This Blog is by Julia Furley, Barrister, at JFH Law.  

In 2015 the debate over the inequality of the sexes has raged. Ironically it hasn’t taken an earth shattering event to incite anger, instead it is the existence of what has been labelled “everyday sexism” that has tipped the balance; tolerance of inequality, particularly in the workplace, has finally run out.

Protests against perceived sexism have punctuated the news this year:

In June Sir Tim Hunt, the Nobel Award winning biochemist, was lambasted across the press and social media for his ill-conceived jokes about the pitfalls of women working in laboratories, made during a speech to the World Conference of Science Journalists in Seoul, South Korea. His comments caused international uproar, although the reaction to his comments divided both the scientific community and many commentators. Nevertheless they resulted in his resignation from UCL, the European Research Council and the Royal Society’s Biological Sciences Awards Committee.

The fire was stoked again on the 7^th September when barrister Charlotte Proudman publicly shamed a senior male solicitor, Alexander Carter-Silk, for complimenting her physical appearance following their connection on a business networking site. She was offended that Mr Carter-Silk felt it appropriate to comment on her “stunning profile picture”. Again, the reaction to the story divided opinion, with some suggesting that Ms Proudman should not have gone public and should learn to take a compliment with good grace, whereas many questioned why any woman should be subject to a physical appraisal on a site dedicated to business networking.

Just days later, a relatively unknown figure outside the legal profession made national headlines with his comments about equal representation of women in the upper echelons of the legal profession. Lord Sumption, a Supreme Court Judge, told the Evening Standard that rushing to achieve gender equality in the judiciary could have “appalling consequences” if achieved through positive discrimination, and suggested that society should wait a further 50 years for gender equality to be achieved naturally. Most controversially he blamed the lack of equal representation on “life style choices” made by women, who are “unwilling to tolerate long hours and poor working conditions”. At present just one of the twelve justices of the Supreme Court is a woman, there are no ethnic minorities, and just twenty one of the one hundred and six members of the Court of Appeal are women.

One can only assume that by lifestyle choices, he meant the inconvenience of giving birth. It should be born in mind that Lord Sumption’s rise to the top did not require years sitting as a judge in the lower courts like most, but instead direct promotion from the practicing bar. An honour never before afforded to a woman.

The outrage from women and men in the legal profession has been palpable, and unintentionally it seems, Lord Sumption has fuelled the debate regarding equality in the 21^st Century.

But sexism is not the sole domain of the scientific and legal communities; But sexism is not the sole domain of the scientific and legal communities; on the 1st October The Telegraph published an article, quoting Jyoti Shah, a consultant urological surgeon at Burton Hospitals NHS Foundation Trust, who had blogged about the sexist “gang culture” prevailing in operating theatres across the UK. She claims that the operating room was male dominated, and was often hostile to females; she cited incidents of being asked to make the tea for her male colleagues and, even more extreme, an incident of a female colleague being subjected to a sexual assault.   Figures revealed that women make up only 11% of the total number of surgical consultants in the UK.

And thus came, with perfect timing, the film Suffragette. The film received its UK premier on the 7thOctober, telling the story of the militant campaign in support of women’s voting rights in the UK one hundred years ago.

The film’s ensemble female cast, including Meryl Streep and Carey Mulligan, later highlighted the high levels of inequality in the arts, entertainment, sports and media industry, in the US, where in 2014 women working full time in the industry earned on average 85% of their male counterparts pay (although one should bear in mind this is quite good when compared with the average across all sectors in the US, where women earn on average 82.5%  of their male counterparts).

It seems that regardless of legislation designed to ensure equality in the work place, and numerous legal cases ensuring that women are paid the same as their male counterparts, there is still a mountain to climb for women in the workplace; particularly in their fight to reach the top of the Professions.

However, notable in the absence of any complaint was the dental profession.

What about equality in 2015: can dentistry hold its head high?  There have been no audible complaints from female dentists, and no exposés in the press of horribly sexist behaviour by senior dentists. Does this mean there is no underlying problem, or just that no one is yet willing to put their head above the parapet?

Since 2007 the GDC have published figures regarding registration in the UK of dental professionals.

In 2007, 35,419 dentists were registered with the GDC. There was quite a significant gender gap; with 61% (21,596) of those registered male and 39% (13,823) female. However, of the 2359 dentists added to the register that year, slightly more than 50% were women.

When looking at dental care professionals (nurses, therapists, hygienists and technicians), an even more significant gender divide opens up. In 2007, 20,219 of all registrants were women, with just 1,508 men registering.

Unfortunately, the GDC do not provide the gender breakdown of those registered on the specialist lists for 2007.

Fast forward to the latest 2015 figures, and how are the numbers looking?

In October 2015, 40,953 dentists were registered with the GDC, and a massive 66,009 dental care professionals.

The good news is that the numbers of female dentists are catching up with men; 53% (21,775) being men and 47% (19,177) being women.

Dental care professionals have however gone even further the other way, with 91% (60,388) women and just 9% (5,711) men.

What does this tell us? In accordance with the numbers of women currently studying for their BDS degrees, the balance of male/female registered dentists is likely to be equal, if not tipping marginally in favour of women over the next 10 years.

What it does not assist us with is how well those women perform in the profession overall, how many achieve senior roles in hospitals and how many become NHS contract holders or practice owners.

Anecdotal evidence tends to suggest that women are quite positive about the profession, finding that the flexibility of associate positions can work well with child care responsibilities; which still tend to fall to women to resolve.

Perhaps more worrying is the male/female ratio of dental care professionals. The vast majority of dental nurses in the UK are women; reflecting the general breakdown for the “caring” occupations such as medical nursing, carers and nursery education. The reason it is worrying is that dental nursing remains relatively low paid and insecure, with many nurses being employed on the now notorious “zero-hour contracts”. The upshot is that women find themselves undertaking work that men would traditionally not be willing to do, largely due to the pay and conditions associated with it. Again anecdotally, there also appears to be reluctance on the behalf of dentists to employ male nurses, as there is an expectation from the patient that nurses will be women.

For dentists, things take a negative turn when one considers the gender of specialists. The GDC have provided statistics in relation to the specialist lists for October 2015, which show that the divide opens up quite dramatically.

Looking at the most “popular” specialisms; orthodontics, endodontics, periodontics, restorative dentistry, oral surgery and prosthodontics there is a significant gender divide:

Of 1373 orthodontists, 52% (720) are men and 48% (653) are women.

Of 277 endodontists, 77% (212) were men and 23% (65) are women.

Of 368 periodontists, 67% (247) are men and 33% (121) are women.

Of 317 restorative dentists, 76% (240) are men and 24% (77) are women.

Of 754 oral surgeons, 72% (544) are men and 28% (210) (are women.

Of 450 prosthodontists 78% (349) are men 22% (101) are women.

Of the 13 specialities, only in dental public health (55 v 62 registrants), oral microbiology (3 v 5 registrants), paediatric dentistry (62 v 182 registrants) and special care dentistry (104 v 218 registrants) did women outnumber the men. All, dare I say it, the more typically “caring” side of the profession.

So why are women so woefully underrepresented in the specialities? One argument again relates to “lifestyle choices”. At a stage in their profession where postgraduate training may appeal to some, many women will also be considering starting a family and will not have either the time or resources available to pursue a speciality. However there is also the question of the decision makers at the competitive entry stage of postgraduate training. Very few “heads of department” positions are currently held by women; could this be affecting the way in which recruitment is undertaken?

Whatever the reason, dentistry like all other professions must give careful consideration as to how we can ensure true equality within our professions. It can no longer be acceptable to suggest that any woman must choose between having children and fulfilling her career potential. More should be done by the Universities, the GDC and the RCS to ensure that women are actively encouraged to undertaken postgraduate training, and that facilities, such as funded crèches on site,  are made available to all those, men and women, who have child care responsibilities.

The author, Julia Furley, is a barrister and partner at JFH Law. Julia has a special interest in dentistry, and currently advises both dental practices and individual dentists on both legal and regulatory obligations.

JFH Law LLP Tel: 020 7388 1658 7b Bayham Street, London, NW1 0EY DX 57064 Camden Town www.jfhlaw.co.uk Follow us on Twitter: @jfhlaw

In my role as Sales Manager at GDPUK, I often get asked what kind of campaign works well on the website and I am always happy to give a few suggestions which I hope helps the client and gives them a few ideas to take away and ponder.

Below are a few bullet points of the suggestions that have come to mind in recent times. Please feel free to add to the suggestions.

The idea behind the list below is that it hopefully gets the client creating an interesting campaign that then gets them a return on their investment and builds a long-term business relationship with our publication.

Our users do notice the adverts but it is upto the advertiser to catch their attention enough that they become fully engaged with the message. The fact that a banner gets shown thousands of times in a month is an obvious advantage of advertising online, your brand has an extra chance of getting noticed on a popular blog or forum thread.

So what are some simple, straightforward methods of getting noticed? A few brief ideas below.

• A good, simple, well designed landing page, that matches the campaign / campaigns. I have blogged about the importance of landing pages before. Read more on this link.

• Experiment with different designs / styles for the banner ads, see what is successful and look to implement banners in different colours and fonts.

• A competition or prize draw to get data for your business, as well as create some buzz around a new product or service.

• Supplement all advertising campaigns with PR that matches the advertising and is shared on social media. Run the same advertising / PR on your social media pages, so it increases brand awareness.

• A successful campaign has been with a company who have used client testimonials "I love using this xxx dental software because...." So showing that fellow dentists use the product and it works for them, creates a positive message.

• A social media campaign that includes advertising on dental websites but run in tandem with social media. For example an equipment manufacturer could collate photos of dentists using the handpieces in their surgeries etc. Create a pinterest style collage.

If you would like to discuss any of the brief suggestions above, we will be attending the BDIA Showcase at the NEC in Birmingham. We can be found on stand F215. All my contact details are below.

Our new media pack for 2016 is also now available for download. It is available here and if you click the image below.

Thanks for reading and hopefully see you in a few days. Cheers.

"Squamous papilloma -- very low mag" by Nephron - Own work. Licensed under CC BY-SA 3.0 via Commons.

In this blog we summarise some important changes in UK legislation, which may have an impact on you and your Practice.

From 1^st October 2015 the following legal changes have come into force:

·         The National Minimum Wage: this will increase from £6.50 to £6.70 for those over 21 years of age; for employees who are aged 18 to 21 the rate will increase from £5.13 to £5.50; Employees under 18 will see an increase in their hourly rate from £3.79 to £3.87; and finally the apprentice rate will increase from £2.73 to £3.30. In relation to apprentices, please note that this rate only applies if the apprentice is under 19 years of age or in their first year of apprenticeship. This means that salaries and all other associated benefits, such as holiday and sick pay must be amended from this date. Failure to do so could result in a claim by an employee for unauthorised deduction from wages;

·         The Consumer Rights Act 2015: the Act aims to consolidate existing UK consumer legislation but will also introduce new provisions relating to statutory remedies for defective goods and services. See below for our full analysis on how the changes will effect dentists;

·         Businesses, including Partnerships, with a turnover of £36 million will be required to publish a slavery and human trafficking statement every year. Whilst this will not directly affect small to medium sizes businesses, we consider there may be an indirect effect on them. Our detailed analysis of the requirements can be found in JFH Law's September 2015 E-Alert;

·         The right for Sikhs to wear a turban instead of a safety helmet will be extended to all work places, with some exceptions applying in relation to military and emergency services. Prior to these changes, Sikhs were exempt from wearing head protection in the construction industry but, because of legal loophole, they were not in less dangerous occupations such as factories. This meant Sikhs could face disciplinary action or dismissal for refusing to wear a safety helmet. In terms of medical treatments, there is no reason why a turban cannot be worn, if covered by a surgical head cover in the normal way it poses no health and safety risk.

Consumer Rights Act 2015

The Consumer Rights Act 2015 (CRA) aims to consolidate existing legislation in relation to consumer rights, whilst introducing new provisions which will come into force from 1^st October 2015. The key reforms are to improve consumer rights and remedies in respect of goods, services and consumer notices, but also to stop the inclusion of unfair terms in consumer contracts.

Under new consumer rights legislation a “trader” is defined as a person acting for purposes relating to their trade, business or profession; whether personally or through others acting in their name. This will include dentists, and their support staff, who provide treatments to a patient. Patients will therefore be deemed “consumers”. As such, patients have ‘consumer rights’ when they enter into an agreement with their dentist.

The following terms are implied into that contract:

1. That the services will be provided with reasonable skill and care;
2. The services will be performed in line with the information provided about the service and in line with information provided about the dentist;
3. That a reasonable price will be paid for the service.
4. That the services will be performed in a reasonable time.

This is broadly similar to the position on consumer rights prior to the CRA.

However, important changes relate to the provision of information to consumers.   Any information said to or written down for the patient, and which the patient relies on when entering into the contract, will be contractually binding; even if it is not in any contract signed by the parties.

Dentists will therefore need to be increasingly careful when a) agreeing timescales to provide treatment, and b) in how they express the likely outcomes of any treatment. Of course it is always advisable to prepare a clear written treatment plan for all patients, but dentists also now need to ensure that conversations had between reception staff, practice managers and treatment coordinators are all properly recorded and documented. If in doubt, make a note and follow up sales consultations with an email or letter summarising what has been said as these discussions are likely to form part of any contract if patients rely upon them.

JFH Law will keep these changes under review and will endeavour to advice on how these changes will work in practice in both the dental and medical professions.

The CRA also has a number of controls on excluding and restricting liability. Perhaps unsurprisingly, a term that excludes the trader’s liability for failure to perform a service with reasonable care and skill will not be binding. But also it will not be possible to attempt to restrict liability when timeframes are not met. Indeed the CRA makes provision for a reduction in price where work is not done within a reasonable time.

The CRA also provides new statutory remedies, namely the right to repeat performance and the right to a reduced price where work is not done to the correct standard or the agreed timeframe. The patient may also have remedies for breach of contract in the normal way, such as damages or specific performance.

Much of these changes will not dramatically alter the way in which dentists operate, as most already have in place excellent record keeping and performance levels in accordance with the requirements of their professional regulations. This is however another level of bureaucracy that dentists and their teams should be aware to avoid unnecessary litigation.

The Trading Standards Institute has produced this very helpful guide for traders in relation to contracts for the supply of services:

http://www.businesscompanion.info/en/quick-guides/services/the-supply-of-services-from-1-october-2015

* picture from Creative Commons

On Wednesday the 7th of October, GDPUK were invited to the launch of Denplan’s new TV advert which will air on our screens from Saturday night (10th Oct) and will run for approximately 3 weeks.

The campaign demonstrates Denplan’s huge investment and commitment to dentistry and the dental practices that they work with. An impressive £1.2 million has been spent on this campaign.

After a short consultation period, Denplan have used the advertising agency “brothers and sisters” to design the advert. Established since 2008, they have a number of famous campaigns in their portfolio including the Thierry Henry advert that aired this year which can be viewed below. Great advert, especially the part when he joins Alex Ferguson and Brian Kidd on the Old Trafford turf!

The Denplan advert

So what does the advert entail? It shows a young man taking a selfie on a day out but everytime he smiles, he snaps his horrendous teeth. These teeth are obviously quite extreme to get the message across and were created by the special effects team at Fangs Fx. (If you click on the link, it gives you a great idea of what they are capable of!) So the bloke starts coming up with ways to cover his teeth, eg putting his cat in front of his mouth or putting his hand in front of his teeth. The producers behind the advert have gone for something that will make the viewers smile and also gets people interacting, which seems to be the current trend for TV adverts, as exposure is limited with the way we all watch TV these days. Let us know what you think, when the advert airs over the weekend? Does it make you smile?

The aim

Denplan would like to increase brand awareness, plus of course help Denplan’s member practices stand out in the competitive market of attracting / retaining patients. Practices have been sent a large amount of marketing material that will be used to engage with patients, so in conjunction with the advert, it will provide excellent opportunities to talk to their patients and forms a part of their practice marketing.

Denplan conducted some selfie research which gives further credence to the campaign. A YouGov survey revealed that a staggering 5.6 million selfies are taken in an average day by adults online which equates to an incredible 2 billion plus per year!  Three quarters (74%) of adults have worried about how their teeth look in photographs and a third of adults (33%) have smiled but purposely not shown their teeth due to being embarrassed by them, so selfies and smiles was an easy place for Denplan to focus their efforts. 

