Goodbye Lansley - Ministers to retake control of NHS

Last Friday (Feb 5) Health Policy Insight published^[i] the draft of the Government's forthcoming White Paper on Health, which was reviewed extensively in the media over the weekend. The main news in it for dentistry was that the paper included proposals to hand over control of water fluoridation to the health secretary and away from local councils. The move was widely welcomed in the profession especially by the CWF network (@network_cwf), the national organisation of dentists supporting water fluoridation.

Andrew (now Lord) Lansley’s 2012 reforms, when he was health secretary, handed control of the measure to local councils, which led, in October 2014, to a decision by Southampton City Council to scrap plans to fluoridate its water. This followed a vigorous campaign by ‘Hampshire Against Fluoridation’ and tentative plans to introduce the measure in other areas such as the North West of England and Hull were quietly dropped. Speaking in the January 14 Commons debate on dental services during Covid-19, health minister Jo Churchill said she was ‘extremely sympathetic’ towards the measure, so we may expect its revival perhaps.

In his report^[ii], the late Professor Jimmy Steele said the first priority of any NHS system should be ‘a strong, co-ordinated public health system’, something that has not been possible with it being devolved to individual local councils,

The Lansley approach, which was controversial in the Conservative/LibDem coalition, was to take power away from ministers and put it in the hands of administrators. NHS England was given ‘power without responsibility’ to quote Stanley Baldwin’s description of the press in the inter-war years^[iii].  But Ministers were still held accountable to Parliament for the NHS; ‘responsibility without power, the worst of all worlds’ as then Home Secretary David Blunkett, described it in 2002.^[iv]

Without going into any detail, the document says there will be ‘enhanced powers of direction for government’ to ensure that ‘those overseeing the health system’ are held to account. For dentistry this could mean that the focus moves from NHS England’s obsession with delivering UDAs to MPs’ demand that anyone who wants to see an NHS dentist can do so - a shift from activity to access.

Secondly the Lansley approach was to promote competition within the service, hence the over-long process of commissioning new services, typically a year or more and, arguably, the botched orthodontic recommissioning exercise.

The pandemic showed, though the commissioning of urgent dental care practices, that the NHS can move rapidly when circumstances demand and so it should be in the future.

In responding to the January 14 debate, health minister, Jo Churchill said that ‘a transformation in dentistry is necessary.’ She continued: “There is a huge opportunity to deliver a greater range of health advice monitoring and support, using dentists and their teams.”

The demise of the Lansley system could give her the opportunity to achieve this.

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^[i] http://www.healthpolicyinsight.com/?q=node%2F1699

^[ii] NHS dental services in England: An independent review led by Professor Jimmy Steele, June 2009

^[iii] ‘power without responsibility – the prerogative of the harlot throughout the ages’, Stanley Baldwin speech on newspaper proprietors March 17, 1931

^[iv] Speech by home secretary, David Blunkett to Labour local government and women’s conference Cardiff, February 2002

A wake up for dental prevention, COVID is worse for patients with periodontal disease.

We are all (well most of us!) now actively involved in prevention and risk assessment. 

We stay at home, keep our distance, wash our hands and wear masks.  We know some people are at higher risk of serious complications and death from COVID than others, so we shield the elderly and those who are clinically vulnerable, and we require our medics, dentists and care workers to wear PPE and engage in comprehensive disinfection routines to protect them and their patients from the close contact they have to have in their essential work.  Our vaccination programmes have initially been targeted at those who, by nature of their inherent risks or lifestyle risk factors, are in most danger. 

It is the coming of age of risk assessment and prevention, a time when the public accept that the inconveniences of doing the right thing are essential to ensure a better future.

I strongly believe that NHS dentistry post-COVID will take on this challenge: the one that says prevention comes first, and to prevent you must first to know your susceptibility and what you personally can do to protect your health.  Treatment is a fix, not a cure and whilst essential to get patients out of pain, should not be the focus of a modern health service.  Advanced restorative treatment on an unhealthy periodontium should not be paid for out of the public purse. 

