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

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

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

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

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

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

Indemnity.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

-----------------------------------------------------------------------------------------------------------------------------------------------------------

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.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------

GDPUK Topic

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

----------------------------------------------------------------------------------------------------------------------------------------------------------------------

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which is to Lead the profession.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Moyes, you must resign.

You must all resign.

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

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

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

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

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