has had a large rise in visitors, one thread on the topic has had over 90 replies from dentists within 36 hours of the first posting on the topic. Twitter has been ablaze, and on Facebook, one page, The Project, in which dentist Prem-Pal Sehmi has commenced a campaign for colleagues to pay £576 when the ARF becomes due next December has attracted more than 2400 colleagues on Facebook, also within a very short time frame. [At the time of writing]

https://www.facebook.com/pages/THE_Project/1378516855727456

On twitter this image shows the sort of exchange progressing. The profession is like a bear which has been poked in the eye too many times, says Eddie Crouch of the BDA PEC and Birmingham LDC.

On the Government’s e-petitions page, Dr Vereen Gupta commenced a petition on the matter, and within 24 hours, this has over 5,500 signatories.

https://submissions.epetitions.direct.gov.uk/petitions/66982

Statistics emerging on GDPUK show that the anger is derived from this rise in Fitness to Practice [FtP] cases, which GDC figures state are stand at 3,700 presently. There are around 24,000 dentists in general practice now, so almost 15% have a case against them. Foir na serious and learned profession, this alone shows the system is very wrong.

The Professional Standards Authority, which oversees the GDC, has reported its grave concerns with the running and governance of GDC, which seems to roll along, unfettered.

All the groups must unite and harness the energy being generated on this matter, so it is up to BDA, Facebook groups, GDPUK, Twitter devotees to keep up the pressure, ensure this campaign goes to the heart of its target.

The biggest step
I finished out that week pondering on my therapy session and the work stresses. My wife, ever the paragon of being right, shied away from the blunt “I told you so” but did make it clear that I should be taking it easier. I asked the PM to block out some time where cancellations had arisen so that I would have a little breathing space, with the proviso that I would of course see any emergencies in those gaps if necessary. I did at this point advise the PM that I was having some issues with stress and needed to cut back a bit (master of understatement here!), and would be looking to book some time off when the books were quieter – about 4 weeks into the future.

I was by now quite aware of the mask I was wearing at work, and of the times when it would slip. I was concerned that it could create problems for the staff directly and put them in an awkward position if my behaviour impacted on a patient. I had seen this happen before when a colleague had suffered from depression, and their extended absences had been explained away at the time as a back injury – a number of patients refused to believe it and some even hassled the staff with questions such as “it’s the drink isn’t it?”.

This led me to discuss the most difficult step in dealing with depression with both my wife and my therapist – that of telling my workmates and staff. It’s one thing to admit to oneself that you need help, another entirely to admit it to others. It’s natural to want to hide our weaknesses from others, even those closest to us, but you can’t expect to get support without laying a decent foundation. My wife was concerned, as was I, that such a disclosure could leak to the patients and potentially put them off seeing me. My therapist countered with the argument that if I didn’t have support in my recovery, I potentially wouldn’t be in a position to see patients anyway. I couldn’t argue with that logic, particularly being a Star Trek fan, so I decided to tell everyone at work and hope for the best.

Except – I couldn’t actually bring myself to tell them face to face. Every time I looked at my nurse, my colleagues and thought of saying what I was going through I felt I may cry. I chickened out and put it in writing, asking the PM to read it to everyone at the staff meeting that week as I wouldn’t be present. The PM graciously agreed, following a short but teary chat at the end of the day.

Below is a copy of the letter. I know this may identify me to any of my colleagues who lurk on GDPUK, but their response to the letter at the time assured me that I can trust them to maintain my anonymity.

Forgive him, he’s an idiot.
Well, it’s been a wee bit longer a break than anticipated. I had intended to give you all a break from my depression over the Christmas period as, let’s face it, Christmas can be depressing enough on its own! I then felt that January wasn’t a particularly cheery month due to

a) the weather
b) the Christmas bills shock
c) tax bills

So I figured I’d leave things a bit longer. Of course, life then intrudes and so here we are nearly half way through the year.

My last blog had seen me arrange the first counselling session. I can’t really say much about that session, apart from it involved a large quantity of tissues, several glasses of water, and a short episode of hyperventilation. I seem to recall some questions over whether I felt I was a risk to myself or others, but as these were asked at a number of the sessions I’m not entirely sure. What I CAN say is that I felt a billion times better when I left the office than when I arrived.

With the benefit of hindsight, I know that this vastly improved mood was both transient and conniving, unfortunately at the time I felt that – having taken that sizeable first step in seeking help – everything would just be OK soon enough. WRONG!