The Impact

So from a dental perspective, what impact will this bring on UK Dentistry? A few thoughts to consider:-

1. Obviously there will be a huge impact for Denplan dental practices but will other dental plan providers also receive a boost? I believe it gets people thinking about their teeth and their dentist, so its a positive piece of marketing for all dental practices.

2. It is fantastic to move away from traditional tv dental advertising and instead Denplan have embraced a modern and fresh approach…. Everyone at the event agreed that this was a brave move and the small crowd were certainly positive about the message that Denplan are hoping to achieve.

3. The use of social media and a hashtag #doitforyourselfie taps nicely into a younger, celebrity obsessed crowd but if it gets the public visiting the dentist on a more frequent basis and talking about dentistry in a positive light, then surely this is a good thing? Dr Roger Matthews (Chief Dental Officer) of Denplan mentioned that motivation is key with patients and he believes that running this campaign could be a great way of motivating patients to visit their dentist on a regular basis and that is obviously the overall aim of the campaign.

4. Dentists are often negatively portrayed in the media but I believe it is refreshing to see a slightly humorous take on the Dental world but with a positive message that people in Britain our proud of their smiles and possibly the work dentists have done on their teeth? This will hopefully be demonstrated over the next few days, as the public share their selfies on www.doitforyourselfie.co.uk. Already a number of selfies have been uploaded!

Unfortunately I can't provide a copy of the advert just yet but I will update this blog with the advert once it has had its premiere. Over the next few days we will be keeping a close eye on the microsite, to see whether it captures the public imagination and the general reaction from the dental community on social media. We certainly hope it does capture the imagination and as stated previously, it achieves the positive message that Denplan are striving for. Please let us know what you think and how the advert will be received?

** Blog now updated**

The advert is due to be shown at 15:28 on ITV1 on Saturday afternoon.

#doitforyourselfie

www.doitforyourselfie.co.uk

The FCA is more than just the OFT with a new name . . .

by Martin Gilbert 

Offering credit to your patients used to be so simple. All you needed was a Consumer Credit Licence and that was it. When a patient wanted to spread the cost of the treatment, you forwarded an application to the lender, they sorted out the paperwork, you did the work and you got paid.

Then the credit crunch came along, and in the aftermath it was decreed that the Office of Fair Trading wasn’t the best organisation to supervise consumer credit (think about the unfettered antics of payday lenders and home reversion scheme providers) and responsibility was transferred to the Financial Conduct Authority.

And they are a different animal altogether. They started gently enough, by writing to all CCL holders and telling them that if they wanted to continue to be credit brokers, they just needed to register for Interim Permission.

Then all IP holders were notified of the Allocation Period in which they have to apply for Authorisation. The last ones finish in February 2016. Applying for authorisation (which for most dentists, who just need to act as Secondary Credit Brokers, will be for Limited Permission) is not too difficult, as long as you have the time and understand the terminology (who knew that ‘agreeing to carry on a regulated activity’ was itself a regulated activity, and one which you have to have).

So you complete the online application and pay the fee. The letter arrives (within their 6 month’s SLA) with your Authorisation, your Firm Reference Number and information about your ongoing obligations. You skim through it, and then file it.

But this is only the start of your relationship with the FCA.

Next you get an email telling you that a Return is due. So you phone the FCA Helpline, who tell you that you should have registered for GABRIEL. Which you didn’t bother with, because you hadn’t really read the letter, and the OFT never used to ask you for any returns, so it hadn’t occurred to you that the FCA would. (CCR008 is required quarterly, CCR007 is annual, and there are fines if you miss the deadlines).

Then you get an email telling you that your Periodic Fee is due. So you phone the FCA Helpline, who tell you that you should have registered for online invoicing. And when you do so, and find the invoice, you’ll see that you also have to pay a Money Service Advice Fee and a Financial Service Ombudsman Levy.

So then you think, I can’t be bothered with this, I’m going to cancel my authorisation. So you phone the FCA Helpline, who tell you that you should have registered for CONNECT (not the one you used for your original application, but the one that was mentioned in that letter) to enable you to make any changes to your standing data. And when you do eventually manage to login, you have to find your way through ‘Start a new application’ to get to the cancellation option.

If you’ve got more money than time, there are plenty of firms out there who’ve made a business out of managing the authorisation for you – typically charging £600 to submit your application and £25 a month for ongoing compliance.

Or you could become an Appointed Representative of a specialist such as Chrysalis Finance, who look after the compliance and the reporting, and provide you with a state of the art online portal to process applications simply and easily. So you can not only get on with giving your patients the best treatments, but you also make them affordable for them. 

Martin Gilbert, a chartered accountant,  is a Director of Chrysalis Finance.

A lot of research into the benefits of using Water Flosser as opposed to string floss has been conducted to date. Independent research studies have shown that the Water Flosser was up to 50% more effective at reversing gingivitis, up to 93% more effective for reducing bleeding and can remove 29% more plaque than string floss.[1]^,[2] It is also significantly more effective for implant and orthodontic patients who are more susceptible to developing gingival inflammation.[3]^,[4]

But, this research would mean nothing without the endorsement of professional hygienists who have a working knowledge of oral irrigation products. Michael Wheeler is a dental hygienist at Bramcote Dental Practice in Castle Cary and an Honorary Senior Lecturer at the University of Kent. When asked about the products available from Waterpik International, Inc. he said:

“I am a firm advocate of the Waterpik® Water Flosser – both for those patients who are having difficulties in maintaining oral hygiene with bridges or crowns, and those who already demonstrate good oral hygiene routines. The Water Flosser is a very effective product and is relatively easy to use, so it’s really beneficial for all. 

“A patient I’d been treating for several years recently highlighted this. She’d had a bridge fitted about 30 years previously and although her oral hygiene was exemplary, she expressed that the bridge caused her some difficulties, especially when it came to maintaining such a high level of oral hygiene. I suggested she incorporate one of the Water Flossers from Waterpik® into her daily cleansing routine, in an attempt to offer her a logical solution to these issues.

“The next time I saw her she was delighted with the results of the oral hygiene adjunct, stating: ‘It’s absolutely life-changing and the best thing I’ve ever used!’ Even I was slightly taken aback by the level of her enthusiasm, but it was great to hear!

“A second patient of mine, a reformed heavy smoker, also noticed an improvement in his oral hygiene with the use of a Water Flosser from Waterpik®.

“It just goes to prove with the right patient, even if their oral hygiene is beyond criticism, you can provide further motivation with the right product.”

Discover the many benefits of clinically proven solutions from Waterpik International, Inc. for yourself, and contact the team today.

For more information on Waterpik International, Inc. please visit www.waterpik.co.uk. Waterpik^® products are available at Amazon, in

Boots and at Superdrug stores across the UK and Ireland.

The GDC specialist lists were established in 1998; the most recent, Special Care Dentistry, being added in 2008. The UK has more recognised areas of specialism than any other European country.  There are currently 4261 registered specialists across the 13 disciplines. The GDC are not obliged to have specialist lists, but are empowered to do so by various pieces of European and domestic legislation and regulation. If they wanted to dispose of the lists it would not require legislative change, but would need a compelling policy reason and would require a significant amount of regulatory change.

There is no comprehensive data about the total number of patients treated by Specialists each year; although there were 2.7 million outpatient appointments within dental speciality clinics and a further 320,000 consultant episodes in 2012/13 according to NHS data. This of course does not account for private patients.

The GDC recently undertook a review of the way in which the specialist lists are regulated. The aim was to determine what the benefit of regulation was when it comes to patient protection and whether the lists did in fact help patients make a more informed choice about their dental treatment.

The first phase of the review began in January 2014; whereby information was obtained from both the public (with a representative sample of 500 adults) and the profession regarding their experiences (there were 68 responses from the profession, including 25 from individual specialists and 5 from GDPs).

Background

Registration

The most common way to obtain entry onto a specialist list is to undertake a recognised training programme. Approximately 500 students per year attempt this route. Alternatively, candidates can seek to illustrate equivalence in “knowledge and experience gained through academic or research work”; commonly known as mediated entry.

European registrants with qualifications in Oral Surgery or Orthodontics are automatically recognised.

In 2011 there were 175 additions to the list, in 2012 245 and in 2013 231.

Title

Only a registered specialist can use the title. This is also true for the use of the “ist”; endodontist, periodontist etc. It is not permissible to use the phrase “specialising in” if you are not registered on a specialist list. The only permissible terms are “special interest in”, “experienced in” and “practice limited to”. Using an incorrect term can lead to professional disciplinary proceedings and/or a conviction and fine.

Cost

The cost of registering on a specialist list are relatively low; just £345 for initial registration and £72 per year thereafter.  

The GDC have calculated that the cost of regulating the specialist lists in 2014 was £339,000, which income is forecast to exceed by 6%. There does not appear to be any comparison with earlier years, and as such it is not known whether this is a constant figure. However, this cost also includes the cost of the review so is likely to be much higher than previous years.

Conclusions of the Review

Does specialist regulation bring any benefits in terms of patient and public protection?

The reality is that public awareness of the specialisms is extremely low; shockingly more than half of those surveyed did not know ANY specialism existed. Only 1% was aware of periodontists and restorative specialist, only 2% of prosthodontics and only 3% of endodontists. The highest recognised term was “cosmetic dentist” at 22%, closely followed by orthodontist at 19%. Worryingly 10% believed implantologist to be a recognised speciality. However, most people felt that it was important that specialists were properly regulated. Unfortunately, only a third of those questioned had even heard of the GDC (and this was when prompted!).

It is useful for specialists and practice owners to bear in mind that when choosing a specialist most of those who did recognise specialisms relied on their dentist’s referral rather than their own research. What is abundantly clear is that dental specialists are not effectively marketing their existence, and by implication their value.  

Of those in the profession who responded, the general view was that regulation should not be decreased and that deregulation risked those not properly qualified attempting procedures outside their capability. However others pointed out the lack of evidence that regulation does in fact improve patient care. Concern was raised re the lack of regulation of specialists post-entry. At present CPD requirements are the same for both GDPs and Specialists.

Is regulation proportionate to the risks posed by dentists providing complex treatments?

Perhaps understandably specialists were more supportive of the lists than GDPs. Some respondents felt that the fees charged were disproportionate. However this is surprising bearing in mind the amount of administration required in certain cases. £345 may seem a lot for someone who has been awarded the CCST, but is a small reflection of the cost of mediated entrance. It is curious that a more diverse fee structure has not been recommended and that practitioners are not being asked to fund appeal hearings, particularly if unsuccessful.

Many respondents questioned the need for the number of specialist lists. However the review concluded that they were necessary due to the number of complex procedures undertaken.

Are the specialist lists the appropriate mechanism for helping patients make more informed choices about care seen as falling outside the remit of a GDP?

74% of patients who had visited a Specialist had been referred by their GPD. Only 4% of those questioned said that they would check the details of their Specialist with a regulator. Although the majority responded that it was important that the information was there if they did want to check.

GDPs and Specialists generally agreed that the lists do assist in making appropriate referrals.

In reality although specialist lists are available on the GDC website, the public a) doesn’t know about the GDC website and b) doesn’t understand the terminology used and significance of qualifications recorded. It would appear that it is the GDC who are failing in the provision of information to patients.

Should the GDC be the body to regulate the specialities?  

It was generally agreed that the GDC are the appropriate body to regulate, however it was pointed out the GDC was reliant on the Royal Colleges to provide guidance on the skills, knowledge and behaviour of specialists. Nor does it quality assure specialist training or have a separate revalidation process in place.

The review made for possible proposals for the future:

1.       Strengthen the GDC’s approach to regulation. The GDC are developing a “work programme” to achieve this and intends to give a clearer definition as to the meaning of specialist, ensuring the lists are correct, “tightening up” mediated access or removing this route entirely, quality assuring specialist training and providing information to patients.

It appears that the only rational for proposing the removal of mediated entry is to reduce costs. Surely a fairer and more sensible approach would be to charge applicants appropriately.

2.       Explore alternative models of regulation:

If the Council is of the view that the current regulation does not offer significant benefits to either the public or patients; is not proportionate; or that resources could be more properly focussed on key regulatory functions; then there would be no further policy changes and instead possible alternatives to statutory regulation would be explored. This could include investigating the possibility of removing all specialist lists save Oral Surgery and Orthodontics:

3.       Continue to regulate the Specialties, but not make any significant policy changes. Although it is still suggested that the mediated entry route would be reduced.

4.       Further analysis of the evidence of improved patient outcomes.

Overall the review has uncovered the alarming lack of understanding by the public regarding Dental Specialists and the Lists. However, on a more positive note, appears to suggest that those within the profession believe that the lists are both necessary and helpful. Of the proposals, only one thing is clear that dentists can expect an attack on the mediated entry route over the coming years; although there seems little justification for this save on costs grounds.

**Blog image from Creative Commons

***This blog has been written for Rumpole of the Surgery by Julia Furley of JFH Law

Welcome back to the Indian Summer of tropical rain…

There was a time when those of use of a certain age [OK Old if you will, but take that tone out of your voice!] decided to pursue dentistry for many reasons one of which was the life time career of care which happened to be comfortably paid.  Professional life was stable, practice management was an ongoing process. Interestingly by and large we saw all the patients who wanted to be seen and managed their dental needs without any political calls for damage limitation of a crisis of “Access”. Those of us so inclined went home for a celebratory glass of cheap Chateau Rinse de Bouche over an FP17. [For those of our younger colleagues unfamiliar with such things, these were the old claim forms that allowed a course of treatment to be ‘claimed’]

Complaints were rare. The GDC were a body to whom one looked up in awe and respect, and yet who played little part in day to day practice. Indemnity was low cost as was the ARF.  At some point in one’s career one would make the decision to up the standards of ones work and seek to change the way one practiced. It was a cycle of professional life.

Meetings [long before CPD became a fashion statement] were a cacophony of chit chat about practice matters.

Morale I would be so bold as to say was always, broadly, high

So what on earth has happened? How do we find ourselves at the edge of a perfect storm of change for the worse?

The GDC are a runaway train of high cost complaints handling and we are all paying through the nose and other orifices too, I should think.  The persistent arrogance and lack of accountability of the GDC and its leadership remain a real cause for concern.  A worry in part because they affect us but we do seem to be able to affect them, nor can the PSA, it seems.

Just look at Indemnity as an example. On the one hand it is a significant chunk of income on an annual basis, now being compulsory [so the lawyers can REALLY get their teeth into you]. On the other hand, despite reassurances, there is a pervasive sensation that they will dig you out of a shallow pit of excrement, but if you are truly up to your neck they may simply leave you to flounder. A worry in part because they affect us but we cannot affect them.

Now we have news of the falling away of dentist incomes.  In a separate and apposite piece of Government news, even that respected statistical body HSCIC, thinks morale is a worry amongst dentists. Now incomes falling is hardly news because most of us have noticed this in the last 5 years.  How? Well, we run these efficient Micro-Businesses, Minister and produce the annual accounts.

Practice Plan’s latest Confidence Monitor is hardly an advert for happy campers under the Governments clinical cosh that is the UDA.  The vast majority of the NHS dependent sector must be feeling very uneasy.

What has caused this change of circumstance?  Why are all the pointers suddenly running the wrong way?  If morale is a precarious state of mind, all this news must surely cause the spiral of decline to turn more quickly unless something is done?

Can morale fall, like the rain, in stair-rods?

Now hold on Dr Prism … Dentists are a resilient bunch – we get by, we generally don’t moan, and we take the rough with the smooth because, let’s face it, there are many worse off than us and despite what the Daily Fail et al may say, we do have a social conscience.

In our day to day work, we [you me and all the other GDPs] take personal responsibility for our situation. It is up to us to be happy … or not as the case may be.  It is up to us to run our businesses. All good so far.

But for the bigger external problems we rely upon an external body to do our work for us.  We reply upon our Academic colleagues to lay out the ground for evidence based clinical practice. Not some random bunch of Red Braces in Wimpole Street who would not know a dental practice if it hit them on the head! We rely upon a representative body to keep the bad news at bay – to fight off the bad guys as it were.

Where are the BDA as our ‘Union’?

