Throughout the 30 years of my career there have been peaks and troughs regarding the NHS dental system. Actually, the peaks (to me at least) have really only been less deep troughs, but I’m sure you will understand what I’m saying. Most of time the profession has seemed to just get on with it and accept what the various contracts have offered, and learnt to work within them (or around them in the case of a minority). What has always happened when we end up in one of the troughs though has been for dental practices to largely and stoically maintain their NHS commitment, despite the pips being squeezed that bit more firmly each time. There have always been a few practices who have moved out of the NHS to private, but the majority have stayed put.

I have my own reasons for considering why practitioners don’t opt out of the NHS and I think it boils down to the following (in no order of importance). There are likely to be other reasons that I haven’t considered so apologies If I have omitted any alternative reasons an individual may have who is reading this.

Fear of the Unknown

Fear of not having enough patients/work

Concern that there will be a proportion of the populous that cant afford private fees

An underlying need to satisfy their own socialist tendencies

Lack of confidence in their own abilities

Fear of loss of the NHS Pension

Too late in their career.

I can’t take each one of these points and discuss them as this would take too long and bore everyone senseless. However, these are the reasons I had for not taking the leap sooner in my career. Everything I felt would go wrong (for the dentists) with this contract has done, and pretty much in the way that many of us predicted right at the beginning.

It is also clear that there are those who have been able to make the NHS work very well for them (usually in a financial manner), but I am not going there in this blog.

It is very apparent though at the moment that there has never been such an uprising of dissent from the profession post Covid, and there is an increased sound of the rattling of a profession’s collective sabres toward the powers that be. I’m informed the private plan providers are gearing up to deal with an ever increasing number of practitioners who are nearer to making the jump to private dentistry than ever before. It seems that the support that was given to practitioners throughout Covid that was initially seen as generous, has now come with the sort of interest payments a government will always put on its help.

For those of us that made the jump a while ago, I can honestly say the grass is not only greener on this side, but the park-keeper isn’t some jobsworth who has no clue and enforces ever more draconian and financially difficult rules when you stray onto the grass. Actually its not really grass anymore, but a dustblown patch of earth, but it has deteriorated over so long those playing on it don’t actually notice anymore.

However, for the first time in long time, I think the profession is more united in its outlook than it has been. Whilst there is still the obvious fear of the unknown, more NHS practitioners are realising that they are unable to shore up a completely broken system and longer. They are hopefully also realising that it isn’t their fault that they haven’t got the resources (both financial and mental) to care for patients but the responsibility of the State to fund this, not them.

I’ve given up trying to count how many times a new contract has been proposed, piloted and then prototyped before being seen as unacceptable to the DHSC. More dentists must be realising that the only thing that will be acceptable to the powers in Whitehall will be the entire population being treated for less than the current NHS budget. The current crisis is showing that this is patently impossible despite the best efforts of the profession, and I suspect that FINALLY there will be a tipping point in the profession that will lead to a mass exodus of caring practitioners leaving the NHS.

At the moment, there seems to be a distinct lack of concrete offerings from DHSC as to what a new contract will contain, but only the most deluded of us would suggest it’ll be better funded for less onerous working conditions. Cynically, one would say (yet again) that this is exactly what the powers that be want, but they have to make the dentists go private of their own accord so as to avoid the government getting the bad press. I somewhat cynically think the DHSC are paying lip service to the profession by making a show of negotiating with the BDA, but in reality using successive low level civil servants on a fast track to somewhere much more important to their careers in order to practice their techniques and to see if they toe the line. I actually asked on one recent webinar with the DHSC negotiator what time his mum was going to call him in for tea…..

I think the profession has to now consider it is at the point where both sides are not really going to agree. The profession can no longer work under this pressure and provide what it is contractually obliged to do; and the government will not increase funding to the degree that is needed to improve the service and access. I think it will need such a complete rethink of how dentistry works in this country that I cant even begin to suggest an option other than a core service. However this course service would have to be funded at the current level, which we all know isn’t going to happen, as core service will be a further excuse to cut the budget rather than fund dentists appropriately for the business risks they take and the skills they have.

We should take heart that the profession now has the upper hand, but if only it chooses to realise. There are not enough of us and to increase the numbers would take years and years (and look how that has ended up with overseas dentists returning home and the GDC not able to sort out the ORE). We are still the only people who can provide the service we do, and its time for use to remember this and embrace it fully. We have to remember we are only human and cannot care for every single person at our own expense. We have to also look after our own mental health and well-being so that we can properly concentrate on delivering the high standard of care we were trained to do, and not what a system is forcing us into.

It’s time to play the endgame and win.

There have recently been many worried rumblings in the profession amongst principals about the issue of vicarious liability and non-delegable duties of care  concerning their associates after the case of Rattan (Rattan V Hughes [2021] EWHC 2032 QB). In this particular case it was found that a principal who hadn’t actually treated a patient was still liable for the negligent treatment by dental associates. 

Dental Corporates and their responsibilities

I might start off by actually saying the title of this blog is probably one of the most Oxymoronic I’ve ever thought of, but then that would probably give away the content and the thread of what follows.

However, I don’t really care if it does give away what follows; because I’m sure that many of my readers will understand just where I am coming from and why there needs to be something done about the environment we currently have in UK dentistry.

No-one can deny that corporate dentistry generally is becoming bigger and bigger as the years pass. I can remember the original clamour back in the mid 1990’s to buy the original corporate ‘shell companies’ that were legally able to provide dentistry under the 1921 re-organisation of the profession. I’m not sure anyone who was in practice in those times could have then foreseen the huge growth of the corporate, but the real change came when all practices were allowed to incorporate (as an aside, does any one else think it’s funny how the Dentists Act 1984 allowed this but still can’t work out how to take a monthly direct debit from us instead of an annual payment, but I digress…..). What is true however is that there is a significant amount of dentistry now provided under the auspices of corporate dental companies, of which some of them are quite large players. I will say here; this blog is not about any specific company; I am sure there will be some out there who have good stories to tell. However, there is no doubt that in some corporates in some places and some practices there is a culture that is not good, not healthy, and downright nasty.

Those of you on Facebook may well also be members of the ‘Mental Dental’ page. This is a hugely important page that has become an important outlet for its members to vent their concerns about a multitude of issues affecting them. By simple extrapolation, many of the issues floated here are likely to not just be unique to the original (often anonymous for good reasons) poster, but relevant to other professionals finding themselves in similar positions.

A good many of the posts on this page (and indeed on most dental specific social media groups) seem to revolve around issues that associates are having with their corporates. Whilst I am the first one to consider that there are always two sides to every story, there is also a common theme to nearly all the threads posted. Note that I didn’t actually say “Corporate Employers’ at this stage; but more of this later.

It is apparent that even if you take into account that not all the stories are likely to be entirely balanced, there are a significant amount of associates who are having problems with the working environment of the corporates. From faulty equipment not getting repaired, running out of materials, a lack of clinical freedom in referring, to outright bullying, the same themes come up over and over again. This can’t just be put down to only having one side of the story surely? The fact that these threads appear so often, from so many different contributors shows that there has to be something more behind the threads.

Some of the more concerning posts often involve bullying of associates. From target driven issues, to ‘you make waves and we’ll report you to the GDC’, this seems to often be driven by management teams within the corporate environment. There is NO place for bullying in any environment, and the fact that some people feel that it is acceptable to disguise this as performance management doesn’t make it in any way acceptable.

But how has this environment come about? I’m pretty sure the dental registrants at board level haven’t issued dictats to their managers condoning the bullying of their teams? However, the need to make money for the shareholders means that these directors have to ensure the business is profitable (although there’s another oxymoron – the profitable corporate..) and the ideas discussed at board level eventually filter down to the teams regionally and locally,

This is where the problem lies in my opinion. When the board comes up with an idea, it is down to those below it to implement this, and the board is not necessarily aware of the fine details in how this is done; just how that it needs to be done. It is down to the teams on the ground to implement that desires of the board. How they therefore go about this is part of the problem. With management teams that are often not fellow dentists (or even registrants on occasion), there can be a lack of understanding of how the profession truly works. Yes, these people can be given training in the dental industry, but they may not have the same ethical and moral compass, or even the need to be registered by the GDC, and therefore do NOT know what it means to be a real professional.

When you hear stories of associates raising concerns to management about slack appointment books causing them to not meet their UDA target, to then be shown edited data showing the books are now full, and threatening them with a counter concern about clinical treatment (that the managers know full well can result in a GDC case and a livelihood threatening result), then you have to consider that the whole structure of corporate dentistry needs re-addressing rapidly. This threat has been real, this is not hypothetical, nor fictional.

Now I’m fairly sure most of the REGISTRANT directors of the corporates are very ethical and still have the moral compass that is needed; but they don’t seem to be getting the message down to their teams very well. Whether this is because they are not being heard above the voices of the non-professionals who have no regulator to fear, or whether the management structure is so poor that the message is not getting through I don’t really care. What is certain however is that a good many of these registrant directors seem to be unable, unwilling, or unprepared to step in to deal with the problems that we hear about, otherwise we would stop hearing of them almost on a weekly basis.

Have these directors forgotten they can be held vicariously responsible for negligent acts and omissions? They seem to rely on the self employed status of associates in order to deny all knowledge of the problem. However, it is becoming more and more apparent that the associates who work in these organisations are less and less likely to be seen as truly self employed as a result of various court cases (Pimlico plumbers, UBER, to name but 2), and it is about time that they took their corporate responsibility a lot more seriously than they appear to. I’m sure a few minds would be somewhat more focused on their ultimate responsibilities if a few of them were found to be vicariously liable for a few clinical issues, or taken to an industrial tribunal by a disgruntled associate (which if you believe the stories on social media might not be a small number).

They cannot hide behind the excuses that they don’t know what is going on. There is enough spoken about in the profession about corporate issues that this is about as believable as saying they aren’t aware Elvis is dead. Whenever there is a problem posted on the various groups, I always recommend that the highest level clinical director be notified, rather than the middle management (which is often the source of the problem) in order to ensure the problem lands at the door of a registrant rather than a (sometimes over-promoted) manager. Recruitment seems to rely on the fact that younger registrants often have ludicrous debts to pay, and therefore will end up working for these organisations as they appear to have little other choice.

Registrant directors need to step up and take the responsibility for the mismanagement and bullying that appears to be a problem in their organisations, and deal with it decisively. If this costs money and time then so be it; but if it does it may well show some of corporates for the shallow and non-profitable businesses that they really are. Alternatively, if they don’t act, it’ll show the profession that these people might not have the integrity, ethics, and morals that are required to be members of our profession.

But if the latter is the case, then the GDC should be told. They should ensure that the need to act in the best interests of the patient is drummed into all those registrants who sit on the boards of the corporates. There should be no hiding behind the corporate structure of these businesses and claiming ignorance of the problem. When the majority of the entire profession seems to be aware of the magnitude of problems with some corporates, then the directors cannot feign ignorance.

The elephant (so big its actually more likely a Mammoth) in the room however is that if these directors were to be removed by the GDC, the remaining non-registrant directors would no longer be able to continue the practice of dentistry and the corporate would no longer be able to function under GDC rules. What this would do for the provision of NHS dentistry would be potentially shattering, with the loss of these businesses. Additionally, is there anyone reading this in any doubt that some corporates would seek to protect their viability by cutting loose the registrant directors and replacing them at the first sign of the GDC taking an interest in them? That would really show the profession just where the priorities of some of these companies lie.

Perhaps this is why there is no appetite to deal with the problem decisively, and instead this will continue to be a problem for years to come, with neither the Registrant Directors OR the GDC taking any form of corporate responsibility for the problems that seem to be within this area of the industry.

Image credit - Maria Eklind under CC licence - modified.

Betrayal by screenshot

I thought that I would mark my return to writing this blog by broaching a subject that has been annoying me (and I’m sure many others) more and more recently.

We have to accept that there are people who walk amongst us every day who are maybe not as deserving of our trust as they should be. It is inevitable that we will experience them both personally and professionally, and that they may not have the same understanding of ethics and morality as we do, and not have the same belief and value structures as we do. It is not necessarily an overt thing that can be observed in an individual, and as such, this trait has been utilised successfully (often by governments, corrupt or otherwise) throughout the years, especially at times of war and public unrest.

These are people who will betray you.

I refer mainly to the events of WW2 and the Cold War as being probably the most obvious known times of the incidence of betrayal. In both of these world events, people often found their lives and that of their families changed irrevocably by the actions of people they worked with or whom they lived amongst.

Such a culture of fear had been generated by the leadership of these countries that once normal people would revert to acting for their own protection, or to inveigle themselves with the regime in order to further themselves, by reporting neighbours, colleagues and even friends to the ‘authorities’. It came to the point that no-one could trust anyone, even members of their own families, for fear of saying or doing the wrong thing leading to extreme and often fatal outcomes. This sort of behaviour will always be present in society to some degree or another, so we should not necessarily find it unusual.

However, the reason I mention the above scenarios is because there is a sinister and similar thing occurring in dentistry today, which is acting to damage the profession hugely. It is creating an environment of distrust, a climate of fear, and preventing free speech and the raising of legitimate concerns about working conditions in dentistry.

I refer to the increasing use of what can only be termed as snitching. We all remember at school the odious type of person who had no qualms whatsoever dropping fellow schoolmates into trouble by running off to a teacher, usually trying to become some form of favoured individual. It’s the same as when you can’t fight your own battles and stand up for yourself and expect mummy or daddy to do it for you. The same thing is becoming much more of an issue in dentistry.

Some of it seems to be taking the form of the use of the ‘Screenshot’; when comments or opinions that appear on social media or the web are photographed and then used to report an individual to the GDC, or even to an employer. The use of anonymity seems to be no protection; I know of a situation that has been posted recently where a screenshot has been reported to a corporate as the anonymous poster revealed enough details for others to determine exactly which corporate was being talked about. This resulted in a potentially serious issue for the anonymous poster, when all they were doing was trying to draw attention to obvious issues (given the theme of many posts about corporates there appears to be very little smoke without fire).

I also know of a colleague who made some comments under his/her own name, only to have these screenshot by apparently someone well known in dentistry report them to the GDC for said comments, just because of a previous disagreement and some bad blood between them. Thankfully the GDC just issued a stock type of warning about social media to our colleague; but had it gone further it would have been interesting for the complainant as they would no longer have been anonymous, and we might have found out who it was.

So it seems that the GDC is now seen as a mechanism for some professionals to get revenge on one another by anonymously reporting one another. There are many satires that abound (on social media of course!) of associates being effectively threatened with being reported to the GDC when they have a disagreement with principals/corporate management, especially if they have departed under less than amicable terms with one another.

Isn’t that the same as blackmail? ‘Keep you mouth shut/do as you’re told/we’ll keep a high retainer or tell the GDC your dentistry isn’t great’? I’m sorry, but I fail to believe it is anything but blackmail. If a professional relationship has deteriorated to the point where people can no longer work together that is one thing: but to then threaten to report each other to our regulator is something I find reprehensible and without honour.

I am also aware of other cases where dentists are only too happy to push their colleagues ‘under a bus’ when they see dentistry that is perhaps a little suboptimal. In many of these cases there is a financial incentive to the first dentist to get the second dentist to pay for the work that a patient might not be able to afford. They then advise the patient to report the dentist to the GDC and/or take legal action. The first dentist seems to forget however their actions can misfire on them, as it is highly unlikely they are of such clinical prowess that they never do any suboptimal work themselves.

Now I’m absolutely not saying that we turn a blind eye to obvious problems that need to be reported to the authorities, and especially where there is a legitimate reason to suspect patient harm is occurring. This is where we DO have to take professional responsibility to our profession to report a colleague ourselves, but not get a patient to do it for us.

But reporting someone to corporate management because a valid concern is being raised and not listened to, and then someone just asking the advice of a hive mind? Using a social media policy as a mechanism to prevent free speech?

Having spies on social media is no different to not to being able trust your neighbours in the Cold War Soviet Union to not tell the KGB.

It certainly appears that the upper echelons of some corporate dental companies has little or no idea about what is actually going on at the tooth-face or if they do they just ignore it – which is probably worse), and they seem to forget fellow professionals will want to discuss with their colleagues these types of situations so that they don’t feel isolated, bullied, or even warn others off working in these places. It appears this lack of insight, coupled with unapproachable and inaccessible high level management leads to frustrations that are then exposed on social media. Personally I have no problem with this as it draws the profession’s attention to things that should be exposed if we are to retain our professional integrity and standing.

But to then use a social media policy to effectively gag a person reminds me of the saying ‘the beatings will continue until morale improves’….

The same is true of those who screenshot and report to the GDC. Freedom of speech is still supposedly a right in this country, and whilst it is one that can have consequences if legal and moral boundaries are crossed, it is still the right of an individual to express themselves. In years gone by, many things would be said at dental gatherings and the pub hat might well have been contentious but said in the heat of the moment; however I don’t remember people standing around with recording devices or making shorthand notes to then use against somebody. It is however now so easy with modern technology to take a screenshot and send it merrily on its way to the GDC and watch the as the drama unfolds from a distance. When this is used as a form of revenge against a colleague for a business dispute or some form of personal disagreement, then it can only be described as the lowest of the low, especially given the draconian manner with which our regulator polices our profession.

And what about those dentists who advise that patients report their previous dentist to the GDC/Solicitors for less than the true professional reason of patient safety? Those who do it because they feel they are somehow superior and have never made a mistake themselves? There could be a multitude of reasons for such behaviour, including financial ones (and not those of the patient I hasten to add).

Have they themselves never tried their best with a patient only to realise they are quite possibly the most challenging and difficult patient ever who consistently misses appointments, and considered this might be a reason? If there is a real patient safety issue then they are obliged themselves to inform the GDC as this is part of our professional responsibility to one another in keeping the public’s faith in us. The fact they get the patient to do it must somehow make them feel they have absolved themselves of the guilt of dropping a fellow professional in it if their reasons are not completely pure and without bias.