A study has just been published from Qatar on the impact of perio disease on COVID outcomes.  Qatar has electronic health records containing medical and dental data (definitely something for the NHS to aspire to!) which facilitated the analysis of confounding factors.  To quote the press release here:

 The case control study of more than 500 patients with COVID-19 found that those with gum disease were 3.5 times more likely to be admitted to intensive care, 4.5 times more likely to need a ventilator, and almost nine times more likely to die compared to those without gum disease.

Blood markers indicating inflammation in the body were significantly higher in COVID-19 patients who had gum disease compared to those who did not, suggesting that inflammation may explain the raised complication rates.

Professor Mariano Sanz, one of the study’s authors, noted that oral bacteria in patients with periodontitis can be inhaled and infect the lungs, particularly in those using a ventilator.

“The results of the study suggest that the inflammation in the oral cavity may open the door to the coronavirus becoming more violent,” said Professor Lior Shapira, EFP president-elect. “Oral care should be part of the health recommendations to reduce the risk for severe COVID-19 outcomes.”

Causality, which is very difficult to prove, is not claimed here, and as always, whilst confounding factors have been adjusted for, those with perio disease often also have other health issues. Maybe the periodontitis is just a manifestation of a tendency to inflammation, and the COVID response simply results from that.   However, the evidence for periodontal disease raising your risk for other systemic diseases is indisputable and growing.

The crunch is this:  gum disease is the easy part to deal with: it is not invasive, expensive or harmful.  When you can stop the disease in its tracks, why risk COVID complications?  Why accept the heightened discomfort and dissatisfaction with your teeth, and the tooth loss that results from periodontitis?  Knowing that gum disease is associated with diabetes, CVD, kidney disease, dementia etc, why would the susceptible patient not choose health over bleeding?

Now is the time to talk prevention: to explain to the susceptible periodontal patient how they are more vulnerable than others in the population; to identify and share the lifestyle factors which put them personally at risk of the disease; to explain the potential impacts on their systemic health, and persuade the patient that it is up to them to take the decision to work with you to take charge of their future. 

Liz Chapple

OHI Ltd, UK provider of PreViser and DEPPA technology

www.previser.co.uk

Last week, Pfizer and BioNTech announced a breakthrough in the fight against the SARS-CoV-2 virus. Pfizer proclaimed its initial Phase 3 data showed its vaccine is 'more than 90% effective'. The news was hungrily devoured and then regurgitated by the national press in an excited fanfare. The BBC reported Health Secretary Matt Hancock as saying the NHS will be ready from December to roll out the new coronavirus vaccine if it gets approved.

There are still dentists and dental care professionals who haven’t returned to work after dentistry resumed in a limited way during the summer. Those dental professionals who have still had no patient contact for months are concerned about the return to work and the change in circumstances in practice. I interviewed one such practitioner.

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

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

Critical Mass 2

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

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

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

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

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

Follow the money

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

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

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

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

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

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

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

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

Have great Easter, assuming the snow has eased back!

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

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

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

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

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

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

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

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

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

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

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

As time has passed, the evil lurking in our diets has worn many different guises – saturated fat was cited as the real villain for decades, as was the lack of dietary fibre back in the 1970s and until recently, carbohydrates dominated many diets as the major food group to avoid. However, today, there is one clear evil – sugar.

The effects of eating too much sugar are complex and there is extensive research on this matter. Excessive sugar consumption is one of the main causes of obesity, which, in turn leads to the associated conditions of Type 2 diabetes, high blood pressure, coronary heart disease, stroke and some forms of cancer[i]. One in four adults and one in five children aged 10-11 in the UK is obese, showing that we have a problem on our hands[ii]. Of course, the ill-effects of sugar consumption on our teeth are very well known, but what is interesting about the recent information on refined sugar (the white crystalline carbohydrate kind) is just how oblivious we are to the amounts we’re all eating – and the many ways it affects us.

Refined sugar is addictive, in the same way as drugs and alcohol are – the more you habitually consume, the more you crave to get the same kind of ‘high’. Hence, there is a perpetual cycle of craving and consumption that renders sugary foods big business – whilst our waistlines grow and teeth decay in tandem. It has been suggested that sugar is more addictive than cocaine; American cardiovascular research scientist, James DiNicolantonio conducted dozens of studies supporting this theory and published his findings in 2014. In one study, lab rats became addicted to cocaine but when sugar was introduced, they immediately switched to that, over the drug, which continued to be supplied[iii].  