Perhaps they themselves experiencing a decline in morale as time and again they fail to make an impact against the onslaught of Government regulation and initiative?  Not so long ago there was the change of subscription system and I seem to recall there was a ‘bit of a fuss’.  Even on a professional matter such as obesity and the sugar debate, it was the medical fraternity that snatched the victory, and the BDA were left to issue a “told you so” PR statement which barely caused a public ripple.  

Perhaps the lesson of influence here was that we need strategic alliances to amplify our voice and our influence.

Why is the BDA so effective on so many levels of “back office” matters and yet on the “Front Line” of headline influence and involvement, it is abjectly falling short. Why is it that as a body of 20000 dentists, they are neither first to be thought of in the media domain nor are they regarded with respect by our political masters?

Incomes … the UDA system …  the Prototypes … the CQC … the GDC and its quisling Dental members …  the GDC and it expansionist ambitions … FtP … more FtP … Professional Morale  … a vision for UK dental care …  Children’s Dental Health … Young dentists and early training...  Planning for Tiers ...   the list goes on where as members [and non-members] we cry out for some serious bloody Bolshiness – and time and again we feel they fall short. Too busy having ‘polite meetings’? You might say that, but I could not possibly comment.

By and large of course those who are in private practice are able to manage their lives and rise above the challenges of NHS practice.  This indeed is reflected in the consistent theme of the HSCIC, Practice Plan and others: their findings relate to NHS practice

So if the NHS GDP is the poor bloody infantry, who are their Generals? 

Well certainly not the new CDO, ironically Colonel [Retired], who is happy to discuss the present and future problems on the same stage as the very man who was their architect, now relishing his role as a non–exec director for a leading Corporate.

The sign of poor morale in an organisation can be its collective ineffectiveness of leadership.

Perhaps the problem of spiralling morale in GDPs is in part due to a perception of low morale at the BDA?

For sure as profession we need a dose of Feelgood Salts and a good kick where it hurts. 

The season is underway.

The BDA need to start scoring some goals.

It’s not like the ball is not in the open, and for sure the net is wide open.  The NHS GDP needs its leaders, its “Generals”, to start doing more than limply waving a PR flag.  I suspect members would prefer one action over the hundred words of a glossy Press Release.

Can it really be a year since we and the BDA all went up in arms over the ARF change?  A fine campaign of action but has 2015 seen it followed through?…  It’s a sad reflection that, as no doubt predicted by Madame Gilvarry and Dr Moyes, the ARF is now seen as small beer – have you looked at your Indemnity bill?

Get a grip BDA.

Start earning your members fees.  Before a large part of the profession withers under your watchful gaze. 

The signs are out there. How many more hints do you need?

Weblinks:

New report looks at motivation and morale of primary care dentists  http://www.hscic.gov.uk/article/6675/New-report-looks-at-motivation-and-morale-of-primary-care-dentists

Dental Earnings and Expenses - 2013-14  http://www.hscic.gov.uk/catalogue/PUB18376

The first NHS Confidence Monitor  https://www.practiceplan.co.uk/dental-plans/the-nhs-confidence-monitor

BDA Current Press Releases  https://www.bda.org/news-centre/press-releases

New CDO to speak at therapists conference  https://www.gdpuk.com/news/latest-news/2004-new-cdo-to-speak-at-therapists-conference

Here is a campaign in which GDPUK can be the leader and get the whole profession to change their thinking, and from there spread outwards.

I believe dentists, their teams and dental company offices and dental events must lead the way by being sugar free.

When we visit a dental organisation offices, or we go on a dental course, a conference, an exhibition, any event at all, we must demand that the organisers make the catering sugar free. As well as the granulated white stuff, we must banish the biscuits and the cakes, put out fruit and other snacks. Our chefs can conjure up delicious sugar free creations - let's make dental events the showcase for them.

I have found it weird that for years we would go to dental events and find white sugar, brown sugar, but we cannot find artificial sweeteners.

We need to banish the sugar from OUR events and encourage hotels, venues and offices to do the same. After dentistry, we must campaign for the NHS events to do the same, there must be hundreds of those every day. Minister of Health?

There are multiple alternatives to sugars for drinks, there are many sugar free options amongst soft drinks

In terms of table top sweeteners, there are intense sweeteners such as saccharin, and there are bulk sweeteners such as sorbitol or sucralose.  Some people cope with artificial sweeteners in drinks, some dislike, we can accept that.  At the premises of dental companies, and in our dental practices the law demands no smoking in the workplace, let dentistry take the lead and encourage adoption of sugar-free to trickle down to all food outlets, all hotels, all workplaces, and from there into homes. It does not have to be forced on anyone, no legislation, just a gentle change.

The larger dental organisations need to change their policies, and shout this from the rooftops. It would be good PR. Give journalists packets of sugar free sweets when the story is launched.

Let's do it, colleagues - we can take the lead and start the change to help our nation's health.

Main blog Image credit - Moyan Brenn under CC licence - not modified.

When an oppressive situation arises develops over the years as the one we have with our current regulator, it is natural initially, to think this won’t directly affect me. Gradually, though, it becomes apparent from the people you hear of who are affected, and then those you personally know that becoming involved, you start to think a little differently.  When its people the calibre of Colin Campbell and ‘Microdentist’ (to name a couple whom I know personally) then as I’ve said before in my previous ramblings, there’s no hope for any of us.

So if this happens to us, we need to know we’ve got the support and help of organisations that can back us to the hilt. The backing of our indemnifiers is our lifejacket; they take our money and promise to help us keep afloat.

But it is becoming apparent that the support we need to rely on might not always be a given. An increasing number of colleagues seem to be being told by their indemnifier that they wont be supported, or they are supported up to a point and then dropped. No smoke without fire? In reality I’m sure there is a degree of this in these situations. Social media is often full of discussions involving this subject, with some of the participants almost wearing a badge of pride that they’ve used their indemnifier multiple times. I’m left thinking in those cases that the problem here isn’t the indemnifier, but the way these individuals are practicing dentistry and not learning from what appears obvious to others. After all, if you keep on crashing your car into the same wall every time you drove to work, perhaps its about time you either drove a different route, learnt where the wall was, buy a slower car you can control, or just give up driving. In these cases the indemnifier is probably absolutely right to start loading the costs of representation.

Is this always the case though? There seem to be so many rumours flying around that suggest if you ring for advice this counts against you, or that if you settle a certain number of times you’ll see your premiums loaded or even cover withdrawn. There is a definite lack of public clarification from the indemnifiers about the decision processes involved in these situations. One of the indemnifiers has said that ringing for advice does NOT load the premium or count towards a risk analysis. But what about a letter that immediately closes a case or offers a refund (which is usually out of the pocket of the practitioner and not the indemnifier). We don’t know what their process of risk assessment is. We need to.

I’ve been aware for a long time of the discretionary nature of much of the indemnity, and the fact it can be withdrawn, and I’m surprised more dentists aren’t. But I’ve never heard of so much of this discretionary withdrawal actually happening as recently. A good part of this is probably due to the unprecedented increase in complaints, but is this the only reason? There isn’t any public explanation usually as to what discretionary cover is, because it’s at their discretion, which is a fantastic catch all, but that doesn’t help us. We don’t actually know what the criteria are, so we don’t actually know if we are going to be helped when we need to be. Some practitioners will be higher risk that others, but that is not necessarily their fault either. Some of those will work in environments that are naturally more hostile than others, such as prisons, and it is not their practicing style that brings the risk to them or the indemnifier but the nature of the patients they treat. I would also strongly argue that there are certain demographics of patients and even geographic hotspots that increase the risk of complaint and claims, and perhaps we should be made more aware of that in order to mitigate the risk to us. We need to know.

I can see the point that if we don’t know what the reasoning is we wont construct our practice around it. A sort of Indemnity Gaming if you like; if you know the criteria that are used then you know what you can get away with and just stay within the margins (if you are a dodgy practitioner that is). But this is what risk assessment should be about. I’m talking about the risk to our livelihood and careers here. We can lose our home due to a regulator that we accept is not fit for purpose, so we need the security that our indemnifier is going to be transparent and fair with us.

I don’t see any profits warning or indications that their membership reserves are running terminally low from any of the indemnifiers which suggests that they are in reasonable financial health. Given the beautiful offices that many of then operate out of confirms that indemnity is big business. Which leads me to where I think part of the problem lies.

The bigger a business, the more it loses its personal touch. There is a immediate personal contact with the advisors who do so much valued work, but they are not going to be the party that decides if support is withdrawn or not. That is likely to be made at a higher level, lacking in the emotive connection with the dentist. There is so much litigation going on now that the indemnifiers have to be large, and have to have the resources necessary to run such organisations. The costs of the support network in order to run the core business are huge. The cost of the legal representation for its clients is also huge, and shows no apparent sign of getting any less. As more patients complain via the medium of ‘No Win No fee’, or direct through the GDC, then the need for the indemnifier grows symbiotically as does the drain on its resources. With the demand to stay in business, then the indemnifier needs to ensure it is financially solid enough to survive to protect its clients. Its survival then becomes the prime reason for its existence, and it becomes even more risk averse. Thus affecting the very clients it is there to protect. Is this why some dentists are finding themselves without a lifejacket? Will there eventually be a multi million pound business protecting the one or two clients who are so risk averse themselves they will never need the indemnifier as they never see a patient?

This symbiosis is no different to any other supply and demand industry. The more the GDC presses ahead with what appears to be the UK’s largest complaints handling business, the more the indemnifiers will grow on the back of the legislative need for us to protect ourselves. The more they need to protect the finances of the business it becomes.

But we need to know they will be there for us when we are walking the plank. Perhaps the indemnifiers should publically reconnect with us, be more transparent, and show us their human side once more. After all, it’s not all about the money….

It’s about saving lives.

Did you read Part 1 of this blog? If not, click here

Image credit -Ian Armstrong under CC licence - not modified.

Readers may or may not have experienced the delights of going on a cruise. So how does a voyage on a Dental Cruise sound?

You join your ship with lots of other passengers and set sail. What is vitally important though is that you’ve been told before you sail you have to provide your own lifejacket. You notice that there are quite a few different sorts and colours. Some are ones that only inflate whilst you have them with you, and some are inflated all the time, even when you get off the ship at the end of your journey. Some passengers even have special coloured expensive ones that some of the lifejacket manufacturers don’t even supply. We’ll come back to those later. The industry is getting bigger and bigger, so more and more life belts have to be made for all those going cruising.

Initially it’s all really nice, the food’s ok, and the accommodation is too. However, there’s something not quite right. The crew seem to be openly hostile to you, and the officers never seem to speak. The captain of the ship and the 1^st officer never come down to speak to the passengers. You’re actually suspicious that the direction the ship is headed isn’t the one you signed up for. Not all the islands you visit are as welcoming as others. After a couple of ports you also start to see the numbers of passengers dwindling a bit and you hear a lot of splashes at night.

You do a little research and you find out that the crew is in better quarters than you are, and your money has gone to pay for that. You have to tip the crew more and more even though the service is rubbish, and then you find out the way they worked out the tips was illegal. More worryingly you hear that the captain orders the crew to round up passengers who might be a danger to those who live on the islands the ship has visited or might visit yet. The captain orders the islanders to report anything they don’t like about the passengers to the bridge. The captain also allows spies to be put ashore to trap some passengers if the locals themselves don’t report the things that are done ashore. Passengers who have committed some sort of infraction are invited to visit the Bridge for a tour. Its not an option. You hear rumours that some of the officers don’t speak as the 1^st officer has ordered their tongues cut out, possibly to prevent mutiny. You laugh at this, but you start to get a bit worried. You realize the crew doesn’t trust the passengers at all. Some of the passengers even report other passengers, or get the islanders to report them, or even join the crew.

Then you see why the passenger numbers are dwindling. Every night, the crew makes those passengers who’ve had the bridge visit walk the plank. They are allowed to take their lifejackets though. Sometimes the crew let the passengers off before they get to the plank, although there isn’t always consistency as to who will be let off or not. Some even get halfway down the plank before they are allowed to come back. Usually that’s because the lifejacket manufacturers send their best machinists and repairers to make sure of the buoyancy of the jacket whilst its owner is on the plank. This costs the manufacturers lots of money, so it’s better if the lifebelts never get used in the first place. But you’ve already paid for the service when you bought the lifejacket.

Most of those that do fall off the plank therefore obviously have their lifejackets to help them. These keep them afloat until the rescue boat picks them up and puts them back on the ship. Sometimes some are thrown overboard before the captain has heard the case and they might be allowed back on board, or they might be put ashore until the case has been heard, then they get to walk the plank all over again.

However, there’s a problem with some of the lifejackets. Not all of them are going to work. Most do, but not all. Any you might be wearing one that isn’t going to work when you need it.

Now some of this is because the passenger has done something so bad that Mercenaries employed by the crew are allowed to puncture the lifebelt. Some of these passengers drown or swim to shore, but either way they never get back on board. Occasionally the crew or even a mercenary punctures a lifebelt through their own incompetence and hope they don’t get found out. The lifejacket repairers sometimes throw a spare lifejacket to them. But sometimes the sharks get them first.

But sometimes its because the maker of the lifebelt has decided not to put the flotation device in a lifebelt because of something you’ve told them or you’ve walked the plank before. It looks the same, and you certainly paid the same for it, but its only when you try to use it that you realize its not working. Remember those with the special coloured expensive lifebelts? They’re really expensive because the normal lifejacket makers wont supply normal ones to these passengers because they keep being made to walk the plank, or just keep jumping overboard because they do stupid things and don’t seem to learn from it. In fact, some of the lifejacket makers wont supply them at all but don’t always say why. Strangely, some of these passengers seem to arrive at the ship in fast cars and occupy the biggest and best passenger suites.

Occasionally there are times when a passenger is walking the plank and the manufacturer of the lifebelt actually takes it off them, either just before they walk, when they’re in the water, or when they get back on board having survived the ordeal. The rules say passengers can’t stay on the ship without a lifejacket, but they now can’t get one to fit, the manufacturer wont sell them another, or they don’t have enough holiday cash left to buy another one. They either have to stowaway for which the penalty is immediate plank walking, or they have to get off at the next port.

The captain no longer answers to the ships owners, but they don’t seem bothered, and the captain and 1^st officer decide they’re going to expand their little seafaring enterprise as a result. There’s a ship right behind with loads of passengers that go ashore and always paint the islands white and harm the natives, and occasionally the captain makes one of them walk a plank, but doesn’t seem that bothered by the harm they’re doing. They don’t have any lifebelts on that ship either.

The passengers frequently get together and talk to one another, but no-one ever has the bravery to arrange a passenger mutiny even though they keep having the cost of the planks added to their tips. Most of the passengers are too busy trying to protect themselves to look out for the others. The senior officers of the crew don’t talk to one another as they haven’t any tongues, and those passengers that become part of the crew and can still talk don’t want to resign as they say they’re the ones that keep the bridge visits and plank walking fair. The happiest are the mercenaries that get to puncture the lifebelts as they get a bonus especially if they can make it take longer. The manufacturers seem to want to really only give the lifebelts to those that will never use them as they don’t have to spend money readying them for plank walking or repairing the punctures. But their top repairers are happy because they get paid more when they have a puncture to repair.

What a silly story…. No one in their right mind would get on that ship if they read that, or stay on it a moment longer than they possibly could once they found out what was happening.

Read Part 2 of this blog by clicking here.

Institutional Arrogance

Many of you will be reading this from the sneaky preview of your ‘mobile device’ while on holiday so I will keep my mumblings brief. Don’t want the present Partners or Spouses to my dear readers getting a holiday stress on!

Holidays are of course the time when you re bond with the family, and past troubles diminish in their significance such that when you return, the sun still shines and the daises are growing. Holidays allow a new focus on the real issues such as the performance of the many Premier League teams.

If you are single of course holidays can be a “fun” time, strangely challenging in some respects. The STO or Short Term One-nighter relationship can lead to some interesting morning conversations.  Matters of Validity of Consent can raise their head.

And so it is, in your professional area of work.  

I do, I do I do …

You will return from holiday to a focus on your note taking and records like never before. For some time this has been defensive, and a recent case [1] now confirms that it is not enough to record what treatment you undertook. You must now have a discussion with your patient about the risks or proposed treatment, and you must know your patient sufficiently well to apply context to those risks, and the end result will be that the patient should be able to agree to a course of action of their own free will.

