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

Missed opportunity?

The Chief Dental Officer for NHS England recently found herself at the forefront of dental media storm. Playfully referred to as “Recallgate” her reported comments drew widespread criticism across a range of the profession’s leading Clinicians, and a lame response through her PR Outlet, Dentistry Online.

All this arose from her presence at the NHS Expo on a stage with some leading colleagues of the Medical and allied professions for a question and answer session.

Expo is an interesting gathering of the great and the good from the world of the NHS and industry.  The proudly proclaim

Health and Care Innovation Expo 2016 is a unique event that showcases innovation and celebrates the people who are changing the NHS, with high-profile speakers and a real focus on learning and sharing.

The NHS you’ll see at Expo on 7 and 8 September is a forward-thinking organisation, staffed by clinicians and managers who welcome innovations in technology and information because they recognise the difference this will make to their patients’ lives. Expo also welcomes and involves partners from across the public, voluntary and commercial sectors, recognising and promoting the role they play in keeping people and communities healthy.

Health and Care Innovation Expo attracts around 5,000 people across two days, the majority of whom are leaders and managers with real ability to lead and drive change in health and social care

So when the opportunity for Dr Hurley to speak, she chose to focus on  one of the most exciting developments in dentistry.

The Recall Interval.

What she said of course was hardly earth moving.

Ration the availability of NHS dentistry for the healthy in order to create space in the system for those who are not healthy and have higher needs.  This is hardly big news, is certainly not innovative, and of course was not presented as rationing by the back door. Instead it was reminder of the NIHCE Guidelines and an opportunity for some predictable side swiping at dentist.

In particular Roy Lilley made the really quite amusing quip that “Dentistry has become a rich man's hobby” The former NHS trust chairman Roy Lilley went on: “It has gone off the high street into lavish surroundings.”  

Thanks Mr Lilley, if your understanding in depth of dentistry reflects your understanding of medicine, the NHS is safe in your hands.  Oh, you are not a manager anymore?

You may follow Mr Lilley on Twitter at https://twitter.com/RoyLilley and contact him direct at @RoyLilley. Judging by his response to the leading BDA member Dr Eddie Crouch taking him to take, he only has a sense of humour on a public stage. Judging by his activity, he has given up NHS Management in favour of tweeting …  83,300 in 7½ years and counting!!

But look: there is a serious point here

Dentistry needs a Cheerleader

Mr Lilley is patently one of many self-appointed cheerleaders for the NHS and its achievements. Good on him. Nice money if you can get it

Dr Hurley had half a chance to really put out there what dentistry as a microbusiness, brimming with technology, can achieve for people. She could have even homed in on the Infant Caries crisis and its attendant GA costs. But no… she chose …. RECALLS!! 

The media just loved her use of the MOT analogy and the Car Mechanic.  If that is the case, I presume that Dr Hurley sees herself as in charge of Service Reception.

On a quiet news day, just feed the hacks a dental story. Works every time!

While smoking is on the decrease, and lifestyle amongst the healthy is improving, there is a section of the population who do not see a dentist and for whom Oral Cancer is a rising trend. If you are going to keep your teeth for 80+ years of adult life, getting the health of the mouth optimal and the habits established when young are critical.

What opportunity did we miss?

No mention of 3D CAD CAM Dental technology [self-invested by the laboratories and dentists – no Government subsidy there]

No mention of the investment dentist as business owners make in their facilities – no government subsidy there, and by and large no financial crisis inflated by excessive management layers.

No mention of the amazing results being offered to rehabilitate oral function using all-on-4 and all-on-6 techniques.

No mention of the amazing dental implant industry. Not a Government subsidy in sight.

No mention of the predictability of endodontics and periodontics being driven by technology of instrumentation and scientific understanding of the biology, and the ever stronger links to general health.  Little Government input there.

No mention of the aesthetic desire of the wider public now being met by a host of non-invasive whitening systems allied to orthodontics. No Government funding there.

No mention of the unsung achievement of orthodontics in lifting the psychologic wellbeing of younger patients by creating the smile that allows a young person the mature into a confident go getting adult.  OK some Government input here.

No mention of the parafunctional diagnosis meaning that dentist can frequently solve chronic pain issues long before the team of neurologists, physicians and chronic pain clinics with their MRI scans and raft of blood tests fail to diagnose and simply write the patient off to a lifetime of expensive medication.

No mention of the almost eliminated need to use mercury containing restorative materials nowadays.

No mention of the fact that Caries is preventable, and excessive sugar for infants is akin to smoking.f course no mention of all of this occurring painfree on nervous patients in one of the most difficult to access, most biologically hostile  parts of the body.  Diistinct lack of real funding here.

No, our CDO in her massive role on that stage at NHS Expo chose to ramble on about a 2-year recall.

We may think Mr Lilley is a “bit of a plonker Rodney” but dentistry needs someone like him.

Dentistry needs a cheerleader to shout our achievements from the roof top, and remind people that nearly all of them are self-funded by dentists and not subsidised by the government at all.

Sadly, Dr Hurley has missed her vocation in the role, choosing instead to follow her Civil Service guide on “How not to rock the boat”

I wonder if there is someone out there , possibly many of you, who could cheerlead our profession? Someone who, like Mr Roy Lilley, is so noisy, so irritating as to be impossible to ignore?

Please step forwards if you are those persons ...

So it’s down to you.  Will YOU be the professions cheereleader?

Have YOU done your bit to cheerlead for our proud profession today?

If not, crack on.  Our younger colleagues will depend on it in the future.

The origins of the something-gate language
https://en.wikipedia.org/wiki/Watergate_scandal

https://www.gdpuk.com/forum/gdpuk-forum/cdo-honeymoon-is-over-22896#p253148
Since the recall speech last week ["recallgate"], the profession has realised who's side she is on, who pays the salary and benefits of the CDO.

The honeymoon period is over.

GDPUK has blogs from
Alun Rees
https://www.gdpuk.com/news/bloggers/entry/1738-cdo-shows-her-true-colours

@DentistGoneBadd

https://www.gdpuk.com/news/bloggers/entry/1741-the-cdo-speaks

Simon Thackeray
https://www.gdpuk.com/news/bloggers/entry/1742-the-honeymoon-is-over

Insight is a wonderful thing

It carries so many meanings.

The GDPs view

Many of you demonstrate it in your daily work, by understanding what makes patients tick. They say one thing to you and you apply years of experience, so that after a few moments of reflection, you translate what the patient just said into a proposal for treatment with a couple of options. Our younger colleagues of course find this the hard bit of clinical practice, but with experience time and dedication all Dentists and DCPs in patient contact can become masters of this art.

At the other extreme, when it all goes wrong and some of our colleagues face GDC proceedings, the ability to reflect upon your circumstances is critical. The ability to show insight at the events that led to the GDC may be critical to a Panel taking a benevolent view.

Insight is an essential attribute for any dentist.  For sure, lack of an ability to apply insight will often lead to trouble. It may compromise your relationship with your patient. You may finish up treating a patient despite the warning signs being there perhaps in the body language, or in the tone of voice used during a conversation.

Time? Not a lot of it about!

We recognise the application of insight as a skill and an attribute amongst our colleagues, and we admire those who have mastered the art of its use.

Of course the need to reflect and to gain insight require something that your NHS masters are reluctant to give you too much of: time

Even the GDC require time to reflect and gain insight. 

So why is it that I think the top of the GDC may lack leadership, and the insight that is required to be effective?

There are at the GDC six Registrant members of the Council and numerous panel members who all, in their work and their practice have to find time to reflect and develop appropriate insight into their cases of regulatory work.

The Times -  6^th August 2016

So it was with some surprise that the Chairman of the GDC, a certain Dr William Moyes PhD Esq, found himself demonstrating what seems to be a surprising ignoranceof the workings of NHS funded dentistry at the weekend, if The Times quote is to be believed.

Many of you will of course regard the summer as the season of slow news and will know that dentists are an easy target.  If I were you I should take it as a compliment.

What never fails to amaze me though is how the media absolutely fail to gain any true understanding, insight dare I say, of the problems associated with the Government offering for the nations dental care

And so it was in last Saturday’s edition of The Times. Front page news no less. It was probably pure coincidence that the de Mello case was about to be started at the GDC.  In fact, it was – a leading colleague single-handedly was trying to have the issue properly addressed. It is now behind a pay wall, but I have copied it below.

The Thunderer bellowed …

The article so nearly nails the issues, and in many respects it almost goes so far as to highlight “The Big Lie” and identify the lack of “Clarity of the Deal”.  A big up to our colleague, Dr Kotari, for getting “High Street Dentistry” on the broadsheet agenda. Patently he did not write the copy.

The message was clear though. Even someone without deep insight into the NHS Dental Service can see it is trying to do too little for too many.  There is only a certain amount of money, and the way it is spent simply does not allow for the provision of a broad range of highly complex procedures for everyone.  There is a very good blog on the BDA site reflecting after this article by a young colleague Dr Robert Chaffe at https://bdaconnect.bda.org/bad-dental-press/ .  The BDA through Dr Mick Armstrong were pretty robust in their reponse at  https://www.bda.org/news-centre/press-releases/bda-response-to-the-times .