I have to reiterate that I am not suggesting a closing of our professional ranks so that problems are never reported; what I am actually saying is that there are some in our profession who cannot and should not be trusted these days because of their own motives and that depresses me.

I sincerely believe these people do not have the same values as the majority of the profession, and are likely to be entirely self-centred and self-absorbed individuals with little insight or no into their own failings. We can only hope that karma eventually serves them a suitable outcome, and they too then find themselves hoist by their own petard at some point in the future. The French at the end of WW2 had a fairly direct way of dealing with collaborators and informants, so history does tend to suggest what goes around comes around for these people.

They are one of the reasons there is a climate of fear where the GDC is concerned, and the GDC will happily use these turncoats to justify the persecution of the profession, as it gives them the legitimacy to say we can’t be trusted to regulate ourselves.

They are one of the reasons that indemnity costs are increasing; because they sow the seed in the patients mind there is money to be made to correct their dental issues. They seem to forget they too are human and can also err… but then they would need insight to realise that, and to understand the GDC is not there to replace dealing with a matter face to face professionally.

They are the reason I sometimes feel ashamed to be a member of this once proud profession.

They are Pariahs.

[ And I bet someone screenshots this article :)   ]

Image credit - Dimitry B  under CC licence - modified.

Image by rakka_pl

Dear Mr Brack,

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

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

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

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

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

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

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

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

Kind Regards,

Simon Thackeray

Image credit - Rakka_pl under CC licence - not modified.

Once again the new patient charges have been announced for the NHS, and once again they have gone up far more than the amount dentists will get for their UDA’s. The third consecutive inflation-busting rise in patient charges means that an ever increasing number of dentists will find themselves as unpaid tax collectors for the government, with the added pleasure of having to continue to practice in a hostile environment where the threat of litigation and GDC involvement is ever present.

So what will it actually take for dentists to wake up and smell the coffee? Patients are paying an increasing amount for their care, and as they do so, direct their annoyance as ever to the dentists. Its unlikely that they will understand or accept the explanation given that the charges are in effect a taxation, as they are too closely linked to the provision of a service.

Why do many of the dental practices seem to forget that they are in truth independent contractors within the NHS, and as such only have to refuse to contract to the NHS in order to retake a degree of control of their own future once again? It can’t be that working within an NHS contract is too easy; we increasingly hear of the demands on the practitioner’s time to fulfil the contract requirements. This time of year is full of comments on social media about the increased flurry of activity in order to hit the UDA’s targets once again or suffer claw-back.

By raising the patient charges, the government is contributing less and less each year to the cost of dental provision. The population of the UK isn’t reducing, and the cost of providing dentistry isn’t either. But for less and less contribution the government is still dictating the terms of the contract, and dentists continue to accept it.

Will it actually take the government to raise the patient charge to £30 for an exam (whilst still paying £25 for the UDA) for dentists to realise that they would be better off just charging the patient £30 and sticking two fingers up at the government? Or is it the NHS pension that people are holding out for? Or the continued chance to pay an associate £10 per UDA when they are really getting £30?

Practice owners (and particularly the bigger practices and corporates) definitely have the whip hand here. I can remember the times when associates were few and far between. It appears that the reverse is now true in many areas of the UK (particularly in metropolitan areas), which allows the principal to reduce the unit price of a UDA paid to an associate. An increase in patient charges will likely bring a drop in the number of patients visiting practices, and in one fell stroke this will reduce the PCR, and reduce the chances of the UDA targets being met, and therefore a claw-back occurring. I know of many associates that are made liable for the gross amount of any claw-back due to their individual underperformance (rather than the net amount they have been paid per UDA). Add this to the NHS pension of the principal that is effectively enhanced by paying a smaller percentage of the UDA value, this hardly puts the principal under any immediate pressure to withdraw from the NHS system they are still aligned with. However, I suggest that it is now causing a much greater ‘Us and Them’ situation with associates than ever before.

So why is it ok to make money out of the associates and not charge the patients a decent amount for their care? Whilst a business has a duty to its shareholders and owners to keep its costs low, with the introduction of the minimum wage this means they don’t tend to be propping up their bottom line by charging their staff for the privilege. They tend to charge their customers for it with the increase in the charge for the product.

Unless you happen to be in a fixed price system…so the only way money can be made (let’s forget upselling to patients using the NHS as a way to get them in the practice for now) is by reducing the costs of the workforce and investment in the business. However the government expect more and more for less and less (look at the next round of orthodontic commissioning that is going on) and it becomes impossible to square the circle unless someone actually pays for it. That certainly isn’t going to be the government.

Given that some patients will not be able to afford the hike in charges does not mean that many others would not pay for a decent service if they had to. Surely having fewer patients (but of the sort that don’t sue and complain) that are being charged a fair amount for the service provided, with no third party dictating targets has to be better for the stress levels of both dentists and patients under their care?

Will it take associates to actually walk away from the profession and retrain? With the current environment of stress due to the GDC, threat of litigation, and the real time reduction in associate income, then this has never been more possible than it is now. And that will lead to a reverse in the associate market again, especially if the (currently unknown) effect of Brexit results in European dentists returning to their home countries – and who wouldn’t if it meant avoiding the GDC and Litigation!

So what will it take for the profession to see the light? That we need to realise the government would still wish to control us if they only contributed £1 in every £100 charged and only then will we react? Or do we need to remember that everyone who owns a practice is a private practitioner already and they should just tell the government:

‘No More’.

Image credit - Pascal under CC licence - not modified.

There have been many episodes I’m sure we all know about where a colleague has done something that has been their eventual professional downfall. Examples like the well publicised cases of Joyce Trail and Desmond D’Mello are a demonstration of how a professional has destroyed their own career and reputation through their actions, whether it be an illegal act, or a dangerous one.

But none is more worrying then the Case of Bawa-Garba. I am sure you are all aware of this, but if not, very briefly this involved a junior paediatrician being charged and found guilty of gross negligence manslaughter due to the tragic death of one of her patients whilst under her care. However, what is unusual about this sentence is that it was not only a very short one, but also suspended; something that very rarely happens in a case like this. As is then the usual route of action, the doctor was referred to the GMC for the associated disciplinary hearing that comes with a conviction. The tribunal found that her fitness to practice was impaired, but allowed her to stay on the register. However, the GMC appealed this decision, and she was subsequently struck off by the High Court last week. Interestingly, an interim orders committee of the GMC suspended the doctor initially, which was overturned on appeal by the high court who ruled that even a serious criminal charge did not always mean that suspension was necessary or appropriate to protect the public.

As someone with a conviction for manslaughter, then one could always argue that a professional actually should not be allowed to practice their art on the public again, but there is case law that supports the more subjective approach that was taken in this case initially. But this case (without going into even more detail) is as much, if not more, of an indictment of the systematic failings of leadership and organisation inherent in the environment Dr Bawa-Garba was working in. That the tribunal found no impairment was significant, as the doctor had engaged in insight, and had placed her reflections on the tragic event on her e-portfolio.

And that is the problem.

By honestly reflecting on the events and committing them to the permanent record of her E-Portfolio, this allowed the GMC to use this reflection against Dr Bawa-Garba, and subsequently was part of the case that was successful against her. In effect, by complying with the requirements of the GMC, she has committed professional suicide by recording her reflections as required. It is fine to record ones reflections to show insight, but to then have them used against you is surely unfair. You would have to trust the regulator implicitly when committing your reflections to a permanent record, and the actions taken by the GMC will have served to destroy any trust that our medical colleagues would have had in their regulator. Given that the GMC has always seemed to be to be a more considered and pragmatic regulator than the GDC of late, then once can only wonder just what manner of jeopardy we will have to place ourselves under as a result of this ruling.

In one fell swoop, the GMC have removed the chance for professionals to show they have learnt from their mistakes and develop in a no (or low) blame environment (as indeed occurs in the aviation industry) and installed a culture of fear that I think even the GDC at its worst a couple of years ago would have struggled to create so effectively. However, with the new GDC rules on CPD and reflective analysis requirements that we now have, is there anyone amongst you that thinks that the same couldn’t possibly happen to dentists? Once a regulator has set a precedent, it is likely that they will all act in the same manner.

I suspect the GMC realise there will be a problem with personal reflection now, and given the release of a blog by the GMC on this issue at the weekend, this might be seen to confirm it. The amount of internet noise coming from the medical profession over this matter is significantly higher than anything we have been able to generate, and as a result one must hope that there is a higher likelihood of something significant developing over the next few weeks and months as a result of this case, something which hopefully will roll down to the GDC as well. Even Jeremy Hunt has raised concerns about this case and its unintended consequences.

Once cannot forget the tragedy of the death of a child in the case, but there has to be consideration of the bigger picture of how a ruling such as this will now probably affect the analysis of mistakes in healthcare that are needed to protect the public.  Furthermore, unless the use of reflective writing is somehow protected, the use against us of our own insightful learning could be our eventual downfall.

Image credit - James Cridland  under CC licence -  modified.

We’re all members of a cult. Whether we like it or not, since mankind first appeared on earth, there has been a need for the majority of humans to flock together in some form or another. Whether it was for protection by strength of numbers, or to increase the genetic variety of a group, the formation of cults, tribes or groups has always been something that the human race has experienced.

I’m not talking here about race-related groupings of human, because that is something far more fundamental. That is all about the genetics that make you part of one race or another, and there is precious little you can actually do about the genes you were born with.

What I’m thinking about here is the tribal nature that makes you support one football team over another, or a different political party to someone else. Religion may also be part of this, but I am going to steer well clear of that for obvious reasons. However what is apparent is that most of these tribes and cults  are based on the shared values and belief structures that the members of the cult have.

“Where is he going with this blog?” I can hear you all thinking. This is not one of my normal types of observational commentary on the state of dentistry where I’m having a go at some (dis)organisation or system in dentistry.

Or is it?

Because it actually is exactly the same as usual in that I’m pointing out something that I believe is fundamentally inherent to the problems that we are experiencing in the profession at the moment.

Cults and tribes are collections of people who flock together under one belief structure. The profession of dentistry is such a tribe. We all share the same skill set fundamentally, and are working together to provide the same goal of health for our patients.

But within a tribe are often sub-tribes and cults. These are the things that seem to me to be dividing the profession in more ways than one and can often cause problems. When we look internally we see the infighting between some of the orthodontists and those providing GDP orthodontics. You can guarantee a lengthy ‘discussion’; when some of the more evangelical on both sides come out to discuss their views on this subject. The same is true of the two cults of private and NHS dentistry.

It is actually possible to be a member of different cults at the same time, and cross over seamlessly from one to another depending on the situation. You might find yourself agreeing with someone from another cult one minute, and then vehemently arguing the next.

When your strongly held values and belief structure is in disagreement with someone else’s equally strongly held views then conflict is almost inevitable. Only the control of the emotional aspects of these differences is what prevents the breakdown of the relationship between these two sides. Some people are able to control it more than others and agree to disagree, but many others are not.

Dentistry is absolutely full of cults.

More so than I think it has ever been before. I personally think the rise of social media and the ease with which one like-minded individual can find others who are from the came cult has been at least partially to blame.

The problems arise when the cults cause not only infighting in the profession, but also are responsible for the perception of the profession to the public (who I’ll just take as one big tribe at the moment).

Within the profession we have the cult of the Key Opinion Leader, some of whom seem to have opinions based on their parallel membership of the financially motivated cult, and who can pay them the most. Then we have the Celebrity dentist cult, often admitting to no personal or clinical failings and who may have sprung from anonymity in record time, with fawning acolytes who can see no fault in their heros. Given the following of some of these two groups, I’m actually waiting to read in the BDA news that 600 cult members have all drunk copious quantities of Hypo in a mass attempt to align their teeth. Ok, maybe that’s a bit far, but what will usually happen is the acolytes will be the ones who get left in the lurch either with the GDC or with a load of obsolete materials when the Guru-esque leader moves onto the next best thing since the last best thing.

There is the huge cult of the NHS dentist, who can often see no way out of the cult, but stay because they are also members of the ‘I’m alright Jack, my pension’s great’ cult or the ‘We cant go private where we are’ cult. There is also the sinister ‘Gamers’ cult, where you’re a member but don’t admit to it, either because you don’t want to, or because you don’t realise you are.

I could go on and on with this but I think I’ve made my point.

I’ve probably managed to alienate a huge chunk of my readers now with those analogies (perhaps it would have been more sensible writing a blog on the various religions after all !) because I’m sure you now will find yourself both agreeing and disagreeing with me and become annoyed at me in some way.

The point I’m making is that the values and beliefs that we have developed place us firmly in pigeonholes and groups in such a way that someone else can make an observation that can start a conflict if you don’t like it. I’ve done precisely that in the previous paragraphs.

But the above is all a myth based on your belief structure, which can be changed if you really want it to. Do you want to be a member of the cult of materialistic egotistical, self-promoters? Fine, do that, but then don’t be shocked when others take issue with that.

Until we have the unification of the profession behind one overriding cult then we will always be divided. Since these cults are nothing to do with our genetics but only down to our beliefs, it is all an entirely fictional situation that causes the problem; a brainwashing due to our desire to hold onto our beliefs and opinions.

We need to not become a profession against itself especially as we have enough external factors affecting us already. Unity and a sense of purpose is more important now that it ever has been.

Image credit - Legominifig under CC licence - not modified.

No one can deny that modern technology has been a revelation in recent years. The use of it to improve diagnostic yields in radiography, to allow mainstream imaging in practice of aspects of dental tissues that we couldn’t previously visualise the same way  can only benefit our patients. Computerisation of dental notes and management systems, (whilst restricted in the choice of manufacturers) have probably improved the efficiency of most dental practices far beyond that of the old paper systems. Digital marketing tools, online presence through websites and blogs, and social media are all here to stay, and have driven the profile of the profession upwards. All in all, I think most of us would agree, technology has been largely a good thing for the profession

But one thing that I am REALLY struggling with that has come about as a result of this type of technology is the increase in Referral Portals for NHS referrals. On the face of it is would seem to be a streamlining of the process needed to refer into secondary care, and reduce the costs and problems with paper referrals. Entering the data via a computer linked to the patient database and directly into the referral systems would seem on the face of it far more efficient that writing a letter and posting it.

So why do I have an issue with it? This sort of advanced technology is right up my street normally. However, because of the way these systems seem to be implemented, I can see potential problems for registrants falling foul of the GDC Standards when they are forced to use them. The GDC standards that I personally think relate to this type of system are :

Standard 1.7 – Put patients interests first before your own or those of any colleague, business or ORGANISATION – these systems tend to be imposed unilateral decisions that don’t seem to have any guarantee that they are better for the patient (or indeed tested fully).

Standard 4.2.6 - If a patient allows you to share information about them, you should ensure that anyone you share it with understands that it is confidential – How does a faceless system with no identification of who receives the data comply with this standard?

Standard 6.3 – Delegate and refer appropriately and effectively. However, someone else often choses where the patient goes and who they see, with the clinician often having no idea of the degree of expertise that clinician actually has. Referrals are even rejected if often irrelevant (but required) tickboxes are not filled in.

Standard 6.1.5 – You must ensure that all patients are fully informed of the names and roles of the dental professionals involved in their care - How does a portal allow us to do this? Do we give all our patients Bill Gates’ name as its done on a PC?

Standard 6.3.1 - You can delegate the responsibility for a task but not the accountability. This means that, although you can ask someone to carry out a task for you, you could still be held accountable if something goes wrong. You should only delegate or refer to another member of the team if you are confident that they have been trained and are both competent and indemnified to do what you are asking.

For me this is the big problem. This alone is where the entire concept falls down unless we are indemnified for the errors of the system. What if this is a life changing referral such as a tumour? You are going to be ultimately responsible as you have to make the referral, and you can guarantee the powers that be who thought it was a good idea to impose the portal will NOT indemnify you against the failure of the referral in some way, nor will the GDC.  If the referral is rejected because of some missing tickbox that is largely irrelevant to the immediate urgency but required because some software engineer hasn’t allowed any flexibility in implementation then I personally cant see how this should ever be the responsibility of the clinician. The fact I might for example omit the patients GP because I’m more interested in the speed of the referral is a pedantic bureaucratic issue and not one of patient care.

I can’t comprehend how we as a profession have allowed this type of loss of control of patient care to creep into our referral systems. I am fairly sure there are practices that are on referral pathways that our patients will be allocated to that many of us would not be happy for them being treated in. Part of being a professional means that you take on the ultimate responsibility for the care of a patient, and the GDC standards means that includes ensuring they are referred to an appropriate colleague. Unless every single one of these referrals is triaged by a clinician then there will be mistakes made. And this pre-assumes the system actually works like it should…..

I have had the misfortune recently of being forced onto a pilot in my local area of just one of these systems. Due to the obviously more knowledgeable people in charge of procurement in my area, they foisted a system onto practitioners without actually discussing anything with them first. To say I experienced problems was an understatement, and I know many others did too (despite the LAT saying the response to their questionnaires about it was overwhelmingly favourable – presumably because the portal lost as many bad responses as it did referrals). To be quite honest, I would have been better served learning how to send smoke signal referrals rather than use the system that was imposed. I did some research into the actual system and found that it had been dropped by at least one area as it was unsatisfactory, and another region have accepted that the same system isn’t good, but it’s the best they’ve seen. Hardly a glowing endorsement is it?