GDC Standards for the Dental Team was of course ahead of the consent game by stating in 2013

3.1.2 You should document the discussions you have with patients in the process of gaining consent. Although a signature on a form is important in verifying that a patient has given consent, it is the discussions that take place with the patient that determine whether the consent is valid.

3.2.2 You must tailor the way you obtain consent to each patient’s needs. You should help them to make informed decisions about their care by giving them information in a format they can easily understand.

This of course all takes time. As busy GDPs in mixed practice, that is the one thing that most of you will lack. The threat of an FtP case against you however focusses your mind.

Welcome back to the Autumn of un-squareable circles, as the GDC in their lofty arrogance see no reason why you should have a problem, that body being out of touch with reality.

OK …  Talking of that body the GDC  …

If you have not heard, the problems have officially been fixed. Hurrah!

The Professional Standards Authority issued a report [2] being most unfair & critical of the GDC. The GDC Press release [3] in response was beautifully dismissive – a masterpiece in Institutional Arrogance. Taking arrogance to a new level. Real Premier League stuff

We have already instigated a significant programme of change within the GDC which will help us to support dental professionals to deliver high standards of care and maintain public confidence in the profession.  

You would never guess that the PSA were critical in the extreme, the GDC being a long way below the standards of other regulators. Someone has to come bottom of the class but the GDC take that ‘achievement’ to a new level. You hear the PSA sighing in frustration.

Constantly we hear the mantra from the Executive Suite in Wimpole Street that a new Parliamentary Section 60 order is needed. And yet we read in Fitness to Practice rules [4] as follows:

Initial consideration by the registrar.

The registrar shall consider a complaint or other information in relation to a registered dentist or a registered dental care professional, including a dentist or dental care professional whose registration is suspended, and shall determine whether a complaint or information amounts to an allegation

So the reality of the GDC’s crisis is that it is entirely in the hands of the Registrar to create a system to sort out the wheat from be chaff in letters of allegation received.  Instead of picking true FtP cases, the Registrar operates a set of rules in which it seems that any allegation is considered seriously.  Good grief, the Caseworkers are in some cases a contracted company. 

The GDC has descended to the role of a commercial Complaints Handling body.

Standards is being used as stick to beat the profession and not as a level of practice to which to aspire.

Fitness to Practice is not a Regulatory function in hands of Ms Gilvarry, it has become a commercial operation of immense cost, be that financial to the wider profession through the ARF, the financial cost to a dentist under investigation, or of course  the emotional cost to dentists.

The way that Ms Gilvarry operates demonstrates that she has mastered the delivery of Institutional Arrogance. In the Chairman, Dr Moyes,  she has a willing partner who has revoked his role of oversight.

Who will rid us of this rotten leadership? The summer may be over but the need remains.

Coalescence

It is time for the six registrant members of the GDC to seriously consider their positions. I assume even they were shocked at the GDC’s Press Release.  The BDA and FGDP, perhaps with DPL, & DDU, and perhaps with Denplan, Practice Plan et al, have a massive role here through the BDJs editor’s concept of Coalescence[5]. Action is needed to grab the attention of both the Minister and the Council.

Unless of course they have all caught the Institutional Arrogance disease

 [1]The Montgomery case - Montomery -v-  Lanarkshire health Board Scotland 2015

[2] PSA link

[3] http://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/General-Dental-Council-response-to-the-PSA%E2%80%99s-report-%E2%80%9CRethinking-Regulation%E2%80%9D.aspx

[4]  http://www.gdc-uk.org/Aboutus/Thecouncil/Meetings%202006/Items%208%20and%209%20FtP%20Rules.pdf

[5]  BDJ leader Vol 219  No 2 July 24^th  “Coalescence”  Stephen Hancocks OBE

Is there anybody out there?

These words introduce the beginning of my favourite song, Pink Floyd’s ‘Comfortably Numb’, the title of which has always struck me as a particularly apt song for dentists.

Several times in my career different parts of the song have resonated with me for various reasons, but this is perhaps the first time the whole song in its entirety relates to dentistry at the moment. For those that don’t know the song, it’s about a reluctant performer who is made to keep going on stage by the various influences and promises of those who seek to benefit most from him, without any consideration as to how the performer is actually feeling inside. Sound familiar? Give a performer a new drug (the continued promise of a new contract??) and that’ll keep you going through the show….(despite the eventual catastrophic effects).

However, I’m not going to muse about the wider issues of dentistry that are analogous to the lyrical musings of Roger Waters otherwise this will be a very long blog.

So, in particular given the recent Professional Standards Authority paper looking into the rethinking of regulation, one has to ask if there is indeed anyone out there who is actually listening to what this paper suggests.

Here we have what is effectively a toothless organization in the PSA (show me precisely what it has actually done to rein in the GDC given its publicized failings over the last few years?) that is suggesting a completely new way of thinking with regard to the regulation of the professions. Its worth a read as there are many things that have been mentioned within the pages of GDPUK.

However, it’s one thing suggesting this radical rethink, but who with the power to actually instigate change is listening to what the PSA have to say? The Health Select Committee still seem to be getting their diaries in order after the election, and with no apparent repeat hearing for the GDC in the offing one has to wonder if other more pressing health matters will take priority over our issues. There appears to be no pending Government Bill in the offing to set up a super regulator (which is what I personally think will happen eventually) or rewrite the outdated legislation of the current regulators. It is obvious that the PSA sees radical failings in the current scheme of regulation, and we all know the opinion it has of the GDC in particular. However, we need to be careful about thinking the PSA is our knight in shining armour riding to the rescue; one of its remits is to review all the decisions of the GDC FtP process and if it feels they are insufficiently protective of the public (i.e. not a harsh enough punishment) then it can order further action against the registrant via a re-hearing. So they are no particular friend of the regulated, but I would counter that by suggesting they are at least an organization with the ability to actually understand what modern regulation requires. They, after all, they keep referring to the paper written by them for the Council for Healthcare Regulatory Excellence on what ‘Right Touch’ regulation means, and it doesn’t appear to always be the touch of the executioner’s sword.

There was a suitably robust call from the BDA for the government to take action as a result of the PSA paper, and whilst this is the sort of thing we need to see and hear from the BDA, once again I have to ask if there is anybody out there to listen? We are unlikely to ever get any press sympathy like the GP’s do; when the Daily Mail is happy to run a story asking if we are all Natural Born Killers as a result of the recent Lion hunting episode then we really are going to lose that battle before we begin. As a profession we already know the issues, so really the BDA is only going to be preaching to converted. How they get the message out to the wider public is the key to getting the regulatory change we so desperately need. That is going to require an awful lot of positive PR and I don’t see much evidence of that. Even the fact we have been harping on about the perils of refined sugar for years seems to have fallen on deaf ears until our medical colleagues woke up to it.

The PSA paper recognizes that over-regulation costing more offers no additional benefit to the patients, or the fact that healthcare has inherent risks that cannot be regulated out without a disproportionate amount of money and time, and that attempting to do so only serves to not only stifle the beneficial innovation that can help the patient, but also the general benefit to the patient overall. None of this will be news to any ethical practitioner reading this; but it’s not us that needs to take heed of this, we need to be listened to by the people who can instigate change and actually have a desire to do so.

The PSA also admit that one of the problems with the current outdated regulation mechanisms is that the action or words of a registrant last lasts only a mere moment or so but can result in serious damage to not only their careers and lives, but the lives of their families too; often having a serious and lasting effect. Again, not news to us particularly, but at least it is being recognized by the PSA. The disproportionate effect of a minor, spurious, or downright vexatious complaint should not be able to carry this threat, and indeed never used to; but more recently seems to be something that we must all be prepared to bear as an occupational risk no matter how diligent we are in our care and dealings with patients.

More interestingly for the GDC though is that the PSA warn against the expanding of the boundaries of regulators and the lack of clarity and tensions this then produces. It’s no secret that Mr. Moyes has said he would like to develop the role of the GDC and broaden its remit. It is already apparent that this seems to have begun, as the GDC is no longer just the upholder of Standards within the profession but has become the de-facto complaints service which will happily look into every single issue it is made aware of. A stop to this ‘mission creep’ as the PSA call it must come sooner rather than later, but again, the PSA has little power to prevent it at the moment.

Yet the GDC in its latest press release once again refuses to acknowledge that responsibility for regulatory failings are in any way its responsibility, choosing to blame once again the legislation that constrains it, and actually indicating it doesn’t go far enough currently. I think most registrants would be of the opinion that when a single complaint can have you in front of a committee that can end your career, then there isn’t actually an issue with the legislation not going far enough. The GDC is also apparently putting in place a series of ‘measures’ to help support the profession in delivering high standards of care and maintain public confidence in the profession. What these measures are we don’t know yet, but of course one way of doing this would be to make sure there are less people able to meet the standards they enforce, either my repositioning the interpretation of standards to make them virtually unattainable, and then ‘help’ by removing the registrants who fall short via the FtP process or by just driving them out of the profession by fear. Maybe this is too cynical a view but it’s hard not to have such thoughts in the current environment.

More and more I hear of dentists leaving the profession due to the immense pressure placed on them every day. Despite their best efforts to remain positive, it is increasingly difficult to not think that the next patient could be the one that ends their career, despite not having done something bad enough to justify such a draconian result. That makes the risk of practicing dentistry increasingly difficult to justify. It would be interesting to see if you are likely to have a longer career these days in the field of professional bungee jumping or crocodile wrestling than clinical dentistry. In what way does this help patients when good practitioners decide to leave our profession?

I remember a satirical comment a few years ago that eventually there would be 100% employment in the UK. Only one person would actually have a job doing something, but all the others would be employed to regulate them. I can see the dental profession going this way if someone in power doesn’t start to listen soon, as there will be less and less people electing to remain in or join our profession. We as individuals therefore need to unite and show the public that the pressures on our profession will directly affect them. Only when the voting public is affected will the situation come to the attention of those in power and change can be made. Although how this will pan out if the supposedly unelectable Jeremy Corbyn takes control of the Labour party and renders the opposition as toothless as the PSA remains to be seen.

Getting back to the title of the song then, the problem is that too many of us are (un)Comfortably Numb with inactivity. So we are reaping the rewards of our complacency and intransigence and will continue to do so unless we unite to do something positive. If we were as vociferous and active as dairy farmers have been recently when things finally got too much to tolerate we would have arranged some form of peaceful and professional group action. Perhaps we should round up a few hundred small cats (lions would be too difficult to risk assess and probably attract the wrong type of dentist) and release them into the General Dental Council chamber at the next meeting. Trying to herd said bunch of cats into Wimpole Street is likely to be simpler than getting dentists to do anything en masse. We could then say not all dentists have a desire to hunt cats (including small ones), and given that social media these days seems to be obsessed with the antics of cute kittens then surely this is guaranteed to get positive press interest. A flock of sheep might be easier to manage, but we don’t really want them in the Council Chamber do we? Tongue in cheek maybe, but food for thought nonetheless.

In all seriousness though, whilst it appears the public at large don’t appear to have a clue what damage over-regulation and the current litigious and complaining environment is doing to the ability for dental professionals to care for them appropriately, these are the same people who in their chosen fields are also likely to be suffering from similar threats. Speak to many of your working adult patients and you’ll find we are not alone in suffering the pressures we are currently under. Admittedly there might not be the same degree of threat to their career and livelihood, but certainly anyone in one of the professions and the emergency services have very similar issues as we do. ‘Guilty until proven Innocent’ is not unique to dentistry.

This is the message that needs to be conveyed in no uncertain terms to the public by both our professional leaders and us as individuals. Only when the public has empathy with us will we have their support. If nothing changes then the profession will dwindle more and more as a lack of morale grows.

For it is they the public as patients who will then suffer most when there are no longer any of us out there.

Image credit -Samuel Rodgers under CC licence - not modified.

We have recently created a Facebook page for GDPUK, where we aim to publish news, blogs, articles and forum posts which are focused on UK Dentistry. We realise the creation of this page is a number of years late but it is better late than never!

Like all digital publishers, we use social media extensively to share articles and blogs. The GDPUK Forum facebook page will be another medium we will use to share our opinion and information on all things Dental.

You will find the Facebook page here - www.facebook.com/GDPUKforum

If you are interested in having the latest dental news from GDPUK appear on your Facebook newsfeed please “like” the page.

We will continue to update and improve the page as much as we can.

Please share this page with friends and dental colleagues. Basically anyone you believe would be interested in reading dental news....

The GDPUK forum remains free to join, you can register here.

Thanks for your help and sharing the message with the whole UK dental community.

Cheers :)

GDPUK remains free to join and to post on the forum. We have close to 9000 members and they love using the resource to keep upto date with all things dental and keep engaged with the dental community. Revenue for the site is generated from banner advertising. Our clients who advertise are predominantly from the dental trade.

Clients of GDPUK often ask us about designing banner ads for the site, so we thought we would put together this simple guide and let you know our thoughts on what makes up an effective banner ad. Obviously when creating a web banner ad, it is important to always look at it from the perspective of the viewers (or your potential customers).

1. Make sure it is correct size. If you are given details of a certain specification or size needed, you should follow the requirements, otherwise the banner ad won’t work.

2. Keep the file sizes to a minimum. Smaller files load faster and it increases the chance of being seen by visitors.

3. Good copy (like all advertising) is very important. Use of graphical elements is good, however, it's the copy that triggers people to find out more about your product. Banners that are effective are kept short and simple. Further info below

4. You want your potential customers to look at your ad, get interested, and click on it, then find out more info about your product on your website (preferably on a relevant landing page on your site). Don’t try to fit all the benefits of your product into that small space, it never looks rights and is ineffective. Simple and clear is the best method.

5. Over the years, the banners that have been the most effective, use an eye-catching hook. Headlines are what trigger people to read the story. Emphasising the benefits of your products more than the features of your products is the way to go.

6. By using a call to action graphic or text you make it very clear to the visitor what you want them to do. For example: For More Information; Download Info Now; Click Here to Purchase. This works with the earlier advice of being simple, clear and direct.

7. Animated GIFs work brilliantly on GDPUK but graphic designers always tell us that you need to avoid using photos and photo-like images on animated GIFs. Because of how GIFs work, the photos won’t look as nice and it will just make the file size huge. It is most likely you will be limited to having just one or two frames for the banner given the file size limits, plus as mentioned before, banners are more effective as a smaller file.

8. If you want to use photos in your ad (for websites only; not on our daily digest emails), consider creating it in Flash or HTML5. It will give you better return in terms of quality and file size.

9. Effective landing pages. We have mentioned this a number of times over the years! When people click on the banner, they should be presented with the relevant campaign or information immediately. They do not want to go to your homepage and be forced to hunt for the information that may exist on another page of your site. An effective landing page produces a great experience for your customer but also better results from your advertising campaigns.

Thanks for reading this guide to creating effective banner ads. We hope you find it useful and a simple blueprint to follow when looking to advertise online.

If you need further information or want to ask a question about this blog. Please get in touch.

Thanks

Jonny

At GDPUK towers we love to keep an eye on the statistics that the site creates. We want to make sure we are still doing all the right things to attract an audience that stays engaged with the site and of course interacting on the forum.

Below are a few stats we would like to share, we are very proud of these and they show that GDPUK is constantly used for news, views, opinion and information.

These stats are up to date, as of 30th June 2015.

• In June 2015 alone, we have had over 100,000 opens of our daily digest emails (sent 3 times a day)

• We published a news story on Friday 26th June called “GDC labelled worst of all regulators”. As of Monday afternoon we have had over 4500 readers. This shows the reach of GDPUK news by using various social media platforms and our daily digest email.

• This year, the site averages 32,000 unique visitors a month

• Users continue to join the site, membership is now getting close to 9000 people, who are all members of the dental community.

• The forum attracts just over 1000 different contributors a year.

• Whilst on the topic of the forum, it continues to attract readers and plenty of engagement. Since our present site went live (late 2008), there have been 18653 topics created and 209771 posts. An average of 11 replies a post. This definitely demonstrates the amazing amount of discussion and activity that takes place on the forum.

By sharing these stats we want to demonstrate the reach of GDPUK and how we feel we get important dental news in front of thousands of readers daily. Thanks for sharing, engaging and reading the site, we appreciate the great dental community that continues to support us.

