anti-bullying week

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Then

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It was a black day anyway.

It had been announced earlier that morning, that Freddie Mercury had died, so I wasn’t particularly bathing my colleagues in the joy-bringing light of my sunny-disposition. I was sitting in my surgery at lunchtime, reading a newspaper (This was the early 90’s, when YouTube was merely a glimmer in Tim Berners-Lee’s eye), when four glum-looking nurses trooped in.

I hadn’t been in the practice for a few days and hadn’t realised that there had been a growing revolt within the practice at the treatment of one of the younger nurses by the practice owners. The bosses were a husband and wife partnership. They really did fancy themselves as upstanding members of the local community, the local LDC and the BDA.

The nurses outlined briefly what had been going on. The male boss had apparently treated the young girl abominably when she put in her resignation letter, the previous week. She gave two weeks’ notice, as dictated in her contract, but the principal told her he wasn’t going to pay her weekly until the day she left “If she behaved.” In those days in that practice, the nurses were all paid on a weekly basis, in cash – a hangover from the old-school dentist who previously owned the business.

The wage they earned from the practice was embarrassingly low and the nurse was distraught since she had urgent bills to pay.

The reason for the deputation of nurses to me was to inform me that it was nothing personal against me, but they had decided to ‘strike’ immediately in protest at their colleague’s treatment and to force the business owners to pay her what she was owed. The male half of the partnership was away on a course on this particular day, and so it would be his wife who would have to deal with the situation, while I could just cancel and go home. Result!

Having been a union official briefly in my previous career, the socialist in me was impressed by their resolve, but I felt I had to advise caution and a rethink – particularly since they didn’t have any representation and the male owner of the practice was an incredibly unpleasant, evil and vindictive bastard.

The strike took place. It was ten past two before the female half of the gruesome duo realised the practice was bereft of nurses and I had to explain what was happening. It was incredibly hard not to erupt into mocking laughter when she burst into tears and asked me to nurse for her. I refused – partly because I was in solidarity with my striking sisters, but also I had no idea how a nurse actually works. To me, dental nursing is alchemy.

The upshot was, the following day, the nurse was paid her money and two nurses were fired. I handed in my resignation the same week, mainly because of their treatment of staff.

The reason that incident popped into my head is the fact that last week was Anti-Bullying Week, coordinated by the Anti-Bullying Alliance.

Other instances of bullying in practice then came flooding back. And they were instances that that affected me directly.

Bullying isn’t exclusively a phenomenon that affects employed staff. When I sold my practice on and became a corporate associate, I became a target for the corporate directorate as soon as I voluntarily told them what had happened following the sale of my practice.

I have previously been quite open in blogs about what happened a couple of months after I sold up. I had three complaints from previous patients, carefully cultivated and promoted by the buyer of the practice. She had plans to use the results from GDC hearings to prove that I was a poor practitioner and it would therefore justify a civil claim for £40K that the dentist was dishonestly claiming for work that she had to replace within six weeks of the takeover. In the end, the GDC threw out the complaints against me and the buyer faced charges of NHS fraud and she subsequently had to endure a twelve month long investigation - little comfort for the stress I had endured as the target of her scheme.

As soon as I heard of the first complaint, I voluntarily told the corporate’s clinical directorate of the circumstances I was in, just to be professional. Big mistake. From then on, my card was marked, despite me outlining my situation completely.

Without me knowing it, the corporate instigated close monitoring of my notes and I then had a humiliating visit from one of the clinical directorate, an incredibly sarcastic and odious individual whose only mission appeared to be to reduce me to quivering jelly, despite his proclamation of being “here to help.” Apart from ripping apart one root-canal I’d done, he went over all aspects of my practice. I will point out that until my buyer took over the practice I had never had a single complaint from a patient at any practice I’d ever worked in.

During that first meeting with the clinical director, he also brought up the fact that I wasn’t ‘maximising capacity’ and then brought up the subject of ‘phasing’ a term I didn’t know before I joined the corporate. At the corporate induction day, the head of the clinical directorate introduced phasing, which I took to mean ‘gaming.’ The idea behind phasing as I saw it, was to unethically bleed the NHS by dragging out treatment over several courses and thus maximising the number of UDA’s you could claim for a patient with high treatment needs. Phasing got a bad press not long after the clinical director’s visit, and suddenly it all went quiet around the invitation to a ‘phasing day.’

It was a pity. I intended recording the ‘course’ though I still have the original induction day all on tape.

Not long after that visit, everything I did was torn apart, though being honest, I made it clear to him that I didn’t like the clinical director one little bit. The final humiliation was having an ‘invitation’ to go to his practice for a refresher in dentistry, also extended by the head of the clinical directorate. I blankly refused, pointing out that if he really wasn’t happy with my standard of work, he should ask all my younger dentist colleagues (spread over two practices) to stop coming in during the day and either asking me for an opinion or asking me to finish their extractions off. That usually meant doing a surgical – not that I ever minded doing that – we all ask for help when we are first starting. Anyway, that riposte appeared to shut the clinical bosses up.

