Believe it or not, it’s just over ten years since the CQC came into being.

I know! It doesn’t seem five minutes since the CQC burst into existence. Sometimes it seems like it’s been hanging over dentistry forever - like the extended impact winter that wiped the dinosaurs out after that postulated asteroid crash-landed without warning – which was a bit like the CQC itself really.  

In England, the CQC is the independent regulator for the quality and safety of care, although to many practitioners, it’s more regarded as a major irritant – another regulatory body to which you have to kowtow, pay an exorbitant fee and produce a forest’s worth of paperwork.

I vaguely remember that the CQC landed on dentistry’s doorstep in about 2011. I was a practice owner in those days and I remember only too clearly, spending most of my spare time writing policies to fulfil forthcoming CQC requirements and being too busy to notice I could have just downloaded them from the internet.

I didn’t have any direct contact with the CQC until I had to go down to one of the organisation’s regional headquarters in the Midlands, for the registered manager’s interview, sometime in 2012. I seem to remember then having to go again a few months later, when the bizarre individual who was about to buy my practice had to have his registered manager’s interview and we had to tell the CQC how we were going to effect the ownership changeover. Naively, I had thought he would simply give me the dosh, and I would skip over the horizon, happily whistling the ABBA hit, Money Money Money. But no, the CQC wanted to make it more complicated and we had to outline our contingency plans for provision of treatment if the practice was consumed by a flood or a volcano. I thought I’d made that clear at my first interview – canoes and a Dyson.

I finalised my practice sale in 2013 so I’ve had no real exposure to CQC fees since, but I seem to remember a registration fee of £1500 or thereabouts.   I had a quick Google this morning and there nowadays seems to be a complicated formula for working out how much dental practices have to pay in fees, based on the number of chairs the practice has, and if you are insane enough to work at more than one site.

I remember that there was a lot of resentment among dental practice owners around

2011-2012 at the introduction of the CQC to the dental field. Many questioned the need for yet another authority to oversee the profession. We’d already got the Health and Safety Executive, the Primary Health Care Trusts (as they were then) and the General Dental Council. Did we REALLY need another?

Yes. We certainly did.

Over the 19 years I had my practice, I had only a couple of informal routine visits from an NHS dental practice advisor. Near the introduction of CQC registration, I had a visit from the area infection control coordinator (until that point I didn’t know such a person existed) to ensure we were complying with HTM-01-05. As it happened, we weren’t - a sink in the decontamination room was in the wrong place and we had to move it to comply with the rules. Apart from that, there was no real oversight of the practice. In most of my ownership days, we still had the random checks from the RDO where the Dental Practice Board would choose a few patients for inspection at the local correction facility (as I liked to call the community dental clinic), but that was it. What went on in your practice was very much your own affair. Nobody randomly checked to see if you were boiling the instruments properly in new saucepans, or diligently spraying the reusable patient bibs with Febreze.

As it happened (and it was probably more luck than judgement), apart from a few bits of paperwork we needed to spruce up, we were pretty near compliant before the CQC came-a-calling. But having worked in a number of practices as an associate before I bought my own place, I can attest that there were a lot of places that would have really struggled to come up to basic CQC expectations, let alone those required by the CQC.

I will describe ONE such practice that I worked at.

It was 1990 and I’d been qualified a couple of years. I joined an old established practice on the Cotswolds border as an associate. The practice had five surgeries and was manned by a husband and wife who were the owners, a long-term associate, a hygienist and moi. The bosses had taken over from two very old school and respected dentists, one of whom appeared to have been grandfathered on to the dental register from his primary job as a barber and blood-letter.

The practice was set in a grand Georgian terraced house, and once you went above the surgeries on the first floor, it appeared that the last vacuum cleaner ever to be used on the 2^nd and 3^rd floors, was the Batty-Fang Carpet Beater 1900. I never saw those floors during my interview, and neither did I see my surgery. When I turned up for the interview, my surgery was in use by the hygienist (apparently) and I couldn’t see into it, the door being solid wood. When I arrived for my first day of work, my surgery was decorated in the style of a 1940’s London Underground station lavatory. Every square inch of the walls, ceiling and floor were tiled in a faded turquoise and the pipes for the aspirator and services lay on top of the floor, presenting a tripping hazard to anyone entering the room. I found out later in the day that the practice was supposed to be haunted. The legend went that the house was originally owned by a well-to-do family and the man of the house had an affair with the housemaid, who I shall call ‘Flora.’ When it all went pear-shaped and Flora became pregnant and was shamed, she hung herself in my surgery (which was the kitchen originally – the fireplace was still in the one wall). Her feet would have dangled over the reclining headrest.  It’s another story, but my associate colleague heard Flora singing late one night on the top floor, and truly I saw an outline of her brushing her hair through a window, one dark winter’s afternoon.