If you would like to join the forum (it’s free) and get a feel for what is happening in UK dentistry in 2015, please follow this link. If you are already a member, keep spreading the word and telling your colleagues about the site :)

Thanks for reading, please get in This email address is being protected from spambots. You need JavaScript enabled to view it. with me if you would like further information on GDPUK.

Jonny

The Hired Gun with a smoking gun….

We all know the GDC has spent the last few years on its own little self-righteous planet, and even given its recent pitiful showing in front of the Health Select Committee there appears to be no sign they are planning to return to normality in the near future.

Indeed, this week, what can only really be described as damning evidence of the GDC’s utter and complete contempt for the process of Justice in its most fundamental form has been revealed.

A case in front of the Professional Conduct Committee this week has revealed that it is not only the initial stages of the disciplinary process that are woefully inadequate which resulted in their huge backlog of cases; but that the basic legal requirement of full disclosure of the case against a registrant may be riddled with horrific inefficiency and contempt for the fundamental tenets of justice. Not only that, the GDC is not following the rules set out for its registrants and flagrantly flouting them in order to pursue its own agenda of what now appears to be a persecution of the profession via its individual registrants. The PCC themselves described it as an ‘Offence to Justice’.

In this particular case, amongst other things, the GDC had 9 different versions of its expert witness report, and failed to submit many of them in a timely manner for the defence case to be prepared. It was still submitting them to the defence on the day of the scheduled hearing. Not only that, but it would appear that evidence the GDC held was not submitted to the defence at all, which may have helped the defence case. Thankfully the outcome has been for justice and propriety to be upheld by the members of the PCC. (who have for some reason remained anonymous)

With the facts that have come out about the way this case has been handled, the GDC has now plumbed new depths it seems. I didn’t think we could be treated with any more contempt that we already were; but this is jaw-droppingly bad. By what definition do the GDC expect us to have fair trial if they don’t submit the evidence as per the rules? They fail by their own standards throughout this case. Where is their duty of candour? Where is their transparency in their dealings with the registrant?  Have they actually read the Human Rights act? I refer them particularly to Article 6, the right to a fair hearing, which quite obviously would not have occurred in this case had it not been for the integrity and the strength of the members of the PCC.

For the PCC to accuse the GDC of being egregious (or outstandingly bad) is an extremely strong and unusual stance for them to take. Whilst this occasionally happens in the criminal and civil courts when a judge or jury might take exception to the conduct of one of the sides, for a committee funded by one of the sides to effectively take a swipe at its paymaster is highly unusual. I know the PCC is made up of independent members, but don’t forget, despite this independence, they are funded by the prosecuting side, the GDC. I am not for one minute casting any doubt on the integrity of any of the members of these panels, and in this particular case nothing could be further from the truth. But one has to wonder how much of a culture of fear is being instilled that pervades throughout any process the GDC is remotely associated with including these committees. How many other cases have been similarly dealt with by the GDC and the PCC not spoken up in the same way? We know now that this is an organization that doesn’t seem to apply the rules of law and justice properly to those it pursues, and even think these rules don’t apply to itself, and then show no insight whatsoever into its failings. Even the GDC solicitor involved in the case appeared to have had an inappropriate contact (not contemporaneously noted incidentally!) with the patient witness in order to ask leading questions and to coach them which also a big no-no.

Just as strident but more worryingly to my eye is the criticism the GDC’s expert witness comes in for at the hands of the committee. I have not seen this amount of criticism of the expert in any case before. It almost seems like he has gone out of his way to act as some sort of private investigator in order to help the GDC secure its desired conviction. There have been a couple of cases recently where the GDC’s expert witness has come in for criticism, but not to this degree.

Expert Witnesses are required to be independent and objective. It is an enormously privileged position to be in as they alone are allowed to give opinion-based evidence to a court and not just statements of fact. They are not and should never be seen as a Hired Gun to destroy the defendant. For whatever reason it would appear that in this case the expert has gone beyond his remit in such a way that one could seriously question that if this were a civil or criminal case whether serious charges against him would be the result of such a deviation from the accepted role. All the expert witness training I’ve done (and I’ve done a lot) has stressed the importance of never being a Hired Gun. I’ve had solicitors request I change parts of my reports to better serve their cases; and the answer has always been an immediate refusal. An expert witness has a duty to the court and to no-one else. We are not Magnum PI no matter how much we might want to be.

But by acting as a hired gun, this expert has now turned this case into a smoking gun.

Experts are no longer immune from prosecution, and given the evidence in this case, one has to wonder if the abuse of process by the GDC and its expert means that this should now be taken further by the defence team in order to recoup their costs. Ironically, the expert could well be professionally covered by the same indemnifier involved in the defence, but then I’d have thought that might be an appropriate time for any discretionary support for the expert to be withdrawn since it appears he acted in such an unusual manner. Its also rather hypocritical of an expert who appears to be acting far outside his remit to feel he can stand in judgment of a practitioner who may or may not be acting outside his sphere of expertise. Unfortunately Expert Witnesses are not regulated in any way other than by their profession; but this behavior has to be close to bringing the ‘profession’ of expert witnesses into disrepute. I know a good many experts who are aghast at the revelations in this case.

I’m sure the acquitted practitioner will probably now want the whole thing to go away, but I really hope that he doesn’t take this lying down; the GDC should be massively on the back foot with this revelation, and the profession’s moral (and legal) advantage should be well and truly rammed home now.

The BDA should also now get very vocally involved again, and if they don’t they are going to miss a huge opportunity. If they approach it through lobbying MP’s they should broadcast this loudly to the profession so we can hear their voice.  Some have said they should call for a complete halt to the GDC investigating process; but this would leave the public open to the risk of any truly dangerous individual being left free to practice. However, in my opinion they should press for every case both this expert and this particular GDC team been involved in to now be independently reopened, re-examined and all at the cost of the GDC. The costs of this should then be made exceptional from the annual GDC budget so they cannot then charge the profession for this. I’m sure they’ve got some indemnity insurance kicking around somewhere they can use. In addition, every pending case that involves just a single patient complaint should be now be suspended until a full independent inquiry (and I don’t mean by some equally flawed organisation like KPMG) into the above cases has been completed. There should be full and complete disclosure, and compensation paid to any registrants if the GDC are found to be in the wrong. Any employees of the GDC found to be in breach should feel the full weight of any legal process, and not be allowed to hide behind the corporate protection of Wimpole Street.

The GDC are quite obviously in breach of the Human Rights Act. There was no way this registrant was going to get a fair trial, and the GDC were quite obviously unconcerned by that. How many times they have done this before now needs to be made public. If we persistently did the same to our patients we would lose our careers, our livelihood, and our professional integrity. They should pay the same price and their executive should now be held vicariously liable if the law has been found to be broken (again…)

Resignations of individuals at the GDC are no longer enough for confidence to be restored in our regulator. The profession should demand the highest powers possible now decide their fate. Whether this should be up to individuals crowd sourcing an opinion from a barrister as to whether the GDC are breaching our human rights; or our indemnifiers taking their own legal action to seek redress for the expenses incurred in cases like the above;  and whether the Health Select Committee recall the GDC Executive to be given the coup de grace; or the BDA continue their lobbying of MPs whilst we keep filling those same MP’s mail sacks with letters. It needs to be all of the above and simultaneously. We need to unleash a veritable storm that cannot be ignored.

Enough is enough. We need to keep taking firm action.  Is the entire profession listening? It’s time to hit back again.

One of my early posts to my digital dentistry blog was entitled “4 A * Reasons Email Marketing is still Alive!” and I looked at the reasons behind why email marketing was still so important.

Nearly 2 years later, this is still seems to be the case. One could argue it is more important than ever. In the recent eConsultancy Census, it was found that revenue from email marketing increased proportionately by 28% in 2014, and was ranked as the number 1 channel in terms of return on investment, with 68% of companies rating the channel as ‘good’ or ‘excellent’.

Email has become part of mobile marketing, it is estimated that mobile can account for up to 70% of all email opens. The banner ads or message on these emails still need to be clear and well positioned, although it’s not just the creative that is important, the sales funnel must also be fully mobile-optimised, with every page working so that they are mobile optimised and keep your customer engaged. A well designed landing page is still always an important part of the process.

We forget that with emails you are often reaching an audience that already knows you, if you have them on your list, they want to hear from you. Email requires a deeper level of engagement and trust. That is the reasons our daily digest emails remain popular. Our members are expecting them.

Therefore advertising on the GDPUK daily digest emails (sent 3 times a day) remains incredibly popular because so many people receive these daily emails to their inboxes and thousands of eyes look at the animated banners on the emails. We use these daily digest emails ourselves as an accidental marketing tool. What started as a way of communicating the latest posts on the forum to our members, has instead become a way for our members to be constantly engaged with the site and what is happening within UK dentistry. We know that not every member reads every thread or email but there is always a subject that appeals to a number of our members and that keeps our site busy and the banners receiving impressions. This means email remains incredibly important for GDPUK plus of course every big business that is online and looking for customers.

So two years after I wrote the blog piece linked above, email marketing remains an important tool for businesses of all sizes and needs to be treated as an integral part of your marketing plans, whether you are looking to reach dentists or members of the public for your practice.

We are all looking to generate leads and gain new customers, is email marketing still something you use to reach these goals or do you find other methods more effective? We look forward to hearing your thoughts, on what works for your business and what doesn’t.

Hope you enjoyed this follow up blog. Thanks!

The Dental Directory had a busy stand at the Scottish Dental Show. Thousands of practices already use The Dental Directory, for everything from consumables to cabinetry and delegates were able to discover just why people keep coming back: fantastic deals, unbeatable customer service and a huge selection of products.
 

The Dental Directory also stocks specialist ranges for facial aesthetics, oral hygiene and orthodontics. With dedicated, knowledgeable reps who want to make dentists’ lives easier and save them money, The Dental Directory offers innovative solutions to common problems such as stock control and how to reduce the time spent ordering.
 

Quality is second-to-none and free next-day delivery is available on most items. If you missed meeting The Dental Directory at the Scottish Dental Show, contact the team today and see how your practice can benefit.

For more information, contact The Dental Directory on

0800 585 585, or visit www.dental-directory.co.uk.

That third letter has a lot to answer for. What DOES it stand for I wonder?

Competent?

Well, the GDC are adamant. In their role as a “Council” They are improving immensely, and have refuted the FGDP’s assertion [1] that they have not "learnt any lessons" after their 2014 ‘Annus Horribilus” [2]

Given that when you are bumping along the bottom, the only way is up, I guess we should on the one hand be grateful for small changes and perhaps acknowledge that internally , the GDC are attempting to re-configure the disaster that is FtP.

Speaking with the Dento-Legal teams, there is a sense that the peak, the height of the tide of FtP, if you will, has either passed is passing.

Complacent?

The GDC in their latest report state [3]

• 9. The triage KPI has improved and is being met in almost all instances. 99% of cases were triaged within 14 days in Q1. This has now been 97% or above for three quarters in a row.
• 10. The Hearings KPI was met in a smaller number of cases in this period. 61% of cases were heard in Q1 within 9 months of referral from IC. This has reduced from 67% in the previous quarter. However, a much larger number of hearings were held in Q1 than Q4 (66 v 37).

Add to that the pilot schemes to require that the NHS get its own house in order with matters of performance and one can see that the steam pressure in Wimpole Street is indeed reducing.

Perhaps it is wrong to regard the GDC as a Great Day for Complacency?  Internally, it appears we have an organisation finally “getting it!”

On an annual basis, it appears that FtP cases may reduce by some 300 to 350.

• 756 cases were received in Q1, when as many as 825 may have been expected.  

So we can expect at the very least a static ARF in December … can’t we?  Too much to hope that the GDC’s success might result in an ARF reduction!!

Talking of which, I wonder what the HoC Health Select Committee report will state. It all seems so long ago now.  In fact, I can even see the GDC Press release batting it away like an annoying fly in an arrogant, even corrupt sort of way. The FGDP pulled no punches for sure. [4]

Corrupt?

We could discuss whether the GDC are a corrupt body [5] – not in the fiscal sense, but in the aggressive occupation of the moral high ground. The FGDP have a point really – the GDC have utterly lost the confidence of the profession.  It is a measure of their arrogance that they fail to see this.  It is a measure of their insularity that they see dentists as a minority Registrant group.

I wonder what it will take for all those dentists and DCPs who partake in the FtP Process and indeed sit on the Council to withdraw their support.

Well, they might wish to consider their position on the matter of the GDC being in discussions with the Dept of Health to see how to amend the regulations to allow the new Oral Health Assessment to be undertaken by Therapists.

The well-worn phrase of Lord Acton suggests that while all power corrupts, absolute power corrupts absolutely.

I put it to you that the GDC is indeed corrupt, by throwing away its independence in its dealings with Government.

It is not acting in the best interest of the patient, it is acting in the best interest of the Minister of the day.

Correct, Competent, Campaigning

The FGDP and BDA are suddenly standing up; their heads are above the political parapets and dentists, as a profession are starting to demand to be heard, to be counted. Join one, join both, but do sit idly by.

What’s in the letter “C”?  Quite a lot as you can see

Enjoy flaming June, the Cricket looks as if it could be exciting  .

Ciao!!

[1]   http://www.fgdp.org.uk/content/news/fgdpuk-statement-care-standards-and-fitness-to-pra.ashx

[2]  http://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/General-Dental-Council-challenges-FGDP(UK)-stance.aspx

[3]  http://www.gdc-uk.org/Aboutus/Thecouncil/Council%20Meeting%20Documents%202014/Review%20of%20Direct%20Access.pdf

[4] http://www.fgdp.org.uk/_assets/pdf/consultation%20responses/hsc%20accountability%20hearing_gdc_fgdp%20submission_feb15.pdf

[5]  http://en.wikipedia.org/wiki/Corruption

Acronyms should be catchy in dentistry, shouldn't they? Surely that's a rule? GDC, BDA, DPL, CQC, NVQ, CPD . . . It also seems to be a rule that they have to be three letter acronyms but maybe the exception proves the point!

I have been puzzled by the newer demand to note non-verifiable education. GDC call it "General CPD".

In my mind non verified means it cannot be defined nor denoted as a specified event in time.

I feel if written down, this act of noting the time spent means it is verified. Expressing this the other way, the act of writing, noting the activity, makes it no longer non-verifiable, to my mind. I therefore offer you 2 minutes of recorded general CPD for reading this article on a dental website, and of course, closing your eyes and reflecting on it.. There you go. Only 174 hours 58 minutes to go and RECORD!

I propose, if the GDC insist we must continue to note this time spent, and they do, this part of recorded CPD has now become not-non-verified and must be renamed as "self verified personal study time".

I'm off to do some SVPST!

Now that's bound to catch on.

Image credit - Moyan Brenn  under CC licence - not modified.

GDPUK took the time to interview Simon Reynolds – Commercial Director of Patient Plan Direct, one of the UK’s fastest growing and most cost effective plan providers, as well as a GDPUK partner.

In the past six months more practices than ever before have opted to work with Patient Plan Direct, either launching a new plan for the first time or transferring an existing base of plan patients from another plan provider. Jonny Jacobs of GDPUK took the time to find out more about Patient Plan Direct’s success:

Jonny GDPUK: Please give us a brief background to how you ended up working in the dental industry?

Simon: “Following my studies in the North West I stuck around the Manchester area and joined Patient Plan Direct’s parent company, First Capital Cashflow, as a business development associate working with both the sales and marketing teams.

“I eventually focused on the marketing side of things and after undertaking a diploma in digital marketing, took up the role of marketing manager at Patient Plan Direct, going on to progress through to my current role as commercial director – managing the business development and marketing teams. I have been involved with Patient Plan Direct for almost five years now, in which time the company has significantly evolved and grown year on year.”

Jonny GDPUK: For those that don’t know of Patient Plan Direct, can you give us a brief potted history?

Simon: “Patient Plan Direct is a dental plan provider similar to the likes of Denplan, Practice Plan and DPAS. The company was formed in 2008 as a subsidiary of our parent company First Capital Cashflow – a long established payments bureau providing payments related services and technology.

“We have embraced technology, cut out a lot of unnecessary paper based administration and benefited from the economies of scale and efficiencies nurtured from our parent company, thus cutting a lot of our own cost bases – resulting in lower fees for our clients!