And as FtP numbers prove, the dentist’s lack of time to reflect and develop insight into the problems of a patient cause that patient to feel abused and make that first GDC contact.

It’s not a difficult loop to get your head around, is it Dr Moyes?

Clearly, it’s about clarity

Anyone with half a brain can see that the future must involve a clear demarcation of what is and what is not available as NHS treatment. The post-code lottery that is exemplified by the extraction -versus- endodontic treatment fiasco reveals the problem that everyone is shouting about.  The only people who will not engage on this matter for no other reason than political fear are the dunderheads at the Department of Health.  Even the BDA recognise that it will have to come - but everytime it is mentioned at DH or NHSE level senior officials shake their heads. "Can't be done dear chap".

UDA Targets are set by …

The message is equally clear about high levels of UDA targets – the dentists do not set these. The Local Area Teams do.  In cases such as that of Dr de Mello, these colleagues may genuinely think they are doing the Governments dirty work for them in an efficient manner, bringing access to the masses at minimal cost.  That is what the Government want, isn’t it?  Dentistry is a broad church and while I would not poersonally be able to cope with a high UDA contract requirement, I know some can.  Does that make them wrong in themnselves?

When I wonder will NHS management be called to account instead of the dentist who is the low hanging fruit of accountability? 

What’s that you say? Never?

Soundbites

So when Dr Moyes, as GDC Chairman is reported in The Times as stating on behalf of the GDC, and I quote from the article:

The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.

What exactly can he mean? Is he saying there is a massive problem? Or is he demonstrating considerable ignorance similar to that which his infamous Pendlebury Lecture highlighted? Shall we assume Mr Chris Smyth, Times Health Editor, is including a quote relevant to the thrust of the article for now.

Can Dr Moyes really have so little insight into the working of dental practice?  It certainly looks like it.

Did Dr Moyes not reflect upon the magnitude of the meaning of his comments?  It certainly appears not. With that one comment Dr Moyes has revealed all that is wrong with his Chairmanship of the Council.

We now have a decent working team in the GDC Executive Leadership. But the Chairman has revealed that he is not neutral, and strategy driven. Instead, he appears to be a simple supporter of that broad-brush vox-pop opinion that “all dentists are trying it on”.

Last call for Dr Moyes…

The time has come for the Chairman of Council to shape up, learn about the long standing problems of NHS funding of dentistry and take on the causative Department of Health as part of the GDCs Strategic role.

Or he must step aside and let a more capable person take the role on. 

It IS clear that it is time for Dr Moyes to reflect upon his position, for the sake of the profession he seeks to regulate and yet for which he patently has scant regard.

Slow news day my foot – have a great break if you are away.

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TIMES INVESTIGATION
The great dental rip-off
Thousands of teeth needlessly extracted as surgeries accused of putting profit before patients

Chris Smyth, Health Editor | Katie Gibbons
August 6 2016, 12:01am,
The Times

Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service

Thousands of people are losing teeth needlessly because it is more lucrative for NHS dentists to take them out than try to save them, an investigation by The Times has found.

Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service. The investigation has also found that some dentists earn almost £500,000 a year in a system that rewards them for cramming in as many patients as they can.

Dozens are claiming for the equivalent of more than 60 check-ups a day, in what has been condemned as an unethical conveyor-belt approach to patients. The upper limit is considered to be 30 a day for one dentist.

Under reforms introduced a decade ago, dentists are paid about £25 for every “unit of dental activity” (UDA) that they carry out. Each check-up, or simple examination, is classed as one UDA; tooth extractions count as three, along with fillings and root canal work, irrespective of how long the treatment takes. Root canal treatment usually lasts more than twice as long as an extraction.

NHS figures seen by The Times show that 30 dentists were paid for more than 15,000 UDAs last year — the equivalent of about 60 simple appointments a day over a standard working week. Ten dentists were paid for more than 18,000 UDAs, equivalent to about £450,000.

Alex Wild, of the TaxPayers’ Alliance, a public spending watchdog, said: “The amount of work dentists do will obviously vary significantly, but the figures at the top end appear totally implausible . . . an urgent review is essential.”

Dentists routinely weigh up how much time and treatment a patient needs against a desire to maximise earnings, say professional leaders who concede that the payment system is causing an “ethical compromise”.

The warning comes before the disciplinary hearing next week of the dentist responsible for the biggest patient alert in NHS history. More than 20,000 people treated by Desmond D’Mello, 62, were called for HIV and hepatitis testing after he allegedly failed to change gloves or clean equipment between appointments in an attempt to see as many patients as possible.

Mike Waplington, president of the British Endodontic Society of root canal specialists, said that extractions had jumped by a fifth and root canal treatment had fallen by almost half after the contract that paid the same for both was introduced in 2006. Root canal treatment could take three times as long as an extraction. “There is an incentive from the system and some dentists may say to patients ‘I can take this tooth out simply’.”

More than two million teeth were taken out on the NHS last year, but Mr Waplington said that many could have been saved, estimating “over the lifetime of the contract it would have affected tens of thousands of teeth”.

Many dentists also feel more comfortable taking teeth out, as only 277 out of more than 40,000 are registered as specialists in root canal work.

Trevor Lamb, co-founder of the Saving Teeth Awareness Campaign, said: “The public are too quick to accept that teeth should be removed. They are unaware of the alternatives and some dentists exploit this. You wouldn’t go into A&E with a broken arm and expect it to be amputated.”

At least 2,000 dentists claimed for more than 8,000 UDAs, equivalent to the upper limit of about 30 check-ups a day. Neel Kothari, a Cambridgeshire dentist seeking reforms, said that it was difficult to do more “in any ethical sense”, with 60 patients a day impossible without cutting corners.

He warned that dentists intent on maximising income might skimp on treatment as well as hygiene. “It’s as if you went to a top restaurant and they served you a Big Mac disguised as a gourmet burger,” he said.

Nigel Carter, chief executive of the Oral Health Foundation, said: “To do a proper assessment of the patient would probably take 20 minutes. But that hasn’t been what the health service has been paying for. There is a bit of an ethical compromise.”

The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.

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GDPUK Topic

https://www.gdpuk.com/forum/gdpuk-forum/the-saturday-times-front-page-the-great-dental-rip-off-22696?start=50#p250635

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Letter to The Times, Tuesday 9^th August

Sir, Your report and editorial suggest that dentists can claim as many UDAs as they like. On the old system, dentists could earn more by carrying out more treatment, and the annual dental budget could only be estimated. The current contract was designed to allow a budget to be set in advance. Each dentist is contracted to carry out a certain number of UDAs a year. If a dentist exceeds the number of UDAs contracted to them they get no additional pay. If they fail to complete the contracted number, their fees are clawed back. The dentists have to tender for contracts each year. Whose fault is it if dentists are paid for a large number of UDAs? However, to claim that the upper limit of patients is 30 per day is unrealistic. In the 1990s I used to work with three staffed surgeries and treated 70 to 80 patients a day. That would equate to more than 30,000 UDAs a year. On a four-day week, I hardly ever ran late.

William Eckhardt

Retired general dental practitioner

Haxey, S Yorks

As you all disappear on your long errant holidays – take note.

Finally the GDC have issued a small puff of white smoke from their chimney in Wimpole Street.

After much personal hard work by our colleague Dr Vicky Holden, and an uncertain amount of work by our representative body at the other end of Wimpole Street, the Council of the GDC voted to remove all address details from their on line register.  60,000 mainly female DCPs will I suspect be mightily relieved.  20,000 odd female dentists will rest a little easier.

If you have not been on the end of unwanted attention, it can be many things. Embarrassing … alarming … irritating … flattering …  laughable …  but worst of all of course is when it becomes frightening … perhaps even sinister.

Many of us will have had nurse as employees who find themselves on the receiving end of unwanted attention from some admirer- in-waiting.  Some of us may have even had to step in on occasion

How the previous CEO of the GDC even thought there was any justification in the first place remains a mystery.  But then the workings of the previous CEO were a mystery of course.

Our patients are entitled to know we are registered. In fact 99% of them assume we are.

Perhaps we should put our GDC Number on all correspondence … estimates, invoices, letters etc. I know many do. It’s not a secret.

But it is right that patients with ulterior motives should not be able to pursue an alternative and unwanted agenda.

So hats off to our GDC.  Of course you might ask why the Council did not do this 2 years ago when it still scorchingly obvious to anyone with half a brain that the matter needed addressing, so to speak.

The Council

This episode suggests that the new senior executive management at the GDC are quite different. There is a sense that their agenda may well be one we could subscribe to.

But perhaps this whole ‘address’ saga says more about the Council. It was those 12 Members, 6 of whom are Registrants, who ducked the issue 2 years ago.

It rather confirms in my mind that we have a better Executive in place at the GDC but we still lack a strong Council who will do the right thing at the right time.

Ah yes ...  that brings me to ‘ole Billy boy.  The Old Guard still sitting in that position at the middle of the table I see. Still writing twaddle-blogs! 

Good job he has been able to keep his address secret all these last few years what with all the FtP debacle!!  Perhaps we can look forward to a new method addressing Dr Moyes in the near future:  The Former Chairman …  Then we might see some real changes.

Have a great holiday. May your sun shine on your upturned cheeks!