For example, in the 2 months I used it, we experienced a plethora of problems. I don’t think it is particularly useful to have to spend over TWO HOURS trying to upload a Periapical radiograph, knowing that if it wasn’t sent the referral would have been rejected. This was a compressed file of just 103kb. I don’t think it is particularly helpful to have half the tick boxes missing for medical histories, or dropdowns that you can’t fill in because they are incorrectly populated. A spell check that allows only the incorrect spelling of a drug is also pretty useless. It’s not useful that the system doesn’t tell you if the referral has gone correctly, or instead forever been lost in the ether of the internet. It’s not professional to have no idea who you have just referred the patient to or who is going to read the information. Not particularly useful if your patient who doesn’t have an email address (like many of my elderly patients) can’t even be referred at all as the system refuses to accept the referral without their email address. It also falls foul of my data security policy of allowing an unknown (to me) commercial third party installing software onto my system (which is massively firewalled both by hardware and software – which would appear to more than can be said for the NHS system if the recent Cryptolocker problem is anything to go by).

But having the system obviously ticks another box for those who confuse boxticking with patient care. By having a system that once again means all the responsibility still lies with the registrant even though they have no control of it is highly convenient for the powers that be. They get to have a load of committee meetings about the procurement, knowing full well that if and when it fails, and if and when patients suffer from it, it will be the clinicians who will get the blame for it. Having a system imposed from above without actually making sure it works is nothing new: lets face it the NHS hardly have a great track record in getting IT infrastructure correct out do they? Heaven help us if our friends at Capita get involved with implementing one of these systems; patients will probably end up with an 18 month wait instead of an 18 week wait. Still, at least losing patients in the system will make the waiting lists look good for the managers and they can get their bonuses for being so successful…..

So unless we get some form of indemnification from those who perpetually get to wash their hands of responsibility, I can’t see how we can use these portals and still adhere to our required standards. Please correct me if I’m wrong.

Image by Benjamin White

No one can have missed the inexorable rise in the use of social media for virtually every kind of interaction we experience in the modern world. From a few users 10 years ago there would appear to be now virtually every corner of the globe unaffected by it (except for maybe some long lost Amazonian tribes – lucky them).

Dentistry has not been slow to embrace this revolution, and as a mechanism of disseminating information world wide, sharing new techniques, and even asking advice about a case, then it there is no doubt that is it hugely helpful. Accessing social media though our smartphones is perhaps the most common application of this media, and it is thought that phones are now become part of the way in which we experience life, and how we form our memories. Certainly, creating a virtual scrapbook on our social media persona that shares with other people is something that will help you look back on events perhaps differently to how you did in the past.

But I worry that some people don’t understand the dangers of social media enough. I’ve written about this before on this blog, and the majority of what I said then holds true now. But there now seem to be some people who take the whole social media thing to be a benchmark by which they should measure their own lives against. There is a relatively new Facebook group called ‘Mental Dental’ which was set up to help dentists with some of the challenging mental health issues that can occur in our profession. Personally as someone who has suffered mental health issues in the past, I think it’s a pretty crass title, but the ethos of the group is actually a pretty good one. Whilst much of the time it might be seen as a moaning forum, there are some quite worrying threads that appear from time to time, and it may be that having this type of forum is beneficial to those wanting to ask advice, or just offload anonymously.

However, one of the recent threads that drew my attention was a post about how a practitioner felt he or she was so unsuccessful when compared to all the other dentists who were posting their personal and professional successes all over social media. This concern was so great in this practitioners mind that they were considering leaving the profession because of it. There has always been a degree of ‘Keeping up with the Jones’s’ in all aspects of our lives, and until one becomes satisfied with themselves as a person, there might always be a tendency to search for success via the medium of materialistic gains. However, what struck me in this case was what appears to be the sheer despair this person was feeling, and all as a result of what some people post on social media.

Social media to this person had become the real world, and the posts of amazing composites, perfect implants, and then fast cars, and exotic holidays was seen as the absolute reality of other peoples lives. The superficiality of such posts is obvious to many, but not to others who may already be suffering from a change in their perception of the world due to the mental health issues that appear to be quite common in our profession. It might not be so easy to ignore these sorts of posts when someone is feeling depressed by the profession, and the damage that this can then do could potentially be quite serious.

There seems to be a lack of humility generally on social media that is behind these types of posts. Whilst it is everyone’s right to post what they want and when they want, certainly the ‘Look at Me aren’t I great’, or the so-called ‘Humble brag’ type of posts sometimes serve only to sometimes make other people feel negatively toward the poster, or more worryingly, negative towards themselves. There is no background to a social media post usually, so the context is completely lost. Does the poster EVER have a bad day? Do they Ever have things go wrong in Clinic? Have they ever worried about their Health/Finances etc.? Given the tone of many of the posts we see, the answer to all the above appears to be no.

It’s important then to keep in mind all that happens on social media is NOT necessarily true, and that we should look more deeply into posts like this. It is vitally important that we should all keep in touch with the real world around us.

Social media is here to stay, but it needs taking with a large pinch of salt at times.

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

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

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

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

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

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

Indemnity.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Another New Year rolls towards us with still nothing particularly concrete planned regarding the new new new NHS Dental Contract. Ok, so there are prototypes running, but there doesn't seem to be any actual date that will see the beginning of a brave new world where all things NHS Dentistry will be rosy once again.

Prototypes seems to be the new buzz word rather than pilots, but unlike a pilot flying a new course, a prototype seems to be something cobbled together that might just possibly fly, but then again might not. The British are pioneers at making prototypes actually fly, but usually in the aeronautical sense. For this to happen it involves a degree of advance planning on the drawing boards, before making models, testing them in a wind tunnel, before finally making a version that might actually fly. There are some occasions where a test pilot has taken the front seat in a prototype only to have met a swift end when something has not quite been right with the design. At least the engineers then can go back to the drawing board and hopefully redesign a problem out of the next version.

But this is where the analogy with the NHS prototypes ends. Instead of learning from the mistakes and problems with the prototypes and design out the problem, the DoH apparently just ignore the data they don't like and carry on with the data they do like. All still fuelled by the ubiquitous UDA. Going back to the analogy, this would be like the designing a solar powered plane expected to fly at 600mph where the wings fall off at 500mph and you can only fly it at night. But since it looks really really good and the Government like it, you can get loads of people on board, so they'll order them. Anyhow, if it crashes, the Government will always blame pilot error. 

People working in the prototypes seem to have varying experiences; those in the blend A models (having a capitation for all band 1 treatments and claiming band 2 and 3's)  are reporting more issues than those in the Blend B (Both band 1 and 2 as capitation and band 3 to be claimed). But what is being reported generally is that access is going to go down with these new ways of working, whilst it is increasing difficult to keep the capitation numbers to target. Access is the only mantra the DoH have, and whilst they pay lip service to quality outcomes, you can rest assured that the only bit of quality they will be interested in will be how much they can claw back when the quality outcomes can't be met. Some of those in the prototypes don't even know how the quality aspect is being calculated as there don't seem to be figure made available (particularly to associates). Given that this is 10% of the contract value, not having the information on what you are being measured on seems to be a significant problem to me.

Having an entirely capitation based system (which will be what the BDA will try for) is better for practitioners ONLY when you have a government that isn't obsessed with output and not interested in the actual quality. By expecting the practitioners to provide the quality as part of their obligations ethically to their patients, and regulated by the GDC, the DoH can quite happily still place the blame at the door of the individual performers on any contract. Its win-win for them still. Anyone who thinks any new contract will be a dental utopia should probably consider leaving the profession now. Almost all commentators say that there is already little enough time to provide the output expected to meet UDA targets; the new system seems even more geared to allowing practices to struggle to hit the new targets. Even successful prototype practices are struggling with the capitation element, as they need many ore new patients to ensure the targets are boing met, but with no space to treat these often high needs patients until 2 or more months down the line, one must wonder how these increase targets are going to benefit good patient care in the brave new world.

Here is now data that shows the amount of principals in practice is reducing, with the increase in associates being proportional to that. However the change is quite extreme, with something like 83% of dentists now working as associates. This will be the norm in the future in my opinion, as with a downward pressure on the income of dentists generally it will become more and more difficult for associates to begin to invest in a practice of their own. I can see parallels with the optical and legal industries here, and incomes of £30,000 for associates becoming routine. Not only that, with the change in the way the new contract may be calculated, and the 'UBER' ruling recently about when self employed might not actually be self employed, then I can foresee a time in the near future when associates become true employees, with the associated increase in liability the employer then has (national insurances, sick pay etc) to cover reducing the wage structure still further. I am also aware of practices who have had to make members of the team redundant, such as therapists as they cannot make the system work for them due to the economics and logistics that seem to be inherent. Still, that's not going to be the DoH's fault is it? Just the dentists who don't run their practice the way the DoH want them to.

Don't get me wrong though; there will still be some highly entrepreneurial dentists out there who will continue to make a very good income from the NHS, but they will be at the head of larger practices or mini-corporates, and backed either by the fortunes made in this system, family money, or outside investors who can see the business model working. There is nothing actually wrong with this either, because fundamentally dentistry is going to be a service industry in the same way as a mobile phone company is, and you don't see all the employees in that industry getting the same salary as the chief executive. It becomes almost irrelevant that many of the 'fee earners' in dentistry are highly educated individuals supported by a well trained team; dentistry is just another 'widget' producing industry for investors to make a profit out of at some point.

One of the reasons that the profitability of corporate practices has been lower has to be due to the income proportions taken by associates. I have no issue personally with what associates earn, but the days of 50% are long gone in this new world, and probably 35% is more realistic for the future. Many law firms expect their fee earners to generate at least 3 to 4 times their salary in order to justify their continued employment. Only in this way will the corporates become as profitable as they need to be to survive long term, and they know this. Coupled with an increased difficulty in earning the udas if the new contract is like the prototypes, with quality frameworks and increased access, then a downward pressure on the highest cost base that can be influenced is certain. In any dental business of a certain size with associates, then I would be pretty sure that the highest 2 costs will be associate wages and staff wages. Only by controlling this aspect, and in an even harsher manner than previously, will the profitability that is needed for continued business survival start to be produced. How fast this will then follow in the smaller practices which have proportionally higher cost bases due to the lack of bulk buying powers is an academic argument.

To finally top this, the BDA  released a press release in the last week indicating just how poor the morale is within the profession. Although this has been known by the profession since at least the time Sheffield United last won a football trophy, they have now decided to let the public know the blindingly obvious. Once again the BDA's public condemnation of a system has been about as vocal as a mute mouse with a sore throat. It should be front page news that half of the UK's NHS dentists are thinking of leaving the NHS, but I haven't seen it in the papers today, but if it does appear it will be spun against us. I was informed (as I was writing this piece) that the BDA are now threatening legal action against NHS England for the patient charge revenue deductions made due to their interpretation of the 2 month rule. But will they get the spin right when they tell the public? Or will the Daily Mail run the 'Greedy Dentists Sue Cash Strapped NHS for more money' headlines because we haven't got a good PR image? At least the BDA are starting to do something positive, but the message has to be managed to our benefit.

So it remains to actually be seen just what might happen in the brave new world of NHS dentistry. Is morale going to improve, or will the DoH continue the beating of the profession until it does? Will there be more time for the quality that our profession is expected to provide? Will there be the correct funding for a First World service?

 Sadly, I think we all know the answers to those questions if we are honest with ourselves.

Political leaders are often said to have a honeymoon period at the very beginning of their new post. At a time where their political capital as at its highest, there tends to be a degree of ‘benefit of the doubt’ given and political opponents treat them well. I get the impression that due to the lack of political opponents to currently wrestle with means that Theresa May has had less of a honeymoon, and more like a ‘swift registry office wedding and straight back to work on Monday’ type of period. There has been no particular need to allow her into the post gently, and indeed she hit the ground running it appears.

It wasn’t quite the same with the new Chief Dental Officer. An initial period of cautious approval and hope that the new incumbent might be a less dogmatic and more approachable one than previously was supported initially by in increase in visibility, and the right kinds of sound bites the made many think this could be someone who is more in tune with dentists than was previously the case.

Well, it certainly looks like the honeymoon is over for our new Chief Dental Officer after the comments this week about routine examinations is anything to go by. Once again it appears the CDO has trotted out the underlying political message desired by the paymasters at DoH. What appeared to start out as a marriage that could work with the profession now appears to be heading for a divorce already.

The comments that were published in the Telegraph and the Daily Mail appear to rehash of those made in 2004 by Raman Bedi, and again in 2011 by Barry Cockcroft, both gleefully published by the Daily Mail, and no doubt trying to reinforce the opinion that the majority of the profession are money grabbing charlatans. The same old mantra is being rolled out by yet another incumbent of the CDO post, which despite its downgrade by government now to a junior supporting role, is nonetheless listened to by the press and therefore the public in order to give more ammunition to the incessant deprofessionalisation of dentistry as a whole. (Or so it seems to me).

In addition, the comments by former NHS Trust Chairman Roy Lilley in the same article that dentistry has become ‘a rich mans hobby’ provided in ‘lavish environments’ would be quite frankly laughable if it weren’t for the fact that they are so offensive. I’m sure he didn’t sit in an office furnished from a secondhand furniture store in a cold draughty office block, so why the hell should we? I could wax lyrical for a long time about my opinions of such people in NHS high office, but I’m sure much of it would give the legal profession many hours of extra work. Suffice to say the ignorance of comments such as this are what I would expect from a member of the ‘profession’ that continually commissioned excessive amounts of UDA’s year on year from D’Mello, and oversaw the disasters at Stafford amongst other things. Perhaps Mr. Lilley would be happier receiving his routine dentistry in the kind of environment that charities such as Bridge2Aid find they have to work in? Perhaps then he might be grateful for the small luxuries his salary allows him to experience. I would suggest he puts some of his money where his mouth is and donates to such deserving causes so they could ever hope to achieve a level of care that even the worse off in our society take for granted.

But I am more concerned the comments made by Col. Hurley seem to go deeper and are potentially more damaging to the profession than any crass comments made by an NHS apparatchik. Comparing the profession to garage mechanics is crude and whilst part of me can always find parallels with any other industry, it is highly disingenuous to make that comparison without thinking more closely. The analogy can be torn apart so easily on many levels.

With the GDC and CQC breathing down the necks of professionals all the time, I’m sure many of them would wish to have a working environment more akin to the relaxed nature (comparatively) of working in a garage. I can’t quite remember the last time the General Garage Council struck a mechanic off for using the wrong oil, or not explaining the different kinds of windscreen washer fluid before servicing a car. In addition, Col Hurley seems to forget that likening the situation to an MOT is also a bit silly, since it is a legal requirement that you have to submit your car for that test every year. Her comparison fails hugely at this point. Perhaps the situation with dental problems (especially that of the huge number of children admitted for GA’s) wouldn’t be as bad if people were compelled by legislation to see a dentist yearly as part of their responsibility to the others contributing to the cost of state run care? But then of course the state wouldn’t be able to afford it and would have to admit as such.

On the other hand, whilst continuing the garage comparison, preventative maintenance is the responsibility of the driver, and there is indeed a whole host of legislation in place to ensure this happens.  So if my garage (ethical and professionally run) recommend I get something rechecked in a period because the vehicle might be dangerous, then I would be foolish to ignore that advice both from a safety and legal point of view. I’m also not likely to blame the mechanic if my car breaks down because I haven’t looked after it.

That there are dodgy garages will be no surprise, but then we all know there are dodgy dental practitioners who, amongst other things, blatantly game the system because the lack of clarity in the current contract makes it possible for them to do so. I suggest however that there are a higher proportion of mechanics that are not ethically guided than dentists due to their lack of professional regulation, and to make an analogy between them therefore is somewhat clumsy and misguided.

Comments like these have more than likely damaged the working relationship between the CDO and the profession in my opinion, and shown that her

Honeymoon period is well and truly over

The open letter to the profession published in January in Dentistry from Col. Hurley suggested that budgeting the NHS funds appropriately was at the forefront of all the planned changes that she would suggest. No one would argue that this is appropriate and should be the way forward. In an era of austerity we have to look at how the finite funding is spent, and I personally agree that much of the NHS budget could be better spent than recycling the same healthy patients.

However, these are often those patients who take an interest in their dental care. When we have 50% of the population not attending a dentist at all, then the budget is going to be spent on those that do. Couple this to the failed UDA system that makes it a financial risk to take on too many high needs patients (who are often those who don’t value the service and miss appointments), then is it any wonder that the small businesses of dental practices need the repeat business of regulars to survive? The screaming lack of clarity that is present in the current contract, and in my opinion will remain in any new contract (purely because of the benefit to the Government and no-one else) is not likely to be addressed anytime soon. There is no appetite for the Government to officially admit dentistry is rationed, yet we all know it is, and instead a press release such as this could have helped both the patients and the profession by being honest about the amount of money the NHS has to spend on routine examinations.

For the first time, it appears an NHS manager (Chris Hopson writing in the Observer) has this weekend finally admitted that that aspirational wishes of the NHS are not met by the funding needed to provide them and rationing is likely in the future. Perhaps the ‘worried well’ that Col. Hurley is referring to as being seen so regularly should actually make way for those who cannot access treatment. Perhaps by publically endorsing a core service that is equitable for all would go a long way to meeting her desire to target the resources of the NHS more appropriately rather than once again making it the dentists fault as usual for the perpetual lack of funding to provide ‘world class’ healthcare for everyone.

So, instead of therefore criticising the dentists for seeing patients more often ‘than needed’, why didn’t she take the opportunity to actually say that the NHS can’t actually afford to fund this type of regular recall, and that it only has the funds to see patients once every two years? A comment such as this is more likely to get the support of the profession since we all know how poorly funded the system is, and yet it doesn’t alienate the profession so much. Suggesting then that the patients are still free to see their dentist 6 monthly, but under a private arrangement, would both inform the public of the truth about the parlous state of NHS funding, and gain the support from the vast majority of dental professionals by talking it out of their hands. Instead of encouraging the patients to question the integrity of the professional caring for them this would be more appropriate surely? It is a chance for her to stand together with the profession she is part of whilst still fulfilling the government need to obtain value for money with its funding.