Yes, my mood had lifted. Yes, I wasn’t crying as much. Yes, I thought I could get back to working as normal. Yes, I thought I was “better”.

Yes, I’m an idiot and was nowhere near better, but that’s the fragile balance of ego & id for you!

The following day at work I was cheery, chatty and pleasant. Some of the staff joked a bit about my finally getting out of the right side of the bed, or of wanting “some of whatever you’re on”, but I just ignored them and got on with my day. I had a pleasant weekend with my wife, relaxed, watched some TV. In other words I behaved normally. This, I now know, was the problem. I was BEHAVING normally, not actually being normal.

This pattern continued through the next week at work, although I would often feel panicky on the way to work and my mood would darken by the end of each day, and often sooner if problems arose. We aren’t talking major problems here, just late arrivals, delayed lab work, snotty patients, etc. Our usual daily niggles frankly.

The next counselling session came about, and I was stunned by how quickly I broke down again in the office. It didn’t occur to me during that week that I was just putting on a show for everyone around me, until the therapist metaphorically whipped back the curtain and popped the spotlight straight on me. Right on cue, I sobbed my heart out.

My therapist was concerned about my having continued to work without at least easing back on the hours or workload, and was clear that my arguments about NHS contracts and targets were all well & good, but were a contributing factor in my stress and depression. It was clear that I still had a long path ahead.
 

Welcome back from the long weekend, now just a few weeks to run and you can all zip off to the sun again  

Monday  was perhaps the new Independence Day, as the Euro results poured in. I worry that this word 'Independence' is being politically hijacked

So:   Are you independent of mind and decision? Really?  Truly?

The EU elections this weekend have thrown three major GDPUK topics into a shaft of light.

Those of you who gaze from a distance at the sheer energy of some of our more vocal members will have notice three threads of great length. One touching on that supposedly untouchable subject, matters of belief and faith, while another has been exploring the issue of the Scottish vote on Independence due to take place later this year. 

Combined with the now famous histrionics of the orthodontic thread, you would be forgiven for having pressed the ‘snooze’ button.

So wake up at the back.   I want you to answer a question for yourself.  What does being independent mean to you?

Mr Farage is celebrating scoring some points in what is normally a three horse race, by arguing for the UK’s independence, and arguing against the £12Bn net spend to the EU every year.

As dentists, we pride ourselves on being independent – in practice, in thought and in action.

Ask 10 dentists a question to which the answer is Yes or No and you will get 20 different answers.

But are we independent? Really? Truly?  Where is the fine line between that and bloody mindedness?

If you practice under Government funding in any of the 4 parts of the UK, do you really feel independent? Or are you reluctantly beholden to how someone else wants you to help and practice dentistry for your patients against your better instinct??

If you are in private practice, are you one of those for whom the next big case is always the one to clear the overdraft?  Therefore you are always on the lookout for some poor soul to benefit from your great skills? Or perhaps you feel you cannot practice good dentistry because of a limited private capitation funding stream not of your making?

We even have this long abused concept of Independent Practice, as though “Private Practice” could be rude and insulting perhaps?  Will the BDA rinse that off for the next batch of unknown NHS England contract changes, I wonder?

Perhaps independence of thought and action is actually impossible without feeling pressurised or being selfish.

Cooperation over independence?

What dentists are masters at is cooperative action.  We run or work within highly efficient micro businesses and at a moments notice we can adapt and cooperate with whomsoever requires our skills and time.  The CQC roll into town – we change and adapt.  A patient arrives – we change and adapt.  New staff requirements develop - we change and adapt.

Long may this be the case because with EU and Scotland and a General Election, the next 18 months are going to be interesting.

That old French phrase has come to life.  Plus ça change, plus c'est la même chose.

Strangely while everything around you seems to be up in the air, it takes a very strong sense of independent spirit to simply wind the windows shut and focus on your patient needs with one hand while with the other you change and adapt

So that’s why four-handed dentists have developed !!

May your June be flaming. Ta-rah for now, fellow enamel warriors

In part 1 of this series, I wrote about the importance of an effective landing page and how it helps to attract new customers to your business. We are now going to look at the key features of an effective landing page. What will make visitors give you the information or business you desire? Below are 6 key attributes of an effective landing page. Please feel free to add other attributes you believe would be effective. 