So…
Two weeks after our vote, give or take and it has been an interesting period to put it mildly.
If you voted Leave, it has been quite hard to lean on the positive, but that is changing. The FTSE 100 is back up, the ‘250 is trailing but improving, and while the Pound has taken a hit, many would argue that has been a trend waiting to happen. Despite Mr Osborne using this week as an excuse to drop his 2020 Deficit promise, the fact is he was a million miles off the mark BEFORE the vote. And then there are the personalities and the power broking.

Non, je ne regrette rien
As a GDP who voted ‘Leave’, do I have regrets? No. Perhaps in future, politicians will take their people seriously instead of overriding our worries with their ‘we know best’ soft speak.
Viz, Mr Cameron, who failed to take Referendum matter seriously enough to have a plan in place, it appears. Similarly, I am surprised to say, the Leave leadership who I suspect were as surprised as the PM that the vote went 52%:48%
I did suggest that it would be a revolution and I do think that is exactly what has happened. About time too, many might suggest.

So what has changed?
Nothing, in the next two years and in reality some greater time than that actually changes. We remain in the EU bound by EU Treaties and Law, making our payments and presumably supplying our MEPs
Now call me cynical.
No sooner had the count been completed than the EU declared that Mr Cameron’s ‘EU Deal’ negotiated in February was declared invalid and was withdrawn! So much for the EU being on Mr Cameron’s side.
Is it me? The EU cannot wait to be shot of us anyway. They have been waiting for this to happen for years.
Where were the ‘Remain’ MEPs during the Referendum campaign? Where were the EU Officials, doing a Grand Tour to report what they the EU does do for us? Quite.
Of course, there has been a huge amount of posturing, and superior sounding comment made by all parties. But the dust is slowly starting to settle and realpolitik is starting to become the accepted wisdom.
The chase for the top job in the Tory party is underway; surely a Brexiteer has to take the job?

The outlook for Labour is unclear as I write this, it appearing that Mr Corbyn feels he does not need the Parliamentary Labour Party on board for him to have another go at winning the leadership.
Just when we need a strong Opposition, they decide to go to the beach!!

A mandate for change, or a vote for planning change?
Now there is a valid point that only 38% of the Electorate voted Leave. There is widespread concern about the Union, given Scotland’s quite specific vote to remain. There is the Irish matter of how to handle and nurture the peace, allied to the thinning border.
It is all very well to say ‘” We voted exit” but accepting that logic recognises that any way forwards has to take account of the 62% of the Electorate who did not vote or voted Remain, it has to take account of Scotland, and it has to take account of Ireland.

That is not a circle that needs squaring – that is a complex multi axis movement joint with a multitude of ways to be set, and this needs arranging BEFORE Article 50 can be invoked. An inclusive approach by the next PM will be critical.

It is my opinion that the result of the referendum, being notable but NOT a mandate, is only a start to such a process, and we are simply not there yet.

It is my opinion that Mr Cameron was mistaken not to create some strong ground rules for the Referendum, in particular to the nature of the need for a vote of in excess of 50% of the Electorate. In any other Committee the world over, that vote was inconclusive enough for the Chairman [ie Mr Cameron] to place his casting vote for the ante status quo.
Burt what is done has been done. What should not happen now is that there should be a rush to make more political mistakes.

Better preparation, and a proper mandate
Despite what has been suggested only today [Sunday 3rd] by Mrs May, there must surely be a General Election to restock Parliament with MPs based upon a final Leave or Remain campaign, before Article 50 can justifiably be invoked. I say that as someone who voted Leave.
The biggest challenge now is for a leader of quality to unite the country in its way forwards. If Mrs Theresa May is the bookies favourite, and given Tory party leadership campaign history of old, Mrs Andrea Leadsom is a likely bet.
These are by all measure the most extraordinary times in which we live.

Hi ho, Hi ho, it's off to work we go ...
And yet tomorrow, we all go off and drill, fill and bill. Nothing changes, except the mood and the strangely opaque vacuum that is the political parties we see around us.
If the past two weeks have been a Political revolution, we must be careful not to cause a Geographic revolution by poor leadership and ill thought out ways forwards.
The leadership elections various at least buy everyone some time, despite what our huffy and impatient EU Leaders might suggest.
The summer vacations could not come at a better time, to allow everyone to take a deep breath.
Leave? What, now? No, in about 3 years time - perhaps even at the 2020 Election time?

The Autumn is when the real work begins.


http://www.andrealeadsom.com/

http://www.europarl.europa.eu/news/en/news-room/20160628IPR34006/MEPs-call-for-swift-Brexit-to-end-uncertainty-and-for-deep-EU-reform
MEPs call for swift Brexit to end uncertainty and for deep EU reform

http://audiovisual.europarl.europa.eu/Page.aspx?id=2885
MEPs call for swift Brexit
Top Story - 28-06-2016
Official visit of the President of the European Parliament in London. A general view of the EPIO London, Europe House on June 18, 2015 where the President of the European Parliament Martin SCHULZ today visited and gave interviews with selected journalists. UK-European Flags

http://europa.eu/rapid/press-release_MEMO-16-2328_en.htm?locale=en
European Commission - Fact Sheet
UK Referendum on Membership of the European Union: Questions & Answers

As a GDP I am really struggling to focus on what my vote should be. So I have set myself the task of reading across the campaigns this weekend.

It’s a busy week, and you too need to do your final reading. If only this was vCPD eh? 

Well why not?    It’s clear that this affects your dental practice, so go reading, message me privately and I will send you a simple feedback document, and a certificate for vCPD. Allow 2 hours.

What is they say about a divorce? You must have a reason to go and a reason to leave.

Do we? Have we?

Here are your links for the Remain and Leave campaigns [also knon as the  “Innit” and  “Exit” !] and other information sources or repute.  If you read over these there will be lots of facts, and a degree of balance.  I have tried to avoid opinion.

https://leave.eu/

http://www.voteleavetakecontrol.org/campaign

http://www.strongerin.co.uk/

http://www.bbc.co.uk/news/politics/eu_referendum

http://www.telegraph.co.uk/eu-referendum/

http://www.theguardian.com/politics

EXIT  If at the end of this, you vote for the UK to exit, you will be lighting the fuse for the first cannon shot in a bloodless revolution.

No less, no more.  The aftermath will be a change in the political landscape of the UK not seen for centuries. Make no mistake, in the past, civil conflinct started over less.

REMAIN  If we vote to stay in, we will have the same group of leading politicians weakened by the arguments in the campaign, but a stronger case for lead influence in Brussels.  Perhaps a vote to remain is a vote for change we do not expect?

Polls

http://whatukthinks.org/eu/opinion-polls/poll-of-polls/

But if the polls are to be believed there is a groubndswell of decided opinion forming. Watch out - the UK electorate has a habit of suprising the pollsters.

If we do indeed vote to exit the political treaty that is the EU two things have to happen.

Firstly, the present political leadership must go.

Secondly, therefore, by any logic,  there must be a snap General Election.

And there begins 5 years hard work to re align our political and trading arrangement with the EU and the world, under new elected leadership.

And, guess what happens if we vote to remain?  Exactly the same.  UK politics will never be the same for this generation.

This is  a big job and on Thursday when you vote, you are not voting for no change.

You are voting for how you want the change to occur and when.

Should we lead from outside the EU and try and lead from within?

Whatever you do, Vote

Whatever you do, respect your neighbour and his or her opinions.

That right to vote is something we have taken for granted these last hundred years.

It’s a new privilege and a new right in many of our Eastern European neighbours home states

And good luck, friends and colleagues.

This really is a momentous event, in which you are free to both witness and partake.

Go use your your freedoms, as wisely as you can, and we will met on the other side.

Motivation is funny old thing. What is that makes you get up and go to work? In amongst the demands of family life, most of us have to insert some productive hours to generate income to fund the lifestyle of our choice. So be it. But dark winters, both meteorologically and professional with persistent bad news, take their toll.

So as the days lengthen, the earth continuing to tilt on its axis, and the temperatures rise, notwithstanding the unusual nature of May snow !]  you feel the burdens of winter lifting. So let the sun warm your face and raise your spirits. It makes a change from rust and frostbite!

May and its adjacent months are the period of Dental Shows, and Conferences. The Dentistry Show in Birmingham, an acclaimed success, despite the fact that only 5% of the registrant population attend. Then the BDA Conference in Manchester takes place at the end of May and the LDC Conference 2 weeks later, in Manchester too. The Scots LDC Conference took place at the end of April.

These events are a chance to catch up, network with colleagues, and begin to feel good about your profession.  Feel the draw of the latest technologies and equipment, dream, perhaps plan, the next big step in your professional life.

It’s not too late to drop into the BDA Conference and call your Representatives to account. 130 Sessions over 3 days. The link is below.  Manchester in May? Blazing sunshine, darling.  If you have not been, give it some thought. Motivate yourself.

Forgiveness is motivating ?

Motivation in its widest sense might mean, for example, that past misdemeanours of our lead regulator fade into a forgiving memory. Sadly recent events mean I cannot avoid mention our old muckers, the "Wimpole Street Stasi".

