Another New Year rolls towards us with still nothing particularly concrete planned regarding the new new new NHS Dental Contract. Ok, so there are prototypes running, but there doesn't seem to be any actual date that will see the beginning of a brave new world where all things NHS Dentistry will be rosy once again.

Prototypes seems to be the new buzz word rather than pilots, but unlike a pilot flying a new course, a prototype seems to be something cobbled together that might just possibly fly, but then again might not. The British are pioneers at making prototypes actually fly, but usually in the aeronautical sense. For this to happen it involves a degree of advance planning on the drawing boards, before making models, testing them in a wind tunnel, before finally making a version that might actually fly. There are some occasions where a test pilot has taken the front seat in a prototype only to have met a swift end when something has not quite been right with the design. At least the engineers then can go back to the drawing board and hopefully redesign a problem out of the next version.

But this is where the analogy with the NHS prototypes ends. Instead of learning from the mistakes and problems with the prototypes and design out the problem, the DoH apparently just ignore the data they don't like and carry on with the data they do like. All still fuelled by the ubiquitous UDA. Going back to the analogy, this would be like the designing a solar powered plane expected to fly at 600mph where the wings fall off at 500mph and you can only fly it at night. But since it looks really really good and the Government like it, you can get loads of people on board, so they'll order them. Anyhow, if it crashes, the Government will always blame pilot error. 

People working in the prototypes seem to have varying experiences; those in the blend A models (having a capitation for all band 1 treatments and claiming band 2 and 3's)  are reporting more issues than those in the Blend B (Both band 1 and 2 as capitation and band 3 to be claimed). But what is being reported generally is that access is going to go down with these new ways of working, whilst it is increasing difficult to keep the capitation numbers to target. Access is the only mantra the DoH have, and whilst they pay lip service to quality outcomes, you can rest assured that the only bit of quality they will be interested in will be how much they can claw back when the quality outcomes can't be met. Some of those in the prototypes don't even know how the quality aspect is being calculated as there don't seem to be figure made available (particularly to associates). Given that this is 10% of the contract value, not having the information on what you are being measured on seems to be a significant problem to me.

Having an entirely capitation based system (which will be what the BDA will try for) is better for practitioners ONLY when you have a government that isn't obsessed with output and not interested in the actual quality. By expecting the practitioners to provide the quality as part of their obligations ethically to their patients, and regulated by the GDC, the DoH can quite happily still place the blame at the door of the individual performers on any contract. Its win-win for them still. Anyone who thinks any new contract will be a dental utopia should probably consider leaving the profession now. Almost all commentators say that there is already little enough time to provide the output expected to meet UDA targets; the new system seems even more geared to allowing practices to struggle to hit the new targets. Even successful prototype practices are struggling with the capitation element, as they need many ore new patients to ensure the targets are boing met, but with no space to treat these often high needs patients until 2 or more months down the line, one must wonder how these increase targets are going to benefit good patient care in the brave new world.

Here is now data that shows the amount of principals in practice is reducing, with the increase in associates being proportional to that. However the change is quite extreme, with something like 83% of dentists now working as associates. This will be the norm in the future in my opinion, as with a downward pressure on the income of dentists generally it will become more and more difficult for associates to begin to invest in a practice of their own. I can see parallels with the optical and legal industries here, and incomes of £30,000 for associates becoming routine. Not only that, with the change in the way the new contract may be calculated, and the 'UBER' ruling recently about when self employed might not actually be self employed, then I can foresee a time in the near future when associates become true employees, with the associated increase in liability the employer then has (national insurances, sick pay etc) to cover reducing the wage structure still further. I am also aware of practices who have had to make members of the team redundant, such as therapists as they cannot make the system work for them due to the economics and logistics that seem to be inherent. Still, that's not going to be the DoH's fault is it? Just the dentists who don't run their practice the way the DoH want them to.

Don't get me wrong though; there will still be some highly entrepreneurial dentists out there who will continue to make a very good income from the NHS, but they will be at the head of larger practices or mini-corporates, and backed either by the fortunes made in this system, family money, or outside investors who can see the business model working. There is nothing actually wrong with this either, because fundamentally dentistry is going to be a service industry in the same way as a mobile phone company is, and you don't see all the employees in that industry getting the same salary as the chief executive. It becomes almost irrelevant that many of the 'fee earners' in dentistry are highly educated individuals supported by a well trained team; dentistry is just another 'widget' producing industry for investors to make a profit out of at some point.