What is amusing is the same papers ran a story only the week before stating that soldiers face a week in jail for missing dental appointments in a bid to reduce the amount of personnel unavailable for military deployment due to dental disease. Is this a not double standard? Coming from the military back ground she does, I’m sure Col. Hurley was aware of this issue before she became CDO. So when the public read these conflicting stories, how are they to make a decision? Is it that dental problems can be so bad that the army punishes offenders who don’t take responsibility for their dental care with jail; or that you don’t actually need to go to the dentist for 2 years? Which is the message about dental health that is correct?

We all have cases to robustly shoot down the 2-year interval theory. For instance, I have a low risk patient who I have been seeing for many years now. Probably one restoration every 6 or 7 years, good oral hygiene etc., and is in the early 40’s. At a routine 6 monthly I spotted a lesion under the tongue. This turned out to be a squamous cell carcinoma. It wasn’t there 6 months previously. They would be one of the patients that fit in the criteria of a biennial examination. I’m sure that would be of great help to a spouse and children if the patient had listened to the advice. Fortunately for the patient we expedited the referral appropriately. However, at the next 6 monthly, there was still some nodal involvement that we picked up. This fell between the review appointments at oncology, was pointed out to them, and now a neck dissection has been performed. Once again, the DENTAL problems were minimal.

What about the increase in the HPV+ types of Oral Cancer that are now being seen in younger lower (traditional) risk patients? Or subtle diet changes that misguided approaches to a healthier lifestyle involve that create more dental problems and more long term cost to the state? I can go on, and I’m sure there are many other examples that people can give.

I can think of NONE of my patients that I would be confident leaving for 2 years without some form of assessment. When you ‘get out of the mouth’ and look at patients as a whole it is astounding how many things can impact their oral health in so many ways, and 24 months is a long time indeed…Whilst I admit there are those patients who never seen to need anything doing, how do we know they won’t suddenly suffer a need for medication or have health issues that change their dental risk? Since the Government seem to fail to take responsibility for educating the population about the risks of the links between health and dental issues then many patients will not automatically seek our advice. When they then return with a mouthful of problems because of some misguided attempt to save the state money because we’ve had to accept the demand for a longer interval between assessments, then I know that we are going to get the blame, and the GDC and ambulance chasers are going to be rubbing their hands together in glee, whilst the DoH wash their hands of the responsibility.

I unfortunately have to keep hammering out to many of my local GMP colleagues that we are not blacksmiths any more, but highly trained medical and surgical colleagues who take a full view of the patient in a holistic manner, but concentrating on the head and neck. It would appear that solely concentrating on just the teeth and gums is what even our CDO feels we are doing given the tone of the comments in the press. I wonder when the last time she actually fully assessed and treated a patient from start to finish, and whether of not the pressure of a real (and not with an institutionalized cohort of patients) dental practice has been experienced.

The BDA press release the same day was suitably pithy; but in reality the message wont be important to the public given they usually jump on any chance to further hate our profession.

But if the headlines actually said something like ‘Dental Trade Union refuse to negotiate with Government’s ‘Top’ Dentist’ then this might allow us to start to get our message across. The DoH is perfectly happy to sensationalise headlines to further their own ends, so it’s about time we did.

Just recently things have been relatively quiet in the area that I usually write about. The GDC seems to have realized the mistakes of the past, and the new executive appears to be making overtures about re-engaging with the profession. Slowly but surely many think there might be a break in the thunderclouds and a glint of sunlight over the profession where our continued regulation is concerned.

One would like to think that there are significant inroads being made by the BDA on our behalf as a result of the regime change at Wimpole Street. However, I think many will doubt this, especially when the GDC themselves have actually questioned who leads our profession.
Surely this is an indictment of the profile of our Trade Union and representative body if those at the regulator have to question whom is actually in charge of dentists? It isn’t the Chief Dental Officer, who is more of an advisor to Government than a figure the profession can rally round. Its definitely not the Head of the GDC. There are many ‘celebrity’ figures in Uk dentistry who give themselves the title of ‘KOL’ (key opinion leaders) but again they are really not the leaders of our profession, often just opinionated souls who have some form of medium through which to express their thoughts (and pictures of their cars!). It’s certainly not organisations like Dental Fusion (or should that be Dental Futile?) and other professional organisations who have very limited memberships.

It really is quite obvious then that it should be the BDA. Whilst there are some strong figures within the organisation, and the work that is done by the employees is excellent, it still seems to suffer from an apparent inertia and lack of awareness as to what it could actually achieve. Whilst it no doubt provides some excellent member services, (such as employment and general advice and the library) it seems to frequently live up to the expectation of the profession as a body that drives really changes.

Take for instance the removal of registrant addresses from the GDC website. I’m pretty sure this has been on the ‘Work in Progress’ list at the BDA for some time. Yet it takes one petition by an individual and the GDC not only look at it, but actually manage somehow to change the entrenched view of Chairman Moyes himself. Now the BDA can say that they have done lots behind the scene, but there’s no use doing this and seemingly not achieving anything, especially if it has been going on for years. To then jump on the bandwagon and claim that the issue being raised by the GDC earlier this year was solely as a result of the BDA exerting pressure (when I happen to know that people at the GDC acknowledge the pressure came from the petition) is a little bit naughty.

The BDA is also the only dental body invited to the table with the DoH when negotiating a new contract. To give an analogy from mother nature; This is a little bit like a seal sitting down with a Great White shark and agreeing on the least painful way of being eaten alive. Evolution has taught many creatures to not get involved too closely with the apex predators, yet the BDA continues its same path in the forlorn hope that one day the shark might have indigestion and the seals won’t get eaten. It will always argue that it is there because of those of its members who haven’t any option other than to be seals and swim in the same sea as the shark. Evolution by supporting other options for these practices has always seemed to be low down on the agenda. Shouldn’t leaders of the seals be telling its members to try to keep away from sharks? Won’t the sharks have to evolve themselves or eventually starve to death?

Another example is the pressure that the BDA should still be putting on the CQC. The CQC has not been the subject of my blog at all in the past, and given the fact that I have been a huge critic of them has surprised even me that they haven’t suffered from my ire yet. Since the appointment of John Milne as their National Advisor there has been a distinct increase in the quality of the inspections generally. There has also been the publication of the ‘Mythbuster’ series of articles on the CQC Website . However, it is apparent that even these can suffer from misinformation. In particular the one regarding radiation protection is riddled with errors that make the further entrenching of incorrect information more likely to be referred to as absolutes when they are not. The fact that these errors might then be referred to by the GDC as the CQC is seen as an authority when charges are brought against a practitioner mean that there can be potential for miscarriages of natural justice.

Whilst there is no intention to mislead, when there is an incorrect interpretation of the legislation, rules, regulations etc. by such as the CQC (who we can argue should be an authority themselves anyhow and shouldn’t make errors like this at all) then the BDA should be swift to bring these errors to the attention of the CQC and more importantly the profession in general. This shouldn’t be in a ‘behind the scenes’ manner, but much more publically. We would then know what they are doing. This is not to embarrass the CQC in any way, but merely to demonstrate the obvious authority the BDA should be seen to have, and command the appropriate respect. Once again these errors were brought to the CQCs attention by an individual.

There is a quite frankly ridiculous amount of legislation that governs the practice of dentistry these days, so much so that it is virtually impossible for individuals to keep on top of all the different aspects of compliance. It is vital therefore that whoever leads our profession has an organizational structure that should know all the things governing and legislating dentistry so intimately that at the first sign of a new urban myth appearing somewhere (and they should be aware of where all these myths originate – looking on GDPUK r Facebook is usually a good place to start) there should be a very public and robust re-affirmation of the real legislative and regulatory situation, and with absolute authority and clarity such that the myth is immediately disproved.

I’m sure we can already hear the cries from the BDA that they already work in this way at the moment for their members, and this is true to a degree, but this is usually in a completely reactive and individual manner, and you usually have to actively seek out this information yourselves. Given the sheer volume of stuff that is out there to comply with it is very simple to get caught up in some of the less controversial urban myths such that they become the new fact, and thus perpetuated more. So you actually have to know something is wrong before you question it, otherwise you will automatically accept it is true and thus it becomes the ‘done thing’ as everyone ends up believing the myth. Just like the obligation to record batch numbers of LA in the notes is a myth.

What about jumping on the incorrect use of standards by Expert Witnesses when these are used in GDC hearings and further entrenched by the rulings? Why hasn’t the BDA produced a definitive standards document regarding an acceptable (not minimum or aspirational) standard that items like a simple dental examination should include, and be recorded in the notes? After all, there is enough expertise within the BDA that a consensus document could be produced simply enough. If it has (and I may have missed it admittedly), why aren’t the Expert Witnesses then referring to a document like this as authority? Why haven’t the Indemnifiers mentioned the existence of a document like this in the defence of colleagues? (and why haven’t the indemnifiers produced one either, perhaps by working with the BDA on it?).

Why haven’t the BDA come down like a ton of bricks very vocally on those LAT’s that transgress or selectively (incorrectly) interpret the regulations? If they have, why haven’t they shamed them so publically so that other LAT’s know they are a force to be reckoned with and won’t try it on with other practitioners?

Finally, what about the headlines in The Times this weekend about (surprise surprise) dentists ripping off the public? There doesn’t seem to have been any attempt by the journalists to even contact the BDA for a comment. Surely one of the first organisations to be approached for comment on a story like this would be the association that is supposed to lead dentists. Or is it that even the press think that a comment from the BDA would be about as strong as a wet tissue? At such a time there should be an automatic and robust defense of the professionals, whilst simultaneously showing the failure of the SYSTEM that they work within, and laying the blame squarely at the door of the DoH and Government.

The BDA really should sometimes show its teeth much more readily (no pun intended). But the only time they have done anything approaching this was the Judicial Review into the ARF in 2014. Even then there didn’t seem to be an ability to press home the victory and hitting the GDC whilst they were still reeling. Rather it seemed to all be ‘behind the scenes’ as usual and waiting for the Health Select Committee to grill Gilvarry and Moyes. Where was the tactical approach of ‘putting the boot’ in when it was most needed?

I will admit that political activism often needs to be done behind closed doors, but we need to know that when this is what we are told is happening, something IS actually being done, rather than just being talked about. The reputation of the BDA is such that many feel it never seems to be achieving anything, and therefore people think that it never does. There are so many issues in dentistry that appear at any time, and the BDA suffers from having to be everything to everyone. But surely there is a common theme amongst all in dentistry that our professional association should be there to lead the way vocally and proactively. Instead it often appears to be more a reactionary organisation with the attitude of ‘mother knows best’.

Well I’m sorry, but given the achievements that individuals have made recently in engaging more successfully than the BDA have, would lead me to suggest far from ‘mother knowing best’, mother is now someone who needs to realize they might actually be past it and new ideas and a new approach are needed.

There are a few vocal people in the BDA, but there are also others who seem to be anonymous and conspicuous by their seeming lack of inspirational leadership. Leadership means setting a visible and vocal example that others can then assist them in taking things forward and more importantly want to take forwards despite the obstacles in the way. It’s certainly not getting behind other people’s crusades and then saying look at what we did to get this done. I know of a good many people within dentistry, many of them household names (and for all the right reasons) who are disillusioned that there is no flag we can rally round as a profession; so much so that groups of like minded individuals are now beginning to draw together in order to do what the BDA should be out there doing.

Which is to Lead the profession.

At the same time, there has to be an acknowledgement of the postion that dentistry is in within the bigger sphere of healthcare. We will never have the public support that the doctors can call on, and we only have to look at the way the Government have played hard-ball with them over the recent contract ‘negotiations’. Lets face reality here. We will not get any concessions, there will be no more money and the conditions will not improve. We have to accept this and move on. The definition of stupid is often said to be doing the same thing over and over again and expecting different results. I think we can quite easily argue the BDA continue to do the same thing over and over again…..

No doubt many of the BDA hierarchy will be offended at this piece; but quite frankly they perhaps need to be. I’m sure there will be suggestions that I should put my money where my mouth is and stand for the PEC. Perhaps they are right. But since I don’t have all the answers I shouldn’t put myself forward as a leader of the profession. But even if I did, the problem with this is that one person will always come up against the establishment, which believes ‘this is the way we’ve always done it’ and ‘we must think of the members’. Paralysis by fear of the unknown results. It would need a radical change to the entire structure and I’m not convinced the more traditionalist members within the BDA would go for that. Open up votes to those disillusioned and no longer members of the BDA then it might be a completely different situation, but then that obviously couldn’t happen.

I’m sure those most annoyed with this blog will be those who have the least reason to be because they probably feel I am not acknowledging the things that the BDA have actually achieved. I’m not having a go at any individuals; but it’s those who wear the BDA badge and don’t do anything vocally, visibly, or productively to manifest change. Being hamstrung by the often archaic position of the trade union often means it is easier to maintain the status quo or just score pyrrhic victories than really trying to elicit the change that is needed.

The recent membership questionnaire is a start to finding out just what members think; the problem is it’s not the members they need to be asking how the BDA can engage more. The very people who are disillusioned with the BDA are not going to be members by definition. Bleating on about joining so your voice can be heard is beginning to wear a bit thin to many of us I’m fairly sure; why join something so you can submit a survey once in a blue moon especially when they refuse to listen to why you might not be a member? It’s a Catch 22 situation that needs to be broken.
 

The BDA needs to ask the ENTIRE profession what it thinks about it. The GDC seems like it is going to try to engage with us as a result of unprecedented problems and the change in executive manpower bringing a fresh look at the issues. If they can do it when constrained by legislation then there is no reason the BDA can’t either.

Its time for the BDA to show just what sort of leaders they really have.

Calm Down, Calm Down, Calm Down

The words of Harry Enfield’s bubble permed Scouse's of the 1990’s are perhaps the most apt at the moment to describe how I feel about the outpouring of angst on the result of the EU Referendum.

Alternatively, to plagiarise somewhat Winston Churchill,

            "Never has so little sense been spoken by so many in so few hours"

I am probably about to join that increasing pile of rubbish, but thought rather than add fuel to what appears to be some as a bonfire of Liberalism and Tolerance I’d try to get a bit of perspective back. I’m certainly no political commentator, (and once you read this you’ll probably agree!!) but I do feel quite strongly how this has developed over the weekend. The sheer vitriol that has been produced in such a short time has been nothing short of shocking, but at least we now have got some real political debate and possibly change on our hands. However, we all need to calm down and stop falling out, because BOTH sides have valid points in my opinion and the only way to move forward now is if we calmly look at the big picture once again.

Because we haven’t actually left Europe. Not yet, and we will not in the next few weeks, months, or years. The referendum was a non-binding one, and merely the biggest opinion poll that has been run in this country for years, albeit with slightly more weight than most have. Unlike the Alternative Voting referendum in 2011, which had a legally binding result, there is no legal duty for a Government to act upon the result of Thursday’s result.

That’s right, Government has no obligation at all to actually heed the result.

It’s certainly monumental that the UK has voted in the way that it has, and there are a multitude of reasons why individuals will have done so. Many of them will have been misguided in other’s eyes, but all of them were personally valid ones to the person who was actually entitled to put their cross in the box. But we have seen the biggest turnout for years that has galvanised the electorate in way that I thought would never happen (now if only we could mobilise dentistry the same way…). This was always going to be a subject dear to the hearts and minds of the populous. It’s a shame that many of the most vocal of those who now feel betrayed by the decision were the ones with the lowest percentage turn out (the 18-24’s having less than 40% turnout). Perhaps there should have been a button on Facebook, or Text your Vote to allow that sector to vote? After all, many of them expect instant and easy solutions without having to actually physically get up and do something…. In addition, a democracy can keep continuing to vote and vote and vote until it gets the answer it wants.

Politically, I am of the opinion that David Cameron has played a political masterstroke. Unlike many, I was not shocked at all when I heard of his resignation. This is a man with an exceptionally astute political mind, and the outcome (although unexpected by many) will have been modelled by advisors. If we read into what he has said in the past, he had only alluded to the fact that a leave vote would result in the British public ‘expecting’ the process to leave the EU to be started straightaway.

An expectation by the public is not the same has an obligation by a politician though, and with his resignation, he has delivered what can only be described as a Hospital Pass to his successor as Prime Minister. For the formal process of leaving the EU to begin, Article 50 of the EU agreement relating to departure has to be formally invoked. Now, it is unclear if the invocation of this can be made by only the Prime Minister, or whether (more likely in my opinion) it has to have been voted on by Parliament in order to become formal. However, the result of the referendum, DID NOT invoke this process, and no matter what the EU Bureaucrats say, the UK is the only entity that can start this process.

So, a political hot potato has been deftly delivered by David Cameron as his last act in office. A new Tory Leader from the Leave side will have to either go against the referendum result, which will immediately destroy their personal credibility and therefore the faith of many people in their suitability to be Prime Minister, or they will have to activate Article 50, which then will probably have to go through parliament to be voted on. If they don’t do this immediately, then doubts about the suitability of the new leader to govern will set in as well. Is this not a most beautiful revenge on his once close allies Boris and Michael? In one fell swoop Cameron has called their bluff magnificently. ‘Leave’ now has to put up or shut up, and either enter into negotiations with the EU saying it was all a ploy to get further concessions, or activate the Article 50 clause, which might be their own political suicide if they don’t truly believe in what they have achieved.

I think we will then have the prospect of a snap General Election that could once again change the political face of the UK and re-establish a new political balance. One that might have Remaining in the EU as one of its fundamental promises. That’ll give the electorate who are currently appealing for a ‘best of 3’ approach to democracy to have another go at influencing the decision. However, quite as possibly with be a further endorsement of the desire to leave, but then there becomes a true mandate for a new Government to act upon. It’s like pressing the Reboot switch.