Spare a thought for the situation of our colleague Dr David Lee, whose wellbeing and reputation have been unnecessarily tested to breaking point by an FtP Hearing at the GDC which was not just thrown out, but was found so wanting that there was NO CASE TO ANSWER. In other words the GDC simply drove an FtP case on a spurious basis.  I urge you to read the hearing while you can, and gasp in anger and sympathy that such events can even be commenced, let alone taken to this £1/4M expensive debacle.

The GDC Chairman, Dr William Moyes, has only last week had the gall to stand up at the Scottish LDCs meeting [linked here to a GDPUK thread] and state that  he is not resigning because, in essence he is part of “The Solution”.  So much for accountability for his Councils distinct lack of proper oversight.

Dr Moyes may be part of some perverse Final Solution but I am not sure that is part of what he has in mind.

For me and my colleagues such as Dr Keith Hayes it is a motivating feeling to think that Dr Moyes is still in post and still does not get it.   Time for a Spring clean? 

So does motivation really increases your capacity to forgive or does it merely allow you to feel justified in moving on in respect of matters about which, in truth, you can do little?

“Whatever, no worries” becomes your daily Gallic shrug.  It’s sunny and the days are long, do I care?

Good job really if you are NHS funded.... Read on ...

Lost you way? You’re not the only ones…

The perils of the all new, singing and dancing Government computerised support in the form of Compass is just ‘one of those things’. Oh for a paper FP17 – oh wait they have changed them, slotted in some extra data collection but failed to print them in time. Online advice on their filling-in is there – but no FP17 other than a sample version!  So use the old ones for now – which Compass of course cannot process properly!

The stories of struggles with Compass are now becoming more than irritating – it is beginning to feel like the software has not been properly specified and it may, if the present shambles is anything to go be, be at least one financial year before all the errors and omissions are corrected. Indeed, Compass and its pointed failures  have been a feature a long thread on GDP UK recently if you have not read it.

Meanwhile, if you are spinning your Compass to see which way it points, Good Luck!   You are not alone…  This was a Government Spring Clean which does not appear to have worked well.

CQC – Motivating better regulation

On the other hand, compliance is never an easy activity. Let’s face it we are all dragged to the altar screaming. The CQC, in particular now they have Dr John Milne in a leading role, barely a year after his Chair of the BDAs GDPC ceased, are actually evolving fast and well and now leading the future of Regulation in the wider sense.

Not only are their processes actually evolving fast and being targeted where needed, but they are dragging all the regulatory participants to the table to sort out who does what.

They are to be congratulated for their initiative, “The Future of Dental Service Regulation”  a punchy, pleasantly  brief document that has great potential to change dentistry for the better. Read it here.

You can take part – so go to the links and get your say in. It will make you feel better.  The CQC are looking increasingly like an effective strategic ally of the Dental Profession, with scope to act where the Professional Services Authority [PSA] lack the teeth.

Now that feels better!!

The weather? Yeah, motivating, isn’t it?

Good job everything else in life is a motivating force for good.

It seems that some of the leading agencies upon which we depend could do with a Spring Clean.

Where shall we start?

Have great one.

LINKS IN DETAIL

SPRING MEETINGS

Dentistry Show http://www.thedentistryshow.co.uk/

BDA Conference https://www.bda.org/conference

LDC Conference http://www.ldcuk.org/

GDC

GDC Case – Dr David Lee https://www.gdc-uk.org/Membersofpublic/Hearings/Determinations%202016/LEE%20PCC%20Determination%20-%20April%202016.pdf

LDC Scotland Moyes encounter https://www.gdpuk.com/forum/gdpuk-forum/thoughts-on-an-encounter-with-dr-moyes-22119

Dr Keith Hayes  http://www.rightpath4.com

COMPASS LINKS

GDPUK Compass thread https://www.gdpuk.com/forum/gdpuk-forum/compass-21660

FP17 R9 Guidance http://www.nhsbsa.nhs.uk/Documents/DentalServices/Completion_of_form_guidance_-_FP17_-_England_(V5)_-_11_2015.pdf

FP17 R9  sample form http://www.nhsbsa.nhs.uk/Documents/DentalServices/20160216_FP17_Proof_Sample.pdf

CQC

Consultation on Regulation: http://www.cqc.org.uk/content/future-dental-service-regulation

The Document http://www.cqc.org.uk/sites/default/files/20151207_future_dental_service_regulation.pdf

Welcome back. I think Easter if officially over, just watch the traffic next week!

Your regulator, the GDC, is trying make the news again.  Perhaps in that ironic respect, it is very successful.  I suggest the smell is not good.

However, perhaps not in in the way it might be hoped. The GDC is spinning the facts to serve its own interest. Again.

You remember the GDC?

It’s that organisation for whom you pay the best part of £900 per year as a work tax.  If your business also funds your staff registration, you will be paying well over £1000 per year. 

It’s that organisation, paid for by you, that squanders money on frippery and self-serving PR, accountancy consultation and £9M building expenditure.  Prudent management of other people’s money is not part of its remit, it would seem.  Your money is used in part for its role as a World Class Complaints Agency [remember all those outrageous FtP cases? …  they are still coming through!].

Seconds away … Round 4  -  Dentistry versus the GDC

It is the latest bleating of the Chairman that should catch your eye and stir your loins with a sense of disbelief and injustice. It certainly has for the BDA [ are you a member - £30 a month for the fighting fund, get on with it!] who have returned to the ring for another fight.  We can but hope that Big Mick is aiming to knock over Chairman Bill and obtain the final ‘fall’.

If you have not taken great interest so far, I am sorry to lean on you again, but please – without YOU taking a simple action, nothing will happen.

As a wet fingered GDP, you CAN make a difference.

The BDA alone cannot clean the stable on your behalf.  The smell and the excrement remain, and it “All hands to the brooms”

Why all the fuss?

You will, I hope, have noted the PSA Report before Christmas.

Finally some three months later Dr Moyes, Chairman of the GDC sticks his head over the parapet. Writing in his Blog, you could take a rosy view of the world in Wimpole Street. This Blog is seemingly the first of many. Boy, I look forward to those … the excitement is too great.

I suggest to you that these are the words of a professionally dying man.  If you read the minutes of the 3 March 2016 GDC Meeting, to which Dr Moyes makes reference, it is clear that the Executive Management Team [EMT] of the GDC have been explicitly humiliated so that the Council can remain in post.

What's the problem?  This is the problem:

• The Council of the GDC have completely washed their hands of any responsibility.
   
• There is no mention anywhere of the failed oversight of the Council
   
• The Council have abjectly failed and yet remain in complete denial.
   
• The Council have been explicitly criticised to an unprecedented level by external bodies from the PSA to Parliament, and yet they hold their heads in the air singing “La La La”.

The BDA are to be congratulated for shovelling more coal on the fire, but I think more is needed yet.

If you know a Council Member, ask them why they have not resigned? If you know of them, write to them and ask them the question.

What "Point of Principle" causes them to stay?

Dr Moyes may think he has got away with it but I think we must all prove him wrong. So very, very wrong.

Until this Council are forced to resign en-masse, nothing will change because it was Dr Moyes and his merry band of Members that oversaw the woeful actions of Ms Gilvarrie, and it is the GDC Council which will design the Job Spec for the new CEO.

If you mix your cake with a poisoned spoon, the cake will always be poisoned.

The GDC have fallen  - The political referees should end it now

The Council of the GDC should resign. The Chairman should already have gone. It is an amazing arrogance of unholy magnitude that he and they have not.

Whom should be first?

It is clear the Chairman has the skin of a rhino and so it is down to the Council to consider their positions based upon the principle of what is right.

Your profession needs your help. Support the BDA. Write to your MP. Write to the Registrant members of the Council. Phone people.

JUST DO SOMETHING

DO NOT BE SILENT.

There is a sense that the BDA have started the final round. You need to shout and holler’ your support.

May all of you have Spring in your steps.

https://www.bda.org/news-centre/press-releases/Pages/New-era-at-GDC-comes-with-0.5-million-cleaning-bill.aspx
BDA: ‘new era’ at GDC comes with £½ million cleaning bill

https://www.bda.org/news-centre/press-releases/Documents/Mick-Armstrong-Bill-Moyes-letter-01-Apr-16.pdf
Mick-Armstrong to Bill Moyes letter 01 Apr 16

https://www.bda.org/news-centre/press-releases/Documents/BDA-GDC-FOI-response-18-Mar-16.pdf
GDC response to BDA FOI request

http://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/Bill-Moyes'-Blog;-Learning-the-lessons-of-the-past.aspx
Bill Moyes' Blog; Learning the lessons of the past

http://www.gdc-uk.org/Aboutus/Thecouncil/Council%20meeting%20documents%202016/20160303%2005%20-%20PSA%20Investigation%20Report.pdf
GDC Council Meeting 3^rd March 2016 Discussion about the PSA

https://www.professionalstandards.org.uk/docs/default-source/psa-library/investigation-report---general-dental-council.pdf?sfvrsn=6
A report on the investigation into the General Dental Council’s handling of a whistleblower’s disclosure about the Investigating Committee
21 December 2015

In my last blog, I noted a developing Critical Mass for change in how we address infant caries and its consequences. And barely a month later, the steam pressure has been increased once again.

The Chief Dental Officer Dr Sarah Hurley, is starting to make public inroads into her role, and recently delivered the 2016 Pendlebury Lecture. It was in stark contrast to the one delivered in 2014, demonstrating a wide understanding of the playing field that is dental health.

