Welcome back to the start of what promises to be an interesting year

There appears to be a consistent theme however running through the early events, which seem to me to be somehow all related. Perhaps not in a complimentary way.

That Letter

Firstly we have the Daily Telegraph Letter, discussed widely on here, as well as a supporting article in the newspaper itself.

http://www.telegraph.co.uk/news/health/news/12079233/Third-World-dentistry-crisis-in-England.html

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

This is of course the third year that such a letter has been published by, this time, some 400 signatories including this writer.  Critically, a small nugget of self-opinionated idealism say some.  By contrast its supporters suggest it is merely a further reasoned cry for a sensible strategy to use the limited Government money for the groups in need. For example, those such as children who finish up in theatre under a GA, or other high needs groups, often postcode affected. 

Just where is the Clarity of the Deal for the rest of us for example?

However, is there a Conspiracy of Silence? Perhaps a mood of disdain? For as we speak some 3 weeks later, the BDA have not mentioned its publication. At all. Anywhere.  You may search their News Releases at https://www.bda.org/news-centre/.

Would you care to wonder WHY the BDA feel so reluctant to even acknowledge the letter let along jump on the brief media bandwagon?  Complacency or Conspiracy? You choose.

The PSA-GDC relationship

It is certainly a case of no love lost. Before Christmas, you will recall,  the GDC were aligned in the crosshairs of the PSA and their hyper critical report.

https://www.professionalstandards.org.uk/footer-pages/news-and-media/latest-news/news-article?id=91bb5b9e-2ce2-6f4b-9ceb-ff0000b2236b

Comment made again on GDP UK and elsewhere has been withering.  It is clear that there is a mood that the Chair of the GDC must go, not just because of these events, but also BEFORE any process to identify a new Chief Executive takes place.

It is therefore very interesting that the GDC have seen it unnecessary to mention in their public media releases anything about this report, let alone any sort of “It’s all good here” spun response.

Complacency or Conspiracy? You choose.

Peter Ward, CEO at the BDA has placed a damning Leader “Whistling in the Dark” in a recent BDJ about the GDC at http://www.nature.com/bdj/journal/v220/n1/full/sj.bdj.2016.1.html

I have stated it before. Others have stated it.  And so we all say, again:

The Chairman must go, and the Council, in particular the Dental Registrant Members of the GDC, should seriously consider their position.

The BDA

Shortly before Christmas , before the letter in the D Tel, the BDA seniors figures and the LDCs met with the new CDO of NHS England, Dr Sarah Hurley and you may read the reports here courtesy of Yorkshire’s East Riding LDC

http://www.eryldc.co.uk/download/i/mark_dl/u/4012071383/4625508579/LDC%20Officials%20Day%20Notes%20Friday%204th%20December%202015.pdf

Is it me? It is similarly interesting to think that since then  the BDA have kept a very tightly sealed pair of public lips on matters pertaining to the disgraced UDA system of Contracting and its Prototype successor

Not a mention, not a dicky bird.

Complacency or Conspiracy? You choose.

There is it might be argued a fine line between complacency and conspiracy as to why each of these bodies [The BDA and the GDC] have chosen to ignore these two unrelated and yet significant events.

In the case of the GDC, I think we can speculate that the present Council are in their final days, especially after the unprecedented mauling by the House of Lords in the debate this week.  I will put that down to complacency therefore.  Please view the debate here http://parliamentlive.tv/Event/Index/2a3f3b86-7d34-448d-ab91-52e134879e49

The GDPC - CDO[NHSE] Relationship

Which leaves me to ponder the conspiratorial nature of the relationship between the GDPC of the BDA [representing all you dentists at the negotiating table for the New 2020 Contracts] and NHS England’s Chief Dental Officer. 

It seems like the old days, for those of you old enough to recall that great old wise owl, Labour leader and Prime Minister Harold Wilson.  Beer and sandwiches at No 10.  In this case, filter coffee and homemade biscuits with a fine group of colleagues.

Transparency is dead.  

Complacency is the food of conspiracy

The outcome is the same.  It appears any chance of truly driving change with the wider interests of the public and profession at heart, in a transparent manner, at the highest level of our Profession, is to be denied.

Instead agreements will be cobbled together in secrecy and behind closed doors by the privileged few.  You will told when you need to know

As was stated recently: we are a  Profession that suffers Group Mural Dyslexia ! Failure to see the writing on the wall.
 