On reflection, I should have just kept my mouth shut about the problems I had with my buyer and not put my head above the parapet. Suffice to say, the not-so-subtle bullying had a more profound effect on my mental health than even the investigations by the GDC and dogged my days in the corporate right up to my day of retirement.

I really hope that neither of those clinical directors are in positions of power. They both seemed to be on massive ego trips, rather than instilling professional excellence among company dentists.

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Now

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And if you think bullying in dentistry isn’t currently a thing and doesn’t need addressing, think again. It’s alive and kicking and has been given a boost by the COVID-19 pandemic. Except the bullying has been cleverly disguised as emergency economics.

I’ve had a number of dental people approach me over the months who have told me of much questionable activity from practice owners particularly with regard to loose interpretations of the emergency NHS regulations related to the payment of dental fees to practices.

I recently had a couple of direct approaches from dental staff working for one particular corporate who told me that associate dentists on high value UDA rates had been given notice after dentistry was reopened in the summer.

I was told that the high-earning sacked dentists were targeted as a cost-saving and cash accumulating strategy - the rationale being that the corporate would still be receiving its full contract value per practice, despite needing to only hit 20% of previous targets. There was speculation that at the other end of the production line, the same corporate was engaging dentists at lower UDA rates – presumably to make up the staffing shortfall.

Coincidentally it was reported that the same corporate was apparently putting appointments in the book in one practice, handled by receptionists, who carried out over-the-phone COVID screening. These screening calls were then being claimed as triage ‘activity.’

If you think that trying to force dentists into accepting unfavourable changes in their practice contracts with the threat of dismissal hanging over their heads during the COVID crisis ISN’T bullying, then you’re wrong.

I heard of one dentist – funnily enough at the same corporate – who was under heavy pressure to leave her practice when the company reneged on a promise made before the pandemic arrived, to allow her to change her hours to accommodate changes in schooling arrangements for her children. Again, the dental professional who told me that, was under the very real impression that the move was part of the company’s attempt to minimise expenses.

Another corporate is apparently promising associates a 20% reduction in renumeration if they fail to ‘collaborate’ with the company on its new policy of ‘patient-led opening hours’ and a 10% reduction in annual pay if associates fail to hit a 2.5 UDA per hour ‘run rate.’ The author of an email to associates implied that the 20% reduction was to reflect fairness – failure to cooperate with the new working hours by certain members of staff, being unfair on those that chose to be financially bullied (my word) into cooperation.

The email outlining the above from the ‘leadership team’ even finished off with an inspirational quote from John F. Kennedy.

But the reality of this particular corporate’s demands was that associates needed to hit around 50% of the previous year’s NHS achievement, with a threat of punitive financial consequences if they didn’t hit that target. This is of course in breach of the NHS’s current stipulations on payments to associates.

One dental surgeon felt unable to perform their duties to the professional standards demanded by governing organisations and also feared safety of the patient, nurse and dentist would be compromised. That dentist resigned, pointing out quite reasonably that any ‘lazy’ dentists should have been approached directly rather than the company imposing such changes on working hours across the board.

Now I know times are hard and I know that even in the best of times, running a dental practice is a precarious business, having done it for two decades. But there are ways and ways of making changes to working practice, and bullying – which this clearly is – isn’t one of them.

Though dentists aren’t the only dental professionals who have been poorly treated in the name of pandemic viability. An example is the dental therapists who are in a similar position to dentists in the way they have to work in surgery.

I would imagine the British Association of Dental Therapists (BADT) and British Society of Dental Hygiene and Therapy (BSDHT) have been overworked in helping members who have been short-changed during the re-establishment of dental services.

I have heard of dental therapists being paid on an hourly rate before the pandemic, but on a return to work only being paid for UDA’s completed. This has meant a vast reduction in income since few UDA’s were finished since treatments were split between the prescribing dentist and the dental therapist. The approaches to payments to therapists seem to vary. One corporate pays its therapists on the same hourly rate as pre-shutdown. Fair play.

The rules regarding payments to dental therapists appear to have been almost deliberately misinterpreted by (mercifully) a few dental practice owners. These owners give the outside appearance that they not totally embraced the nuances of the rules and the fact that the NHS payments made to practices are for the team as a whole and not exclusively dentists. Some have even been trying to reduce payments based on what therapists have received from the HMRC’s Self-Employment Support Scheme grant – irrelevant to NHS payments and frankly, not their business. This was bullying by implying you’d bring your mates from the HMRC to the scrap.

The fact that ultimately, practices will have to face the consequences of not complying with NHS requirements, seems to have just passed a few practice owners and corporates by. Meanwhile, other practices have simply told dental therapists to apply for the government support scheme grants and have decided not to pay therapists. Full stop.

I’m lucky. It’s been seven years since I ran my own practice and I can’t imagine what it’s like to operate as a practice owner in these bizarre days and difficult circumstances. It must be incredibly hard to balance the books and keep afloat. Despite that, all know is I would try and do my utmost to treat my colleagues in the way that I would like to be treated.

But there again, I was a hopeless businessman and an even more incompetent bully.