We have now heard that the Scottish MPs under Sturgeon will actively block the departure of the UK from the EU if this goes through parliament for a vote. So nothing at the moment is a given for the UK actually managing to leave the United States of Europe. The majority of the political commentators will know all this but cynically I’m of the opinion it serves the purpose of the media to keep all the froth and agitation going at the moment to confuse the populous even more and influence how they think whilst selling papers.

And the leaders of country with such political ability in the world didn’t see this outcome as possible?????

I suppose I should have a few opinions on what this means in Dentistry then. Well, for a start the GDC isn’t going to be affected by it at all. The Dentists Act 1984 is a piece of UK legislation and whilst it has EU aspects covered by such as the Human Rights Act and Data Protection Act, and has to be compatible with EU tenets of law, nothing within the day to day interpretation of the Act is likely to be affected by what happened last week. The same is true with the CQC. The UK is wonderful at developing infrastructure like this, and certainly doesn’t need the EU to make a business out of bureaucracy. There certainly won’t be a bonfire of the dental Quangos whether we stay in or out is my prediction.

There are a significant number of EU graduates working in the UK, and I don’t see any evidence that coachloads will be shipped back through the Channel Tunnel before it is bricked up overnight. What might actually happen though is that the corporates might find their supply of naïve EU dentists dries up due to the uncertainty of the future direction of the UK, and they might actually have to pay a competitive income to get people to work for them. This will no doubt affect their bottom line somewhat, and they might actually find they are now susceptible to the same pressures that normal practices are under and have to adapt the same way as we have all done. This can only be a good thing in order to restore the competitive balance in our profession.

What also might be beneficial to dentistry from leaving is the restoration of parity to our own graduates. Those who graduate from the UK have to complete foundation training before being allowed to work in the NHS, yet those from the EU don’t. Not only that, because the EU training is seen as equivalent to the UK, we cannot impose requirements like the ORE on them. Are all the EU Dental training courses the same quality? I think some of us might disagree that every single course is.  Surely this has benefitted those from the EU more than our homegrown graduates, and this potential discrimination can be possibly now be addressed in the future.

We still don’t really know what will happen with the prices of dental goods in the long term. Much of it is indeed made in the EU, but the USA and Asia are also vast markets, and not necessarily unified like the EU. China as an emerging market has already rocked the world of the dental technicians, and there is no reason why that cannot happen in the rest of dentistry. Admittedly controlling quality is going to be the issue, which worries me, but there are also some highly ethical businesses there that would work well within dentistry. There will be inevitably be some adjustments of prices because of the strength of the pound, but equally there is now an opportunity for entrepreneurs within the dental supply chain to start ‘disrupting’ the usual model.

The one thing we are unsure of is the overall effect on the general public and their incomes. Potentially this is huge, and the instability that is coming will affect them to an unknown degree. It is notable that the professional advice from the likes of the Bank Of England is to keep calm, whereas those who have a self interest, either towards the EU, or financially, in keeping the markets volatile is to Panic and Run Away. I know what I shall be doing. At times like this speculators usually manage to be the overall winners anyhow, so it’s in their interest to keep earning their money how they always have done.

But all this pre-assumes we will actually leave. I’m afraid I don’t believe the upper echelons of political power (and by that I don’t mean government but the high level civil servants who are in post despite what political flag is flying over Westminster) haven’t already worked out what their long game is and planned their chess moves accordingly.

So, we need to keep calm, because we haven’t actually left yet, and I personally don’t think we were ever going to….

Though the real question is can we trust any of them anymore?

Image credit - Muffinn under CC licence - not modified.

I’ve been at the BDA conference in Manchester last week, and as usual have thoroughly enjoyed the networking that this event always brings. I’ve finally met people who have been virtual friends for some time and caught up with those who I’ve known for years. However for me there were two distinct highlights to the whole event.

Firstly, there were two people who I really did not expect to bump into, let alone have a conversation with. We have for so long been under the thumb of an unapproachable and unrealistic regulator that it took me by complete surprise to see that both the new CEO of the GDC Ian Brack, and the Head of Fitness to Practice Jonathan Green were not only present, but actually in the bar of the Hotel where I was staying. Given the previous CEO’s somewhat adversarial attitude towards us lowly insects trying our best despite the ever increasing pressures on us, and her distinct lack of engagement with the profession, to actually see the new CEO of the GDC present at the conference was a positive revelation.

Obviously me being the shrinking violet that I am (and fuelled a little bit by the generous BDA Drinks reception), I felt I had to speak to him. Now, I’m sure many of you would expect me to have launched full tilt with a somewhat barbed attack at the legion failings of the GDC management structure over the past years, but I’m afraid I have to disappoint you all.

I actually thanked him.

I thanked him for taking a step in the right direction and showing his face at the conference, because this is a step that was NEVER been taken by his predecessor (and also not by Moyes to my knowledge) and in my opinion showed that he might just possibly be aware of the damage that has been created by the culture so apparent over the last years.

Its early days I know, (and the jury will be out for some time yet) and I had only a few brief words with him, but in that short conversation I was left with the overriding impression that this might be someone who is prepared to work WITH the profession instead of against it. Since the care of patients is a joint responsibility of both the profession and the regulator, he agreed with the sentiment that therefore we are effectively ‘in it together’. Not only that, but there was an approachability and an authenticity that came across very swiftly in a short time.

Now, before you all start thinking that I’ve been somehow subsumed by the GDC into changing my tune completely, I can categorically assure you I have not. In the week that a FTP over homeopathic dentistry was thrown out after 2 years of stress for the practitioner, when it could have been dealt with by a swift letter saying you’ve got a month to remove your claims, then it shows things still are far from right. But we have a huge backlog of cases some of which are only now surfacing. Like a supertanker, the GDC isn’t going to turn round quickly, and I think there is still more that can be done publically by them to build some bridges. For instance, where was Chairman Moyes? Shouldn’t he do something to try to learn about the profession he regulates, or was he busy learning about washing machines and other consumer products since he thinks dentistry is so closely related?

Perhaps we are approaching the time when the GDC changes from a reactive organisation to one that is proactive (like the GMC). Where does it say that the GDC can’t give us advice in a positive and supportive manner? Rather than building their remit as Bill’s complaints handling super empire, why not give some more vocal and obvious guidance on how we can avoid the wrath of the regulator? Being proactive to prevent problems will be surely less expensive than reactive and shutting the stable door once the horse has bolted? It should also cost us far less in both the ARF and Indemnity. After all, this is what patient safety is all about, and that is their remit as set down in law.

I think that the growth of the FTP Division of the GDC was (and maybe still is albeit more slowly) growing at such a rate that it would be unsustainable within the next 5 years. There would have to be an ARF of such a huge amount that it would result in it being almost as ridiculous as some of the indemnity figures out there (another sore point) and there would be none of us left allowed to practice if we didn’t pay. I suspect there are people at the GDC who know this, and that there might now hopefully be a concerted effort to get back on track. Perhaps a raising of the bar where misconduct is concerned would be a start.

But getting it back on track will need the concerted effort of many people. This brings me to the absolute highlight (for me and I know many others) of the entire weekend. The presentation by Colin Campbell regarding his fitness to practice experience with the GDC.

Such a passionate, humble, ego-less, and at times emotional presentation has not been witnessed at conference for many years, if indeed ever. But it was not a dig and a rant at the GDC. Far from it. It was a clarion call for the profession to unite to change the status quo we find ourselves in. A call to develop a working discourse with the GDC (and NOT behind closed doors or behind the scenes). A suggestion to develop standards of dental care that can be defined in the literature that we can all follow, including the Expert Witnesses, some of whom still seem unaware of their duty of impartiality, and the correct standards to apply. A request for a meeting of the minds of the profession to leave their societies, their egos, and their self-interest behind and to unite for one cause.

To Protect the Patient.

Never has a focus on what is the singular most important thing in our profession been so starkly and beautifully pointed out to an audience.

Using data from a survey of almost 1500 dentists that had been offered to (and declined by) the BDA previously (and correctly statistically analysed so it was robust), in conjunction with live voting from the audience using the latest app technology, it confirmed not only that 90% or so of us felt the GDC wasn’t helping patient safety, but that the majority of dentists practice defensive dentistry. What was probably more embarrassing for the BDA was the fact that the majority of the audience, who were all members of the BDA, felt their trade union was not doing enough.

This blog is too brief to describe the entire lecture. However, the electric atmosphere in the largest hall of the conference must be mentioned, when at the end of what must have been an emotionally draining time for Colin, the entire audience stood and gave a standing ovation. Never in all the years of attending conference have I ever witnessed such a phenomenon. Such was the power of the presentation and how hard it hit home. Never has an audience been so united by one person so humble and considered in what he said.

So the message is simple. We can begin to elicit change now. The smouldering match has been lit, and the kindling has been placed. All that is now needed is for the entire profession (and in this I include those at the GDC who have an appetite for doing the right thing) to unite and fan the flames. Any egos will extinguish the fire, and so will the draft from the closing doors to rooms where traditionally the discussions have taken place. The positions of those straw men and women of the General Dental Council who have been nothing more than puppets to the Guy Fawkes will not survive the gathering heat.

This tiny glimmer of hope can become an inferno of change.

It would appear that I have to make an unreserved and wholehearted apology to the entire profession. You might have read my blog of the 1^st April, and for those who didn’t realize it, this was an entirely tongue in cheek observation of the profession in general.

However, in my attempt to take a humorous look at dentistry and so e of the characters that inhabit it, it appears that I was closer to the truth than I thought. It appears someone has taken it a little too seriously as only a couple of days later the real life manifestation of ‘Speedy Smiles’ seemed to appear in the guise of http://straightteethdirect.com. I didn’t bother patenting the idea as I thought it was too far fetched, but obviously someone saw more potential in it than I did.

Now many of us felt that this was someone just perpetuating my joke a little longer, but alas, it seems that this is a real defacto business.

I am aghast. I must apologise unreservedly that my joke has become someone’s new business plan.

I’m all for innovation in dentistry and long been a supporter of it, but it has to be in the patients best interests and above all ethical and moral. There are some true innovators out there who combine aspirational patient care with inspirational treatment ideas, and the profession and our patients are all much richer for that. In fact, there has always been a trend for the true innovators in business do something totally ‘disruptive’ to the models that we know. Apple have built an entire lifestyle culture around their products and their innovative ideas of how we do things such as listen to music and purchase software. So much so, many of the old media systems are becoming defunct. And what about the rise of Uber? Having a disruptive view of the taxi service has lead to the inexorable rise of this new service provider, and certainly divided opinion in the sector. Whilst it can be argued that a new way of providing dental care to the masses is precisely one of these types of established market disruptions there is an enormous difference in our market over that of taxis and phones; that of patient safety and our ethical responsibilities.

I’ve long been arguing that we seem to be in a race to the bottom, and it appears to me that we are now plumbing some new depths that I even I thought our profession would never reach. For me to invent a company one week and then find my overactive and warped humour has actually been closer to the truth than I thought has been a shock to me. This new company has very little information on its website, so there are many questions that need answering. I have indeed tried to ask them, but lo and behold, the ‘contact us’ link doesn’t work. How better to avoid having to answer awkward questions than to have a dead link on your website?

A bit of digging reveals that this business venture is actually headed by a UK dental registrant. I can only assume that they have been in some form of suspended animation for the last couple of years whilst the GDC has trundled its way through the profession like a bulldozer in the Amazonian rainforest. Only someone who has been on a retreat to the deeper depths of another planet without any form of contact with the UK dental market could actually think this is sensible move.

This raises so many important questions that I’ve tried asking but had no reply. For instance:

• How on earth can an entirely remote system of diagnosis and treatment planning meet with any of the GDC standards?
• Where is the duty of care?
• Does a specialist diagnose the malocclusion?
• Are all the technicians GDC registered? (I am lead to understand it is a UK laboratory providing the service)
• Who will be stupid enough to provide IPR on a patient who you have no relationship with, not knowing the final treatment plan?
• When some dentists can barely take impressions, how do you expect patients to do this?
• Who is responsible when (not if) the treatment goes wrong or doesn’t meet expectations?
• How are the distance selling rules and cool off periods dealt with?
• How does the legal responsibility to determine the material risks to a patient we now have because of Lanarkshire v Montgomery square with this?
• Who are the ‘assigned dentists’ who oversee the cases? Are they orthodontists or graduates of the Academy of Seen One Done One Taught One?
• Is this actually a ploy to drive the patients to affiliated dental practices for the work?

I am sincerely hoping that the indemnifiers for once use their discretionary power to withdraw any support from this venture if it is as ill advised and crass as it appears.  Certainly I hope that none of my money will be used to defend such a venture, so one can only hope the person behind this has enough personal wealth to back it themselves if patients suffer, and not ‘Cameroned’ it all off into an offshore haven.

If I may give a medical analogy, would this company jump on the opportunity to allow one to buy a kidney on line and cut out the middle man? Is that ethical or even legal? Would they offer to deal in controlled medicines direct to the patients without proper prescription? Because this is in reality no different to what is being offered. A set of pictures and models looked at remotely are NO substitution for a full examination, and that should be from an experienced practitioner in the field. The provision of dental care is like any medical specialism and as such is governed by legislation in order to protect the patient. It is just like any other form of treatment, and whilst I’m in full support of marketing and the development of new initiatives to allow patients to seek treatment more easily (so I’m no dinosaur) this is a step into the black hole of dubious ethics and seems driven more by the financial gains than the desire to help patients. And on the subject of Dinosaurs, just because the technology probably exists to recreate one of those genetically, that wouldn’t make it right. Technology needs ethics and a moral compass to be used for patient care, and this venture doesn’t seem to have either from where I sit. I know many people that agree given the chatter on social media.

Whilst it sticks in the throat to admit it, one only has to look at the crass forms of marking that sometimes occurs in dentistry to have to sometimes agree with the GDC that its pursuit of the profession is justified, because there really are some people who should be ejected from our profession forthwith. When you have aggressive tag lines such as ‘Click Convert Sell’, (which is also something to do with the same registrant behind this venture), and things like ‘Best of the Best’ awards for ‘piratical’ dentists,  one only has to recall the mis-selling of PPI in the 90’s to think this is probably going to visit our profession very shortly with this sort of venture. We will all suffer then, but usually the main perpetrators of these things get away with it and it’s the rest of the profession that has to pay.

The Orthodontists and GDP’s have long been at loggerheads, and will probably remain so, but this really is something that they should now get their heads together over. It appears to me that most of the time they seem to argue about the evidence base for this that and the other, and rarely come to any conclusion other than the other side is wrong. But I think they both might be able to pull together on this one, and agree for once that there probably really isn’t much in the way of proper studies that show the success of a self administered orthodontic alignment system that would stand up to peer review of any kind.

Perhaps the BOS can therefore simultaneously build some bridges and produce a press release and advert this time that would be also supportive to GDP’s in their condemnation of what appears to be a dangerous venture. At least if a GDP goes on a weekend course for the latest fad system, the patient has recourse to a real indemnified person (the dentist), and there is a human input for the patient to discuss issues with. A duty of care has been established and the refined law of this land will recompense for any negligence that ensures. With an entirely digital system (and one that doesn’t seem to have the ability for you to contact easily) then where is the necessary communication that patients will need when things go wrong? Who is responsible? Will it all be down to a dodgy impression the patient sent? Will it therefore always be the patient’s fault?

I would like to formally invite the person behind this venture to enter into a public discussion on this forum as to the business plan, the problem solving modalities, the indemnities in place, and the ethics and morals backing this new venture. I’m more than happy to be proved wrong (as I’ve spent my entire marriage being wrong according to the wife!), and it might just be my ignorance that is making me have these concerns. Perhaps we can invite some of the indemnifiers and maybe even borrow one of the attack-dogs of the GDC (once they’ve sated their appetite on a single issue complaint of course) to referee the discussion and give us their input.

So come on. Lets discuss this professionally. Surely we haven’t reached the point where the profession has eaten itself?

Image Credit: Emily Davies

In a parallel universe….

We have recently learnt of a new entry into the burgeoning short term orthodontic market in the UK. Due to launch on the 1^st April 2016, this news comes as a GDPUK exclusive.

Speedy Grins is a system designed to fit as seamlessly in to a practitioners armoury in the same way as 12lb lump hammer would in a florists. Based on a revolutionary bracket design, where the individual brackets are made from papier mache and dissolve after 3 months whether the teeth are straight or not, the system is backed by 12 hours of extensive research from the Baywatch University Lifelong Learning Self Help Institute of Technology. The unique selling point is that it is the first system to guarantee no extractions will ever be needed for treatment to work. As a result they claim this will make GDP’s ‘experience the same joy as orthodontists do at never having to take out teeth anymore’.

There is a sister product called Slanted Smile which is exactly the same as Speedy Grins, and only comes into being at the end of treatment when the analysis of the smile is done; if the teeth are straight then the patient had the Speedy Grin treatment, and if the teeth still look they were thrown at the face and stayed where they landed then the patient bought the Slanted Smile Product. The company claim this is the first example of a “Patient Responsive’ system. Dentists upload a drawing of the patients teeth, and using their patented treatment planning system called the ‘Central Responsive Analysis Program’ which is designed to give the patient an indication of what someone else’s teeth would look like in their mouth, a treatment plan is formulated by the company, and then the components are sent back for fitting. The company obviously take full responsibility for the treatment planning result, making this ideal for the beginner to ‘orthomadontification’, as the company have called the technique.

