Tis the season to be jolly
Fah la la la lah, la lah la lah

Well after an autumn break to see how the land takes up the fertiliser of restful thought, we approach the Christmas break with a need for reflection.

What has 2016 thrown at us?

A reason to be cheerful? A season of Goodwill? A sense of hope?

There are three major areas that seem to be affecting the profession at this time.

There is the issue of the GDC and its new Case Examiners.

It is too early to say if this will genuinely make a difference. What we want is for the GDC to stop trying to be a Complaints House, taking everything on no matter how trivial.

Dr Colin Campbell, a widely-respected colleague in the Midlands, with a personal history of the dealings of the bludgeon that is FtP, clearly thinks not – again with personal experience.

But then again, why would CEs make a difference? They have been tasked and trained by the very organisation that had the problem in the first place.  And the problem is that the GDC do not reject anything.

Some of the recent cases suggest that the GDC still do not know what a proper complaint is. The whole list of FTP is awash with material that is either better managed locally and or indeed a simple internal disciplinary matter.

So, if you have not done so, get your £900 out for another year of outrageous wasteful use of your money. But do so with a good grace. It could be worse. 

Couldn’t it?

Is it me or have we become so numb and subservient that we just accept it as a nuisance nowadays?

NHS Pilots – self funded by dentists!!

Meanwhile, perhaps all is well with new NHS Pilots. We all know there is new money, and we all know that the DH wants to get bodies through the doors, never mind whether anyone does any dentistry.  But the idea of a Care Pathway appears to be well received on its own merits.

But there appears to be strange anomaly that the pilot practice may face up to 10% - YES TEN PERCENT – clawback – which if your profit is running at 20% reflects HALF THE PRACTICE PROFIT -  which for most Pilot Principals suggests a cold winter looms.

Good on the BDA for highlighting this matter, on stage at the Local Dental Committees Officials Day , with the DH Head of Finance and the “fabulous” Dr Sara Hurley [You did see the Good Morning interview spat between our CDO for NHS England and Dr Tony Kilcoyne didn’t you?] sitting along side as Dr Henry laid into them in no undertain terms.

Indemnity in Crisis?

Maybe all is well with our support network, the Medical Indemnity Organisations. You know – Dental Protection, DDU, MDDUS and the newer companies such as Taylor Defence Services.

Well, who knows?  There are stories of some colleagues finding their cover withdrawn in a discretionary manner halfway through a case.  There are many stories of colleagues finding their annual cover suddenly approaching 5 figures and beyond.  There is still no clear method for subscription calculation although one hears mutterings about the legendary ‘grid’.  A sort of Spot the Ball for Indemnity subscriptions!

Whatever the truth, there is a financial crisis in Indemnity, driven by a combination of commercially proactive lawyers and an overzealous GDC. So much so that there is a one day crisis conference being held in January

After many discussions about rising Indemnity and concerns some colleagues have been left with no cover or representation etc., A 1-day Seminar is being organised by Dental Practice at the Hilton Metropole, Birmingham NEC, on Friday 27th January 2017 from 08.30 to 17.30pm.

Concerns are being expressed across the dental sector about the delivery of Professional Indemnity cover and what is and is not included in the various offerings from the MDO’s. As a result, and in conjunction with many key decision makers, it has been decided to hold this 1-day seminar to look at the current situation, with much time for Q&As.

Places will be limited and are expected to be in high demand so, to avoid being disappointed, contact Rodney Pitt, Editor and Conference Organiser at This email address is being protected from spambots. You need JavaScript enabled to view it.

Well that all makes for an energetic start to 2017.

It must be time for another letter to educate the public again, if the recernt rubbish written  by Hunter Davies in the Times is anything to go by!

I suggest we all turn to our loved ones and count our blessings.  In the year that we have lost Leonard Cohen, AA Gill and Greg Lake, we will not be short of words and music.