Critical Mass 2

It comes at the end of a week in which the state of children’s teeth once again was publicly pilloried, on the back of the General Anaesthetic numbers.

While it remains a problem in England, just look at Scotland. After many decades when Scotland has been spiritual home of the UKs dental problems, it suddenly produces numbers through its Child Smile initiative that suggests significant inroads are being made to improve the health of children’s teeth and prevent dental caries [and thereby reduce the costs and morbidity of unrestricted dental breakdown]. It is not really rocket science, they have just been investing in infant dental health.

So we in England [and Wales and Northern Ireland to a similar extent, but out with the CDO[NHSE]’s remit] have a problem.

We know the target population for any changes must now be parents and infants in equal measure.  There seems to be ample evidence that parking the dental professionals in discrete buildings, called Dental Surgeries, is simply not working, and it is evidence that Dr Hurley seeks.

We know that the medical stakeholders are now on board, as obesity and diabetes rear their heads with all the long term cost implications. Indeed it is the medical drive for a sugar tax to discourage the dietary shortcomings that is also driving the publicity that emerged in the Daily Telegraph over the weekend of the 26^th February, and was subsequently widely discussed on broadcast and printed media.

Follow the money

So increasingly the priority is being defined. But the thorny issue will arise of funding.

Which Departments will pay?   How will we [the public] pay for the inevitable targeted measures that are due to follow, as day follows night?  A sugar tax undoubtedly could easily raise the funds but the political will in the chaos pre-Referendum is clearly not there.

There is a serious danger in the current fiscal period of restraint that the HM Treasury will insist on a cost neutral option.  Maybe not, but we must for now assume that.

Could it be that the GDP Budget is being eyeballed [at £3.4Bn] as the low hanging fruit of funding that could or perhaps should be used to address the issue of infant dental health?

The Chief Dental Officer is clearly leading dental health to a better place – but who will pay for this Piper’s plans?

The role must soon change it seems to that of Chief Decision Officer.  

Interesting times, but the sooner we address the issue of Dental Health for the young child, the sooner we can restore some pride to our profession.
 

As a GDP you would do well to plan for big changes. Not sure what but for sure very significant.
 

Have great Easter, assuming the snow has eased back!

2016 letter to Telegraph http://www.telegraph.co.uk/comment/letters/12077501/Letter-The-NHS-dental-health-system-is-unfit-for-purpose.html

Dentistry response http://www.dentistry.co.uk/2016/01/11/nhs-dentistry-letter-published-in-the-telegraph-unhelpful/

Feb 26 article DTel  http://www.telegraph.co.uk/news/health/news/12174796/Thousands-of-children-have-decayed-teeth-out-in-hospital.html

BDAs Press release  https://www.bda.org/news-centre/press-releases/tooth-decay-stats-should-offer-wake-up-call-on-prevention

GDPUK News https://www.gdpuk.com/news/latest-news/2151-gas-for-dental-extractions-in-children-on-increase

GDPUK CDOs response https://www.gdpuk.com/news/latest-news/2152-strong-response-to-child-ga-figures

GDPUK Scan of other media [Dr Tony Kilcoyne]  https://www.gdpuk.com/forum/gdpuk-forum/telegraph-third-world-dentistry-crisis-in-engand-21379?start=130#p239340

Scottish example  http://www.child-smile.org.uk/professionals/childsmile-core/toothbrushing-programme-national-standards.aspx

·         Since 2011, all elements have been delivered in all Health Board areas throughout Scotland.

·         "As a result of our efforts, dental health in Scotland is improving, particularly in deprived communities. In the Primary 7 age group dental health has never been better and on a Scotland level the target of 60 per cent of this age group having no obvious decay has been met. This is a fantastic success story."

Summary of 2016 Pendlebury lecture http://www.fgdp.org.uk/content/news/synopsis-of-the-2016-malcolm-pendlebury-memorial-l.ashx

There is a concept in nuclear chemistry which many will be familiar with. Critical Mass has been adapted to apply almost any situation nowadays.   When a process of change is beginning, Critical Mass is used to refer to that point when change becomes inevitable.

What starts as a mood that change is needed becomes a minority activity with early adopters, eventually tipping over the edge for widespread general change for the better.

The bigger the system, the more one can see change with necessary Critical Mass at work on a daily basis

Early Years - has General Dental Practice failed?

Is “Early Years” dentistry about to undergo a change of massive significance? Is the state of children’s teeth [as it relates to caries and GA Admissions] about to trigger a political Critical Mass change

The problem of course is this:

£3billion of funding, give or take, by the Government, aims at funding dentists to sit there waiting for patients to wheel their little rug-rats in for a ‘check-up’.

Sadly, two facts suggest this time-honoured approach is a fail.

Firstly only 50% of the population actually go to the dentist, and that is without weighting the numbers towards any problems with new migrant or ethnic groups.

Secondly, by the time the child appears for their check-up age 3-4, the caries is already established, the dietary patterns are embedded and the Prevention horse has, by and large, well and truly bolted.

http://www.hscic.gov.uk/catalogue/PUB17794/prov-mont-hes-admi-outp-ae-April 2014 to March 2015-toi-rep.xlsx  is a spreadsheet of child hospital treatment number suggesting in England alone some 110000 admissions for dental caries at about £670 per admission .

My back-of-my-vape-packet estimate is that some £73Million is spent [in England alone] with hospitals sorting out the fact that community prevention of dental disease in children has failed.  The medics have now woken up to the fact that this same diet is leading to an epidemic of child obesity and diabetes.

This pressure for change, smouldering for some time,  arguably gathered pace with the excellent planning document, Delivering better oral health: an evidence-based toolkit for prevention at

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/367563/DBOHv32014OCTMainDocument_3.pdf

Then we have the January 2015 Faculty of Dental Surgery issuing this report:

The state of children’s oral health in England at

https://www.rcseng.ac.uk/fds/policy/documents/fds-report-on-the-state-of-childrens-oral-health

GDPs do their best - but what is needed?

Patently dental teams who care for caries affected early-years-children do their best, often with imaginative and innovative outreach, but the numbers for GA Admissions suggest the problems fires are still raging despite the attempts to limit the spread by the profession from the GDP model.

Is the demand for planning of a different dental intervention for the first three years beginning to gather momentum? Are we indeed reaching a point where the energy and desire for change to be planned means that significant change will indeed become a priority?

Just look at the last year of public domain comment and criticism of the present status.

The Sugar-Obesity-Diabetes-Caries complex

Sugar is now being discussed in a widespread public debate about obesity [be it child or adult] and diabetes but led his time our medical colleagues. Caries is being discussed too.

Dentistry was the subject of an adjournment debate in the House of Commons this last week

Various media events [including the 3^rd Daily Telegraph Letter] have taken place in which members of the profession have presented the view that the present system of delivery of dental care is simply failing to deliver any effective prevention to the early-years child.

It is also unclear if the new GDP Pilots will change much in the context of a developing problem and reducing financial resources in Government spending plan. It is clear the new CDO [NHSE] has sensed this and is trying to wind the initial changes back and see where the true problem lies an th evidence takes her.

Evidence?

Sadly, there is no real evidence, because we have a problem which requires action for which an integrated approach has never been trialled, let alone undertaken.

One example of the media attention is a recent BBC Look North slot with Dr Tony Kilcoyne.  The BDA it is reported are meeting with the Chief Medical Officer’s team.

Dentistry on its own is a small backwater of medical provision.

But when we start to get frequent interventions by the medical profession, increasing interest by the broadcast media, and an increasing public desire to understand and discuss the situation as it relates to THEIR dental health and that of their children,  … well anything can happen.

Now what happens to the GDP’s element of the  NHS Budget on the back of such changes is, of course, a separate discussion.

But can all this really happen? Will we really witness 2016 as the year that Critical Mass for real change will be reached.

Dentistry and Medicine united?

I suggest the need for a “National Early Years Preventive Strategy” will be crafted which integrates medicine and dental care into a program targeted at mothers and their children and wider families that will aim to influence the diet and dental care of the under 3’s.

We as a profession have arguing this case for years and the Department of Heath have merely sat by.

I sense the medical profession are not going to sit idly by and watch the sugar/obesity/diabetes/caries scanal  wreak further havoc, be it to personal heath or their budgets.

We can but hope. 

We can hope that as a profession we are included in the delivery of a  solution.

We can but hope that something better comes out of it for the wider work of Geneal Dental Practice.

Welcome back to the Indian Summer of tropical rain…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where are the BDA as our ‘Union’?

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

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

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

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

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

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

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

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

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

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

The season is underway.

The BDA need to start scoring some goals.

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

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

Get a grip BDA.

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

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

Weblinks:

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

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

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

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

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

Institutional Arrogance

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

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

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

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

I do, I do I do …

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

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

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

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

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

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

OK …  Talking of that body the GDC  …

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

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

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

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

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

Initial consideration by the registrar.

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

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

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

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

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

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

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

Coalescence

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

Unless of course they have all caught the Institutional Arrogance disease

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

[2] PSA link

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

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

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

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

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

The definition of the word revolution includes this:

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

The 8th May - the day things changed

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

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

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

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

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

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

Dentistry... why, is there a problem?