The worrying thing is that refined sugar sneaks into the vast majority of our foods. The average Briton, often without knowing it, consumes 238 teaspoons of sugar each week[iv]. Jamie Oliver recently put pressure on David Cameron to introduce a sugar tax on fizzy drinks but they’re not the only culprits containing levels of sugar the human body simply wasn’t designed to digest. It’s recommended that we consume no more than 6 teaspoons of sugar per day or 30 grams[v]. But, it isn’t hard to see how we’re often keeping to the high end of recommended amounts or exceeding them. Shop bought French dressing contains up to 7 grams of sugar per serving, many pasta sauces have between 6 and 12 grams, processed white bread contains half a teaspoon of sugar per slice and just one pint of cider represents 20 grams of sugar[vi].

When we compare the rate at which we are tucking away refined sugar with our century-old predecessors, just one can of fizzy drink equates to more sugar than they typically consumed in an entire year[vii]. In the not too distant past, refined sugar was rarely used, and the sugars our bodies need to function were derived from natural produce such as milk, fruit and vegetables. It makes the orange at the bottom of a child’s Christmas stocking make sense, this would have been a wonderfully sweet treat for those who’d never experienced the chocolate version around today.

The effects of sugar intake on our oral health are entirely detrimental – any such food will react with plaque creating acids that damage teeth. Even a fruit smoothie made entirely out of natural produce is a concern as the acids become much more powerful in a concentrated form. There are certain foods that are worse than others and some measures that can be taken to lessen the damage done by them. For example, straws are recommended for the consumption of fizzy drinks so that the offending liquid doesn’t soak teeth and the surround tissue in the mouth. Also, if sugary foods are going to be eaten it is advisable that they are encompassed in meal times so that teeth are not under the constant attack that snacking and grazing on these treats all day will constitute. Of course, as a result of our over consumption of sugar, a thorough oral hygiene regime is ever more crucial.

Four members of the Rodericks management team will soon be participating in the “Sleep Out for Centrepoint” on 12^th November, hoping to help raise awareness and donations to support the amazing work of the charity.

Georgina Linton, Training Manager at Rodericks, is among those sleeping rough for the cause:

“As part of Rodericks’ work with Centrepoint, I had been looking into how the group could help regarding the dental and health education needs of individuals the charity supports. It is an inspiring organisation that not only helps young people get off the streets, but also helps build them a future by teaching essential life skills.

“I jumped at the chance to get more involved and raise money through the ‘Sleep Out’ campaign and my colleagues Aaron Baldwin, Kavita Malhotra and Lesley Marr were keen to join me.”

The group will sleep under the stars at The Old Truman Brewery on Brick Lane in London this November, hoping to raise £1,500 towards this fantastic cause.

All donations, however large or small, are greatly appreciated and can be given at sleepout2015-londonotb.everydayhero.com/uk/rodericks/members.

Thank you for your support!

For more details about the “Sleep Out for Centrepoint” or to get involved, visit www.centrepoint.org.uk/news-events/events/sleep-out.

For more information about Rodericks please visit www.rodericksdental.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it.

or call 01604 602491.

As the Association of Dental Groups (ADG) continues to promote prevention of dental health problems and delivery of quality outcomes for patients in a sustainable, high quality manner, Mouth Cancer Action Month remains of utmost importance.

“As long term supporters of the British Dental Health Foundation and Mouth Cancer Action Month, we are as pleased as ever to be able to contribute to such a worthy cause,” comments Chair of the ADG, David Worskett. “By working together we can tackle oral cancer and make a real difference to those who suffer, one campaign at a time.”

Indeed, now that Mouth Cancer Action Month is underway – as launched by the British Dental Health Foundation on the 29^th of October at the House of Commons – the ADG will once again resume its task of raising awareness on diagnosis and prevention.

Currently, statistics show that only 40% of patients who develop mouth cancer visit the dentist with concerns. [i] But as Chief Executive of the British Dental Health Foundation Dr Nigel Carter OBE explains, “if the dental and wider health profession can inform and urge patients to regularly attend dental check-ups, we can increase the chances of mouth cancer being detected at an early stage.”