Put your practice to bed, and come back refreshed after a nod to the year, raring to go – unless of course you rely on Southern Railway in which case, the very best of luck!

If Christmas is your celebration, may yours be peaceful and joyful. That much we can be assured of

http://campbellacademy.co.uk/blog/failed-hurdle/
Dr Colin Campbell – the GDC have failed at their first hurdle

https://www.gdpuk.com/news/latest-news/2403-henrik-gives-update-on-prototypes
Henrik Overgaard-Nielsen, Chair, BDA General Dental Practice Committee, has posted an update about the prototype contracts on the BDA website

Also here for BDA members
https://bdaconnect.bda.org/dental-contract-reform-an-update-on-prototypes/

http://www.content.digital.nhs.uk/catalogue/PUB22526  for NHS report of Motivation

Dental Working Hours, 2014/15 and 2015/16 Motivation Analysis, Experimental Statistics

Let me start with an apology ...

Those of you of a certain age may recognise my poor attempt at an ironic pun. That of course is nothing to do with my age – I am just a poor punner, so to speak.

One Week to go, Eight Weeks from certainty, 

We are 8 weeks from a General Election the outcome of which is regarded widely as the most uncertain for many generations. We are also less than a week from a most important event: Roll up, roll up, it’s the GDC under the microscope of political accountability … [well, hopefully!]

By the time you read this the House of Commons Health Committee will have parked dentistry [though the GDC Accountability Hearing] on the electoral back burner.  We’re done, the politicians will say, slamming shut their leather bound folders.

Long live the GDC

Of course we have all blown a lot of hot air about the GDC. I for one wrote majestically of the

“Delusional Management Executive and Council, demonstrably out of touch with the real events”.  I have to say I was rather proud of that!

What’s the point is making such a comment, though, if the examining Health Committee were to be so easily misled by a slippery GDC presentation?  We shall see. Our medical colleague, Dr Sarah Woolaston [a GMC Registrant] strikes me as a good pair of hands to chair the Committee and we live in hope that the GDC are “flamed”.  I for one called for the GDC to be placed in Special Measures.  Will there be tears for the GDC? I suspect not.

So for this Parliament, dentistry is all over. The Chief Dental Officer [NHS England] appointment is not even worthy of news yet.

Tiers of Tears?

And yet an ominous clinical change is afoot which will potentially be a most divisive one.  I refer to the introduction of Tiers to the delivery of dental care.  Orthodontics is now beginning to see it being proposed, while it has been flagged for some time in GDP and of course Oral Surgery have systems being rolled out.

In essence, perhaps we could liken it to our childhood friend Noddy:

Tier 1  -  Noddy can talk to Big Ears about driving but not drive a car

Tier 2  -  Noddy can drive, but not on the road at the same time as  Big Ears

Tier 3  -  Noddy can drive on the same road as Big Ears at the same time

Tier 4  -  Noddy and Big Ears can share the driving of Mr Plod’s police car

If there is one subject you should examine for your future practice, I urge you keep your eye on this ball.  As a young practitioner, it may simply guide your career development.

But as an older practitioner, the way these tiers are being mooted may expect to have an enormous impact on your ability to provide more advanced dentistry as part of your mixed practice.
 

You may wish to plan your practice development now, before the prototypes come in and before Tiers are presented to you on a plate, rather like a new diet of limited crumbs

Because I suspect many practices are only truly viable because of the ability to mix NHS and private care. Their clinical skill comes from the apprenticeship that is a life in General Dental Practice

While Tiers are arguably driven by good thinking about the big picture, and are here to stay, I worry that the unexpected outcome will be to drive unexpected massive change through older practitioners, who in many cases of course are the practice owners.  In all of this, the reality of Austerity 2 after the election – there has already been flagged real terms budget cut of up to 20% - makes the reality at GDP level quite different

Don’t let you and your practice be the one to experience Tears for Fears.  The Law of Unexpected Outcomes may well be alive and well

Valedictum

On a closing note, not unrelated, I am sure tears will be shed for the retirement of our colleague , the Chief Dental Officer, Dr Barry Cockcroft. The old position of CDO was of course downgraded, politically speaking, to NHS England, now outside the Elephantine corridors of power in London. This poacher turned gamekeeper [for he was indeed in high office at the BDA] can have improved access to a safe retirement in the knowledge that his project of UDAs has lasted the test of time, even if did not pass any other test!!  Let us hope that the next incumbent of the position does not also leave office with the same defunct system in place in years to come.