The company is headed up by entrepreneur Rolf Pialo who realized there currently aren’t quite enough orthodontists angry with GDP’s at the moment and he saw a hole in the market which he swiftly stepped in to fill. Claiming the system will move teeth ‘faster than a speeding hedgehog’, the brackets come pre-glued with a revolutionary 76^th generation cement which only has to be held next to the mouth for the bracket to automatically find and attach itself to the correct tooth. A bond strength ‘stronger than wet tissue’ is also claimed.

The training is a 22 minute FacetwitTube video which is presented by the celebrity dentist and system endorsee,  Dr Sean One-Dunnwan, who was recently voted the 945^th most influential person in Ovine Dentistry in the Falkland Islands after qualifying last week. Apparently there are only 11,782 places left on the next course so people need to hurry before it sells out completely. In an exclusive interview recorded from behind the wheel of his new rented 701 ½ bhp Porshabentlighini, the celebrity toothsmith explained why he got involved with the new system. “It’s basically the best thing since the last best thing before the previous best thing I was involved with so that’s good enough for me.” Unfortunately he had to cut the interview short as his tea was ready according to his mum.

There has been some controversy (as there always is when these new systems come out) that this will affect the business models of the specialist orthodontists, but the company behind Speedy Grins are adamant that given their experience in the Oral Surgery Sector with their MegaSupaImplant system and the huge increase in workload for Oral Surgeons now taking out simple retained roots and mobile teeth so the delegates on their Advanced Implant technique 1hr course can start placing their products means that the Orthodontists should have nothing to worry about. So much so that they have also added a free refresher course to their portfolio to enable orthodontists to fill the gaps in their books with premolar extractions instead.

As part of the package, delegates will also get free marketing materials endorsed by Marketing ‘Guru’ and failed Seal trainer Billy Bull consisting of a badger suit, 3 stuffed gerbils, a tin of lilac paint and a pink biro. There is also a version with a costume of a Parus Major as well for those who want to make a great tit of themselves.

The system is already accredited by a new regulatory body, the General Expert Specialist & Technical Amalgamated Professional Organisation who have already started recruiting case handlers from Costa and Starbucks in anticipation of the increase in patient complaints arising from the use of such an advanced system. We understand they think the patient is unlikely to be able to consent to the treatment without a 17 year cooling off period and explanation of the procedure in Andalusian interpretive mime with Gaelic Subtitles. Work is well underway to ensure the ‘Organisation’ meet their new targets. As a result, their new gallows facility will be constructed from a variety of materials, including the finest aged mahogany and oak (although pine would have been sufficient). There will also be one made from Meccano for the implantologists so they feel at home before their final drop. Any registrant caught gaming will be hung in the same way as anyone else, but they will now have to pay for their own rope as that is only available privately. Their new Head of Corrective Discipline Mme Prila Olof was said to be most excited at the news of the Speedy Grins announcement as there were still some registrants who had not been ‘disciplined’ yet and she was described as being ‘positively moist’ at the thought of more business for the ‘Organisation’.

The announcement has also been broadly welcomed by a new professional association for dentists, the Association Somehow Leading Everyone Everywhere Professionally, the spokesperson for which was quoted as saying ‘Baaaaaaaa’ and making a sound like a wet fart in a colander before flouncing off in a puff of talcum powder.

All persons depicted in this article are entirely the product of the author’s imagination and bear no resemblance to any person living or dead. Any similarities are therefore entirely coincidental. Any organisation or company is also entirely the product of fiction and again is not intended to represent any current or past organisation or business. Any similarities are entirely coincidental. This article is for the reader’s entertainment and is not intended to be representative of any situation real or otherwise in any way shape or form.

[This blog was first published on the morning of 1st April 2016]

Ever since humans started to trade with themselves there has always been the need for them to feel that have got a bargain in some way. It’s human nature to actually feel like you got something worth more for less than you needed or intended to pay, and as such that drives many businesses in a constant battle to attract customers by offering bargains.

There’s a simple explanation for value in any transaction.

• If you pay a lot for something that’s poor quality it then it’s a rip off.
• If you pay a lot for something that is high quality then that is acceptable (and even possibly exclusive)
• If you get something that is poor quality for a low price then that’s called cheap.
• If you get something that is high quality for a low price then that’s a bargain.

Everybody loves a bargain. That’s why sales are so popular all the time, trying to get people to spend money they don’t have on products they don’t need. You only have to look at Groupon and Wowcher to see the type of offers that are touted on there. This is not necessarily a problem in the consumer driven world that supermarkets and retail stores operate in, but caveat emptor is the mantra that we should all employ when looking at this type of trading. Its also the way that our Beloved Chairman would probably like to see in his Red Book of ‘How the Dental market should evolve’, at least according to his now infamous Pendlebury Lecture.

The problem with this of course is that there isn’t a particular need to have ethics in those kind of industries that can price cut and offer heavy loss leading deals in order to get people through the doors and then upsell. It also usually involves already cheap products, or those with artificially hiked prices then given a huge discount, to con the buying into thinking they are getting a bargain.  

The reason for this is if it appears too good to be true, then it probably is (for someone). There stories galore of businesses that have almost or actually imploded due to a demand that they didn’t foresee when offering a ‘too good to be true’ deal. One of the most famous was the Hoover free flights promotion in 1992. Due to a huge surplus of electrical products they needed to sell, they came up with the offer of 2 free round trip tickets to destinations such as America. Somehow they failed to realize that offering tickets that were worth well in excess of the product they were trying to sell (the qualifying purchase only needed to be over £100) would result in an overwhelming demand for their products and hence the tickets. The court cases took until 1998 to settle, and cost Hoover an estimated £50million pounds. It would probably have been less costly for Hoover to scrap the products they needed to sell rather than to retain their market share. They were big enough to survive, but not everyone would be so lucky in a similar situation.

So what has this got to do with dentistry? Well, there has been an increasing trend to offer these kind of deals to entice patients into practices which are probably too good to be true. It’s a matter of contention that this is how some mixed practices operate, by offering certain NHS items to patients and then upselling the options that ‘aren’t available’ on the NHS. Even after 10 years of the new contract I am still struggling to understand the concept of how offering an NHS exam but having to see the hygienist privately works within the contract, and no one at all has yet presented an argument to me that convinces me this isn’t just a form of upselling by getting the patient in on the pretext of NHS treatment and then providing a private upgrade. Whilst business survival is paramount in dentistry in the same way as any other business, some often seem to forget there is a higher ethical plane that dentistry must lie on when running our businesses.

People outside dentistry don’t often get this, and one of those appears to be Mr Moyes, but also there is an increasing amount of people within the profession itself who have, shall we say, ‘flexible’ ethics when it comes to the upselling game and marketing in general, and who seem to forget what it means to be part of a caring profession. Is it any wonder that some GDC cases have an accusation that the financial motivation of the registrant one of the reasons the case is being heard?

Marketing is vital to the survival of dental business, but not at the expense of our professionalism, which is inextricably linked to our ethical compass. Something those who sit on the outside of our profession seem to forget. With the increase in non-registrant owned corporate practices, we have some people who see dentistry as just another business and apply the same rules to it as would be more appropriate for a supermarket. They however don’t run the same risks as those who are regulated do. 

A recent example would be that of the clinics in Manchester and London offering deals on limited outcome orthodontics through Groupon. These clinics now appear to have gone to the wall leaving patients who have paid for treatment up front out of pocket and a significant number of them now facing the prospect of paying more for the completion of their treatment. What their perception of the profession will now be can only be guessed, but it isn’t likely to be good.

And then we wonder why as a profession we get bad press, and are labelled greedy dentists. Even the GDC have got something right recently in the warnings about the use of things like Groupon to promote dentistry. That does actually seem at odds with the beliefs of their consumer-rights driven Chairman. It will be interesting to see how this situation develops, since there is likely to be little or no regulatory comeback against the owner of these clinics, but the full weight of the GDC may be felt by the registrants who were involved with the treatment of those affected.

Selling a product for a price far less than it costs elsewhere will attract people who are after a bargain. Restored implants for £795? Orthodontics for £995? Is it all part of a mechanism to draw people in and then upsell using crass pseudo ‘ethical’ selling (that potentially doesn’t even meet with the requirements of Montgomery let alone those of the GDC) to actually get the purchaser to buy something that actually profitable rather than the offer? But this isn’t a pocket money purchase, and these patients are likely to be attracted by the ability to have something they thought they couldn’t afford. So the business model of upselling is not necessarily going to work, as these patients might not be able to afford a bigger investment. There is then an exceptionally fine line between your bargain purchase becoming a rip off because it doesn’t turn out to be what it was promised to be. Anecdotally, purchasers like these are often the ones who have no particular loyalty to a practice and are shopping on price alone. The same ones who are usually well aware of how to use social media to destroy a reputation, and then take further legal action….

It doesn’t matter that these people will now maybe only end up paying roughly the same as it would have cost to have the treatment provided by a different practitioner in the first place; they have been misled into thinking they could afford something that they wouldn’t normally be able to and their bargain has now become a rip-off. The point is these people have suffered at the hands of our profession and we will all pay the price for that eventually. The owner of the clinic involved appears not to be a registrant, and the business model used to draw people in means that both the clinic and Groupon are likely to have been paid up front which improves their cashflow. But surely the ethics of this type of business are not those of a caring professional? Pile ‘em high and sell them cheap whilst upselling to a customer might work in some industries, but dentistry has the subtle difference of being driven by a core ethical requirement to do the right thing FOR THE PATIENT. With the change in the rules that allowed the increase in corporate dentistry and non-registrant ownership that had been restricted since the 1920’s, one could argue that the good old days were actually better for both the patients and the profession. Were ethics and professionalism more in the forefront of the profession those days?

Whilst all this is an example of what has happened in a case where a non-registrant is involved, I think there are probably registrants who should be taking a long hard look at themselves, possibly both individually and as members of corporate organisations.

I’m afraid that I for once agree with the GDC over their warnings of involvement with this kind of marketing practice.

This is a race for the bottom financially, but more importantly ethically, that I for one am not going to compete in.

Image credit -Gordon Joly under CC licence

Rather than my usual look at what’s going on at the Schloss Moyes on Wimpole Street, I just thought I’d just ask a few questions this month, and leave the reader to think a bit about the possible answers.

I’ve become aware recently about the sheer scale of the money spent by the GDC on the whole PSA situation. The chances of getting answers from our arrogant and out of touch regulator are about the same as getting to watch the Titanic arriving in New York next week, carrying Lord Lucan, with Glenn Miller playing mood music in the bar whilst Elvis sings to Shergar on the top deck, but we can live in hope. Surely all that has now happened over the last few years with the GDC must start to bring some change.

1. How is it possible for the GDC to spend £735,000 of registrants money on the legal fallout of the Whistleblower affair and not have to answer to the profession or parliament for this?

2. Since this includes the GDC having to respond to ‘Letters of Claim’ involving members of the GDC, exactly how many of them are being sued and why are registrants picking up the bill for the actions of individuals?

3. Since the BDA know of this why have they not told the profession of the sheer scale of this use of registrants money?

4. Does this figure appear publically in the accounts of the GDC? If not, why not?

5. Why did the GDC spend £230,000 on the recruitment or ‘refreshing’ of the Investigating Committee in 2014 when it was likely the section 60 order would result in the recruitment of Case Examiners within a short period of time? Why couldn’t the existing members just carry on a bit longer and this money be saved?

6. As the Council members are aware of the inordinate amount of money being spent on what is basically incompetence and a lack of the correct procedures being followed or being in place, why has there been no public criticism by them of this?

7. Do all regulators spend a million pounds with such lack of transparency?

8. Given the ‘Objectionable Practice’ being run by the Investigating Committee Secretariat that lead to this whistleblowing, how many registrants have had the incorrect sanctions applied to them that shouldn’t have been?

9. How many of them have had their careers and personal lives affected by this?

10. Have these registrants been contacted and informed there may have been a breach in the natural justice they have a right to expect? If not why not?

11. Where is the duty of candour from the GDC to tell the truth about this situation involving registrants? Its not even mentioned in the latest Pravda press release or email from Moyes Towers.

12. Has anyone at the GDC been made aware we actually have a Human Rights Act in the UK and this applies to registrants since they are actually Human Beings?

13. Now Lord Hunt has been highly critical of the GDC in the Lords, and it has also been raised in the Commons during the recent Section 60 debate, why have there been no immediate resignations of the Council Members?

14. Does anyone think the Council Members have held the executive to account properly at any point in the last 3 years?

15. If not, why do we actually have a Council?

16. Should the present Chair and Council have anything to do at all with the recruitment of the new Chief Executive?

17. How much has Ms. Gilvarry’s departure cost registrants?

18. Why should her incompetent leadership be rewarded financially at the registrant’s expense with a termination package?

19. When are the BDA, DPL, DDU, FGDP, and all the other groups directly involved actually going to sit down together and PROPERLY talk to one another formally and lead the profession from the front?

20. Have the Executive, the Chair, and the Council actually been guilty of malfeasance in public office?

And your bonus question….

21. Should Bill pay for his own taxi when he leaves for the last time or should we let him have one last final trip on expenses?

Image credit - Colin Kinner under CC licence - not modified.    

I could basically repeat this mantra for the whole of this blog and I don’t think many would disagree with it (except of course Bill himself). However, I think my readers are more used to having a bit more to get their teeth into, so I’ll pad this out a little more. It won’t run to the 306 pages of the Professional Standards Authority report (here) into the GDC, but the sentiment is the same…

As well as reading my ramblings, I would strongly urge you read two blogs by a couple of fellow colleagues whom I have the utmost respect for. This blog was not originally going to be about Ghosts of Christmases Past, Present, and Future, but it is quite an appropriate analogy.

These are our perspectives on what has gone before, what is still happening, and what we need to do. Three views for the price of one.

http://dominicohooley.svbtle.com/a-christmas-tale

http://campbellacademy.co.uk/blog/short-gdc-update/

I am very aware of the warnings by Dental Protection not to be too critical of the GDC in public. However, I think the publication of the recent report allows me to point out some factual issues in that report, and exercise my right to free speech about a public body without too much fear.

The PSA’s whistleblower report makes fascinating, and at times unbelievable reading. What is clear from it is that the GDC at both Executive and Council level is not only a failed organisation, but a completely and utterly incompetent, insensitive, and dare I say it, corrupt (in the ethical and moral sense) edifice that now needs to be put out of OUR misery.

The report is probably the reason that Ms. Gilvarry has decided the time is right to move on. We can only hope that other regulators do not suffer in the same way as we have in the recent past; I would certainly hope any organisation thinking of engaging her in a similar position is made aware of this damning report and the role she quite obviously played. It’s really not something I’d want on my CV.

From the writing of policies by untrained and unknowledgeable staff who then went on to train more untrained and unknowledgeable staff in the process of discipline (via the Investigating Committee), the lack of scrutiny of the IC’s work, the failure to correct the problems outlined in the previous PSA report, having an ineffectual whistleblowing policy, rewriting it and it still being useless, to the utter lack of oversight by the very Council whose duty it is to ensure the Executive do not go off on a tangent, there can be no doubt the GDC has become a derided regulator both by the profession and the PSA.

So how on earth then can the Chair feel he can remain in post too? Not only that, are the other members of the Council so isolated from the real world situation everyone else can clearly see, that they somehow feel they have no responsibility for this disaster of an organisation that they are at the head of?

Having a regulator that uses untrained staff, described by their own director as just ‘bums on seats’ and ‘clones’, to be responsible for an entire section of a professional disciplinary process is nothing short of negligent. It is admitted in the PSA report that they were under pressure from the Executive to ‘Get the Job Done’, which implies the rulebook went out of the window. When people’s careers, livelihoods, wellbeing and indeed their personal lives are being held in the hands of people quite obviously out of their depth and unaware of their duty, then that attitude by the Executive is utterly reprehensible. Not only that, there still has to be the accountability that is sadly lacking. These members of staff are not specifically blamed by the PSA for the problems, as it was recognized the responsibility was entirely that of those in overall charge of the systems (and some of them are no longer in post thankfully), but one would hope that the moral compass of anybody involved would direct them to make the right decision and now leave.

Whilst the influence of these people was seemingly only on the members of the Investigating Committee, one would hope that the integrity of those on that committee was such as to not be influenced by them. However, by a simple process of extrapolation it makes one worry that other committees were under pressure of being influenced in the same way. The evidence for this isn’t in the PSA report because they didn’t specifically look for it, but we all know the GDC have acted unlawfully before in setting the ARF, which isn’t exactly a great track record. Not only that, but the findings suggest that the situation the PSA investigated with the Investigating Committee leaves the GDC open to further legal challenges via Judicial Review over the decisions it made. I would therefore suggest that EVERY SINGLE case that falls within the dates the report encompasses is reviewed and looked at independently, at the GDC’s own cost. If that bankrupts it, good. Perhaps the Government might take notice when it has to bail out the GDC.

It’s a bit like a parent dealing with a delinquent child; it tends to ignore it hoping things will get better, then gives it a stern talking too, but when it finally has to go down to the police station and bail it out for a serious offence the realisation that there is probably something perhaps seriously wrong with its offspring begins to dawn.

It’s one thing Ms. Gilvarry falling on her sword (or was she pushed?), but the supervisory role of the council during this period was non-existent. In addition, the judgment of the chair has also been called into question over decisions that he made. The sort of important decisions we take for granted will be made correctly by someone in his position. The sort of decisions that if we made incorrectly would see us in front of the regulators fearing for our careers….

There is NO way that Dr Moyes has the respect of the profession as a result. He has shown his lack of understanding of the profession on so many occasions, starting with the infamous Pendebury lecture where he likened us to the supermarket sector. That’s all well and good in this increasingly consumerist world, but you don’t get people losing their careers if they give you the wrong shape carrot or your tin of beans is past the sell by date.

So I address the final part of this blog to those people involved in the whole sorry affair.