If any headway is to be made, these wise words must be implemented. Indeed, with the latest figures showing that 6,767[ii] people are diagnosed with mouth cancer in the UK each year, it is important that as many people as possible get involved with Mouth Cancer Action Month.

Whether it’s the Blue Lip Selfie Campaign – where all you need to do is take a selfie of yourself and share it with the hashtag #bluelipselfie – or showing your support by wearing a blue ribbon badge, your participation is crucial to the success of the campaign.

Another useful tool available is the oral cancer CPD module available through the ADG, designed by {my}dentist. While it may not be mandatory, recapping on areas such as early symptoms, referral and treatment pathways for the disease and improving patient awareness could be the difference between saving and losing a life.

That is why the ADG is pleased to announce the return of the CPD module, and hopes that the tool will help in the battle against mouth cancer. The module is free to review, with only a small cost of £25 plus VAT – £5 of which will be donated to the British Dental Health Foundation and the Mouth Cancer Action Month campaign – for those wishing to apply for a CPD certificate.

Ultimately, the campaign needs all the help and support it can get, especially as research indicates that early detection of mouth cancer can result in a survival outcome of 90%.[iii]

For more information on Mouth Cancer Action Month, the CPD module and to find out how you can be a part of the month long November campaign, contact the ADG today.

For more information about the ADG visit www.dentalgroups.co.uk.

It is well documented and often discussed that the professional climate we work in at the moment is an unhappy one, and there is a lot of uncertainty and disharmony with the regulators and governing bodies.

Indeed a recent news report that suggested doctors and dentists should ‘snoop’ on colleagues to ensure they are not prescribing too many antibiotics made me question the amount of negative press the healthcare professions receive.[i] We have all heard about the dangers and concerns around the over-prescription of antibiotics and the inevitable antibiotic resistance crisis, and certainly action is required to counteract the rise in the unnecessary prescription of these medicines.

However, this report appeared to be yet another negative piece designed to make doctors and dentists worry about every move they make. Rather than galvanising the profession into action, the effect that this will have will be to encourage the opposite. Doctors and dentists soon won’t feel able to do anything at all because they’ll all be too frightened to do something wrong.

It’s interesting to note that there is so much negative press in the news towards doctors and dentists, and yet at the same time, a recent report from the NHS, a Summary of the Dental Results from the GP Patient Survey: July to September 2014, showed that the majority of NHS dental patients rate their care as positive.[ii] Indeed we hear more about the failures and mistakes and horror stories form the profession than the good news stories – of which I am sure there are many. To a certain extent this is to be expected, it’s how the national media works, but who is there standing up for us? Shouting about the amazing things UK doctors and dentist do on a daily basis? Yes there can be issues in dentistry around pricing and communication, as highlighted by the Which? report, but anything positive seems to get swept under the carpet.

Of course the GDC’s job is to regulate us, not to promote the profession. So who is out there actively advocating the good things about dentistry? Who is supporting better oral health and the excellent, tireless, often thankless work doctors and dentists do?

The national media is all too quick to vilify and denigrate the healthcare professions, when what we really need is a series of good new stories. Perhaps we should all stop and consider something amazing a colleague has accomplished lately; or an instance where someone has gone above and beyond the call of duty. Share this story with your peers and friends and maybe we can all start to spread a little good news.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.

The biggest step
I finished out that week pondering on my therapy session and the work stresses. My wife, ever the paragon of being right, shied away from the blunt “I told you so” but did make it clear that I should be taking it easier. I asked the PM to block out some time where cancellations had arisen so that I would have a little breathing space, with the proviso that I would of course see any emergencies in those gaps if necessary. I did at this point advise the PM that I was having some issues with stress and needed to cut back a bit (master of understatement here!), and would be looking to book some time off when the books were quieter – about 4 weeks into the future.

I was by now quite aware of the mask I was wearing at work, and of the times when it would slip. I was concerned that it could create problems for the staff directly and put them in an awkward position if my behaviour impacted on a patient. I had seen this happen before when a colleague had suffered from depression, and their extended absences had been explained away at the time as a back injury – a number of patients refused to believe it and some even hassled the staff with questions such as “it’s the drink isn’t it?”.