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

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

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

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

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

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

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

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

Perhaps dentistry will feature during the post-election negotiations?

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

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

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

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

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

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

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

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

The Clock is Ticking

As of writing, there are about 30 odd days to go to the UK General Election [1] and politics may have changed for ever. The 2-party system may well be broken. It seems likely that the smaller parties will have a relatively huge amount of influence over the eventual policies of the Government that emerges. If Proportional Representation had no role to play in “First Past The Post”, it perhaps does under a mixed multi-party system of coalition where FPTP does not produce a clear Government.  A clear outcome is … well, far from clear. I sense a theme I might return to.

Who remembers the HSC?

Until then of course, we are in the frenetic work up to Election Day across the UK, allied to significant numbers of local elections are due to take place on 7^th May.[2] Parliament dissolved of course at the end of March. The Health Select Committee report of the GDC Accountability Hearing will now have to be signed off under the new Government.  Wouldn’t you just love to know what’s in the draft that no doubt sits in a pending tray somewhere?  You can never get a decent leak when you want one! For those of you with short memories in Wimpole Street, it was clear the HSC were collectively unimpressed with the performance of certain executives.

Dentist in Politics

Many Dentists and Dental Professionals play their part in local communities and will have local or national agendas of their own. To all of you, the very best of luck. It’s a busy time.  Stay focussed and may the votes go your way.

Indeed in the GDPUK forum we have our very own blogger Dr Pramod Subbaraman [3] who is a parliamentary candidate for the Liberal Democrat party in Edinburgh South. Scotland of course are still vibrant in their political engagement after the 2014 independence referendum. Sir, we wish you well.  Ironically, if present polls are to be believed, the Independence agenda re-emerge after the election because of the influence of an enlarged Scottish National Party in the House of Commons.

More wet fingered dentists in top level politics is a positive process – it can only help the cause of the nation’s Oral health and ensure that the dental and oral health inequalities rise up the political agenda.  There is a sense of “Rome burning” about the facts on the ground of GA Admissions for children for surgical dentistry [4] while the Department of Health and its mouthpieces at NHS England assure one and all that the system of UDA related access  has clearly been a big success, broadly speaking. I really must get a new pair of hindsight-o-scopes.

You ARE political influence

But imagine you are standing around one day in your local market place and the candidates for your local seat are canvassing your support.  You were planning to “do you bit for the profession” and therefore plan to ask one question. 

What should it be?

What would swing it for you if a candidate were to ask you for their vote?

Let me take you back to a previous blog in which I raised a “Trumpet Call for Clarity of the Deal”.[5]  In it I suggested the GDC might take this role on and demand clear rules on what dental care is available under the NHS.  For those who are interested, I did write to the Chairman of the GDC and he delegated his reply that “It was not their job”. Too busy counting the FtP hearings, I suspect!

The consumer organisation Which? [6] and the Office of Fair Trading [7] tear their hair out over the constant complaint that patients never know what’s available under the NHS and what’s not . Report after report is critical – and yet – this strange fudge is NOT of the dentists’ making.

We did not choose this system or the lack of clarity. 

The DH chose this. It is the Department of Health who seem content to see dentists accused of misleading patients.  What could their motive possibly be?  Surely not to deflect eyes and attention away from the other concerns over Government funding and management of oral health?

It is patently wrong that every individual dentist should decide what constitutes ‘need’ on a one by one process with every single patient.  How can anyone with half a political brain even remotely justify it?

Unclear Prototypes & Mixed Practice

The new Prototype Contracts are being rolled out at “Pilot” level and still there is no clarity.  The now retired CDO was on record as saying it was not required as part of the new contracts. We can but hope that the new incumbent will see sense and change this unsustainable approach.

The future of dental practice in this country will depend on the success of mixed practice.

The ability to fund privately some dental care alongside an NHS funded element is critical to the small business that is dentistry. Multiple strings of income may well be the ONLY reason that many practices will continue to subsidise the State offering for the benefit of their patients.

But there have to be clear rules. At the moment there are NO rules.  In fact it is so ridiculous at the moment that the rules appear to be written only when the patient complains. At that point the GDC seem to think that investing in your London Day Care might be a jolly good use of funds.

If McEnroe had been a dentist ...

Our old ranting tennis star John McEnroe would have had something to say.  “You cannot be serious” [8]

The patient has a right to know where the boundaries lie. All patients should be able to share an experience of the same rules being applied. The dentists need to know where the boundaries lie. 

Otherwise there is a great risk that the GDC call you to order at an FtP hearing should the patient complain that you applied too harsh a judgement of NHS “need”.

So the one question, I put to you, that you should raise with your candidate who asks for your vote is

“Will you ensure Clarity of NHS Dental Treatment?”

Our politicians need to look at dentistry through the patients eye’s, not through the upturned bottle lens that the Department of Health use.

Patients deserve better and it is the Parliamentary candidates you will meet in the next 4 weeks who will influence future policy

At present 22000 dentists apply different rules across 20 patients per day – because that is what the DH require.

That’s half a million confused patients per day

Ask them:  Will you put a stop to the confusion?  Will you provide absolute clarity on what the patient can expect under NHS dental care?  

If not, why not?

Meanwhile – control that excitement out there.   I am off to watch some paint dry …

“Now, will you be voting Mrs Goggins, open wide, there’s lovely, bring the next one up Nurse …!

Makes a change from talking about the weather and holiday plans. May your Easter break be relaxing and Spring like. The onslaught has yet to come!!

[1]          http://may2015.com/

[2]          http://www.parliament.uk/about/how/elections-and-voting/general/general-election-timetable-2015/

[3]          https://www.gdpuk.com/news/bloggers/pramod-subbaraman

[4]          http://www.telegraph.co.uk/news/health/news/10964323/Tooth-decay-is-the-biggest-cause-of-primary-school-children-being-hospitalised.html

[5]          https://www.gdpuk.com/news/bloggers/enamel-prism/entry/907-the-gdc-clarity-of-purpose

[6]          http://www.which.co.uk/campaigns/dental-treatment-costs/

[7]          http://webarchive.nationalarchives.gov.uk/20140402142426/http:/www.oft.gov.uk/shared_oft/market-studies/Dentistry/OFT1414.pdf
 

[8]          https://www.youtube.com/watch?v=ekQ_Ja02gTY

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
 

The DH & GDPC – Bedfellows Or Bedfoes?

Take the Dept for Health [DH].
Add in an ineffective General Dental Practice Committee [GDPC] at the BDA
Keep the vociferous Local Dental Committees [LDCs] at arm’s length…
What do you have?

General Dental Chaos?

The other GDC and “The Referendum” are not the only kids on the dental block. The chaos of Contract Reform is still lurking in the periphery of our vision, and really ought to be a full on crisis for shouting about.

To those of you of a Gaelic disposition North of the border, good luck for the forthcoming shenanigans. By the time you read this Scotland might be heading toward independence if YES prevails – or toward much reduced dependence if the NOES have it. In some respects, our Scots colleagues have the best of all worlds – they have retained Fee For Service, and have a relatively user friendly Government. Any changes frankly are less than likely to cause great change or disadvantage in the short to medium term.

English [and Welsh] dentists on the other hand … From where I sit, the DH heads are still in the sand as we head out to a 9 year old discredited Contract with so many problems, it is laughable.

What with the GDC imploding and Scotland commanding our attention [the irony of a UK wide GDC trying to set an ARF on the day that Scotland may break away is not lost] it is easy to forget that in the background NHS England and the DH are trying to blag the next Contract Reform package
Increasingly, if you keep your ear to the ground, it appears that a Train Crash in slow motion is a suitable mind-set.

2015 not long now …

2015, people …. it is only next year – and what have we to show? Discredited pilots, great suspicion that the Corporates are trying to wedge the DH door open for personal gain, and a weak GDPC who continue to fail to nail down the critical issues.

The LDCs it has to be said are populated by wet fingered dentists who understand the issues. It is the LDCs who supposedly guide opinion at the BDA’s GDPC. Is that not what the LDC Conference is all about? Trickle-up democracy and all that?

And yet after all these years there is a feeling that the BDA’s GDPC is simply not taking the DH to task.
While opinion varies, there is a mood that the LDCs are passing water into wind when trying to influence the GDPC. If you would care to get that special ‘under the counter’ view of those in the know, you will find that there is a feeling that the GDPC are so desperate to see the present contract replaced that have forgotten all the headline issues that plague the current fiasco, overseen by the late PCTs and now NHS England’s LAT gate guardians.

Ask anyone, you all know it. The current problems abound. Whether it be the massive and unfair discrepancy in UDA values. or fairness in dealing with high needs patients – there are serious issues of finance. The clinical disaster of Endodontics is mirrored in the back office with HTM 01-05 and its fictional evidence base. What about Nurses and their enhanced professional status – no funding and no pensions! Status, indeed!!

Never mind the matter of practice sales or incorporation difficulties and how the CQC cope with it all.

Wake the GDPC up … NOW!

Now that the ARF is a matter closed in all but the detail, [OK so the GDC have gone running to KPMG in a panic and put the decision back 6 weeks – but are we fooled?] and while your antennae are still vibrating, why not turn some of your energy to the GDPC and their effectiveness in making sure YOUR contract is beneficial to you in 2015.