A little more energy is required if we are to see the Profession make progress against the political headwinds this year.

Perhaps a little less complacency and a little more Conspiring to rebel?  We can but hope!

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.

Is there anybody out there?

These words introduce the beginning of my favourite song, Pink Floyd’s ‘Comfortably Numb’, the title of which has always struck me as a particularly apt song for dentists.

Several times in my career different parts of the song have resonated with me for various reasons, but this is perhaps the first time the whole song in its entirety relates to dentistry at the moment. For those that don’t know the song, it’s about a reluctant performer who is made to keep going on stage by the various influences and promises of those who seek to benefit most from him, without any consideration as to how the performer is actually feeling inside. Sound familiar? Give a performer a new drug (the continued promise of a new contract??) and that’ll keep you going through the show….(despite the eventual catastrophic effects).

However, I’m not going to muse about the wider issues of dentistry that are analogous to the lyrical musings of Roger Waters otherwise this will be a very long blog.

So, in particular given the recent Professional Standards Authority paper looking into the rethinking of regulation, one has to ask if there is indeed anyone out there who is actually listening to what this paper suggests.

Here we have what is effectively a toothless organization in the PSA (show me precisely what it has actually done to rein in the GDC given its publicized failings over the last few years?) that is suggesting a completely new way of thinking with regard to the regulation of the professions. Its worth a read as there are many things that have been mentioned within the pages of GDPUK.

However, it’s one thing suggesting this radical rethink, but who with the power to actually instigate change is listening to what the PSA have to say? The Health Select Committee still seem to be getting their diaries in order after the election, and with no apparent repeat hearing for the GDC in the offing one has to wonder if other more pressing health matters will take priority over our issues. There appears to be no pending Government Bill in the offing to set up a super regulator (which is what I personally think will happen eventually) or rewrite the outdated legislation of the current regulators. It is obvious that the PSA sees radical failings in the current scheme of regulation, and we all know the opinion it has of the GDC in particular. However, we need to be careful about thinking the PSA is our knight in shining armour riding to the rescue; one of its remits is to review all the decisions of the GDC FtP process and if it feels they are insufficiently protective of the public (i.e. not a harsh enough punishment) then it can order further action against the registrant via a re-hearing. So they are no particular friend of the regulated, but I would counter that by suggesting they are at least an organization with the ability to actually understand what modern regulation requires. They, after all, they keep referring to the paper written by them for the Council for Healthcare Regulatory Excellence on what ‘Right Touch’ regulation means, and it doesn’t appear to always be the touch of the executioner’s sword.

There was a suitably robust call from the BDA for the government to take action as a result of the PSA paper, and whilst this is the sort of thing we need to see and hear from the BDA, once again I have to ask if there is anybody out there to listen? We are unlikely to ever get any press sympathy like the GP’s do; when the Daily Mail is happy to run a story asking if we are all Natural Born Killers as a result of the recent Lion hunting episode then we really are going to lose that battle before we begin. As a profession we already know the issues, so really the BDA is only going to be preaching to converted. How they get the message out to the wider public is the key to getting the regulatory change we so desperately need. That is going to require an awful lot of positive PR and I don’t see much evidence of that. Even the fact we have been harping on about the perils of refined sugar for years seems to have fallen on deaf ears until our medical colleagues woke up to it.

The PSA paper recognizes that over-regulation costing more offers no additional benefit to the patients, or the fact that healthcare has inherent risks that cannot be regulated out without a disproportionate amount of money and time, and that attempting to do so only serves to not only stifle the beneficial innovation that can help the patient, but also the general benefit to the patient overall. None of this will be news to any ethical practitioner reading this; but it’s not us that needs to take heed of this, we need to be listened to by the people who can instigate change and actually have a desire to do so.

The PSA also admit that one of the problems with the current outdated regulation mechanisms is that the action or words of a registrant last lasts only a mere moment or so but can result in serious damage to not only their careers and lives, but the lives of their families too; often having a serious and lasting effect. Again, not news to us particularly, but at least it is being recognized by the PSA. The disproportionate effect of a minor, spurious, or downright vexatious complaint should not be able to carry this threat, and indeed never used to; but more recently seems to be something that we must all be prepared to bear as an occupational risk no matter how diligent we are in our care and dealings with patients.

