When an oppressive situation arises develops over the years as the one we have with our current regulator, it is natural initially, to think this won’t directly affect me. Gradually, though, it becomes apparent from the people you hear of who are affected, and then those you personally know that becoming involved, you start to think a little differently.  When its people the calibre of Colin Campbell and ‘Microdentist’ (to name a couple whom I know personally) then as I’ve said before in my previous ramblings, there’s no hope for any of us.

So if this happens to us, we need to know we’ve got the support and help of organisations that can back us to the hilt. The backing of our indemnifiers is our lifejacket; they take our money and promise to help us keep afloat.

But it is becoming apparent that the support we need to rely on might not always be a given. An increasing number of colleagues seem to be being told by their indemnifier that they wont be supported, or they are supported up to a point and then dropped. No smoke without fire? In reality I’m sure there is a degree of this in these situations. Social media is often full of discussions involving this subject, with some of the participants almost wearing a badge of pride that they’ve used their indemnifier multiple times. I’m left thinking in those cases that the problem here isn’t the indemnifier, but the way these individuals are practicing dentistry and not learning from what appears obvious to others. After all, if you keep on crashing your car into the same wall every time you drove to work, perhaps its about time you either drove a different route, learnt where the wall was, buy a slower car you can control, or just give up driving. In these cases the indemnifier is probably absolutely right to start loading the costs of representation.

Is this always the case though? There seem to be so many rumours flying around that suggest if you ring for advice this counts against you, or that if you settle a certain number of times you’ll see your premiums loaded or even cover withdrawn. There is a definite lack of public clarification from the indemnifiers about the decision processes involved in these situations. One of the indemnifiers has said that ringing for advice does NOT load the premium or count towards a risk analysis. But what about a letter that immediately closes a case or offers a refund (which is usually out of the pocket of the practitioner and not the indemnifier). We don’t know what their process of risk assessment is. We need to.

I’ve been aware for a long time of the discretionary nature of much of the indemnity, and the fact it can be withdrawn, and I’m surprised more dentists aren’t. But I’ve never heard of so much of this discretionary withdrawal actually happening as recently. A good part of this is probably due to the unprecedented increase in complaints, but is this the only reason? There isn’t any public explanation usually as to what discretionary cover is, because it’s at their discretion, which is a fantastic catch all, but that doesn’t help us. We don’t actually know what the criteria are, so we don’t actually know if we are going to be helped when we need to be. Some practitioners will be higher risk that others, but that is not necessarily their fault either. Some of those will work in environments that are naturally more hostile than others, such as prisons, and it is not their practicing style that brings the risk to them or the indemnifier but the nature of the patients they treat. I would also strongly argue that there are certain demographics of patients and even geographic hotspots that increase the risk of complaint and claims, and perhaps we should be made more aware of that in order to mitigate the risk to us. We need to know.

I can see the point that if we don’t know what the reasoning is we wont construct our practice around it. A sort of Indemnity Gaming if you like; if you know the criteria that are used then you know what you can get away with and just stay within the margins (if you are a dodgy practitioner that is). But this is what risk assessment should be about. I’m talking about the risk to our livelihood and careers here. We can lose our home due to a regulator that we accept is not fit for purpose, so we need the security that our indemnifier is going to be transparent and fair with us.

I don’t see any profits warning or indications that their membership reserves are running terminally low from any of the indemnifiers which suggests that they are in reasonable financial health. Given the beautiful offices that many of then operate out of confirms that indemnity is big business. Which leads me to where I think part of the problem lies.

The bigger a business, the more it loses its personal touch. There is a immediate personal contact with the advisors who do so much valued work, but they are not going to be the party that decides if support is withdrawn or not. That is likely to be made at a higher level, lacking in the emotive connection with the dentist. There is so much litigation going on now that the indemnifiers have to be large, and have to have the resources necessary to run such organisations. The costs of the support network in order to run the core business are huge. The cost of the legal representation for its clients is also huge, and shows no apparent sign of getting any less. As more patients complain via the medium of ‘No Win No fee’, or direct through the GDC, then the need for the indemnifier grows symbiotically as does the drain on its resources. With the demand to stay in business, then the indemnifier needs to ensure it is financially solid enough to survive to protect its clients. Its survival then becomes the prime reason for its existence, and it becomes even more risk averse. Thus affecting the very clients it is there to protect. Is this why some dentists are finding themselves without a lifejacket? Will there eventually be a multi million pound business protecting the one or two clients who are so risk averse themselves they will never need the indemnifier as they never see a patient?

This symbiosis is no different to any other supply and demand industry. The more the GDC presses ahead with what appears to be the UK’s largest complaints handling business, the more the indemnifiers will grow on the back of the legislative need for us to protect ourselves. The more they need to protect the finances of the business it becomes.

But we need to know they will be there for us when we are walking the plank. Perhaps the indemnifiers should publically reconnect with us, be more transparent, and show us their human side once more. After all, it’s not all about the money….

It’s about saving lives.

Did you read Part 1 of this blog? If not, click here

Image credit -Ian Armstrong under CC licence - not modified.