After all, if you want to pay your ARF and not simply take a pay cut to do it, you need Dr Milne and his GDPC colleagues to pull their collective bloody fingers out and to do so a bit quick. This next month or two is the last chance saloon before the Civil Service wrap it up for the election.

Time for the swarm of dentists to move along Wimpole Street. Even if you are NOT a BDA member – it is the GDPC who are gambling away your heard earned fees with their laziness and ineffectiveness at dealing with the DH.

You called the GDC to account.

May I suggest you ALL now call the GDPC to account. It’s your wallet that will pay for their failure.

• 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!

That is indeed a question!!

Phew, what a scorcher. 

If you think the meteorological heat is oppressive, you want to try working in Wimpole Street. AirCon does nothing to relieve the heat of the pressure the GDC should be feeling.

What interesting, perhaps desperate times we live in.

The world is awash with wildfire wars with all the suffering that ensues.  The state of children’s teeth of those who do not ‘get’ the dental health message in this country remains an unresolved scandal.  Contract Reform of NHS Dentistry in England has become a fictional event of the future. The CDO England must be playing a lot of golf these days because there is naff all else going on. Dento-legal indemnity has started to rise in cost alarmingly as  the GDC and it’s woeful Fitness to Practise regime comes off the wheels.

But it takes a proposed rise in ARF to really galvanise the profession in a unanimous outpouring of anger.

Well directed anger?

This is being expressed in many ways – letters to MP’s, the professional Standards Authority, letters to the GDC allied to Freedom of Information requests to name but a few.  At meetings, the conversation is grim and consistent – it’s the GDC innit?

Even our old muckers the BDA have bared some teeth which, to judge by their public statements, are finally sharp enough to threaten injury.

What is happening so far can be summarised as a collective professional rant.  There is nothing wrong with that.  This process of ‘ranting’ is a precursor to something much more effective

It is well know that RANT is actually an acronym

The RANT acronym

• Review your position

• Analyse your options for Action

• Notify interested parties of impending Action

• Take action

Where are we?

I think we are heading out toward the last element, if only driven by the timescale.

A request for legal review, a BDA driven legal challenge, and protesting by payment in cash at the front desk of the GDC are just some of the actions being proposed.  What about resignation of a significant cadre of the dentists they need to make the processes and systems function?

What about calling for the resignation of the Dental Professional GDC members en masse?  It certainly seems to have merit.

Will the ARF be less than proposed? My money says “yes”

Will we see heads roll at the GDC?  The CEO, Ms Gilvarry for example? Its hard to see how her position can possibly remain tenable.  She certainly has lost our confidence, but I would imagine the GDC staff are pretty low as well.

What about our new appointed Chairman, Mr William Moyes?  His condescending e-mail to registrants allied to his Pendlebury Lecture suggest a level of isolation and ignorance that make you wonder how he ever got the job.  Based on his utterances so far, he simply does not get it.  Based on the lack of communication by the GDC’s Dental Professional members, I thinks its safe to assume the GDC has battened down the hatches and GDC Council Members are prevented from public comment. So much for transparency.  The ARF was not even an agenda item at the GDC Council meeting of 24 July.

Problem?  What problem?

The GDC have absolutely lost the confidence of the profession.  The have proved themselves to be the most incompetent of Regulatory bodies, and they are asking us to pay for their ineptitude.

The short answer Madam Chief Executive and Mr Chairman is “NO – NOT ON OUR WATCH”

You fix your problems first and we might talk then .

Until then, we will continue with the biggest professional RANT seen for many years.

Once again I profess my grateful thanks for the GDC’s role in uniting the profession, finally.

Enjoy your break people. Be assured, the heat will still be turned up when you return.

Yours, rantingly :)

Grateful thanks

Like many I am grateful for the services of the GDC. I pay the ARF secure in the knowledge that my patients are safe and the money well spent.

Presently though I feel I have more to thank them for than usual.  I hope my readers understand irony ...

Professional disunity?

Just when the state of the dental profession cannot look more perverse, the GDC have achieved something that the last 8 years of the DH and their man at the helm of the 2006 UDA disaster has failed to cause.

Numerous LDC Conferences calling for this and calling for that – the ever calm and serene profession of dentistry has just adapted and carried on.

Implosion at the BDA and barely an extra glass of claret was supped at the ripples on the water of our profession as calm discussion took place about politics.

A raft of daft changes came along such as the UDA system, the HTM document, the OFT report you all now the form – and we ranted for a few months but quietly took another blow to the body, absorbed the costs and “moved on”.

The public acknowledgement that the Contract Pilots have been a sham and that any changes to come will be merely prototype in nature and at least 2 years down the line.  Dentists have had a bit of a cough to their colleagues and carry on, “being busy”.

The dreadful farce of Foundation Dentists lacking places allied to their debt and many were heard to comment widely and indeed care deeply, but the rump of the profession have likely returned to their skate-like lying on the bottom.  “They’ll get by” we all thought. “Wouldn’t recommend it to my chidren” we muttered. Next please.

The CQC came over the horizon brandishing a large bill and a lot of empty folders and by and large we have paid the charge and filled the folders, only to carry as before doing what we do – meeting, greeting, interacting with & treating patients with their range of ailments and fears.

Incoming, incoming ...

But the GDC, in their proposed hike of the ARF to £945, allied to a comical  consultation so pre-determined as to be reminiscent of a past communist regime have caused the profession to both awaken and threaten to unite in a way never seen before.

Just when it was looking very interesting, the satellite of the GDC, the Dental Complaints Service fire their own salvo at the profession. The DCS may be “at arm’s length” and independent or so they claim – but they are wholly funded by the GDC, ergo our ARF’s – so how independent they are is, shall we say, somewhat debatable.

What effect was intended, I wonder when the DCS took a full page advert in the weekend colour magazine of the Daily Telegraph claiming to act on anything less than COMPLETE satisfaction for every patient.

I have a three letter acronym of my own - FFS!!

Professional unity?

Never in 35 years have I seen such united sentiment and anger, perhaps however more importantly associated with individual response and action. The electrons are red hot with e-mails, complaints and letters to MP’s and these bodies.  How ironic that when a patient complains about us, we are always assumed to be in the wrong. When we complain about these bodies, they are always correct and indeed learning. Is it just me? 

So, what now?

Well this is an unprecedented time, and it will call for unprecedented action.

Perhaps a mass sentiment requires a big organisation to coordinate a big response. There seems to be a widespread sentiment that the GDC has lost completely any confidence it may have had with the profession. Of course they will blandly point to some piece of biased research they did to show how well regarded they are. 

They may not realise but the rules have changed and the gloves are off. Big boys games demand big boys rules. And it is the GDC and the DCS who started this.

Who will rid us of this poison organisation, who will deal it a fatal blow, for it is a big monster and well protected by the armour of politics?

We must thank the GDC & DCS – the profession appears to have finally awoken, and if I am not mistaken, this time it is getting to its feet.

Interesting times with a little smoke of excitement.  Who will wager what we see next? I won’t!!

Have a good week, worker bees. Tootle pip.

 

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

Serious stuff or a Lamentable & Brazen attempt to kowtow to the big agencies?

Those of you who are still ave dwelling after the wettest winter on record may have missed the strong discussions on GDPUK regarding a US development in Fixed Orthodontic mechanics.

Wake up at the back ….  Ortho fills diaries …  You might say it whets your appetite as opposed to your gardens.

There is a fascinating shift occurring in Orthodontic practice in UK Dental Practice.

For much of the profession, ortho remains the remit of a local specialist.  For a significant cadre however, the skills and learning required are well within the grasp of a competent GDP. Indeed many specialists with a teaching bent are want to publicly encourage us GDPs to take up the baton in a responsible and measured manner.

But …

There appears to be a rapidly strengthening sense of threat.

The specialists are feeling threatened by the GDPs marching across their patch, and the not-long-past British Orthodontic Society advert in a national broadsheet ruffled more than a few feathers. The GDPs are thinking this can’t be all that difficult and are starting to strut their stuff on this fertile ground for business – after all, every year another cohort of young patients pop into your sights.

So how interesting it is, then, to observe on one side of the vested interest fence we have Dr Viazis and the Fastbraces® brand becoming the torch of vocal GDP protagonists, to the evident irritation of many.

On the other side of ethical glass screen see how Align Technologies & Invisalign® are quietly starting to insert themselves into the postgraduate teaching programmes, in  manner of poacher-turned-gamekeeper,  and are now part of 7 centres in the UK

Influence, Sir? That'll cost you ...

We have always known that money buys influence. How you use that money determines how effective your influence might be.

Orthodontics appears to be a good example of the same desire to apply money and buy influence having opposite effects from differing companies.

As a GDP, if you are doing ortho, it’s Caveat Emptor.  Dark forces of corruption lurk, seeking to separate you from your money and are not far beneath the surface.

Cynical? Qui , moi?

“Come along there, move along please, another QuickBuck will be along in a minute.”

Nearly all men can stand adversity, but if you want to test a man's character, give him power.
Abraham Lincoln

Ok its crunch week, and the quote I have used here seems apposite to the issues at stake in Wimpole Street this Friday, 21st Febrary.