This led me to discuss the most difficult step in dealing with depression with both my wife and my therapist – that of telling my workmates and staff. It’s one thing to admit to oneself that you need help, another entirely to admit it to others. It’s natural to want to hide our weaknesses from others, even those closest to us, but you can’t expect to get support without laying a decent foundation. My wife was concerned, as was I, that such a disclosure could leak to the patients and potentially put them off seeing me. My therapist countered with the argument that if I didn’t have support in my recovery, I potentially wouldn’t be in a position to see patients anyway. I couldn’t argue with that logic, particularly being a Star Trek fan, so I decided to tell everyone at work and hope for the best.

Except – I couldn’t actually bring myself to tell them face to face. Every time I looked at my nurse, my colleagues and thought of saying what I was going through I felt I may cry. I chickened out and put it in writing, asking the PM to read it to everyone at the staff meeting that week as I wouldn’t be present. The PM graciously agreed, following a short but teary chat at the end of the day.

Below is a copy of the letter. I know this may identify me to any of my colleagues who lurk on GDPUK, but their response to the letter at the time assured me that I can trust them to maintain my anonymity.

Forgive him, he’s an idiot.
Well, it’s been a wee bit longer a break than anticipated. I had intended to give you all a break from my depression over the Christmas period as, let’s face it, Christmas can be depressing enough on its own! I then felt that January wasn’t a particularly cheery month due to

a) the weather
b) the Christmas bills shock
c) tax bills

So I figured I’d leave things a bit longer. Of course, life then intrudes and so here we are nearly half way through the year.

My last blog had seen me arrange the first counselling session. I can’t really say much about that session, apart from it involved a large quantity of tissues, several glasses of water, and a short episode of hyperventilation. I seem to recall some questions over whether I felt I was a risk to myself or others, but as these were asked at a number of the sessions I’m not entirely sure. What I CAN say is that I felt a billion times better when I left the office than when I arrived.

With the benefit of hindsight, I know that this vastly improved mood was both transient and conniving, unfortunately at the time I felt that – having taken that sizeable first step in seeking help – everything would just be OK soon enough. WRONG!

Yes, my mood had lifted. Yes, I wasn’t crying as much. Yes, I thought I could get back to working as normal. Yes, I thought I was “better”.

Yes, I’m an idiot and was nowhere near better, but that’s the fragile balance of ego & id for you!

The following day at work I was cheery, chatty and pleasant. Some of the staff joked a bit about my finally getting out of the right side of the bed, or of wanting “some of whatever you’re on”, but I just ignored them and got on with my day. I had a pleasant weekend with my wife, relaxed, watched some TV. In other words I behaved normally. This, I now know, was the problem. I was BEHAVING normally, not actually being normal.

This pattern continued through the next week at work, although I would often feel panicky on the way to work and my mood would darken by the end of each day, and often sooner if problems arose. We aren’t talking major problems here, just late arrivals, delayed lab work, snotty patients, etc. Our usual daily niggles frankly.

The next counselling session came about, and I was stunned by how quickly I broke down again in the office. It didn’t occur to me during that week that I was just putting on a show for everyone around me, until the therapist metaphorically whipped back the curtain and popped the spotlight straight on me. Right on cue, I sobbed my heart out.

My therapist was concerned about my having continued to work without at least easing back on the hours or workload, and was clear that my arguments about NHS contracts and targets were all well & good, but were a contributing factor in my stress and depression. It was clear that I still had a long path ahead.
 

What can CHALLENGE do?

• CHALLENGE will argue and lobby powerfully in support of the dental profession’s position as the key providers of oral health care in the UK. The process of building a new dental service cannot be done in secret.
• CHALLENGE will organise forums and events in which key players can be given the chance to air their views and break through the logjam created by the BDA and the Department of Health both of whom have excellent reasons to exclude others from the debate.
• Carry out field research among the profession to establish their opinions, hopes and fears. This is not a feature of any of the work being carried out at the moment. Suppressing the voice of the dental profession is unforgiveable when it is the profession as a whole that will be required to carry out whatever emerges from the discussions, using their businesses and the human resource they control. That voice must be heard loud and clear.
• CHALLENGE will listen to the voices of those whose work is strongly linked to the dental profession and industry but not part of the established professional hierarchy. The dental industry supports the dental profession in a symbiotic relationship – each needs the other. The importance of that element of the industry needs to be recognised.