After a week I could stand no more. I discovered that Tanya the hygienist only worked in the practice two days a week and although not spectacular, it at least had an acceptable, if dirty wall-covering. I asked if I could swap rooms and poor Tanya found herself in the lavatory. She never thanked me.  I asked the practice owners if I could decorate the room myself and at my expense. The bosses agreed. I did it in a nice bright pink and I put some decorative borders up. The husband came in first thing on the Monday after I had decorated, put his head around the door and said without a hint of humour: “It looks like a bleeding tart’s boudoir in here.”

Unfortunately, the equipment was as old as the building and the delivery unit was the size of a modest Buckingham Palace fridge and it was about as manoeuvrable as trying to get a Dalek up the stairs. It had polyoxybenzylmethylenglycolanhydride (Bakelite) control switches and buttons and piping that had been repaired by shortening so often, when you moved the drills in a patient’s mouth, the unit was dragged with it. In the two years I was there, I never saw an engineer come in to service the equipment (not that the spare parts were still made for the units). I’m sure it would never have come through a thorough PAT test with flying or even submerged colours. My unit had a dodgy connection with the handpieces and every now and then there would be an explosion of air and what remained of the air-tubing would fly off and snake wildly about the room like a twerking cobra. I point blank refused to have anything to do with fiddling about with the equipment and so my nurse would go and fetch the husband. I REALLY want to name him, but I can’t, so I’ll call him Boris. Anyway, Boris would invariably come with a pair of scissors in his hand and a cannister of sturdy floss, and tie the tubing back on to the handpiece coupling until the perished rubber broke again.

Fortunately, the CQC also ensure premises are safe and up to the mark these days. Boris’s place wasn’t. I doubt that the electrics of the practice had been checked since Thomas Edison was a lad. One day I was doing a full denture try in. I had just given a deaf lady a mirror so she could have a good look and the small, white, straight set up. There was suddenly a loud bang and a flash from behind her. A Bakelite electrical socket (without anything plugged in) had just exploded with no provocation. I jumped and my nurse shrieked, but the patient just sat there wondering if the shade was maybe a little bit dark. She even carried on looking intensely at the denture while Boris ran into the room behind her with a fire extinguisher and started spraying powder all over the place. I can’t remember off hand if the socket was ever dealt with afterwards. We were probably told never to use it again.

One of the worst incidents that happened at this place and inspired me to look for a job elsewhere was when I was treating a patient and Boris’s nurse flew in and said “Can you give Mr Aguecheek a hand…NOW!”

I went into the lavatory-surgery to find Boris was struggling to keep a child anaesthetised. “Just pop the E out for me” he shouted.   I went cold but did it. I hadn’t realised until that point that he was doing child general anaesthetics acting as operator and anaesthetist. I knew for a fact that his nurse wasn’t trained at all, being a newby. I rarely lost my temper, but told him as soon as the opportunity arose, that he was never to involve me in GA’s again.

But that probably wasn’t the worst of it. Oh no. I discovered while I was working my notice, that Boris and his wife Priscilla didn’t dispose of sharps through a clinical waste company. He apparently used to box them up and dispose of them just as the local tip was shutting and it was getting dark. I found that out from one of the receptionists as I was having a chat between patients. I had only just muttered “That is absolutely disgusting” to turn round to find Priscilla was standing behind me. Well it WAS disgusting and again, I told them that I would have to report them to the local Family Practitioner’s Committee (as it was then) if I witnessed them doing it again.

Suffice to say, they also ignored employment laws. A trainee nurse who had gotten fed up with £2.40 per hour they paid, handed in her notice. At the end of the first week of her fortnight’s notice, they withheld her wages, only giving them to her after the rest of the nurses and I, threatened to strike. After I put my own notice in, I found two of my monthly payments were delayed and Boris used to sneak out of the practice so he didn’t have to see me. He worked on the first floor and I was told by his nurse that he daily tiptoed down the stairs quietly so I wasn’t aware he was leaving. One morning, I finished early and waited for him. I flew out and ran at him, catching him halfway up the stairs. I’m not a big bloke, but when I get angry, I can make myself big. When he came back from lunch, he gave me two cheques.

The thing that was interesting here, and it accounts for the fact that I am not impressed by people on committees is that both Boris and Priscilla were ‘upstanding’ members of the local dental community. Both were big in the British Dental Association locally, and both had been LDC members, yet they operated like that.

So do we need the CQC?