The Probe carries its coverage of the Big Lie discussions which carry on from  Dr Kilcoyne’s leading campaign . The letter in the Daily Telegraph stirred the waters.

The effect of The Probe is to relight the fires of this burning issue in a very welcome manner. The consistent spin of the official replies is becoming eye crossing.

There is general worry that the tripartite comfy zone that is the table around which the BDA, the DH and NHS England sit is looking increasingly as though it is actually a defensive set up to protect their interests, at the cost the care of the patient by dentists.

And so this Friday, as BDA Members YOU have a chance to make YOUR voice heard.

If you cannot attend this EGM, please ensure you vote by proxy. Crack on now because it is a carefully defined legally binding process.  You cannot just phone a mate the day before.

Now is the chance to fire up your Representative Association.  Put a rocket up their collective arses if you will.

There will not be a second chance before Contract Reform hits you between the eyes.

It is a well worn quote of Napoleon Hill, but still, it applies.

“Whatever you want, oh discontented man, step up, pay the price – and take it.”

Good luck to our illustrious and historic Profession – it is not too dramatic to say that a large part of the future of the present generation of GDPs hangs on what happens this Friday.

I told you January was interesting …

First we have a BDA EGM on the cards. Anyone who reads tea leaves must be thinking Friday 21^st of February is the new Ides of March. While the BDA turns in on itself in what some might see as a death roll, the world moves on and, boy, how fast!

The DFT numbers have been formally announced – see the link – and the big picture?  1 in 5 students have not got a job to look forward to – nice motivation if you can get it – NOT!  Approximately 240 out the UK Graduate bag of about 1100 have been ‘placed on a “Reserve List” I say approximately – the numbers are not entirely clear even if the big picture is.   What’s that – about 10% in the end? well, give or take.

Have we all been witness to a Coup d’Etat in dentistry – CoPDenD have quietly become the most influential body in dentistry. If you are a student on the receiving end, it must feel like a very unfair and cruel arbitrary selection process.

You know what sucks?  It is clear that CoPDenD would have you believe that the NHS and it’s public funding is the only kid on the block. They saw off Private Vocational Training and now have a monopoly grip on the peri-graduation phase of ones career. Is it me or does CoPDenD have a funny smell around it?

The size of the private dental market is now likely bigger than all of the NHS dental funding for dental care, both primary and secondary.

So why is there not a flourishing private-public partnership in dentistry in which the shortfalls of NHS funded DFT are more than taken up by a commercial organisation?  If ever an opportunity for the FGDP to do something practical ever has been missed this must be it.  I’ll bet if SERCO or Compass were bidding, Private VT would be up and  running by now.

And now ... midway though a Manpower Review at the Higher Education Funding body…  the word on the block  is that a blanket 10% student cut across the board has been enacted with immediate effect.  The Twittersphere is lighting up this week as the well  hinted cuts are finally publicised.

Perversely, that actually sounds like some form of a solution.  Fewer graduating dentists are an inevitable consequence of reduced Government funding. Since we all know the Government IS broke, maybe this 10% cut will be in ADDITION to the chopping of two dental schools, which is being widely trawled.

That will in 2 years mean a broad reduction of about 270 students per annum - job done, CoPDenD’s DFT books balanced.

But where is the drive to use the vibrant private market to create educational opportunities which support and supplement the NHS funded basic training? Lots of willing weekenders but no structure.

In its small way, dentistry is now witnessing the effects of lack of public funding. If the profession of dentistry is a thermometer for public finances, the mercury is falling.  So be it. Can’t spend what we don’t have.  It is not entirely unexpected after all

But there is a £7Bn, and growing,  private market for dentistry.   In fact, year on year growth of 10% and more is anticipated.

There has to be a better way.  The big picture of publicly funded dentistry is gaining a degree of focus.  We need to ensure that private dentistry builds its own big picture, and fast.

How? By whom?

Questions a’plenty. Answers on a postcard please!  If 10% of you reply…

See you soon people. How much more news can there be?

https://www.bda.org/docs/EGM-Notice-2014-02-21.pdf

http://www.copdend.org/content.aspx?Group=press%20releases&Page=press%20release%20january%202014

http://www.dentalschoolscouncil.ac.uk/

http://www.hefce.ac.uk/

What on earth is going on in dentistry? 

Is it me?  Has the pace of prospective change suddenly become turbo-charged?

It is worth reminding the profession and its representatives that by and large, in GDP we are NOT employed. We are independent contractors.  So why do the DH and our academic colleagues keep trying to treat us as though we are their whipping boys. 

If you are an associate, I reckon you might be worrying about the lie of the tea leaves.  Ever fancied re training as a Therapist?, Sorry to say , but it might be a good investment.

If you are a practice owner, under the NHS, the Ides of March 2015 look an ominous date.  Your business is dependent upon Government funding; you are NOT employed and yet you are being treated as an employee.  Is it really worth the [soon to be emasculated] pension?

As a private practice owner, are the Government REALLY going to impose rules to eliminate your freedom to practice the way you see fit?  You have the freedom to plan and the capacity to respond. But there are massive changes a’coming.  Bone up ... you have been warned.

In no particular order we have

• ·         The CDO stating that NHS dental care will continue to be an unspecified [and ergo unlimited] commitment.
•           Piltos continuing to point to disastrous Patient Charge Revenue allied to the "It can only work with Therapists"  big picture.
• ·         Suddenly there is a proposal to break up the skill base for GDP into “Tiers” – and as many are already wondering, with associated ‘registration and accreditation’ costs.  Allowing Quangocrat driven deskilling is by any description professional suicide.
• ·         The Chairman of the GDPC starting to play some cards as the negotiations continue for “Contract Reform”.
• ·         There seems to be a groundswell of academic attempt to wield influence over the activities of GDPs –from Prof Steele’s changes underway to Dr Chate at the RCS Edinburgh starting to flag GDPs activities in simple orthodontics

Well, I might be a cynical old git, but I reckon the Dept of Health horse has probably already bolted.  I think it highly likely that we are about witness a pre-planned  move to the date of Contract Reform.  Standby for change and press releases on a quarterly basis. Standby for the BDA being outflanked and out-manoeuvred as the soul of dentistry is once agin under threat.  Having a Big Stick is of no use against an out-of-reach elephant.

I reckon the purpose of all this phoney consultation is simply to drag the profession along with a mouldy carrot.

If, as a profession we do not like what Prof Steele’s changes are presenting, and do not think that these changes will either benefit our patients or our businesses, and our associate colleagues, we have a duty to act.

We have a duty to say NO.

The BDA has a duty to say NO

We have a follow on duty to carry our patients with us in this Brave New World.

Its looks like Christmas 2013 will be line-in-the-sand time folks.

Which version of Brave New World do you want to be part of?   The Government’s or your own?

Do you want someone else whipping you at their pace or do you want to control how your career and business evolves?

Strap in guys and girls, the ride is getting bumpy.

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

You know that change I mentioned last time  which is now is well and truly upon us ?  And to all you menopausal old geezer and gals, that is not what I refer to!

The green shoots of spring have begun their turn toward autumnal decay.  The nights draw in and so the darkness of Winter is approaching. There is a mistiness in the air. A murky shadow in the developing gloom. As the last light of the sun flickers, the web glitters with the silky net, ready to capture any unsuspecting prey.

The 9-legged predator that is GDC Standards has landed amongst us. But this is but a side story of evening reading material. Let me put that to one side as a “must” read !  The REAL story lies further down the street where the growing conditions are notably worse.

And so it is the case that The BDA departed the early part of 2013 brimming with the green shoots of optimism that a new era was beginning. Strategic Plans and New Membership structures had been planted seeded and watered. Sods of change had been ceremonially and publicly turned. The sun shone , it must have seemed, permanently upon the righteous, hereinafter known as The PEC Men.

And yet …

The year appears to be closing with the gloom of the unexpected. There has been a withering of such promised growth. This tale of dento-horticultural disaster is only emerging under the spotlight that is networking via GDP UK.  Were it not for such a group, you could cheerfully read the musings of the Chief Executive and believe that not only is everything green that is growing, but also that the Indian summer of new membership has produced some fine blossom, thank you.

In a perverse way, sometimes it takes a shock to resuscitate a dead body. One must hope that there is a defibrillating effect upon the Wimpole Street cognoscenti of the truth that is multiple redundancies and a major drop of in income, allied to an urgent need to realign the BDA business model. That’s shrink and contract to you and me.

Let’s just hope that the Dept of Health does not see the BDA’s 15% budget cut as leading the way forwards for the 2015 contract values.

The upcoming BDTA Show in Birmingham is cause for professional celebration of the industry that supports our work. Now that’s planting a positive idea, people.  Go spend the £200 you saved on your BDA membership on some decent kit.

Perhaps this time, there might also be an opportunity to disseminate news and discussion about the BDA on a wider basis.  If you are going, why not use your visit to drop by the GDP UK stand and catch up with the facts, and failing that have a good old gossip anyway. You won’t get much out of the BDA if current events are anything to go by! And make the most of it – who know what will happen to the Conference next year?

This tale of the unexpected may be the birth of a "new" BDA. At the very least we should hope that the BDA is "Renewed".

Let us all hope one shock is enough.

Now ... must check that list of my subscriptions for next year ...