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Key principles underpinning the CHALLENGE approach to a new GDS contract in 2014/5

Any new system must concentrate its efforts on delivering –

·         Improved oral health for the population as a whole

·         An oral care system that patients understand and can trust

·         A profession that can take pride in its work

These are the simple but important features of a successful contractual arrangement between the dental profession and the Government.

In addition, CHALLENGE would say that the following issues are just as important -

·         A system where the roles of the state and of individual service providers  are crystal clear

·         A system in which the NHS and non-NHS system work in combination, not in opposition

·         a system in which the profession is encouraged and empowered to act professionally

Whatever emerges from the discussions between the profession and the NHS must be able to demonstrate that it has matched these issues with due sensitivity to the needs of both sides. Both sides need to recognise the need for fiscal control and integrity and both sides need to understand that if high clinical standards are required then the funding has to be there to support those standards.

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Chief Dental Officer for England issues a ‘Call to Action’ to the dental profession to help find workable solutions to the contractual problems that have beset the NHS general dental service since the introduction of the last set of contractual changes in 2006.

You’re a bit late getting to the party, Barry, but now you are here you will be pleased to know that your old adversaries CHALLENGE have been resurrected and are looking forward to joining a robust debate alongside you.

Barry, you will remember, but for those who are too young to recall, CHALLENGE was a political pressure group set up in the wake of the 2006 contract debacle. They argued long and strong for major changes early in the life of the new contracts. They even made a significant appearance in front of a Parliamentary Health Select Committee back in 2008. The three founder members were Eddie Crouch, John Renshaw and Ian Gordon. These are well known names with a long track record of standing up for GDPs in the one-sided battle with the Department of Health. The same three professional leaders are still the face of CHALLENGE.

The call for action from the CDO provides us dentists with quite an intriguing headline, especially coming from one of the most obdurate supporters of the status quo. Barry Cockcroft comes to the vexatious arguments over the way the NHS GDS and its various contractual formats work for patients and for dentists after telling anyone who would listen - for years on end - that the service is in great shape and patients are deliriously happy with the way they are treated.

Well, if Barry wants to hear from the profession, CHALLENGE is willing to take up the cudgels once again to promote and articulate the message we hear coming from all the GDPs we listen to on a regular basis. In the near future we will be running our own listening exercise to gather up data on how you see the contract and how you feel you have fared in the eight years since it began. We also need to know your concerns about the pilots being run at the moment and the possible shape of a new service that may emerge.

If we as a profession are to make any real impact other than making a lot of noise and blowing out a lot of hot air, we need your input to validate what we are saying. When that chance comes along please take the few moments it will require to put down, for our benefit and for the benefit of all your colleagues, exactly how you feel about the situation you find yourself in.

If Barry wants action, CHALLENGE says let’s give it to him!!

John Renshaw

CHALLENGE

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OK, so there I was, sat in my surgery having my little Monday morning meltdown. Through the blur of tears I could just make out the figure of my practice manager who had guessed that all was not well. Between sobs I just about managed to get across what I was feeling at that moment. PM was understanding, and went straight to my PC to review the daylist. Within a couple of minutes PM had determined which patients could be rebooked, blocked some time out and sat down to discuss the day with me.
We agreed that the patients PM had selected (long appointments but non-urgent – no risk of decay/deterioration – and unlikely to moan about the change) could be rebooked and some of the space freed used for the inevitable emergency appointments which would have to come from my absent colleague. I was the only dentist in the building and would have to try to manage the day as best I could.
For those who have raised the question in the forum, yes I am in primarily NHS practice, so service provision under the terms of the contract has to be managed.

I duly went to see my medical practitioner the next Monday. I’m fortunate that my GP runs early morning sessions on some days, so I was able to get an appointment before work.

I felt some trepidation at the visit, in some part to my colleague’s earlier insistence against talking to his GP. His reasons were that “he would just stuff me full of pills, and wouldn’t think of me as a professional”. Frankly, my colleague couldn’t have been more wrong!