We reserve the right to have a barney with you Barry, but the least you deserve is a drink on us.  A glass of Chateau Fluoride perhaps – the one with the varnished cork?

 May your retirement be a long, happy and enjoyable one. 

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/inquiries/parliament-2010/2015-accountability-hearing-general-dental-council/

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/membership/

http://www.england.nhs.uk/wp-content/uploads/2013/02/commissioning-dental.pdf

2015… anticlimactic or more to come?

It been a funny old year.  As you sup your Christmas tot, you might perhaps take some time to reflect? Pull a chair up, let’s while away a minute. It’s cold outside, so would you be kind and throw a log on the fire?

For a profession that should really be quietly under the public radar, and in the state of a ship sailing steadily and smoothly, the waters have been mighty choppy this year.  The raging CQC currents have by and large subsided, while the torpedo of the ARF, allied to the air strike that is Medico Legal costs arising from the FtP debacle, was a direct hit.

Tears or Tiers?

The winds of NHS “Tiering” are gathering, and forecast is that a storm will develop around the Prototype Contracts which has yet to peak.  The UDA unfairness continues to block out the sun, especially for those of you who by whatever means have run out of UDAs for the last 3 months.

Great Deeds for Christmas?

The GDC have, shall we say, come to our attention this last year in an unprecedented way. The present leadership of the GDC have shown themselves to be arrogant, intransigent, out of touch, and in an irony befitting of their Standards document, utterly without a care in the world about the profession.

I hope you have not been in a time warp and that the events of the last few weeks have not passed you by.

The GDC now finds itself on the wrong end of a judgement at the High Court. Do not believe everything you read in their oh-so-friendly e-mails – honesty and transparency are two things woefully lacking in this broken organisation. However, they offer a level of Spin for which a former Prime Minister would be proud.

The time has come, the walrus said…

In answer to your question “What next?” I suggest you ALL whizz over to the petition at the link below to sign your support for the resignation of Mr Moyes and Ms Gilvarry.  It is you, my friends who will keep this agenda alive – please do your bit. Responsibility must be acknowledged and frankly after this last few months, there can be no other honourable way.

There are 36000 Dentists and if you do nothing else to support your profession this year, please sign it.  Unless of course you think the GDC are spot on and a fine example of public body efficiency…

PLEASE SIGN THIS PETITION

Please visit https://www.change.org/p/gdc-gdc-leadership-resignations-needed-the-courts-and-profession-have-spoken

Better Deeds for All?  

Go’arn, go’arn, go’arn … you know you want to

But the BDA in contrast have risen to the challenge. If you are not a member, and can stretch to the additional cost, my commendation is at least throw them one year’s membership as a thank you for their action on your behalf. 

https://www.bda.org/strongertogether

Because of their resistance to the GDC steamroller, a process has been started at the political level which, in my opinion, will likely see some change driven by ministers over the next year. If you did not see the debate raised by our colleague Sir Paul Beresford, it is worth an hour of vCPD to see Mr Dan Poulter the Minister state unequivocally that in his eyes the GDC were bang out of order! This is the link
http://www.parliamentlive.tv/Main/Player.aspx?meetingId=16685&st=11:00:00

A Christmas Truce?

As The Christmas season passes [and for those not so inclined, may it be an appropriately Festive one] it is time to stop worrying about matters dental and just chill out with your family & friends. If you are like me and prefer your own company, may the mountain that you climb offer perspective and energy. 