Yes we do. The pally pally relationship they must have had with the local dental practice advisor obviously didn’t address major problems with their practice. In these days where we are all faced with a torrent of potential litigation every day, at least complying with the high standards set by the CQC reduces risks marginally and prevents inadvertent swamping by an avalanche.

But it all turned out okay in the end for Boris and Priscilla.

They both dead now.

On average, there are approximately 6,000 employment tribunals being presented each month in this country. In dentistry, we see a large volume of cases in which practice principals have failed to issue their staff with proper employment contracts. Despite the fact that the provision of such contracts has been a statutory requirement since 1978, there are still many practices that fail to do so – why this should be the case is hard to determine, but it is indicative of an attitude that fails to recognise the importance of the staff. 

Failing to provide employment contracts to any member of your team is not only a breach of statutory requirement, it can also leave practice owners vulnerable should there be dispute with a member of staff. For example, without an employment contract, there is no clear procedure for staff holidays, sick pay, overtime of discipline.

It is also quite likely that if a tribunal comes across a case where an employer has not provided a contract, they are likely to sympathise with the employee’s position. Thus, the lack of a contract can actually jeopardise the chances of successfully defending against such proceedings.

But by including a clause in an employment contract, that defines the procedures that will be followed in all aspects of work within your practice, you will be suitably protected.

To reinforce this, it is also prudent to supply a comprehensive staff handbook. This must be bespoke to your dental practice and will expand upon the terms detailed in the employment contract, focussing on specific circumstances that may be unique to you and your team. Of course, it must be regularly updated to reflect new legislation and practice changes, and it is absolutely vital to include a thorough introduction to the handbook in any staff inductions.

Ultimately there are two reasons to invest yourself in a comprehensive handbook like this. Firstly, you will be able to significantly reduce the chances of becoming embroiled in a dispute and being taken to a tribunal. The second is that your business will come across as professional, serious, fair and competent.

Of course, these precautions are not guaranteed to stop all staff misconduct, but they do provide an efficient safety-net to fall back on if matters turn nasty. What’s more, it will promote staff happiness, because they will feel protected and valued – and, of course, happy staff should equal happy patients.

John Grant of Goodman Grant Lawyers for Dentists - a NASDAL member

For more information call John Grant on 0113 834 3705 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk

A NASDAL and ASPD MEMBER

In the UK, there a number of people who are contracted to do unsociable hours with estimations from the Labour Force Survey in 2005 showing 3.6 million in shift work employment.¹ Indeed, with many working in healthcare, manufacturing, transport, communications and hospitality professions, nine to five is no longer considered to be the norm.

With reports showing a decline in nightshifts and the three-day working pattern, it appears that emergence of ‘other types of shift work’ is on the rise highlighting the constant change that workers face.²

Finding the time

Because of the erratic and unpredictable patterns that shift work brings, it can therefore be difficult for people to arrange and attend much needed or emergency appointments.

In comparison to fixed contracts, which specify pre-arranged working days, shift work rotas are subject to change and can often not be distributed to staff until the last minute. As you would expect, booking an appointment in advance can become a seemingly impossible task.

What’s more, because employers are not required by law to allow workers to attend medical and dental appointments in work time,³ booking an appointment without a definite rota is out of the question, unless annual leave is approved for that specific time.

The toll on oral health

Not only does working unsociable hours and shift work have an effect on the convenience of booking an appointment, it could also create or contribute to medical and oral health problems.

Although there is insufficient research specifically on the topic of oral health in patients who work these hours, there is some evidence to suggest that it can be damaging to a person’s general health and wellbeing. As well as affecting sleep, weight and increasing the chance of diabetes, studies have shown a link between shift work and increased cardiovascular morbidity.⁴

The solution

Making appointments more accessible and offering online booking will encourage the general and oral health of shift workers. The current system has many flaws including busy phone lines, lack of out-of-hours options and limited choice of appointment times.

In comparison, online booking is flexible and transparent, offering 24/7 access to available appointments. A quick, easy-to-use and stress free alternative, online platforms such as Zesty offer a solution to those who work unsociable hours.

If you want to streamline your practice, optimise your surgery time and allow patients who do shift work to access services, contact Zesty today.