“Since our inception we’ve sustained our low cost, flat and transparent fee structure of £1 per patient per month (inclusive of VAT and patient Worldwide A&E cover underwritten by Hiscox) whilst other plan providers have marginally increased their administration fees each year.

“Since the company formed, our team has grown and our service delivery and support has evolved in line with market demands. We now work with over 300 practices across the breadth of the UK, helping them to develop, grow and retain a solid base of plan patients.”

Jonny GDPUK: How does Patient Plan Direct differ to other plan providers?

Simon: “Our core proposition is our low cost fee structure, enabling a dental practice to maximise the income and profitability a dental plan generates. It is our ethos to maintain this position in the market, at the same time ensuring we provide first-class training alongside business and marketing support to ensure we can help a practice reach its objectives.

“Our fee structure can easily prove to be 2-3 times more cost effective than other plan providers, enabling a practice with even a modest base of plan patients to easily make significant cost savings year on year in comparison to working with other plan providers. Moreover, we’re very focused on flexibility and branding, offering a fully practice branded solution with the freedom for a practice to determine their own plan offering, structure and price point.

There may be some misconceptions that our service is a no frills / vanilla option when it comes to dental plan administration. However, on the contrary, whilst we don’t offer support in other areas such as CQC guidance, hold annual golf days, invite ‘key’ clients to trips abroad, or hand out ice creams at dental shows, we do invest in our team, processes, technology and support whilst keeping our costs to a minimum and passing these savings on to the many happy practices that work with us."

Jonny GDPUK: What trends are you seeing in the payment plans market?

Simon: “The biggest trend I have noticed for some time now is the lack of appetite from practitioners to either introduce or continue to grow an existing capitation based plan such as Denplan Care. There are so many reasons this is the case, which I could talk about separately for hours on end.  We have worked with many practices that have transferred from another plan provider and opted to put a cap on their capitation plans (only keeping existing capitation patients on this type of plan), opting to only promote and grow a maintenance based plan moving forward.

“The other noticeable trend is the increase in principal dentists making the switch to private dentistry and using a dental plan as a vehicle to make the transition, enabling their patients to budget with a monthly payment to see their preferred dentist. Of course this is all in line with not keeping all their eggs in one basket in light of the uncertainty around the future of the NHS. My team and I relish the opportunity to get involved in this type of plan launch, delving into the viability analysis and financial modelling to identify and recommend the best strategy for the principal, practice and patients.

“Finally, we’ve worked with a number of practices recently that have decided not to take on a plan provider transfer for a number of reasons, but instead have opted to run a new plan administered by Patient Plan Direct alongside their existing plan, taking advantage of cost savings in admin fees  for new patients joining the practice’s plan.”

Jonny GDPUK: How long have you been aware of GDPUK? Why do you think it works so well?

Simon: “I have been aware of GDPUK for as long as I’ve been involved in dentistry. It’s the place I usually hear about the latest news and opinion. As such, I visit the site daily to keep up to speed on what’s new in the world of dentistry.  With all the challenges that the dental profession faces these days (many of which are well documented and discussed within GDPUK), it’s so important there is a place where dental professionals can freely express opinion, discuss ideas and offer each other advice, feedback and moral support.

“Every credit to yourself and Tony for keeping the forum running for what is now coming up to 20 years! Long may it continue.”

Jonny GDPUK: As an advertiser on the site, have you found the site a good place to gain business?

Simon: “Without doubt the site has helped raise our brand awareness and helped us extend our message to market, educating the industry on our service proposition. We have had plenty of new enquiries and new clients that initially explained “we saw you on GDPUK”.

“I see the forum as very well respected and trusted amongst the industry; as such it’s a fantastic site to attach our brand to.”

As a private plan provider, how do you see the future of NHS dentistry panning out?

Simon: “Now we have the general election out of the way and details of the prototype dental contracts are becoming a hot topic of discussion, I think it’s safe to say that irrespective of what the new contract eventually looks like, employment under the NHS is not likely to provide greater income for less graft and a stress free life. As such, I’m pretty certain the NHS won't be for everyone and as there was in 2006 there will be a noticeable shift in the number making the move to practicing privately – a process which has already begun.

“Clearly if a dentist or practice is considering the switch from NHS to private, the introduction of a dental plan is a very obvious and proven strategy to achieve the move successfully and retain happy patients.”

Contact Details for Simon:

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Tel: 08448486888

Mob: 075407063232

Web: www.patientplandirect.co.uk

Web: www.firstcapitalcashflow.com

Twitter: @PatientPlan

Dear Colonel Hurley,

The profession would like to congratulate you on your appointment to the post of Chief Dental Officer. As someone with a reputation for professional change management, then your appointment is seen as a welcome one by many.

The profession has not recently been blessed with a CDO who it can feel it truly relates to, and many may feel that the last few years have been detrimental to the quality of dental care available in the United Kingdom. Whilst the position of CDO will always be to do the will of its paymaster, Her Majesty’s Government, I am sure you will continually keep your professional responsibility to the profession at the forefront of your mind.

At a time of unprecedented change and pressure within the profession, you will have the opportunity to rebuild the bridges that have been lost over the years. One of the ways of doing this would be to listen very closely to the concerns of the profession, and most importantly do not be afraid to tell the truth of the problems we are experiencing. After all, you are a member of our profession first and foremost, and what is bad for the profession is bad for patient care.

A New NHS contract will no doubt be a priority; but in whatever incarnation this takes, it needs complete and total clarity as to what treatment is available for patients under the rules. There should be no room for abuse by those who use a lack of definition to perpetuate the problems of the current system. Contract negotiations based on honesty are a must; and if the government cannot afford what it wants, then it should be told in no uncertain terms that this is impossible to achieve. Not only do our representatives the BDA have this responsibility, but so do you. Only by listening to and working with the profession in a fully engaged and mutually respectful manner can this be secured. If this means a core service for the NHS, or a new way of thinking that benefits both patients and teams alike then it should be piloted properly and not forced on the profession in the manner it has before; please don’t forget that the success of dental care depends on those delivering it. You have a track record in delivering high quality change within a budget; but do not underestimate the suspicion of the profession as to how government will treat them.

The inequities of dental care must be addressed; and the continued lack of a joined up policy on dental health in the nation is still something that makes dentistry a poor cousin to other health issues. When dental problems are the number one cause of admission to hospital for children, can nobody actually see it would be cheaper to fight the problem at source rather than wait until the problem occurs? There would be no better long term legacy for a CDO than to have truly changed the face of dental health in the UK for the better. A public face of the profession that is prepared to stand up for the patient and not hide behind government spin and empty promises is what the profession requires if faith in the position of CDO is to be renewed. A clear message is what the public need.

The situation with our young practitioners having to play some kind of bizarre lottery to gain a job on graduation is another aspect of the profession that you must turn your attention to. At the very beginning of their careers, we have an increasing number of them considering whether or not they have made the right choice for their futures; and by association this is the future of the profession too. Whilst part of this lack of morale lies at the door of our failing regulator, to then heap on the uncertainty of a tiering system will eventually result in the profession being devoid of is youngest talent, without which it will wither.

So, as you approach the start of your tenure as CDO, the profession can only really ask one thing of you.

After years of obfuscation, spin, and confusion;

We need clarity.

Yours Sincerely,

The Profession.

Image credit - Jason Dean  under CC licence - not modified.

I have been reading coverage and watching interviews about the latest book by Steve Hilton. Apparently, he is the favourite political guru of David Cameron and therefore his ideas are ones we might expect to be implemented in the next five years. You might find a perusal of @stevehiltonguru on Twitter to be interesting, his TV appearances suggest he has been coach to “Call me Dave” in the way Chris Barrow has been a polarising national coach to the UK dental profession.

Our profession has massive frustrations with our daily lives and the restrictions which are all around us, reaching out to almost affect our pattern of breathing. Steve Hilton argues that what has happened, as our information society has developed, is that it has become easier and easier for systems which we must follow to be written and then codified. I believe our dental profession has been trapped by this codifying of systems, almost trying to make every dentist work and behave in the same way, with the same paperwork, the same records. The words I am using here could be used for every field in the UK, ask your spouse, your friends, professional colleagues, business people, all are being stifled by the weight of the state's hefty duvet of regulation.

In the 20th century, Hilton argues, due to the way communications worked, only the people in the centre were able to make decisions, and these rippled out, in some cases enforced. Before the Industrial Revolution, decisions were taken locally as the communications of the times meant a distant ruler in the capital city may impose large scale decisions such as war and taxation. The King in the castle could not micro-manage the daily actions of subjects hundreds of miles away, the local lord, or sherrif imposed their version for their area.

Can the philosophy of applying those systems allow us to be trusted again with making our own decisions, our own leadership, rather than being force fed by the nanny state?

Nationally, this broad idea encompasses powerful, executive, city mayors. This concept is being taken forward, we will see this as more and more city mayors take office across the UK. The benefits will be a translation of what may be a well meaning law or regulation emanating from a Whitehall Minister's desk, into what this means in a locality, where a well argued, seemingly sensible, national edict may be counter intuitive to the situation on the ground.

If there are to be more and more local mayors, or decision makers, could this idea be applied to dentistry? Many agree that the whole profession is frustrated daily by the national edicts which do not fit in with how we run things on the ground, in our own practices, or in our own areas?

In oral health provision, the needs of differing areas do vary widely. Truly local decisions will help people on the ground, the providers of healthcare working together with the recipients of this care. How can we move the profession away from political control, away from the politicos who are able to speak publicly and utter soothing platitudes, but when devising and enacting changes, they seem to be regularly and plainly wrong? But our decision makers must be of the people, possibly elected, and definitely not from the present Dental Public Health elite who continue to drive change in their narrow eyed image.

Decision making for the future of our profession needs to be more human, more involving, and not just showered onto dentistry from the top down. This itself will mean different things to different people, but will allow concepts from grass roots to flourish, we have many mechanisms for communication, to set the agenda, and make the changes. The age of imposing change must now be over.

My call now is for our largest trade union, the BDA, to take this forward to this new Government on terms that fit in with their style, their politics, their understanding,  in order to make a change to the top down mindset. This is about freedom, modern politics, and a move away from the paternal style of the last century, using modern coimmunications but not only in a single direction.

Things are changing in the website world, mobile websites are becoming increasingly important with Google placing an emphasis on websites having a mobile version. Users of mobile phones now expect a mobile version or an app for the business that makes their lives easier.

Over the last few years, there has been a huge growth in mobile apps, with large businesses having their own mobile app but things are now changing and evolving with smaller businesses now getting in on the act. It is now possible to have one for your dental practice. This seems a strange concept to some but there are a number of benefits that could really help your dental practice.

As we all know, everyone seems to be using their mobiles for the majority of tasks, with the average person in Britain, using their mobile for over 2 hours a day. Your patients will be no different.

The GDPUK Services team can now offer you the ability to have your own app custom built for your dental practice. Once it is built (usually takes approx 4 weeks) it will be made available on the Apple and Google Play Stores for download by your patients.

Below are five reasons an app could benefit your practice.

1. Loyalty Scheme

With the loyalty scheme built into the app, all you have to do with an app is scan a code in the practice and the patient's loyalty card is automatically marked, they can then redeem a voucher when they reach a certain number. All this is done automatically. This will be a reason your patient will keep the app on their phone, they will feel like they are getting extra value / service from visiting their dentist.

2. Presence

Having your own app is a great way of doing something different and innovative in your local area and will impress your patients. Having an app gives your patients a constant reminder of your presence in the community and that your practice can be seen as innovators.

3. Engage with patients

Patients can message your practice directly from the app, they can request an appointment for specific items of treatment. They can also gain direct access from the app to your Facebook and Twitter accounts as well as your blog or any other social media etc.

4. Push Messaging

You can push messages directly to everyone who has it. Push messaging is free and has close to a 95% read rate which when you compare to an average open rate of just 20% for an email that practices send to patients.

5. Referrals

With a mobile app your patients can refer you directly to their friends and family via Facebook, Twitter, email or text. As we are all aware there is nothing more powerful than a personal referral for any business, for dentists personal recommendations / referrals often work brilliantly because they provide confidence to the potential new patient and also prove to your team and yourself that you are doing the right things. A number of referrals a month from the app will make the small investment in the app totally worth it.

For further information on the app and the costs involved please have a look at our new services website and specific page on the app. Links below. If you have any further questions please email us - This email address is being protected from spambots. You need JavaScript enabled to view it.

www.gdpuk.com/services

www.gdpuk.com/app

Is it safe to come out from my cave now? Can we talk politics?  It is tempting to be cynical and use that worn phrase, Plus ça change … [1]  

To those of you with connections in Nepal, my sympathy and best wishes - coping with such a series of natural disasters is never easy. The Nepalese Governments rejection of the UK's Heavy Lift helicopter offer suggest that politics can rear its ugly head in any circumstance.

In a small way, I suspect UK dentistry will prove no different.

Unfinished Business

The election has been and gone. [You have noticed, haven’t you?] As revolutions go it was typical – the outcome was unexpected, although change was assured.  Everything is up in the air, and yet already the dust is settling and the view of the future challenges is clearing. There is a sense of unfinished business in many respects, allied to concern that reform, be it to Regulatory Bodies or or Contract Reform, is going to suffer Mission Creep

In the space of a month for all its abject lack of mention during the election campaign, there has been a series of small seismic shifts in dentistry.

 

Tremors of Change

The new CDO was appointed [2] and Colonel Dr Sarah Hurley's name was confirmed; although announced on the NHS England web site, it is strangely absent from the DH Portal.  NHS England stated:

Sara will ….. champion the role of dentists and dentistry within the health system.

I look forward to that because it was for sure absent under the previous incumbent who even now is espousing the increased use of Dental Therapists.  Her military experience should stand her well in trying to wrench the proud profession of dentistry away from the red braced bean counters.

The BDA Conference, following on the heels of the UK wide Vote, was a successful venture, multiple stages and speakers offering a cracking breadth of topics to hear about. Big Dr Mick issued his rallying call, [3] and if anyone can lift an Agincourt like salute to the DH, he and his PEC  are your ‘archers’.

The election threw an unpredicted outcome of a moderately strong Government, albeit with a large degree of SNP oversight.

The former CDO has already hit the lecture circuit and interview network, the glossy big magazine from Practice Plan being the one to catch the early eye, but with what agenda in mind it remains to be seen, except perhaps to self-aggrandise the achievement of the 2006 UDA contract. A strange retirement project I would suggest.

Jimmy Steele, the ubiquitous Toon Professor of all that is good, has spoken about the new Prototypes in guarded terms [4]  – suggesting that we are heading toward a sensible format for NHS funded dental delivery. The nature of his caution suggest that money will be the driver or the deal breaker.  Model Two appears to win his tentative vote at this time

Perhaps most interestingly, the FGDP, in a move to assist beleaguered dentists, has made their standards Open Source, [5] as well as criticising the GDC and its appointed ‘experts’ for constantly placing the bar too high in FtP cases.  The GDC it must be said have publicly challenged this respected professional body. [6]

So what now?

We now face the prospect of proper austerity, with a new budget in July. Further real cuts are forecast  and I for one would not bet on dental funding under the NHS increasing to ensure proper delivery of any new contract.  Suddenly massive promises are on the horizon for 24/7 operation allied to an increase of 5000 WTE GMPs – and you can see dentistry as funded by the Government being parked up a narrowing alley.

 

So the rallying call is very simple –

We must expose the lack of clarity of the NHS offering which looks to be similarly present under the new contract proposals.

We must drive increase dental funding to be directed at child dental health

If ever the case for fluoridation should now be put to bed, it surely must be now – the cost effectiveness alone must appeal to a newly empowered Chancellor.

And the GDC are still awaiting the HSC Report, but our regulator is hardly a reformed body despite their strongly worded rebuff to the FGDP

Dental revolutions are often subtle, like slow burning fuses.  I think there are a number of fuses smouldering here.  The summer should be interesting because at some stage there will be a loud bang.