Perhaps we might find it in our hearts to wish all those at the GDC peace and goodwill.

So will 2015 quieten down?

We shall see. The agenda will change but it seems like there is much more to grab your attention on the way. To our young graduate colleagues, welcome to the funny farm and good luck coping with the massive changes that are brewing.

Be positive for 2015

Remember, the NHS is not the only outfit in town. Behind all the huff and puff of politics and the GDC qwankers¹, private practice is a driving example of modern, efficient small business, focussed absolutely on patient care through a strong relationship with the dental team, offering a route to lifelong dental health aided by some amazing CAD CAM technology. Indeed the Good Ship SS Private Practice has been quietly sailing around all the politics and as any members of it ‘crew’ will tell you, when you sit down with your patient and start building trust, the rest of the world melts away.

If you have half an inkling to start a process of being less, or indeed NOT dependent on the Government for your business income, why not use the next couple of weeks to plan your first step. With all the changes afoot, allied to a certainty that there will be no more money when they demand extra activity from you, it’s the least you can do for your patients.

Life without the NHS actually makes tolerating the GDC a whole lot easier! And without NCAS and spurious GDC referrals, you will be a lot less likely to have your FtP day . Hurrah!!

So 2014 is a wrap.

To all my reader my thanks. To all of you, a peaceful end to the year and remember … they’re only teeth !  But they don’t ‘alf cause trouble, eh?

1                     http://www.urbandictionary.com/define.php?term=Quanker
 

2                     Join the BDA at https://www.bda.org/strongertogether
 

3                     http://www.parliamentlive.tv/Main/Player.aspx?meetingId=16685&st=11:00:00

4                     Sign the petition seeking GDC Resignations at
https://www.change.org/p/gdc-gdc-leadership-resignations-needed-the-courts-and-profession-have-spoken
 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cooperation over independence?

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

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

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

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

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

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

As the autumnal fall returns once again and the ominous portent of a Comet Ison[1] in the morning sky passes I am minded to wonder at our innate ability to disagree.  There is a really intriguing book out there called   Them and Us: How Neanderthal predation created modern humans by Danny Vendramini  [2] Basically, our behaviour is nothing new!

The BDA saga has not gone away, we are told – well, actually we are NOT told …  but the vox pop of internet chat suggest that those in office at the BDA are running in internal disagreement, and of course all the outsiders like myself are far better placed to run the show.  There is no agreement it seems, and we are polarised into them and us.

Then of course there is how to deal with ‘the problem patient’.  Not only do we all differ, separating into the “This is how to do it” camp on the one hand, and the “No you fool, do it this way” camp on the other.   Never mind that the poor bloody patient is always wrong.  Them is always right and Us is never wrong.

Orthodontics appears to be generating a fair share of divisionary comment:  Far from everyone synergising to the wider benefit of the patient community and for the greater good, we just have to bicker and squabble over long term or short term, GDP or specialist , ultra modern self ligating or out of date elastics.  Throw in a spooful of commercial self interest and the fuse is lit for a right royal bust up.

What would the public think?    Oh – them and us again!

There is a fine line between appropriate professional disagreement and internecine  warfare. We must as a profession beware of breaching it ... if we actually care. Maybe we just like a good fight!

Gawd ‘elp the poor old GDPs if the BDA and BOS combine forces …

Seriously:  who will draw this disparate medley of headstrong prima donnae professionals together? 

If we fight amongst ourselves, the Governments work is done.

Ah … now there is the Ultimate “Them and Us”.

I blame Comet Ison.  Enjoy Thanksgiving, don't all fight over the Turkey now. That would far too Neanderthal ...