Email This email address is being protected from spambots. You need JavaScript enabled to view it. visit www.zesty.co.uk or call 02037717799 for more details today

¹ Unite guide to shift work and night work – a health and safety issue for unite members. Revised October 2013. Accessed online 24^th July 2015.

http://www.unitetheunion.org/uploaded/documents/ShiftandNightWork%2011-4950.pdf

² Changes in shift work patterns over the last ten years (1999 – 2009). Prepared by Office for National Statistics for the Health and Safety Executive 2011. Accessed online 6^th August 2015 http://www.hse.gov.uk/research/rrpdf/rr887.pdf

³ Advice Guide. Citizens advice bureau. Accessed online 24^th July 2015 https://www.citizensadvice.org.uk/Documents/Advice%20factsheets/Employment/e-time-off-work.pdf

⁴ Europe Published Central. Shift work and health – a critical review of the literature on working hours. J.M Harrington. Accessed online 24^th July 2015 http://europepmc.org/abstract/med/784775

Dental professionals are familiar with the sights; sounds and smells of the practice but these can be the catalyst for fear in some patients. Hearing the sound of the drill can evoke the perception of pain, the smell of cleaning solutions may bring back negative thoughts and the clinical environment, instruments or the sight of the chair can terrify some people.

National surveys reveal that around 36% of patients experience moderate dental anxiety and 12% of adults were classified as having extreme dental anxiety.[1] There is not always a clear-cut reason for dental phobia but many patients explain that they have been scarred by a previous traumatic experience.[2] Others are afraid of the unknown and many have simply inherited dental fear by association from their peers or parents.

The most common fear among patients is pain.[3] A phobia of needles is also reported by thousands of men and woman and the thought of having an oral injection understandably exacerbates their anxiety. A significant number of patients become anxious when they feel out of control, confined or helpless. Some people are terrified of not being able to breathe or swallow, have a fear of gagging or vomiting and others cannot cope with hands or instruments in their mouth or near their face.

Any practitioner will be aware that anxious patients need understanding and empathy, a level of support that makes them feel as comfortable and relaxed without prying into their inhibitions. It is important talk reassuringly to the patient whilst respecting their wishes. It’s critical to take plenty of time to explain every detail, maintain eye contact and encourage them to take deep breaths to calm down.

Even when fearful patients attend for a check up, they have made a terrific effort to be there. They may not be able to respond to your questions or feel like making small talk but you can put them at ease by being kind, gentle, patient and most importantly, non-judgemental. If the patient has severe dental or oral health problems due to neglect it may be ideal to break the diagnosis down and explain it in stages to avoid increased anxiety.

If the diagnosis is complex, you might need to refer the patient to a specialist practice, but you will need to be confident that they have the ability and empathy to treat anxious patients. London Smile Clinic is a referral practice with a team of specialist dental practitioners that are experienced in treating nervous patients. It is a centre of excellence with exceptionally high standards of dentistry and offer orthodontic, implantology and periodontal treatments as well as cosmetic dentistry. The dental team strive to make patients as comfortable and relaxed as possible and take the time to be gentle and understanding.

On facing their fears, patient can often feel surprised at how well they have been able to cope. Practitioners can boost their confidence by praising them and assuring them that they will look forward to their next visit, which will hopefully be less worrying.

For more information, please contact 020 7255 2559 or
visit www.londonsmile.co.uk/refer

Many modern companies in all industries offer an array of employee benefits. There are various different schemes available, from those that provide tax incentives for employees cycling to work, to others supporting child care costs. The nature of the benefits provided will depend on each team and their individual needs.

Aside from the obvious compensations to employees, these benefit schemes also offer advantages to the employer and business. Happier staff tends to increase their engagement and maximise productivity, ultimately having a positive effect on profitability.

Healthcare benefits will also help improve the health and wellbeing of staff for reduced sickness absences. These are probably one of the most cherished schemes offered, as they entitle employees to private health and dental care, with a considerable proportion of the cost covered.

But how is this relevant to you as a dental care provider?

Most dental practices are run as a business, and an increase in new patients, higher frequency footfall and busier chair occupancy is the ultimate goal from a ‘bottom-line’ perspective. By being part of these healthcare plans and working with those who offer them, patients who use the cover will come to you for their treatment. There are businesses out there that manage healthcare plans in this way, liaising with insurance companies and dental providers to provide the highest quality of dental care for those who take out cover.

Munroe Sutton has more than 3 decades of experience in designing, organising and managing dental plans that improve the affordability and accessibility of quality dental treatment. Their dental plan was created by dentists, for dentists, so is committed to providing fair compensation and supporting the patient relationship. By working with leading financial, insurance and healthcare companies, as well as the smaller local unions and trade associations, Monroe Sutton is able to promote your practice to a huge number of new patients, all at no cost to you.

Further still, Monroe Sutton believes in prompt payment for the services provided to healthcare plan patients, ensuring a reliable cash flow.

Attracting new patients is an integral aspect of your business’ success, and it doesn’t have to be time-consuming or expensive to you. By getting involved with the healthcare and dental plans offered to businesses and individuals, you can not only help more people enhance their oral and general health, but also build your patient base and grow your business.

For more information please call 0808 234 3558

or visit www.munroesutton.co.uk