More interestingly for the GDC though is that the PSA warn against the expanding of the boundaries of regulators and the lack of clarity and tensions this then produces. It’s no secret that Mr. Moyes has said he would like to develop the role of the GDC and broaden its remit. It is already apparent that this seems to have begun, as the GDC is no longer just the upholder of Standards within the profession but has become the de-facto complaints service which will happily look into every single issue it is made aware of. A stop to this ‘mission creep’ as the PSA call it must come sooner rather than later, but again, the PSA has little power to prevent it at the moment.

Yet the GDC in its latest press release once again refuses to acknowledge that responsibility for regulatory failings are in any way its responsibility, choosing to blame once again the legislation that constrains it, and actually indicating it doesn’t go far enough currently. I think most registrants would be of the opinion that when a single complaint can have you in front of a committee that can end your career, then there isn’t actually an issue with the legislation not going far enough. The GDC is also apparently putting in place a series of ‘measures’ to help support the profession in delivering high standards of care and maintain public confidence in the profession. What these measures are we don’t know yet, but of course one way of doing this would be to make sure there are less people able to meet the standards they enforce, either my repositioning the interpretation of standards to make them virtually unattainable, and then ‘help’ by removing the registrants who fall short via the FtP process or by just driving them out of the profession by fear. Maybe this is too cynical a view but it’s hard not to have such thoughts in the current environment.

More and more I hear of dentists leaving the profession due to the immense pressure placed on them every day. Despite their best efforts to remain positive, it is increasingly difficult to not think that the next patient could be the one that ends their career, despite not having done something bad enough to justify such a draconian result. That makes the risk of practicing dentistry increasingly difficult to justify. It would be interesting to see if you are likely to have a longer career these days in the field of professional bungee jumping or crocodile wrestling than clinical dentistry. In what way does this help patients when good practitioners decide to leave our profession?

I remember a satirical comment a few years ago that eventually there would be 100% employment in the UK. Only one person would actually have a job doing something, but all the others would be employed to regulate them. I can see the dental profession going this way if someone in power doesn’t start to listen soon, as there will be less and less people electing to remain in or join our profession. We as individuals therefore need to unite and show the public that the pressures on our profession will directly affect them. Only when the voting public is affected will the situation come to the attention of those in power and change can be made. Although how this will pan out if the supposedly unelectable Jeremy Corbyn takes control of the Labour party and renders the opposition as toothless as the PSA remains to be seen.

Getting back to the title of the song then, the problem is that too many of us are (un)Comfortably Numb with inactivity. So we are reaping the rewards of our complacency and intransigence and will continue to do so unless we unite to do something positive. If we were as vociferous and active as dairy farmers have been recently when things finally got too much to tolerate we would have arranged some form of peaceful and professional group action. Perhaps we should round up a few hundred small cats (lions would be too difficult to risk assess and probably attract the wrong type of dentist) and release them into the General Dental Council chamber at the next meeting. Trying to herd said bunch of cats into Wimpole Street is likely to be simpler than getting dentists to do anything en masse. We could then say not all dentists have a desire to hunt cats (including small ones), and given that social media these days seems to be obsessed with the antics of cute kittens then surely this is guaranteed to get positive press interest. A flock of sheep might be easier to manage, but we don’t really want them in the Council Chamber do we? Tongue in cheek maybe, but food for thought nonetheless.

In all seriousness though, whilst it appears the public at large don’t appear to have a clue what damage over-regulation and the current litigious and complaining environment is doing to the ability for dental professionals to care for them appropriately, these are the same people who in their chosen fields are also likely to be suffering from similar threats. Speak to many of your working adult patients and you’ll find we are not alone in suffering the pressures we are currently under. Admittedly there might not be the same degree of threat to their career and livelihood, but certainly anyone in one of the professions and the emergency services have very similar issues as we do. ‘Guilty until proven Innocent’ is not unique to dentistry.

This is the message that needs to be conveyed in no uncertain terms to the public by both our professional leaders and us as individuals. Only when the public has empathy with us will we have their support. If nothing changes then the profession will dwindle more and more as a lack of morale grows.

For it is they the public as patients who will then suffer most when there are no longer any of us out there.

Image credit -Samuel Rodgers under CC licence - not modified.