[1]  http://www.bbc.co.uk/news/science-environment-25001732

[2]  http://www.themandus.org/   
Them and Us by Danny Vendramini
With acknowledgement to the author for the image

Those of you who read and digest the news and views of dentistry at large will perhaps have noticed the recent Private Dentistry Awards¹.  A rip roaring time in London for all who attended.  A sore head or two the next day I’ll bet.

The recent announcement of the winners serves to highlight the lengths that many colleagues will go to strive for excellence. They are also extraordinary in that they can find the time to document their activities and seek to obtain external recognition. To all who entered and indeed were in the awards, heartfelt congratulations.

To all of you who did not enter, I am sure I am not alone in noticing that the effect rubs off.

You read about how others do things.  You read about ideas and marketing. You introduce these things in your own way into your own practice.  Just because you do not enter does not mean you are not a winner.

Of course, the clue is in the name – none of these particular practices lay claim to  providing dental care under the NHS, although how many of them employ NHS associates remains to be detailed.

But as we witness NHS England purging their Performers List with suspect letters of a dodgy tone threatening removal arbitrarily simply because it suits someone in London’s database management skills, it seems to me that there is no doubt about this: Beware the false security that the Government offers.

Left to its own devices, Dentistry as a business and a profession would make a far better job of marketing its services at the right price, in the right place, to best suit a particular patient base than any mish-mash of Reds, Ambers and Greens that the Government’s Department of Health lackeys can come up with. Why it is that our academic colleagues often fail to see or understand this paradigm remains a mystery.  Are we all really that imbued with social guilt so that any talk to do with the NHS simply proves it is culturally embedded?

That must be the counterpart message of the BDA as it emerges leaner, poorer, but fitter and raring to “engage”.

By all means engage with the DH, but the BDA must lay out the subtle threat that we do have to courage to do it ourselves, and will do it better.

Now that is a profession in a win-win position. The winners of such a brave approach would be everyone, patients included.

1        http://www.dentistry.co.uk/news/smiles-and-success-uk%E2%80%99s-private-practices

2        http://www.privatedentistry.co.uk/awards/

So.. its all over. That’s it for another year.  

Farewell BDTA Showcase ....   Sadly true

Farewell BDA problems. ....   Sadly untrue

I find myself intrigued by the numbers. About 4000 dentists attend, and about 14000 ‘others’. It seems there is a massive networking opportunity here, and perfectly positioned at the centre of the country, and yet barely 20% of owner dentists attend. I wonder what would make it a “MUST” – maybe a GDC standard?

To those of you who did indeed support our industry, well done.  Your investment in the future of good dentistry, at your risk, using your money [well maybe with a little help from a finance company] speaks volumes for the ethics of dentists.  If you did not make that purchase decision, perhaps you were put off by a pushy salesman who reckoned he or she knew it all?

When the new Government contract comes around, you will be fully IT’d up … won’t you?  Do it now, build your IT Ark  BEFORE the storm.

It was also of course an opportunity for some big organisations to get down and dirty. 

The GDC stand saw a steady  passing of interested people, many of them DCPs …  I wonder if like me you feel nervous going up to them – should you be anonymous just in case?  Can they really call you to account for just ‘having a go’ at the stand? I sincerely hope not.

GDPUK of course ‘trailblazingly’ set the standard for shiny shoes - but I never did find an answer to how to get shiny white crocs in the surgery!  It was THE place to meet and chat though.  If there was a centre to the Showcase, the GDPUK stand was it.  Just like it’s the centre of open opinion now. And if you have one, about anything, please come online and jot it down.

Talking of pushy salesmen, the BDA missed a trick in Birmingham, choosing instead to simply whip up a bit of spin with their racket by issuing yet another “All part of the grand plan” statement, care of the Chief Executive and PEC Chairman.  Good on you, lads.

Dodgy salesmen eh? You can smell that reptilian oil from a mile off.

With thanks to Matt at The Telegraph for the image. The original may be found at http://www.telegraph.co.uk/news/matt/?cartoon=10371411&cc=10345727