To the Investigating Committee Secretariat, you must ensure nothing like this is ever allowed to happen again. The overwhelming majority of people in dentistry are good people, and they are not numbers that need processing despite your instructions to ‘get the job done’ by what appears to be a bunch of Dentist Haters. There is no defence to the excuse of ‘we were just following orders’; Nuremberg in 1947 saw to that. Whilst the GDC whistleblowing policy has been shown to be pretty useless, please bear in mind the need to do the right thing if there are things you are not comfortable with. Please remember, you are not the judge and jury.

To the members of the council; you might have thought that being part of the GDC would be altruistic and for the greater benefit of our profession. It should be. You might even have thought it looked good on the CV. At one time it would have conveyed respect and deference. But given the utter failings and lack of detailed, focussed, professional management that has occurred, you might be better admitting you were unwittingly coerced by the members of a ruling Politburo, which might go some way to rescuing both your CV and your own professional reputation. The Council’s oversight has been so lacking, not even Specsavers could help it.

Finally, wake up and smell the coffee Dr. Moyes. You seem to have absolutely no idea what being part of a profession is, and the members of the council have obviously not educated you properly (or been allowed to). The insight that you rightly demand of your registrants has been sadly lacking by your entire organisation, and given the tone of your emails to us particularly by yourself. I’m just waiting the email from you saying what a resounding endorsement of the GDC the PSA report is, since that’s the usual spin that is put on things at Wimpole Street. Your oversight of the Executive has been completely ineffectual. Your part in this whole debacle cannot be brushed under the table; it happened on your watch so you must bear responsibility at least in part. It’s quite ironic that some of your previous posts have been with the Office of Fair Trading and Monitor. Because there has been absolutely nothing fair about this organisation whilst you have been at the head, and your monitoring of what was going on around you appears to have been non-existent. Dentists might be in the minority of whom you regulate; but believe me without us the profession couldn’t exist. Ignore us at your peril.

For that reason your fitness to regulate has been found impaired and you must face the sanctions.

Dr. Moyes, you must resign.

You must all resign.

All through my life I have had to account for my actions and omissions to somebody. Parents, teachers, the wife (sometimes J ), and obviously now to my patients and regulators. This is no different to any of you reading this. Accountability for our actions keeps us on the correct path (hopefully) and having a regulatory mechanism and a legal system that should be just and proportionate helps to define what that path is. Whether our spouses are just and proportionate in keeping us on that path is another matter entirely!

But we work in a system where there appears to be very little or even a complete absence of accountability for the actions of those who influence us in some way.

The departure of Ms Gilvarry from the GDC is a case in point; I’m sure there will be rather nice pay off from the ever expanding coffers of the Wimpole Street Complaints Enforcement Company that she currently runs. Following this will presumably be a move into another similar role where her unique skills and qualities will be valued just as much as they were on Wimpole Street. She departs not a moment too soon for the profession in my opinion, but what should stick in the minds of each and every one of us is that there will be absolutely no accountability for the debacle that has occurred during her tenure at the GDC once she has left her post. Had any one of us dental registrants been at the head of our individual organisations and found to be lacking to the degree the GDC has, then our regulators (both GDC and CQC) would have had no hesitation in making us accountable for our inabilities to manage and provide our patients with an appropriate and safe service. I’m absolutely sure if we had been found to be acting in an unlawful manner then the full weight of accountability would have come crashing down on us very rapidly.

Surely rather than a pay off there should be some form of public accountability that executives in positions like this should answer too. The money from any pay off could be placed in a fund to support those practitioners who have suffered injustice at the hands of the GDC in the period of her tenure. It won’t be anywhere near enough, but it would a start and an acknowledgement by the GDC that they have often got it wrong and need to make reparations. And yes, I still believe in the tooth fairy.

The recent report into the HBOS crash in the recession has ruled that about 10 of the executives were culpable in some way for the mismanagement of the company. It has been recommended that they never work in banking again. Whilst I’m sure they will still get lucrative posts in industry (and some indeed have already), at least there is an accountability for their actions in some way and a degree of public shaming. The Iceland banking crash resulted in jail sentences for those found to be culpable which many feel was an appropriate redress.

In addition, we still have a Council that appears to be run similarly to the politics of Zimbabwe. Where is the mechanism to address this? The registrant members of the Council do not seem to be making any difference whatsoever to the decisions made. Are they there just to keep the numbers up? Aren’t they supposed to be part of the accountability system the Executive answers to? And why is there no public mention to the stance Council members are taking? Is every vote unanimous these days? Such questions need a mechanism of accountability to be in place to answer them.

A chief executive is no different to the captain of a ship. There might be various members of crew responsible for various aspects of the running of it; but it is the captain who is in ultimate charge and therefore has the final responsibility. Captain Smith went down with the RMS Titanic, in effect accounting for his responsibility with the ultimate sacrifice of his life. The tragedy of the Costa Concordia has resulted in criminal accountability for the captain who unbelievably left the sinking ship before all the passengers had. Anyone who leaves a ship prematurely that is sinking due to their poor leadership and navigational skills is thinking only of themselves; no consideration to the effect of the disaster on other people’s lives can be at the forefront of their minds, and saving their own skin is paramount. The Council is effectively equivalent to the Directors of a shipping line, and they too can be found liable for policy errors that lead to disaster. The difference is maritime law has robust legislation and accountability for these people, and justice is usually swift, fair, and effective.

Unfortunately we never seem to see this in our profession. From the Commissioners who continued to allow ludicrous amounts of UDA’s over the years in the D’Mello situation, to the lack of appropriate measures taken against the corporate mismanagement in the Stafford fiasco, there is always a scapegoat found in the medical, nursing or dental profession to take the fall. Until we have some form of register for people in the higher echelons of regulation and management of our healthcare in the UK, we will always have this lack of accountability and problems will continue. For instance, if I forgo my registration with the GDC and go off to run a hospital incompetently then there isn’t really any likelihood of a significant punishment that will end my career, ill probably just get moved laterally or get a consultancy position somewhere. There seems to be a reluctance to press for corporate manslaughter charges, and vicarious liability seems to be rarely found. Yet if I forget to write down a medical history or fail to justify my reasons for placing LA whilst simultaneously allowing my child to sit behind reception doing some colouring-in then potentially its career over. Our accountability has gone too far, yet for many others it doesn’t go anywhere near far enough.

We have regulatory bodies and members of those bodies that are accountable to no-one. We have non-dental registrants at the head of dental corporates, companies and organisations who are accountable to no-one, yet are setting policies or advertising services that could affect the care of patients adversely. We have dental registrants at the head of businesses that blame the individuals at the tooth-face for problems, whilst chasing profit in preference to supporting the clinicians appropriately. We have an Ex CDO who has supported the flawed UDA’s system passionately despite all the obvious problems with it. We’ll have another contract from the DoH eventually that will only be designed to further cut the budget and get us to provide more for less. We have expert witnesses who appear to be unable or unwilling to use the correct standards without any redress. And we have Commissioners and Management who in many cases are promoted far beyond their abilities and understanding of healthcare. I can’t recall reading anything of the accountability of any of these groups recently, but please correct me if I am wrong.

Hopefully the new CEO at Complaints Enforcement Plc will have a more proportional idea of how the Dentists Act should be enforced. Because enforced it has to be; but please, not with a zeal verging on fanaticism; it has to be with the right touch and a realisation that this profession is generally very, very good at what it does for the patients and that true misconduct and dishonesty is actually quite rare. But until all those tainted by the problems at Wimpole Street have accepted their responsibilities and left then nothing will change. The shipping line will get to choose a new captain, but we still can’t get off the ship. Bill Moyes expects our patients to have choices and make us accountable, but is impregnable from such actions himself. We need an entirely new crew who are not used to piloting a battleship with its guns constantly trained on the profession whilst getting it to pay for the ammunition used in the barrage.

Until we have accountability for all those currently immune against the effects of the mistakes that humans naturally make then they will never be able to empathise with what we go through on a daily basis in our professional life. Only by respecting the responsibility we have because of the accountability we have, firstly to our patients and then to our regulators, will they finally appreciate what we do and the problems we encounter. The old Council with its primarily registrant make up had this, and the profession wasn’t any more unsafe then than it is now. In fact, in my opinion it is actually far more unsafe for patients now when practitioners are working defensively, and when you can get a single complaint ending a career, without accounting for the thousands of patients who were being cared for (probably) appropriately by that practitioner. Just who is going to be made accountable for this damage to patient care long term?

Because without full accountability for all those involved in providing, regulating and commissioning healthcare, nothing will ever change.

It was not until recently that I have thought of the significance of the year 1984. The year that the Dentist’s Act was put on the statute books is also the year George Orwell wrote about in his 1949 Novel. What a coincidence.

I was never one for this sort of literary masterpiece in my youth, preferring more escapism than that provided by the rather dark writings of George Orwell. After all, how would a fictional writing about a society that records what its members say in order to use against those same members be relevant to my future career? A story about a society that encourages members to report one another to the authorities in order to punish them for minor transgressions was not really going to be hugely useful when human biology and chemistry was going to be the entry requirements for dentistry in a couple of years….

How wrong was I. It would appear that in fact 1984 is a highly relevant textbook on how the regulation of dentistry is currently modelled.  Just like in Orwell’s Tome we have individuals who are all too happy to report colleagues directly to the authorities; multiple omnipresent organisations taking the role of the morally correct ready to report us immediately to Big Brother for everything and anything, and now, with the information that appears to be coming to light from the numerous Subject Access Requests (SAR), the actual holding of data on some (if not all) of us by the GDC.

Despite the assurances recently at the Dental Protection study day by the Head of FtP, Jonathan Green, that the only reason a watch is kept on GDPUK is to report to the executive about what the profession think of the GDC, I find myself just a little uncomfortable that this is not entirely the whole reason why. If the GDC want to know what we think of them then fine;

BUT WHY KEEP IT ON THE REGISTRANT’S FILE?

There can be NO reason whatsoever to keep this information logged against an individual. None. Feeding back to the executive the opinion of the profession is one thing, and probably sensible. However, it seems they don’t want to do anything particularly to improve our perception of them; possibly they are just making sure they’ve got the level of fear just right in the profession so we keep toeing the line. But storing that information in the registrant’s data file is not necessary. Unless they are going to use it against us at a later date there can be no reason for that.

Now it might just be entirely innocent and that it is just an administrative mistake why this potential breach of the Data Protection Act is occurring; and lets face it, the GDC have got history in this area as the Information Commissioner has just recently ordered undertakings to be made by the GDC for a previous breach. It might even be that the head of FtP wasn’t actually aware of what was going on in another department. But it is none the less worrying as to why the right to freedom of speech (Article 10 of the Human Rights Act) is being is being threatened in this way. Surely if individuals think their comments made on a private professional forum are somehow being noted and stored this will make them think twice about contributing in the first place. A Public Body such as the GDC has responsibility to uphold the Human Rights of those it is responsible for, not to make them feel threatened.

All this is before we get onto the subject of using Private Investigators in order to further challenge the Human Rights of its registrants. It would appear that this is down to the Professional Standards Authority wanting the GDC to be more proactive in ensuring registrants are kept on the straight and narrow. Perhaps the BDA should engage the services of a PI company and then send them to check on members of the FtP panels or the GDC executive themselves. I can imagine the outcry at 37 Wimpole Street if this were to happen, but surely they too are all innocent until proven guilty just as the registrants are? I am also intrigued as to why the use of Private Investigators is allowed, since neither the GDC nor the PSA appear on the list of the 40 types of authority sanctioned to use them under the Regulation of Investigatory Powers Act 2000. Perhaps someone more legally trained can enlighten me as to the mechanism under which they can use them legitimately, because all I can see is the infringement of Article 8 of the Human Rights Act, the right to privacy.

I have been writing for GDPUK for just over a year now, and whilst I am still awaiting my SAR, I am pretty sure there will be references to these blogs made. Why? They are on the public facing side of GDPUK for a start and accessible to all. They are also my individual views, which I am entitled to hold, about a regulator that has been shown to be acting in a draconian, inefficient, illegal (remember the ARF consultation?) and now it appears an Orwellian manner. Now as far as I am concerned, I have never knowingly written one word that isn’t true. It is not unprofessional to tell the truth; indeed we have a professional duty to do so. It is not misconduct to tell the truth, and it is not bringing the profession into disrepute to tell the truth. It is also not illegal and it is not dishonest to tell the truth (obviously!). But I am worried that a regulator that is still so out of touch will try to deprive me of my livelihood and professional standing just because I have spoken up about its failings. Why else would it probably be keeping references to things I’ve said? Given some of the strange heads of charges still found on FtP hearings (do ANY of us justify the ‘reason for a try in’ in our notes?) it wouldn’t be too hard to come up with something suitably fitting for my literary forays. Perhaps when I get my SAR there will now be absolutely nothing about my views in there. Especially if they read this article…..

Literary analogies seem to abound in the way 37 Wimpole Street appears to do its business, from the McCarthyism of Miller’s Crucible and its tales of the Salem Witch Hunt to the totalitarianism power of the Communist era in Orwell’s 1984. A combination of these two literary masterpieces seems to be the current operations manual for the GDC in how it polices its registrants.

In that case I think it’s time for the profession to bring the works of J K Rowling to life…..

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.

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.

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.

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.

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.

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.

What is it about our profession that makes us targets for everyone? From the press to the government, from our patients to regulators, what have we ACTUALLY done to deserve the increased regulation, the increase in complaints and litigation, and the constant vitriol of the press?

There is a constant ‘hum’ in the background in my opinion that represents the unrelenting pressure we are under, and in my opinion, for no real reason.

We have the press always looking for a ‘Dodgy Dentist’ story, with hopefully some evidence of how we rip off the public, but if they don’t have that evidence, they’ll misrepresent something anyhow. We have some of the regulators literally strangling the freedom out of our profession, and we have the legal profession all too willing to take advantage of our (costly and rapidly increasing) indemnity.

Have we let ourselves become some sort of professional whipping boy by our virtue of our dignity and professionalism in the past? Or do some of our colleagues (both past and present) have to answer for this perception of us? By not standing up more vociferously in the past, have we allowed what amounts to the various playground bullies to keep on taking a free hit at us knowing we don’t, won’t, or can’t fight back? Whilst I agree we need to put our house in order where some things are concerned (such as gaming) for which I then feel the criticism is just; but I can’t be the only one who feels that we are just waiting for the next onslaught of negativity to land on us from somewhere.

Why else would the public still believe the often ridiculous stories printed in the press? Interestingly, they never seem to associate ‘their’ dentist with the type of stories that come out. In that case why on earth do we still have the bad press? Where is our PR? Why do we have to couch everything positive we do in such woolly airy-fairy language so we don’t look like we are blowing our own trumpet?

If this blog seems to be coming from a negative direction, then you’re right; The state of mind that I carry from time to time about my profession is the reason for this, and I know I’m not alone feeling this way. Both the BDA and DPL have recently released press statement with evidence that dentists (and probably by association their teams and families) are generally more ‘down’ than the rest of the population. Given that we are largely exposed to the general issues affecting all the rest of the populous in the same way, then the only reason we must be feeling more depressed is because of how we are additionally affected by the profession we are actually in.

Any profession that has a desire to care for another human will always have more than its fair share of pressure heaped upon its members; that comes with the territory. This isn’t the issue here though; it’s the overload that comes from all the different influences that drive down the morale and therefore the well being of the profession into the ground. In a previous blog, I asked the question  Are you Scared? It would seem we have good reason to be if the GDC figures for the likelihood of appearing before FtP are to believed (but then the phrase ‘believable GDC Figures’ is actually an Oxymoron according to the High Court J) and now DPL have added their figures that 90% of practitioners fear they are more likely to be sued than 5 years ago which further adds to that fear.

I remember being told when I first qualified that there was a chance that I would be sued once in my career. Because of the mindset now more common in Uk Dentistry, I think I’m now on borrowed time having not had this in 24 years of practice, rather than actually thinking I might be doing the right thing by my patients. It’s the same fact, but the wrong way of looking at it.

There seem to be more people wanting to leave the profession than ever before. I doubt that we know this solely because of the advent of social media making it far easier to share and disseminate ones feelings. We have always had some form of dental grapevine telling us what is going on, and social media makes news get round faster and more widely. The ripples of discontent are now turning into a tide, and one hopes this will stop before a veritable tsunami hits the profession. Add to that the tragic but increasingly common stories of professionals committing suicide as a direct result of the pressures they are under and we have to come to the conclusion that some of our colleagues are drowning under the waves of increasing risk, not of their own making.

We seem to be torn between pillar and post all the time. Comply with this, inform about that, don’t do that anymore, make sure you’ve certificates for this, you have to pay for this now, you need a licence for that, and so on seemingly ad infinitum. I joke with my patients (those that I don’t think will sue) that I wonder how many rules, regulations, recommendations, dictats and compliances I will breach in their appointment today…..

And then some bright spark comes along and thinks the Family and Friends Test is a good idea to load on a profession already appearing to spend most of its time on complying with stuff rather than actually producing things that benefit others. Remember it only takes that final straw to break the camel’s back.

The problem is that there often seems to be no-one to turn to for advice when we are suffering from this mindset. We are all in the same boat at moment and there is seemingly no escape from any of this. Is it any wonder then that people have a poor state of mind? The public has their perception of us that never seems to change, and there is little or no organized support from within the profession; we have to actively go and seek professional advice independently.

We are not alone in this though; it seems to be all medical professions generally that are coming under increasing pressure. For the GMC to actually consider the wellbeing of its registrants who are under investigation and begin to put in place a form of support network is both tragic and admirable. It seems it has finally dawned on a regulator that registrants are human beings as well. One would like to think the GDC have read the recent article in the BMJ about the impact of complaints on its registrants[i], and indeed I have submitted a freedom of information request to find out if they are even aware of this document.