Enjoy your long weekend

[1] http://en.wiktionary.org/wiki/plus_%C3%A7a_change

[2] http://www.england.nhs.uk/2015/04/27/new-chief-dental-officer/

[3] https://www.bda.org/news-centre/press-releases/Pages/Dentists-leader-issues-rallying-cry-to-the-profession.aspx

[4] https://www.bda.org/news-centre/press-releases/steele-on-contract-reform-type-b-prototypes-closest-to-my-original-vision

[5] http://www.fgdp.org.uk/content/news/fgdpuk-launches-the-open-standards-initiative.ashx

[6] http://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/General-Dental-Council-challenges-FGDP(UK)-stance.aspx

Since 1987, the Edison Awards™ have recognized and honored some of the most innovative new products, services and business leaders in the world. The Awards are named after Thomas Alva Edison (1847-1931) whose extraordinary new product and market development methods garnered him 1,093 U.S. patents and made him a household name across the world. The Edison Awards symbolize the persistence and excellence personified by Thomas Edison, while also strengthening the human drive for innovation, creativity and ingenuity.

The Edison Awards™ are among the most prestigious accolades honoring excellence in new product and service development, marketing, human-centered design and innovation. Unique to the world of award programs, the Edison Awards™ are focused on the innovators as much as the innovations. Award winners represent "game changing" products, services and excellence and leadership in innovation around four criteria: Concept, Value, Delivery and Impact. An Edison Award represents significant value to the award winner and to the cause of innovation.

In the Dental Tools catergory, NSK won gold for the Ti-Max Z45L. The handpiece is the worlds first 45 degree electric attachment handpiece. It features a unique, two-way water spray mode. A jet spray option helps prevent subcutaneous emphysema in surgical procedures and a mist spray option effectively cools the bur making it suitable for both surgical and traditional procedures with difficult access.

Link to the award winners here. If you have a look at the page, there are some very interesting and innovative products that have won awards. Worth a read. 

Below is a video about the handpiece that won the prestigious award.

Further information on the handpieces can be found on the NSK website

http://www.uk.nsk-dental.com/products/contra-angles/ti-max_z/

tel: 0800 634 1909

• http://www.nsk-uk.com

Tony Jacobs writes: Massive thanks to Pramod for writing this series of blogs against a backdrop of political change both in Scotland and of a backlash against the Coalition's minority partner party. All at GDPUK wish him well in finding a job and settling back down again, I will make sure he keeps us informed!

The one thing that has been a constant in my entire career so far, and has been the fundamental guiding force to everything I do, has been my ethical compass.

Where it came from originally I suppose was my upbringing, but then further refined by exposure to teaching (particularly clinical) of such a style it helped me to understand what an important position we as professionals hold, and the huge responsibilities we have to other people, primarily our patients.

Whilst clinical experience and techniques have doubtless changed through my practicing career as it does for all of us, the ethics of how and what I do have remained a fundamental baseline that cannot be compromised in my opinion.

I’m sure for the majority of the profession this rings happily true. So much so I have wrestled with even submitting this blog for publication. After all, none of us know anyone in the profession who could do with taking a good look at themselves and thinking about what I’ve written here…..

There are times when I have had to wrestle with what the right course of action is clinically, but these dilemmas have always been fairly straightforward when put in the perspective of how other medical professionals might have to act, and I’m actually quite grateful that for the vast majority of us our day to day decisions are rarely likely to have life changing impacts on our patients, especially when compared to the huge responsibilities of cardiac surgeons or oncologists for example.

But….

If our ethical compasses have become somehow magnetized by a malign influence that we fail to see, ignore, or indeed we positively allow to affect us in some way, then our actions will have potentially life changing impacts on our patients. Ok, so maybe not as severe as for the medical professionals mentioned above; but certainly at odds with the ‘First do No Harm’ principle we swear an oath to.

I am purposely NOT going to go into the potential malign influences of the NHS contract and how it might be abused or gamed; I leave readers to draw their own conclusions about this after reading this piece. What I will say is that my examples below probably only scratch the surface of what might be happening in our profession.

There is huge increase in the cost of indemnity, and whilst we have a GDC that is not fit for purpose causing at least part of this increase, it surely cannot be solely due to that alone. We can blame no win-no fee solicitors to a degree, but don’t forget that cases have to have some merit to be paid out, even if only on the balance of probabilities. Otherwise, they are defensible.

So, consider the parallel increase in availability of orthodontics and implants in recent years. This blog incidentally is NOT aimed solely at the orthodontic aspect although it may seem so; it is purely written from my personal experience of one aspect of our profession that I have experience in so feel able to comment on a bit more.

These treatments are by their very nature high value items, and potentially have a higher profit margin that some of the more routine treatments offered. The courses maybe expensive, as is the equipment needed to carry out the treatment. Being the principal of a practice that offers both these treatments, I am pretty well placed to know the financial aspects of them. What is worrying is that there seems to be a section of the profession that immediately has a new direction on their ethical compass when they start to offer these services, sometimes after only a weekend course. Admittedly this might apply more to the orthodontic side of things as I think it is now more recognized that implants are not quite as simple as Meccano to install.

But with the increase in availability (or is it an increase in higher pressure marketing and selling??) we see the parallel, and often steeper rise in litigation and Fitness to Practice associated with these treatments. Personally, I think a good chunk of this is due to the magnetism that potentially affects the compass of some of the profession after being exposed to these treatment modalities.

It’s one thing coming away from a weekend composite course having learnt what is likely to be a refinement of an existing technique, to actually introducing a whole new treatment modality to your patient base that wasn’t taught at all at undergraduate level. The ethics of such a situation are different in my eyes. When at least some of the course is given over to how to sell the new treatment to your patients on some courses (rather than spending it further exploring the ethics, assessment, case selection etc) it is not surprising that magnetism is already starting to alter the direction of the needle on your compass…

There is nothing wrong with a return on investment, but it’s how you go about getting that return that might be the problem.

Let me give you some background with regard to my orthodontic experience to put into perspective where I am coming from.

I was fortunate to work as a clinical assistant in the mid 90’s in orthodontics. One morning per week I treated patients under the supervision of a consultant in a regional hospital, and this continued for about 4 or 5 years. By that time I had seen and indeed treated some pretty advanced cases under very close supervision. I was also treating simpler cases in practice as an associate. Along with another general practitioner, we estimated this experience prepared us to treat perhaps 30% more of our orthodontic patients in practice, but more importantly it had taught us how to identify what we definitely couldn’t or shouldn’t treat. The ethics of what we could now do was drilled home all the time since we often got to see the slightly more ‘random’ orthodontic treatments that had failed in the hands of practitioners with experience only of removable appliances at undergraduate level.

We had begun to Know what we Didn’t Know.

Since then I have also been on the courses for commercially available appliances of different types, and had the advantage of my previous experience in looking at the systems and the teaching a little more objectively than perhaps some of the other delegates.

The problem comes when some of our profession don’t have these limiting factors in their internal ethical system. Some are possibly not enough motivated by the desire to always only do the right thing by their patient, but by their own financial and even egotistical drives. There have always been those in our profession who seem to have a sliding scale of principles, and are more driven for their own gains (and the patients may or may not gain as a result). I actually don’t feel that there are any more truly ‘bad guys’ in dentistry now as a percentage than in the past despite what the GDC think; but I think the potential for damage to our patients has increased because perhaps the fundamental ethics we should all have in place, in some are allowed to erode.

Combine this with the further issue now that with a lack of experience at undergraduate level for some aspects of dentistry, the starting point for not knowing what you don’t know is now much lower than perhaps it was in the past. This is where the ethics should come in to play, and whilst I applaud the efforts to fill a gap in the treatment needs by offering training in fields not covered by the undergraduate training, there doesn’t seem to be an ethical ‘lock’ in place with some practitioners to prevent them seeking their financial gain over that of the patient.

More controversially with regards to their ethical direction, perhaps they Don’t (want to) know what they Don’t Know about ethics?

So when the treatment goes awry because of not knowing enough about what wasn’t known, and the ethical direction was slightly (or massively) off, the profession has a HUGE potential for life changing impacts on both patients and its members.

This brings me on to the thorny subject of ‘selling’ in dentistry. Now, I have absolutely NO issues with dentistry as a retail environment, offering services to patients. Indeed, in order to keep a viable business in this ever competitive age, you have to consider how best to let your patients know the services you can offer them. I certainly do, and I feel it is another method of protecting ourselves from criticism that we are not offering a full range of options to our patients.

But ‘selling’ has to be fundamentally and overwhelmingly in the patient’s benefit, and not ours. I worry about some of the techniques I know can be used by some industries that if (or should that be when?) used in ours would exert an influence on the patient designed to get them to agree to treatment whether that is the right thing for them or not, or even more worryingly, whether the practitioner is truly capable of providing the treatment correctly or not. The pound signs appear, the ethics can get completely switched off, and it becomes a one sided benefit.

But what if you actually CAN’T solve those issues? (and are either aware you can’t, or just bite off more than you can chew?). The classical ‘Over Promising and Under Delivering’ is a guaranteed route to problems for patients and the reputation of the profession.

This is where the huge problem occurs. The practitioner that doesn’t know ENOUGH about what he/she doesn’t know, having been blinded by clinical and other courses that seem to offer all the answers to patients problems and get them to agree to treatment, with an underlying anaesthesia of the ethical values (if they ever had one in some cases) for what ever reason is not doing the best for their patient.

At all.

Without the ethical compass pointing in the correct direction, then there are those in the profession who cannot with their hands on the hearts say that they are truly driven by doing the right thing for patients. Take the ego and the financial aspect out, and their direction is quite possibly completely lost.

Until we make sure all our ethical compasses are calibrated properly, I’m afraid the GDC (in whatever guise it takes) will continue to be on our backs, and our Indemnity will continue to rise. The press will see us in the wrong light, and so will patients.

We need a return to the fundamental values of what we do and what that means to us and the patients.

And to do that, The Only Way is Ethics.

Image credit - Paul Downey  under CC licence - not modified.

These are politically exciting times in which we live. The earth shaking events in Nepal are unrelated of course and to those of you connected in any way, I hope that our thoughts and prayers provide comfort.

The French have had their revolutions. So have the Russians. The North American history is littered with conflict. Closer to home the Scots were victim of some brutal clearances.  The Irish found themselves on a similar receiving end of some English-driven realpolitik. The English have had their civil wars be they flower based or parliamentary in origin.

The definition of the word revolution includes this:

• a dramatic and wide-reaching change in conditions, attitudes, or operation.
  • synonyms:  dramatic change, radical change, drastic/radical alteration, complete shift, sea change, metamorphosis, transformation, conversion,innovation, breakaway;

The 8th May - the day things changed

And now we are about to witness a UK wide political revolution.  A conflict of ideas and ideals as dramatic as any more military revolution.

On Friday the 8^th May, the manifestos of the various parties will be torn into small bargaining chips. All political discussion will become secret and behind many sets of closed doors as the hidden powerhouses of advisers thrash out a deal which allows either Mr Miliband or Mr Cameron to pay a visit to Her Majesty and request that they be allowed to form a Government.

Your conversation with your patients on Friday 8th will at least be a bit different from the usual weather and holidays. But what will you think?  If we have no clear large party, by definition we have a coalition at best and minority Government at worst.  First past the post only work if you have a winner. Imagine you are overseeing a race and because you forgot your stopwatch and glasses, the result looks like a sort of fuzzy dead heat where does that leave the voting system?  In dentistry of course we used to have transferrable votes for electing the GDC - heady days, eh? We were ahead of the game I suggest.

Where does this leave dentistry in the minds of our politicians?

I for one find it quite extraordinary that less than a year ago we as a profession were making headlines with child dental health and child hospital admissions being the headline concern, but allied to issues of obesity, diet and refined carbohydrate.  You all know what it takes to be dentally healthy.

The drive for caries-free children is not a mystery. You all know that.

Dentistry... why, is there a problem?

So has dentistry been, if not a headline element, perhaps a second string part of any debate?

Nah.  Non.  Nyet.  Not a dicky bird.  It’s as though the 45% of the population who never visit a dentist are happy to take their own teeth out, [and for those of you so inclined to listen again, our colleague Dr Tony Kilcoyne had to endure a strange slot on Jezza Vine on BBC R2 recently].^[1]

Meanwhile the 55% of the population who do visit a dentist are commendably happy with their service and experience, and are no doubt filling out the FFT as we speak.

Well they will be, until told by dentist A that their crown and root canal must be privately funded, and yet dentist B can provide the same treatment for a friend under the NHS and everyone is correct!

Clarity of NHS provision in dentistry is a ticking political time bomb with a shortening fuse. The lawyers are the ones who keep relighting the fuse and at some point it will be a major problem.

And yet sadly, dentistry has as a profession and an NHS Primary Care service been parked in the sidings of political irrelevance. We have in political terms, been marked with a large tick.

Have the politicians taken their eyes off the dental ball? You might think so. If you read the NHS Confidence Survey by Practice Plan, ^[2]  the mood of dentists is darkening from so many angles it is hard to find true optimism anywhere for Government funded activity. ^[3]

Well come the 8^th May we are going to witness the start of a Revolution whoever polls the most votes.  Indeed those who poll the least may feature the most.

Perhaps dentistry will feature during the post-election negotiations?

And of course for those of you in Manchester for the BDA Conference…  ^[4]   Well maybe that will be the long-needed start of a dental revolution.

It’s not too late to check in and go have an excellent three days of networking and updating across a huge range of dentistry

A chance perhaps for at the very least a bit of private revolution.

Enjoy the long weekends coming up.  That grass is still growing...

[1]  Dr Tony Kilcoyne on BBC R2  http://www.bbc.co.uk/programmes/b05qsjpl

[2]  Practice Plan NHS Confidence Monitor  http://www.NHSDentistryInsights.co.uk

[3]  Dr Claire Roberts at Dentistry portal http://www.dentistry.co.uk/2015/04/22/reflecting-future-nhs/

[4]  BDA Conference agenda 
https://bdaconnect.bda.org/wp-content/uploads/2015/04/Conference-Preview-Brochure-2015-WEB.pdf

GDPUK were proud to have exhibited last week at the Dentistry Show 2015. We really enjoyed being there and taking part in the wide-ranging exhibition.

Below are a few short observations from my two days at the show…...

• The stands and displays seemed larger than ever, a sign that the show is growing and continues to evolve.

• There was a huge range of exhibitors and lectures, this meant there was something for everyone

• The inclusion of DTS alongside the Dentistry Show made the exhibition even bigger and inclusive.

• Closer Still Media (the owners of Dentistry Show) are very commercially minded which reflects on the show, is this good for dentistry? I would say yes because it means the other exhibitions improve what they are offering and they have managed to gain support from the majority of the larger dental trade companies. What do you think?

• Great to meet loads of people from the GDPUK community. Feedback on the site is always important and it is great to receive compliments about the website. It remains extremely popular with dentists and an amazing resource for advice, information and opinion. Join for free today. We have had nearly 400 new members in the last 6 weeks alone.

• From a personal perspective, loads of interest and commitment to advertising on the site, GDPUK is seen as a great marketing tool and community to be involved in! It was great to catch up with old friends and new. Over the next year we hope to improve the service and range of options available to our clients.

• The one negative from our experience was that in our exhibitor agreement with the Dentistry Show we were to be associated with the GDP Theatre but on arrival at the show, there was no GDPUK logos anywhere to be seen, either at the theatre or in the programme. This was very disappointing, as it was something we had heavily publicised before the show.

• A positive thread was posted on the forum in the aftermath of the Dentistry Show, created by an enthusiastic dentist on the site, Jeremy Cooper. Why the Dentistry Show is the BEST. It has thoughts on the show from a number of prominent people in dentistry including members of the trade. Worth a read!

Members of the forum meeting - putting names to the faces!

Our feeling about exhibiting was summed brilliantly by our website designer, resident techie and dentist, Steve Van Russelt who posted on another thread “Its great to meet up with the real people behind the posts that make the forum so vital. Most people think or suspect that we are there as a commercial concern so have to be reassured that yes it is free to members and no we're not going to sell their contact details. So we encouraged new members to join, but the majority of the voluntary traffic and the most heart-warming aspect was all of those current members that went out of their way to visit, say how important the site is to them to keep them informed, entertained and in the loop - reducing any sense of isolation and just saying thanks for that.”

So overall it was a very enjoyable few days in Birmingham. We hope we will be able to exhibit again next year. In the meantime we will continue to improve the site and all it offers. It was great to meet people in the flesh and not just from their online persona or email address, we look forward to meeting you all again.