1. USP – Unique Selling Point

For our clients, they are looking to offer dentists a product or service that sets it apart from the competition. The client needs to break down what they are offering to the customer and when successful, it should be clear and attract attention. The first headline used needs to clearly describe what your product or service can offer and why they should be interested.

2. Picture or video

A picture or even better a video of someone using the product or service gives the users the feeling of what it is or what it looks like. This gets the customers thinking how they could use the product or service in their everyday life and how it would benefit them. A dental example;  A new dental handpiece being shown in a video being used by a dentist, gets the reader thinking about them using it in their practice and how it will benefit them.

3. The benefits of what you offer.

After the USP, you now need to give your reader a few more details. So how will the product or service benefit the reader? You need to think from the customer’s point of view. How will the new handpiece (for example) benefit the dentist, what features or advantages can you prove over your competitors?

4. Keep it simple

You want your reader to make a decision, for a decision to be more likely, the clearer and simpler your page needs to be.  As well as your landing pages, this also applies to a homepage. Traffic will often hit your homepage, so it should be treated like sales specific landing pages; keep your offer and strategy simple. Only offer a few places that can be clicked, keep the reader focused on the reason they clicked through to your landing page in the first place!

5. Testimonials / Proof

You want to show that your product is being utilised by other people in the field. People are more likely to use something that they can see is being used by others. If a product has excellent reviews or testimonials, then you need to shout about it. Other ways of demonstrating that the product is the best; Number of customers, organisations that you count as customers or awards received for your product or service. If you can provide evidence of testimonials, reviews or awards you will build trust and then sales!

6. CTA - Call to Action

CTA or call to action is incredibly important. You need to incorporate a bold, clear call to action into the design of the landing page. This could take a number of different forms, phone number, email address, contact form, social media links. The key is to think like the customer, make it as easy and straightforward as possible. The call to action details should be displayed a number of times on the page if possible.

We are constantly adapting and changing our own website and this is the huge advantage of being an online publication. Pages you create can be changed at anytime, so experiment with what works and what doesn’t and don’t be scared to try out different tactics or marketing plans.

If you would like to discuss how to market your brand or product on GDPUK.com, please This email address is being protected from spambots. You need JavaScript enabled to view it.. We can organise a marketing strategy that will work for your business needs. 

Landing Pages

Part1...The importance of an effective landing page

GDPUK.com earns revenue from banner ads, we display adverts from companies looking to attract dentists as customers. The most successful banners, direct the user to a specific landing page. A good landing page should be seen as a part of your sales team, in the first part of this series I have listed some thoughts on the importance of an effective landing page.

A landing page is a web page that allows you to capture a visitor’s information through a lead-capture form. These are often known as a conversion form.

Landing pages are created to convert traffic into qualified leads. If you can focus on converting visitors into leads, landing pages are all about positive ROI. This is where a good landing page can make all the difference.

So why are landing pages important?

• They help you focus on conversion. The focus has to be on converting visitors into leads. A few simple ideas could be contact details for a free white paper, or contact details for a sample of your product.
• Direct. By using a landing page you will start to find that a landing page can be more effective than just directing traffic to a homepage, which is likely to be a waste of time. Once someone makes the effort to click on a banner, if the landing page matches what is on the banner, the odds of converting the click into a lead will increase dramatically.
• Generation of leads. If an effective page is created, it is suddenly a lot easier to capture leads. Every time a lead completes a conversion form on a landing page your sales team collects valuable information. Obviously this is a great for the sales team, as they are receiving warm leads to target.
• The more the better. Once you start creating a range of landing pages for different offers, the more opportunities you will create to convert visitors into leads.
• Makes the expenditure on advertising worthwhile. The landing page should sell your product; the language on the landing page needs to be customised and persuasive to your target audience. If you are creating specific ads (which many GDPUK clients do) then it is pointless if you’re only going to send potential customers in the direction of your homepage.

I hope this blog gives you an idea of the importance of a landing page and how getting it right can lead to an increase in revenue. Advertising online is something we are all still learning about, but we believe by investing in your landing page, it is a great start to achieving a return from your online advertising.

For further information on how we can help with the marketing of your brand or product or to learn how we can help with a landing page for your advert, This email address is being protected from spambots. You need JavaScript enabled to view it..

We will publish part two of this series next week, which will give you some ideas of the key features of an effective landing page. 

Serious stuff or a Lamentable & Brazen attempt to kowtow to the big agencies?