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
 

Oh cripes, oh crumbs! What have I gone and done?
I’ve only gone and broken GDC Principle Number One.
I tried so hard to put his interests well before mine,
But he works shifts and wanted me on Sunday at half-nine
Does an FtP await me?

Oh cripes oh crumbs! Now I’m in the poo!
I’ve only gone and broken GDC Principle Number Two.
I tried to communicate effectively, I really really did.
But he's a Glaswegian Kiwi and I couldn’t understand what he sid.
Does an FtP await me?

Oh cripes, oh crumbs! They’ll hang me from a tree!
I’ve only gone and broken GDC Principle Number Three.
I thought consent was valid, I really talked it through,
But his Uncle’s anti-fluoride and now they’re going to sue
Does an FtP await me?

Oh cripes, oh crumbs! They’ll strike me off for sure
I’ve only gone and broken GDC Principle Number Four.
His wife checked his appointment, the nurse said he wasn’t in
He was knocking off his secretary, committing carnal sin
Does an FtP await me?

Oh cripes, oh crumbs! They’ll boil me alive!
I’ve only gone and broken GDC Principle Number Five.
Anyone can complain to us, be it grumble, moan or wail
We thought me made it pretty clear, but we don’t have them in Braille!
Does an FtP await me?


Oh cripes, oh crumbs! They’ll torture me with sticks!
I’ve only gone and broken GDC Principle Number Six.
I referred her to a Specialist, one I’ve used a lot,
But she wanted to see another one, and now I’m in a spot
Does an FtP await me?

Oh cripes, oh crumbs! This is DLP’s heaven
I’ve only gone and broken GDC Principle Number Seven
I thought I could root fill a tooth, but I’m not able to you see
There are many many lawyers who know much much more than me!
Does an FtP await me?

Oh cripes, oh crumbs! Is another career too late?
I’ve only gone and broken GDC Principle Number Eight.
I thought her weight loss was down to a calorie controlled diet
I didn’t know she was under stress and I shouldn’t have kept quiet
Does an FtP await me?

Oh cripes, oh crumbs! Open the bottle of wine!
I’ve only gone and broken GDC Principle Number Nine.
I try to be upstanding, honest, good and true,
But I follow the GDC’s example – now that JUST WILL NOT DO!
Does an FtP await me?

Mike Ingram

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

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

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

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

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

This brings me to the point of this blog.

Civil Disobedience.

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

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

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

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

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

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

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

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

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

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

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

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

I am.

* Image from Wikimedia Commons.

“If we’d asked people what they wanted, they would have said faster horses”, Henry Ford is famously quoted as saying.

And this week we have news reports about the car insurance industry being subjected to further “market reforms” in order to deliver cheaper end-consumer prices.

But this is a fundamental misunderstanding of the markets.

If you look at the résumé of our first appointed chair of the General Dental Council [GDC], Bill Moyes, you will see that he has led several market-driven initiatives in various roles, and it wouldn’t be a leap of the imagination to consider that he has been appointed into the GDC to fulfil a “market-driven” reform. Dentistry has long suffered an image problem; consumers feel that prices (and pay) are too high, that dentistry delivers poor value to the consumer and that there is a conspiracy of the profession against the public – it is only necessary to have the briefest of reads through the comments section on any newspaper that publishes a dental article to see that the accusations of “rip-off” rear their head at a very early stage.

But this premise is entirely wrong. The problem with a free market is that the results are entirely unpredictable. Economic journals are full of perfectly logical explanations as to why markets behaved in a certain way – crucially, behaved and not behave. That is, the analysis of the markets and the rationality of them is done post hoc.

One of the most fundamental problems I can see with the approach of trying to manipulate markets in order to deliver a specific outcome is that it rarely works, or often, even where it does work, often this is not what the consumer demands or buys, although they may insist at the outset that that is what they want.

In our particular dental industry, I would hazard a guess that many people (of a non-dental nature) believe that market reforms will deliver cheaper dentistry, through increasing the supply of the dental workforce. I would suggest that this is unlikely to work for a variety of reasons. Firstly, costs represent some 60-70% of the price that the patient pays. Given that the average pay for dentists has been declining in real terms for some time, if we were to cut pay for dentists by 10%, then this can translate into only a 3-4% price saving for patients. And I don’t believe that we can cut pay much further without running into another economic problem – that of a shortage. If you pay too little for something, you create a shortage. In this case, how many dentists do you think would leave the profession if average pay drops below a certain point? (I would suggest £50,000 for associates, on average, and £75,000 for principals)

So if cost savings are to be made for the end consumer prices, this will have to come from reduced costs. And here we already have an idea of what happens from another industry – the British car industry. Throughout the 60s and 70s, the British car industry suffered a slow and agonising death over many years, selling outdated cars, with poor workmanship and a reputation for declining quality, and in some cases, with cars selling at less than the cost of manufacture. Do these problems sound familiar?

Of course the British car industry eventually collapsed, superceded by German and Japanese competitors who were operating on free market conditions, and produced innovation and rapid improvements in delivering things people wanted rather than what they told government-led focus groups that they wanted. The eventual death of Rover marked a turning point and renaissance of the British car industry, and now we have world class manufacturing and design, but for this to happen we had to see the government leave the industry and several companies to go under.

I sincerely hope that dentistry has its “Rover moment” soon. I believe in the free markets, but a belief in the free markets also means accepting when they don’t deliver quite what you thought they would. And that doesn’t always mean that what will be delivered will be cheaper: sometimes, what is delivered is “better” rather than “cheaper”. I believe that health and dentistry falls into this camp.

After all, when was the last time you saw a car maker advertise how cheap they’d made the braking system?

Free markets tend to deliver better healthcare, by and large, which is often but not always cheaper. I would therefore issue a challenge – if this is truly the purpose of Mr Moyes’ appointment, I would suggest that he can best serve the public by completely withdrawing any government interference in the market, but only on the proviso that he and they MUST accept that prices will almost certainly rise, but also must accept that this may result in longer term reduction of cost. Otherwise we run the risk of delivering the cheapest horses in the world when the rest of the world has moved onto cars.  

Image credit - Coen Dijkman  under CC licence - not modified.

• 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!