**Thanks to Erica Kilburn and her team at EK Communications for the pictures - http://ekcommunications.co.uk/

Thursday 16th April 2015 is the day I will never forget.  I was in surgery with Amy.  Bea was at reception.  It was a life changing moment for me and I am sure, for all of us, by Dr Chris Tavares BDS

THE CARDIAC ARREST

We were ready to get the patient in.  At around 3:45 pm,  Amy went out to get him in.  As the surgery door opened I could hear him having a laugh with Bea.  He came in, we exchanged the usual superficial pleasantries, had a laugh.  Asked him how he was. He said “Fine, very well thank you”.   Soon, was this to change.

He told me he had fractured a tooth in the upper right area this morning. There was no pain but it was sharp.  I turned round to type this into the clinical notes.  I could see that his ASA rating was 1.  Nothing medically to worry about.  As I was typing, I heard heavy breathing behind me.  I turned round and saw his eyes had closed, his right leg was hanging off the side of the dental chair and as I faced him, calling his name and shaking him and lightly slapping his face, the breathing became more laboured.   I lowered the chair back right down and called him again.  Suddenly he came round and said: “Yes, yes I’m ok”…and then….he was ‘gone’ again. The breathing became more laboured to an alarming level. 

I asked for the emergency kit and Amy came back with it.  He was still breathing heavily.  As I attached the pulse oximeter to his finger, his head suddenly came forward, tongue protruded and his breathing become a desperate stridor.   His face then went completely purple / ashen. 

Immediately I instructed Amy to let reception know “Medical Emergency.  Cardiac Arrest. Call an Ambulance.”  She went straight outside.  I noted the time and started CPR immediately.  30 compressions to 2 breaths.   At one stage, I vaguely remember thinking part consciously, that If I don’t do this, he will die. It was a battle between death and I and death was not going to take him, not on my watch.  I pumped like mad.

I heard Bea, shout, if he was breathing. I shouted back: “No. Cardiac arrest. Not breathing.”  

Amy came back in and brought the AED in. We connected it up and followed the instructions.  Bea stayed on the phone in, in case 999 needed to speak to her.

The AED spoke in an incredibly loud ‘voice’:

“Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I did this and the whole chest arched and lifted off the chair with part of his body.  The AED assessed the rhythm again and instructed us to continue to carry out CPR. 

Meanwhile as Bea had more training in Med Emergency, she came in and Amy went outside to wait for the ambulance.  As I carried out compressions, the pulse oximeter showed a pulse of 110  and oxygen content of 70%.   This little bit of information was reassuring as our AED did not have a screen with the ECG tracing. 

The AED instructed again:  “Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I followed the instructions.

The first paramedic arrived. This was about 11 minutes from the time the patient went into cardiac arrest.   I continued CPR.  He took over immediately to check the back of the chair was firm enough and immediately said ‘yes’, good.  I then took over again as he got his gear out.

The AED instructed again:

“Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I did this and the chest arched and lifted off the chair.  The AED assessed the rhythm again and instructed us to continue to carry out CPR. 

Suddenly the patient responded and pushed my hands off his chest!  Then went still again.

The paramedic was in no hurry to attach his AED.  He asked if our AED showed what was happening on a screen.  I said no.  He seemed happy to continue with our AED at the moment.

The AED instructed again:  “Stand back. Do not touch the patient.  Assessing rhythm…..Shock advised…….Press the red button and shock.”  I did this and the chest arched and lifted off the chair.  The AED assessed the rhythm again and instructed us to continue to carry out CPR. 

By now two more paramedic vehicles and the ambulance had arrived.  Literally minutes if not seconds, 4 more paramedics came into the surgery.   The lead paramedic, the first one who arrived, switched over to his AED which had an ECG tracing.   The second lead asked about the medical history of the patient and I informed him it wall all clear. 

The third paramedic took over external cardiac massage as the second put an IV line in.  Sugar level was tested. Negative.

It is difficult to recall exactly what happened when and what was done when and in what order.  An airway was put in.   A drip was set up.  At some time I think they also injected something.  They did other things I am not sure what.  They also attached a contraption that carried out external cardiac massage.

As they looked at the ECG I heard the second paramedic say to the lead, “That’s VT” (I think that’s what he said. There was definitely a ‘V’ in his sentence) and this was confirmed by the first.  Everyone was instructed to stand away from the patient, they pressed a button, you could hear a ‘whine’ as the defibrillator charged and they shocked the heart again. 

The ECG tracing went flat and suddenly started up again and I could see what appeared as a more ‘normal’ tracing.  Then it took on another pattern again. 

They were in the surgery for about 1 hr to 1 hr 30 mins.  The tracing on the ECG was erratic and inconsistent in that time.  Every time they shocked him, the line went flat and then started again.

I had to help to deliver the oxygen for a few minutes.   In total the patient’s heart was shocked 6 - 7 times.

I am sure he had ‘come’ round a few times in that 90 minutes.

After the last shock, I cannot say exactly when but I suddenly realised they had stopped the compressions and delivery of oxygen.   They were moving around more relaxed. The lead paramedic asked one of the ambulance drivers to bring something in.  Then he asked her to bring the stretcher in.  I thought: “What, is he…dead?”. 

I had forgotten about the ECG.  I suddenly remembered it and looked over at it…..even though the patient was unconscious and no obvious signs of life, to me, ……… there was a ‘normal’ heart tracing on the ECG.   Very regular and steady.  I looked at his chest…he was breathing on his own!  I thought: “My God, there’s a normal rhythm!”  

They lifted him onto the stretcher with the airway and ‘automatic cardiac massage’ contraption still in place, I think. The airway was definitely in.   I suppose in case he needed it again.

3 of the paramedics went with the patient to the hospital, having taken the patient’s personal details.  2 stayed behind to pack up and clear up.  I asked the second paramedic if the patient was OK.  He looked at me, looked at our AED the oxygen cylinder and said pensively:

“He’s OK. Will have to see if he pulls through.  Hopefully there is no brain damage.  You got the oxygen,…. (he looked at the AED again, which was lying on the surgery floor) …….you had the defib…….you saved his life.” He said nodding.   It had not dawned on me at the time the significance of what he was saying.

The two remaining paramedics left, saying that they’ll be back to pick up the last remaining paramedic vehicle when they’ve finished at the hospital.

THE IMMEDIATE AFTERMATH

The three of us sat down, numb and started talking about the incident.  Bea made cups of tea and we sat in the staff room.  We agreed we could not have done anymore.  When he had been put into the ambulance, Amy said she heard one paramedics say to another that the patient had pulled the airway out.  This was put back in then the doors were closed. So it was good, it was reassuring to know that he was alive when he left the surgery to be taken to the hospital. 

There were no elation and shouts of joy. Just numbness.  The shock and disbelief that we had just be part of and witnesses to a full blown cardiac arrest in our dental chair.

As Amy and Bea were talking, I remember I had asked one of the paramedics if there was something we should do or someone we should report to. He said there was nothing.  If the patient dies, the police will be round to make their enquires and investigate.  If he pulls through, we probably won’t hear from anyone.

When I look back now, I cannot help but feel what a sad and unacceptable and ridiculous situation the profession has been put into by those who have the authority to ‘rule’ over us but really have been given or taken more authority that they deserve.  I have been told by a paramedic that we did the right things and possibly saved someone’s life, at the moment, but instead of elation at a professional stance of doing the right thing, unfortunately I started worrying about whether I had all the right ‘paperwork’, dotted all the ‘i’s and crossed all the ’t’s if there was an investigation!

When we finished our tea and I could see we were alright, we went down stairs to tidy up.  Bea put a note to order a new set of adult pads for the defibrillator.  I checked the oxygen content whilst Amy put the Medical Emergency things away.

It would have been about an hour to 90 mins when the door bell rang. Paramedics 1 and 2 were there.  We looked at them holding our breaths.  I asked how the patient was.  The lead said, looking at the ground:

“We have some news for you.  Looked up and smiled. We have him up and talking.  He’s actually up and talking.  He must have had a massive blood clot in the artery. They are thinking of discharging him in a few days. Well done” as he looked at each of us.

The relief from the three of us was palpable in the air.  He’s OK!

The 2nd paramedic looked at the three of us, then at me in the eyes and said something about CPR, getting the oxygen in then…..

“You had the defib…….YOU SAVED HIS LIFE””, nodding and repeated as he looked round at the three of us: “you saved his life, well done” and smiled.

I thanked them for delivering the good news, thanked them for getting here so quickly and for all they had done.

The two then left.

We shut the door and elation!  The total release of suppressed, involuntary tension.  Earlier on once the paramedics had arrived, Bea had cancelled the rest of the patients for the day and evening. I felt they deserved to have the rest of the day off!  Fortunately we weren’t seeing patients the next day.  They went home.

I stayed behind for a bit.

PERSONAL REFELECTION

Bea and Amy were just great.  I could not have asked for better support.  This was the first, and last I hope (!), medical emergency we had to deal with and, for all that, in at the deep end.    Amy just carried out unquestioning what she was asked to do.  Bea, calmly called the ambulance and handled the reception area.  In fact, as Bea was cancelling one of the patients’ appointment, he commended her on how calm she was when talking to him, given what she was in the midst of.

We were lucky there were no other patients in then.  No one ‘collapsed’ , broke down in tears or freaked out.  They both held it together.  Just amazing.

I will forever be grateful for the regulation that insisted we had Continual Professional Development (CPD) on “Medical Emergency” every year.  Every year we had a hands on 3 hours training session and I would also attend an additional lecture session.  I was never sure how much of this I actually retained in my head.

I made sure we held a medical emergency drill once a month. Only I knew when I would call one. I would always choose a time so we had a different number of staff around. We may miss a month at most but we held the drill regularly.

I am in no doubt this was one of five things that affected the outcome.

INSTINCT

When something like this happens, there is no time to think, no time to work your way through some mental venn diagrams or following the boxes of a mental flowchart.  It had to be instinct and what was already in your subconscious. 

Everyone just went into action. Everything just went so smoothly.  The call for the ambulance. Staying online with the 999 operator. Waiting outside for the ambulance.  Amy saw him and made a beeline for him.  CPR: 30 compressions to 2 breaths.

I have no doubts the regular drills helped us all.

STRIDOR & SUBSEQUENT LOSS OF COLOUR

I did not have to work out if he was breathing or his heart was beating. This just told me …negative.  I was lucky to have had these signs.

I just started immediate CPR and the ambulance was called. 

The rapid response I am sure contributed to the outcome.

CARDIAC COMPRESSIONS

One can never know if one is compressing chest deep enough.  You can’t measure the depth of compressions in such situations.In this case the colour of his face instructed me.  I could actually see the colour come back to his face.   This helped a lot when one is not consciously in a thinking mode and operating on instinct.

AUTOMATIC EXTERNAL DEFIBRILLATOR

The enemy to anything we do …….is ‘doubt’.  If you start asking yourself, doubting your actions, for anything, it is a recipe for disaster or failure.

He was, as I came to know, in VT/VF. I have no doubts the AED contributed to the positive outcome, directly and INDIRECTLY. 

Before the AED was connected, I was just pumping away but no idea if it was helping. 

The question always in the back of my mind is if I’m doing the right thing at the right time. 

When I connected the AED up, the minute I heard its “voice”, I was immediately aware of a sudden mental, physical and emotional relaxation. It was like having the consultant cardiologist in the surgery.

“Stand back…do not touch the patient…assessing rhythm….shock advised….press the red button and shock.”  I just thought: My God, his heart is being monitored now.  “Somebody” knew what was going on.  There is nothing more to do but follow the instructions.  It had an immediate calming effect on the whole process.

I had wondered if I should buy the AED.  I did. We’ve had it for 5 - 6 years now, every day checking the “green ready” light is on, never once thinking we will need it.  I have absolutely no regrets in buying it. 

I am well aware that there is still going on a major disagreement amongst professionals whether the AED is necessary in the dental surgery.  I will have no hesitation now to say YES.  I cannot be more appreciative of the AED.  It made the whole incident so much more easy to handle and I will forever be grateful we had one.  It actually helped to calm the room.   Was it ‘the thing’ that saved his life?  I don’t know.

I remember hearing at a lecture on Medical Emergencies.  I cannot remember who it was.  What he said was that we can never fully know exactly what is happening to the heart muscle and how it will respond to anything we do.  The patient, to all intents and purposes, is dying or nearly dead. If there is anything we can do that will remotely contribute to a positive outcome….DO IT.

Of course there is never absolute certainty in life.  The consequences of our actions can never be fully predictable.  If one will only act if one is always absolutely certain of the consequences of one’s actions, then one would just sit and do nothing.

The AED contributed in two major ways:

1    It really calmed the room whilst we waiting for the paramedics to arrive.

2    As I saw on the ECG screen later, it gave the heart a chance to re-establish a normal rhythm.

I HAVE ABSOLUTELY NO DOUBTS THE AED CONTRIBUTED TO THE POSITIVE OUTCOME in this case.

LUCK

Pure luck had a lot to do with it.  We were lucky the paramedics were able to arrive so quickly and there were so many.   They were just amazing.  They went about what they had to do in a calm, confident and controlled manner. 

We were lucky, before the paramedics arrived, none of us freaked out.  I have no doubts the regular drills we had played a large part.

One can never say for sure what exactly it is that brought about the positive outcome but I am sure luck played a part in it.

WHERE AM I NOW?

There is the disbelief that I was actually  deep in the middle of it all.  I actually looked at the face of someone who was clinically dead and he pulled through?   I came back from the Dentistry Show the day after ‘the event’ and went straight to the surgery, to call the hospital to see how he was. There was a slight eerie feeling going into that empty building, into the surgery. It was all clean, tidy and quiet. I could not help but wonder if 24 hours earlier, did all that really happen?

The suddenness of it all is what is so frightening. There were no medical history concerns.  One minute he was there, two minutes later he was gone. If he had been in his car, 5 minutes late for his appointment, he would have had it in the car and could have ploughed into a bus stop with men, women and children.

I value my life much more now.  An appreciation of what I have, life, wife and children,friends and who I am.  So much we take for granted. 

I was surprised how well we all were when we attended to patients two days later.  It will take some time for the slight apprehension to dissipate.  Is this person going to suddenly have a heart attack on me?

The recent developments, all the nonsense, in the dental profession had really got me down.   All the effort in having to keep a surgery running with all the nonsense regulatory compliance and then having more piled on, unnecessarily.  I had been tired of putting so much effort into working as a dentist and getting so little back in return as the pressure of legislature piled on.  I was tired of legislature getting in the way of patient care. 

This ‘event’ has helped me to see things in perspective. This has been a good boost in morale as at least, all this effort came to fruition.  I am very proud of my staff and I hope they are of themselves too.

There is a mixture of emotions or feelings in myself.  Of course there is an immense feeling of gratefulness that we had a positive outcome.  Then, there is the feeling that one has been in a ‘privileged’ place, if that’s the word to use.  To have been involved in the thick of things and have a positive outcome.  Then there is something else I am aware of.   I am not sure how to describe it but it is a good feeling……….there is a deep seated feeling of stillness.

Every so often, the words that still ring in my ears:  “You had the defib……you saved his life.”

That inner stillness…..is….good.

Chris.

Dr Chris Tavares,

Dental Practitioner, Derby

April 2015

This blog was first published in April 2015, a few days after the event. In May 2016, after seeing more data, Dr Chris Tavares added the following:

I wanted to correct a few inaccuracies so as to be fair to the East Midlands Ambulance Service who did such a fantastic job on the day and to give credit when and where credit is due.

In the heat of things, a second can seem like a minute. A minute can seem like three minutes. I was able to download the data from the AED which records an ECG tracing every second. The AED analyses the rhythm every 2 minutes and advises to shock or not.  I was able to work out the exact timeline from this.

The heart was in VF.  CPR was started within 10 seconds of cardiac arrest.  The first shock to the heart was within two minutes of cardiac arrest.  The first paramedic arrived 5 minutes from the time we dialled 999. The five paramedics were in the surgery for about half an hour when a normal heart rhythm and spontaneous respiration were re-established and the gentleman was taken to the hospital. 

I have no doubts the rapid sequence of responses added to the positive outcome.

 The whole situation can best be summed up:

 “We did what we had to do ... the paramedics did their magic ... and the hospital staff performed the miracle.”

The gentleman is alive and leading a full life, no brain damage, no external scars.

Buy an Automated External Defibrillator and save a life.