From time to time I utilize the skills of a very skilled NLPT (neurolinguistic psychotherapist) in order to re-calibrate myself. I’m lucky that I have a support network around me and (now) have an ability to realize when professional life is starting to get to me. I have no issue admitting this, but I’m sure there are many who wouldn’t dream of taking this sort of step, let alone admit to it. Whilst some people might be happy to whinge on GDPUk or social media about how they feel, it’s the silent ones who we need to perhaps be more concerned about. We are all in this together, and we are a caring profession. That doesn’t just mean our patients though; it means those within our profession as well. There is no formal or indeed informal system in place for professionals to seek out the kind of positivity they need. Whilst there is a Sick Dentist Scheme and the BDA Benevolent Fund, there is actually nothing in place for the Wellbeing and State of Mind of the profession. This is something the BDA could and should run with in my opinion. Access to professional advice and counsel about our mindset is more important than HR, Indemnity and Compliance issues. After all, none of those are relevant if we are in the wrong personal mindset. Dentistry is ONLY a job, and we can personally survive without it if we have to.

Our responsibility as a caring profession MUST include ourselves. We have never been more united than recently, and I finally think that there is a tipping point being reached about how we can unify for the good of the profession and therefore the patients.

But how do those isolated and with the wrong state of mind know there is finally a light at the end of the tunnel?

I think that’s our responsibility. We have to continue to grow stronger, to grow more united, and to reach out to all our professional colleagues. We need to show people that there is a way to fight back against this feeling. The speed with which the legal fees for Keith Watson were raised within 48hours shows there is the support out there from the profession for each other, and this needs to continue.

So its time to stop this feeling and to draw together the collective support we can. We need to make ourselves available in physical or virtual form for our colleagues. More importantly lobby organizations like the BDA to put in place formal systems of support to allow practitioners to gain access to. If we felt it would be appropriate to trust the GDC to not act judgmentally, they would also be an ideal organization to have some form of support system allied to their role; after all, what better way of protecting the public than to ensure the well being of the registrants?

There is light at the end of the tunnel; and we’re holding it.

Image credit - Kudomomo  under CC licence - not modified.

When I qualified back in the early 1990’s, social media wasn’t exactly on the radar. The thought of being able to connect with a multitude of people instantly was the stuff of imagination. The Pub was our Facebook, and the only ‘likes’ we had were the various guest beers.

Now it’s such a part of our everyday lives that normal channels of communication are seemingly used in the minority. When you can connect with the entire world’s population from the comfort of your home, and carry on multiple conversations about multiple subjects simultaneously, the days of popping out for a beer and a chat with a mate seem numbered.

But what about the social etiquette, and more importantly the professional etiquette we employ when online? The GDC have standards that we should adhere too, and indeed GDPUk is actually specifically mentioned in them such is the impact social media has made on the profession. Specific specialist sites like GDPUk aren’t generally the issue, and whilst there are sometimes a few comments made that might get the GDC or lawyers a trifle interested, these sort of sites are generally appropriately populated and commented upon.

The problem are the wider platforms especially those such as Twitter and Facebook. Some users don’t seem to get the fact they are in no way whatsoever a place to remain private and anonymous despite what you might think.

Whilst the ‘more mature’ professionals seem to have the general hang of the way we should conduct ourselves, I worry that some of the younger members of the profession haven’t quite got the gist of what being a professional is yet and how they should present themselves in public to the public. Because no matter what steps they take, if they have a social and professional presence on media like that, they are well and truly exposed to public scrutiny.

There are a multitude of Facebook pages for Dental matters. Some are better than others, but all suffer from the same fundamental problem. They are not private. In order to use them you have some sort of visibility. For instance, if I wanted to discuss a case over a beer in the pub with a mate, I wouldn’t be doing it whilst posing in a mirror with oiled muscles. But that’s what communicating with some of the personas on social media is like. Some of the fairer sex seems to be somewhat less than modest in their attire on occasion, and one has to wonder if this is what the public expect of its professional classes. A couple of clicks and you generally have a range of private information about ‘friends’, particularly the more self-obsessed ones.

What about commenting into the perceived anonymity of an electronic device in such a way that you wouldn’t do in person? I’ve witnessed many an argument that would never happen in real life due to the social ethics the majority of us have; but once in the safety of the digital world the ‘keyboard warriors’ tend to lose all sense of propriety and the moral compass seems to have lost its direction.  And then there are the artists of self-promotion who feel every other comment has to be some form of pseudo advert for a business venture, or course you can’t possibly miss. I’m becoming guilty of the last one as my Twitter account now is used almost solely for the promotion of this blog and GDPUk. You see, the boundaries of who you are as a person, and who you are as a professional are becoming so grey with social media like Facebook that it feels safe to make that sort of comment, and think there is no comeback.

Finally, there are the vast numbers of photos of patients and cases that we see bandied around social media. The GDC is very clear on this,  in standard 4.2.3, where it states ‘You must not post any information or comments about patients on social networking or blogging sites’. Period. We can use ‘Professional Social Media’ but social networking sites are a no-no according to the exact wording. Personally, I think the GDC are possibly a little behind the times on this, as there are a good number of very good Facebook pages where some quite good discussions take place; however it remains to be seen if the GDC feels this is ‘professional social media’ when used in this way, as after all, they are the ones who get to decide….

The big problem though is that many people forget just what can happen to these comments and photos once they've been posted.

I’ve heard stories of people using screenshots of comments made on social media and then threatening to use them as evidence to send to the GDC. Screenshots can be shared outside the domain we think we are posting in, and as such can be disseminated far more than we might have considered when we posted. Unfortunately the self-righteous are rife on social media, and often mistake what is only free speech for something to get offended by, and take draconian steps.

I’ve seen the fallout when comments in a public section of a site then get even nastier privately; and I’ve seen wholesale bar-brawls break out in some places (although they’re usually involving musicians ? ). This is like taking a voice recorder or video camera to every meeting you have with a professional in case they say something that offends you so you have evidence and can report them. Since the GDC love nothing better than a good old Fitness to Practice case, we need to really be aware of what we put on social media, how we do it, and the persona we use on there. I think it is only a matter of time before there will be a full-blown case against a registrant involving some indiscretion or inappropriate comment on social media.

Now I’m no Luddite, prude, or some ‘holier than thou’ observer; as a forthright Yorkshireman I tend to say how it is and if you don’t like that then that’s your problem not mine. I’ve got patients as Facebook friends, and I tend to be exactly the same person online as I am in real life. I’m aware that anything I say there is something that I should be happy to share in a professional environment. I’m a real person and don’t have any airs and graces or chip on my shoulder that mean I think I’m some sort of superior being because I’m a dentist. But I can’t help thinking that some of the comments, personas, and attitudes we see as the public face of some of those in dentistry give the GDC every right to be concerned about the public perception of the profession, because if people can’t differentiate between a digital persona and a real one when they are posting then they really do deserve the attention of our regulator. The rationality and politeness filters seem to disappear from some of our profession when they get infant of some kind of keyboard. Couple all this with a competing bunch of the self-righteous, and the self-obsessed and we have a recipe for the profession to start imploding.

It certainly feels like it is one rule for the GDC and one for us where social media is concerned; the sheer fact you can ‘like’ the fact a colleague has been struck off, suspended etc, is not what I call professional. There’s also no associated comment when a colleague has been exonerated, like in the case of the Scottish dentist Keith Watson, who then attempted to take a vexatious patient with an apparent history of suing dentists, to court for defamation, which unfortunately he has had to abandon at great financial cost to himself.

But, this case shows there can be huge good come out of social media and its immediacy. In the space of less than 24 hours a fund had been created to support Dr Watson, a newly qualified member of our profession who would no doubt be financially challenged by a huge legal bill this early in his career.

http://www.gofundme.com/keithwatson Not only that, the messages of support for Keith have been flying around social media all day and latterly on GDPUK itself.  When used appropriately then, we have a fantastic medium to help people.

We need to embrace social media as its here to stay; it can be hugely useful, and massively informative; but we must use it appropriately, and think about the consequences of our presence in the virtual world. That’s what it means to be a professional.

The Health Select Committee will be holding an accountability meeting with the GDC on the 3^rd of March. It’s about time too, as they haven’t been asked to account at all to anyone but the judiciary recently (and they lost). It will be interesting to see if they try to spin that meeting in the same way as they did in the press release just after the decision in the high court in December.

It looks like the GDC have finally got to face the only people who they are answerable to. I wonder if they are going to try to wiggle out of the unavoidable truths?

I presume everyone reading this is going to submit his or her evidence to the HSC through this link before the deadline of 19^th February.

No?

Why not?

Are you scared?

Well actually, that is probably extremely close to the truth. I am personally quite worried these days that a GDC letter will arrive on my doorstep for some reason or another (and that is not because I know I have something to fear – my inherent belief structure tries to ensure I do the right thing by patients at all times, but I have also been openly critical of the GDC, which I’m sure they do not like – and they get to decide what is deemed as professional or not).  All someone these days has to say (even in jest) is “I’ll report you to the GDC for…” or ‘I bet the GDC have their eyes on you” and it feels like a letter from Wimpole Street is already winging its way to you starting the process of investigation and a potential loss of livelihood.

The lack of proportionality that has been written about previously means that a situation like this could be an increasing possibility for all of us. It’s why the ARF had to go up according to the GDC for goodness sake. To put a few figures on this, if you reckon on 40,000 dental registrants having about a 40 year career, and the current data from the GDC is that there were 1700 complaints in the first 6 months of 2014, then the maths shows that each registrant will have 3.4 complaints in a career. (3400 complaints x40 /40,000). Some of these complaints are against DCP’s, ok, and not all of them will go to the full Fitness to Practice hearing,  (but 40% of them currently do) but I’m sure you get the overall idea. Is it right that if this way of dealing with complaints continues, on average, every single dentist will have to face this career-wrenching possibility more than once? This alone tells the general reader that the regulator is going the wrong way about it.

Since the GDC are the initial arbiters of our standards and decide an investigation will run to see if there are any grounds to an allegation, and there is currently the interminable wait for a hearing, then I don’t honestly think I could mentally deal with that kind of pressure for that long with the fear of loosing all that I have put into patient care, this profession, and that of my livelihood and ability to provide for my family. Even if an investigation goes all the way to a hearing, is there any guarantee that there will be an understanding of the pressure we are now practicing daily under from the committee, especially when it is made up of so many lay persons?  Tony Jacobs wrote an excellent blog on this subject.

Some of you will have no doubt read the very eloquent and erudite blog written by Colin Campbell, a very well thought of colleague in my locality and indeed nationally. Colin is one of the most ethical and conscientious practitioners I have ever met. If you haven’t read it then it is a ‘must read’, because Colin is a person who wears his heart on his sleeve and this series of blogs are likely to be a wholly authentic and personal view of how HE felt during the process he went through.

There are many (most of us?) out there that fear the GDC, and not for the correct reasons. We need to respect our regulator, and know that whilst it absolutely MUST act to protect the public, it is not effective ‘right touch’ regulation to do this by ruling the profession with that kind of fear. Using a methodology akin to continuing the beatings until the morale improves is not how it works these days.

Mistakes happen; I was once told right at the beginning of my dental career by an older practitioner the reason he was more experienced than me is because he had made more mistakes than me. Nobody is ever going to excuse the type of mistakes that are so dangerous they have to be dealt with swiftly and appropriately. But if we are to be perpetually living in the fear that one minor transgression will bring the full weight of our regulator down on our backs then that is wrong.

There are also bad people in our profession; nobody is denying that, and I will certainly make no excuses for them. But the climate of fear that pervades the profession at the moment is no way to prevent mistakes from happening, and it certainly wont do ANYTHING to stop that minority who are out to damage people because  they probably don’t have the emotional or ethical values to allow them to feel the fear those of us that practice ethically and responsibly (and fearfully) do.

So at the moment I remain scared. But I will still be submitting evidence to the Select Committee because I cannot, and will not be made to feel this way for the rest of my practicing career. We care for patients every day, but we also have to care about our future health for the sake of our families. After all, we too are human, just like the public the GDC must protect.

We have to stand up to the GDC and now show them the true and high calibre of the vast majority of Dental Professionals.

Blog image Edvard Munch [Public domain], via Wikimedia Commons 

Its becoming very apparent that there is a distinct lack of transparency where some practitioners are concerned with regard to what is and isn’t available on the NHS. This has been going on from the beginning of the new contract, and has caused much heated discussion over the years.

When you consider that not even the CDO was prepared to give an actual list of NHS treatments, instead relying on the ‘All that is Clinical Necessary’ definition that is deliberately intended to obfuscate, then it isn’t really surprising there are almost as many different interpretations as there seem to be contract holders.

We can argue amongst ourselves as to when something should be, or can be provided on the NHS, but the end consumer, the Patient, is stuck in the middle of this unsatisfactory situation, and that should be our prime concern.

The GDC are now starting the come down on those practitioners who they feel have been misleading, or even dishonest in their definition of what is available, and since the balance of probability legal test is used, the weight of evidence does not have to be as high as a criminal issue to find a practitioner guilty, and then suffer the consequences.

However, until recently, the difference of opinions as to what is legitimate and what is ‘gaming’ has largely been discussed only within the dental profession itself. This is NOT intended to be a blog about what gaming is; it’s sufficient to say though that we have to acknowledge it exists within the profession.

This week, Which? have now waded into the argument, with a campaign to ‘Clean Up Dental Costs’

It would appear that they have found this distinct lack of transparency in the pricing of dental care, and in particular the differences between private and NHS care. Not only that, they appear to have also found that about a quarter of those surveyed were unsure of the differences between NHS and Private.

More worryingly, 40% of respondents were unaware that all treatment that was clinical necessary was available on the NHS. This lack of awareness plays right into the hands of those practitioners who have been guilty of perhaps ‘massaging’ the NHS contract to their benefit and not that of the patient. One question it asks is who is responsible for the overall education of the general public as to what is available to them; it is accepted that expert opinion and advice is needed when the general public seek the aid of a professional, so they can perhaps not be held completely responsible for not knowing the ins and outs of dental treatment. On the other hand though, is ‘All that is Clinically Necessary’ too difficult a concept for the Government via NHS England to convey to the populus in some way? The lack of this clarity has lead to varying degrees of confusion, alternative interpretations of the contract (not tested in law to my knowledge) and downright dishonestly and misleading behaviour at the expense of the patients.

Whenever gaming rears it head in discussions on this and any other forum it polarizes opinion hugely, and usually ends up in a slanging match of NHS vs Private. As I’ve said this is not the aim of this blog, but merely to get people to think about the consequences of what we in the profession have begun to create for ourselves and our patients.

It’s one of the huge elephants in the room in our profession at the moment.

There is no doubt that gaming is rife amongst some practitioners. Not all of them, but I would wager that there will be a fair number of mixed practices that are operating at the very edge of what is actually the correct definition of ‘Clinically Necessary’ throughout the country. The fact this aspect of the contract has not been tested in law is probably somewhat fortuitous for all concerned.

Of these practices, I think there will probably be some of them actually deliberately seeking to maximize their financial advantages over those of the patient. This is in direct breach of the GDC standards relating to putting a professional’s needs over that of the patient. It wont be an excuse to use ignorance of the rules of the contract to defend this either, or the continued financial survival of a practice. The continued ignorance of the patients in knowing what is and isn’t available themselves, and the plausibility of the explanations given (‘its isn’t available on the NHS’ is a difficult phrase to argue against for a majority of patients) mean it is simple for some practitioners to pull the wool over the eyes of the public.

If we want to take a stance against the way the GDC is acting at the moment, but there is sufficient evidence that some practitioners are being more ‘flexible’ with the interpretation of clinically necessary, then we can hardly take the moral high ground against them, as individuals are misleading the public the GDC are tasked to protect. How can we protest at that? When we have a Chairman of the GDC who has a background in the Office of Fair Trading it is not beyond the bounds of thought that his wish to broaden his remit has the tacit approval of the powers that be, and will include any future tests of NHS vs Private provision. Incidentally, Which? are not calling on the profession to clean up their act; they’re calling on our regulator and NHS England to do it for us.

In addition, if the Big Lie is to be exposed in all its glory, we as a profession can’t then be seen to be obscuring the failure of the contract by blurring the treatments that patients are receiving on the NHS and Privately. By misleading patients as to what is and isn’t available, to the benefit of the practitioner, is never going to expose the lack of funding inherent in the system.

Lack of transparency of fees has always seemed to be a problem with our profession. The artificially low NHS prices when compared with private means a significant number of the population have no understanding of the real costs of dentistry, and I think we really as a profession don’t go far enough to explain this to the public. Couple that with the confusion now as to what is and what isn’t available on the NHS then it is no wonder Which? have waded into the fray on the side of the consumer.

I personally don’t think it will be long before some form of disclosure along the lines of that seen by Independent Financial Advisors will be compulsory. With the GDC being final arbiters of our professional conduct, any lack of transparency in financial issues are already taken as being as serious as those of clinical errors. We will therefore reap what we sow where it come to financial misdemeanours.

We are in an ever increasingly consumer driven society, and we have to get our house in order if we are to retain the professional status we think we deserve. If we don’t, then we only have ourselves to blame for what is then enforced on the profession in the future. We can resist consumerism and try to hang on to the last bastions of professionalism, but if some of our profession are less open with their dealings with those consumers, then we will all pay the price.

The consequences of gaming are coming home to roost whether we like it or not.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This brings me to the point of this blog.

Civil Disobedience.

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

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

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

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

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

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

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

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

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

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

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

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

I am.

* Image from Wikimedia Commons.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Appropriate Bedfellows?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What happens when an Immovable Object meets an Irresistible Force?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I think they should.

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

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

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

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

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