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Published: Monday, 29 November 2010 13:36

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Report by Dr Jane Ainsworth, BDS.

The day began with Bruce Mayhew’s presentation ‘Winning with a Team’ - Bruce paid tribute to his staff and his family, and defined success as ‘Good dentistry – good staff – good profits ‘ – too many practitioners, he said, managed the first two but not the last. He said practitioners should charge a proper fee to do the job properly, and try to give patients what they want – he will often build teeth up in composite if patients can’t afford a crown. Bruce has just celebrated 50 years in practice and his continuing enthusiasm is an inspiration – his advice is to do what you enjoy, refer what you don’t, and what someone else could do better.

Andrew Dawood then spoke on ‘3D technologies for simplified implant therapy’ – the title being something of a modest understatement, since the cases Andrew undertakes are far from simple. He showed how cone-beam radiography is used to give much greater accuracy in implant placement and can obviate the need for bone grafting in elderly patients with resorbed ridges and when treating cancer patients who have had a maxillectomy – the slides of his cases were awe-inspiring.

Darrin Robinson, Director of Clinical Services and Commissioning at IDH, spoke on ‘Business skills for Practice Owners and Associates’. He gave a somewhat daunting list of the qualities dentists need to succeed – to be a good communicator, a good negotiator, empathetic, able to listen, able to manage change, possessing mentorship skills, good at personal organisation and effectiveness, financial management, able to cope with staff and HR issues…..and that’s before you do any clinical work – no wonder many of us feel tired all the time! But reflecting what Bruce had said earlier, Darrin said the key was self-knowledge and to recognise what you are good at and what you enjoy, and choose your role in dentistry accordingly. He said that NHS practices must manage their activity by having a written plan with performers for contract delivery, with agreed amounts of time for leave and training. Progress should be reviewed monthly, and this should be shared with the practice as a means of encouraging efficiency. He observed that the corporates followed the same basic aim as small practices –like Mr. Micawber, to make more money than you spend, and it really was as simple as that.

Derek Samuel, IDH’s Contracts Manager, then gave a talk entitled ‘Poacher Turned Gamekeeper’ – a reference to his previous life in NHS management. He said that contract holders should maximise their relationship with the NHS by building trust – deliver the contract, do what you say, and manage expectations. Practitioners should showcase their quality and value for money through positive patient feedback, vital signs data, and volunteering to pilot PCT initiatives such as fluoride application and smoking cessation. They should understand the system and how decisions are made - these will not necessarily be in the practitioner’s interest and sometimes it would be necessary to drive the process along. While there were occasions when we should be aggressive with PCTs, a win-win partnership approach was generally better. He felt that we should make more use of collective bargaining at both national and local level, and thought that such support was essential, especially for small practices.

The morning closed with Amarjit Gill, the BDA president, talking about the future of dentistry against a background of rapid social and economic change. He stressed how important it was to be aware of change and anticipate it, and quoted Stephen Covey’s maxim –‘live out of your imagination, not your history’. Debatable, of course, but the fact remains that spending on NHS dentistry has remained almost static for the last twenty years, whereas spending on private dentistry has risen from £2billion in 2000 to £7billion in 2010, and is estimated to be £15 billion by 2015……what patients buy is health, beauty, and remedial treatment in that order, and they want to buy it in nicer practices. The most rapidly growing market is young women from less well-off backgrounds, perhaps not that much of a surprise to those of us who work in less well-off areas.

After an excellent lunch, the conference resumed with Ray Steggles talking about his work on the development of Quorum Sensing Inhibitor enhanced antibiotic therapy –QSIant – in the treatment of advanced periodontal disease. Ray’s dedication and conviction shone throughout his presentation. He explained that bacteria in biofilm act like multicellular organisms and disruption of the biofilm is essential to modify the host response. For some patients with very deep pockets, homecare cannot achieve this. Quorum sensing inhibitors overcome resistance of the biofilm and allow antibacterials to penetrate the biofilm, and block enzyme production. Ray has treated 90 patients with generalised advanced periodontal disease who had responded inadequately to conventional treatment, using QSIant, and obtained an excellent or good response in 85% of cases - a most impressive achievement, which could lead to real change in the management of what is a very distressing condition for patients.

It’s always interesting to get an inside view of another profession - or perhaps that should be a view of our profession from another professional’s perspective - and Alex Hall from Mfg Solicitors gave us both in an entertaining presentation on ‘Precedents that help Dentistry’. Alex mentioned three recent cases which had set precedents – that of our own Eddie Crouch in 2008 which established that PCTs could not alter the mandatory clauses in a contract, Tomkins 2010 regarding the calculation of contract value, and Bue 2010 relating to termination of a contract on the death of a sole provider. The purpose of Judicial Review was the protection of the citizen against the State, in our case embodied in the PCTs, LHBs, and the CQC. Our contracts state that the PCTs must act reasonably, and this concept of reasonableness derives from a case in Wednesbury many years ago. PCTs are now being challenged on the grounds of Wednesbury unreasonableness over matters such as refusal to allow a practice to incorporate, or refusal to include a practitioner in their List. Alex also talked about how the principle of Promissory Estoppel can be used where a PCT has reneged on a verbal promise and a practitioner has been disadvantaged as a result, and the precedents that have been used to establish self-employed status of associates.

Ross Hobson concluded the presentations with Orthodontics– subtitled ‘Just Hairdressing for teeth?’, perhaps the answer is, ‘So what if it is?’ – most of us would feel less happy without the services of our hairdresser and the fact that successful orthodontics has a positive benefit in terms of patients’ self esteem does not make the orthodontist any the less skilled or professional, and makes the current disaster that is NHS provision seem positively callous. Ross talked about what can and cannot be achieved orthodontically, and the limitations of ‘fast smiles’, case selection being all-important and permanent retention a necessity.

Humour is of course an essential ingredient on GDPUK and this was supplied with the GDPUK Awards, presented at the end of Conference by Andy Bates, graphics by GDPUK’s resident computer and Photoshop expert Steve Van Russelt. The Greatest Disservice Satellite Industry Leeching off Dentistry Award went to Cannon; and the Bad CPD Award to Dental Buying Group. The Paperwork before Patients Award was won by the CQC, and the ultimate Humphrey Goldenbollocks Supreme Award to HTM0105.

The most frequently asked question of the day was ‘When can we have another one?’ – an indication that the GDPUK Conference 2010 wasn’t just a professional meeting but a social event too, and a great opportunity to catch up with old friends and establish new ones who had previously only been avatars or usernames, in a great venue.
An excellent day all round, and many thanks are due to Tony J, Steve, and all the speakers and sponsors.

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