My GP was understanding, honest and helpful, to the point that I broke down crying in front of him as I was so glad to get some of the weight off my chest to someone other than my wife.

He asked about how everything had happened, listened intently, and advised me that my wife was indeed right in insisting I seek help. He actually phrased it as “I’m divorced, so I normally wouldn’t admit that a wife was right, but in this case she’s bang on.” It lightened my mood immensely.

He did indeed give me some antidepressants – a low dose – and urged me to try them for at least 2 weeks before questioning their efficacy. He also gave me the numbers of 2 counselling services I could access via the NHS, and subtly hinted at which one was going to deal with me more efficiently (Hint: the one NOT run directly by the NHS).

He stated that he would not sign me off at that time, as he was pretty sure I would ignore the recommendation for some time off in any case (let’s face it – self employed, practice to run, duty of care and all that jazz – he was right).

My GP also asked about my level of self-medication (i.e. alcohol, drugs). My response was “No more than usual”, which of course prompted a much deeper discussion of drinking habits. I consider myself lucky in not having what some may term an “addictive personality”, in that whilst I do enjoy a couple of beers or bottle of wine with dinner, and do have the odd blow out with friends, I can equally go for weeks without touching alcohol at all. I did smoke a bit in my teens, but it was never something I felt I HAD to do. I did partake of some illicit substances while at Uni, and – to paraphrase many noted politicians – I did inhale. Again, it was never what one may term a habit.

As I noted in my first entry, one of the stressors for me was my colleague’s frequent absences. I half joked to my GP on that first appointment that it would be typical if I received a call on my way to work advising that my colleague was “ill”.

You can guess where the story goes from here can’t you?

I was driving to the practice when the phone rang. I could see it was his number on the car display.

I had a little meltdown.

I had to pull over into a bus lane as I was shaking and crying so hard I couldn’t see to drive. I didn’t answer the phone. I couldn’t. It never crossed my mind that he could have been calling for another reason.

I pulled myself together after about 20 minutes and continued to the practice. Upon arrival I could see his car wasn’t there, and could hear the staff making calls to cancel his patients as I walked through the door.

I walked into my surgery, asked my nurse to give me 5 minutes, and had another little meltdown.

To be continued……

[Almodovar has replied to some comments in the GDPUK forum made in that  forum.]

To help raise funds for the Mouth Cancer Screening Accreditation Scheme, DPAS Practice Consultant Louise Bone, is running in the Glasgow 10K Race this October.

Sponsored by practice-branded dental plan provider, DPAS, the Mouth Cancer Screening Accreditation Scheme is the Mouth Cancer Foundation’s new life-saving initiative which accredits dental practices that routinely screen for oral cancer using their ‘2 Minutes to Save a Life’ screening protocol and meet other specific criteria.

The Mouth Cancer Screening Accreditation Scheme also aims to improve outcomes for head and neck cancer sufferers in accordance with the BDA’s occasional paper for the early detection and prevention of oral cancer and NICE guidelines. In addition, it embraces recent CQC, Information Governance and Clinical Governance requirements, as well as responding to the GDC’s recommendation for continuous professional development for the management of oral cancer.

Explaining her reasons for taking part in the race, Louise said, “As a previous Specialist Dental Nurse in the Regional Oral and Maxillofacial Surgery Department at St John's Hospital, I worked very closely with patients who had head and neck cancer, so I have seen first hand the devastating impact that mouth cancer can have. This was one of the most rewarding jobs I've ever had, in fact I’m still in contact with some of my previous patients, so I am delighted to do anything I can to help this worthwhile charity bring greater awareness of the need for early detection of mouth cancer.”

Louise has never run a 10K race before, but is hoping to complete the course in less than 60 minutes. She is training hard and taking some time away from her main hobby of horse riding in order to take up this challenge.

To sponsor Louise and help save lives, please visit http://uk.virginmoneygiving.com/LouiseBoneDPAS2MinutestoSaveaLife

The Mouth Cancer Screening Accreditation Scheme is open to any dentist registered with the GDC or any dental practice whose clinicians are registered with the GDC For more information please contact the Mouth Cancer Foundation via This email address is being protected from spambots. You need JavaScript enabled to view it. or call +44 (0) 1924 950 950 for more information.