One of the reasons that the profitability of corporate practices has been lower has to be due to the income proportions taken by associates. I have no issue personally with what associates earn, but the days of 50% are long gone in this new world, and probably 35% is more realistic for the future. Many law firms expect their fee earners to generate at least 3 to 4 times their salary in order to justify their continued employment. Only in this way will the corporates become as profitable as they need to be to survive long term, and they know this. Coupled with an increased difficulty in earning the udas if the new contract is like the prototypes, with quality frameworks and increased access, then a downward pressure on the highest cost base that can be influenced is certain. In any dental business of a certain size with associates, then I would be pretty sure that the highest 2 costs will be associate wages and staff wages. Only by controlling this aspect, and in an even harsher manner than previously, will the profitability that is needed for continued business survival start to be produced. How fast this will then follow in the smaller practices which have proportionally higher cost bases due to the lack of bulk buying powers is an academic argument.

To finally top this, the BDA  released a press release in the last week indicating just how poor the morale is within the profession. Although this has been known by the profession since at least the time Sheffield United last won a football trophy, they have now decided to let the public know the blindingly obvious. Once again the BDA's public condemnation of a system has been about as vocal as a mute mouse with a sore throat. It should be front page news that half of the UK's NHS dentists are thinking of leaving the NHS, but I haven't seen it in the papers today, but if it does appear it will be spun against us. I was informed (as I was writing this piece) that the BDA are now threatening legal action against NHS England for the patient charge revenue deductions made due to their interpretation of the 2 month rule. But will they get the spin right when they tell the public? Or will the Daily Mail run the 'Greedy Dentists Sue Cash Strapped NHS for more money' headlines because we haven't got a good PR image? At least the BDA are starting to do something positive, but the message has to be managed to our benefit.

So it remains to actually be seen just what might happen in the brave new world of NHS dentistry. Is morale going to improve, or will the DoH continue the beating of the profession until it does? Will there be more time for the quality that our profession is expected to provide? Will there be the correct funding for a First World service?

 Sadly, I think we all know the answers to those questions if we are honest with ourselves.

Tis the season to be jolly
Fah la la la lah, la lah la lah

Well after an autumn break to see how the land takes up the fertiliser of restful thought, we approach the Christmas break with a need for reflection.

What has 2016 thrown at us?

A reason to be cheerful? A season of Goodwill? A sense of hope?

There are three major areas that seem to be affecting the profession at this time.

There is the issue of the GDC and its new Case Examiners.

It is too early to say if this will genuinely make a difference. What we want is for the GDC to stop trying to be a Complaints House, taking everything on no matter how trivial.

Dr Colin Campbell, a widely-respected colleague in the Midlands, with a personal history of the dealings of the bludgeon that is FtP, clearly thinks not – again with personal experience.

But then again, why would CEs make a difference? They have been tasked and trained by the very organisation that had the problem in the first place.  And the problem is that the GDC do not reject anything.

Some of the recent cases suggest that the GDC still do not know what a proper complaint is. The whole list of FTP is awash with material that is either better managed locally and or indeed a simple internal disciplinary matter.

So, if you have not done so, get your £900 out for another year of outrageous wasteful use of your money. But do so with a good grace. It could be worse. 

Couldn’t it?

Is it me or have we become so numb and subservient that we just accept it as a nuisance nowadays?

NHS Pilots – self funded by dentists!!

Meanwhile, perhaps all is well with new NHS Pilots. We all know there is new money, and we all know that the DH wants to get bodies through the doors, never mind whether anyone does any dentistry.  But the idea of a Care Pathway appears to be well received on its own merits.

But there appears to be strange anomaly that the pilot practice may face up to 10% - YES TEN PERCENT – clawback – which if your profit is running at 20% reflects HALF THE PRACTICE PROFIT -  which for most Pilot Principals suggests a cold winter looms.

Good on the BDA for highlighting this matter, on stage at the Local Dental Committees Officials Day , with the DH Head of Finance and the “fabulous” Dr Sara Hurley [You did see the Good Morning interview spat between our CDO for NHS England and Dr Tony Kilcoyne didn’t you?] sitting along side as Dr Henry laid into them in no undertain terms.

Indemnity in Crisis?

Maybe all is well with our support network, the Medical Indemnity Organisations. You know – Dental Protection, DDU, MDDUS and the newer companies such as Taylor Defence Services.

Well, who knows?  There are stories of some colleagues finding their cover withdrawn in a discretionary manner halfway through a case.  There are many stories of colleagues finding their annual cover suddenly approaching 5 figures and beyond.  There is still no clear method for subscription calculation although one hears mutterings about the legendary ‘grid’.  A sort of Spot the Ball for Indemnity subscriptions!

Whatever the truth, there is a financial crisis in Indemnity, driven by a combination of commercially proactive lawyers and an overzealous GDC. So much so that there is a one day crisis conference being held in January

After many discussions about rising Indemnity and concerns some colleagues have been left with no cover or representation etc., A 1-day Seminar is being organised by Dental Practice at the Hilton Metropole, Birmingham NEC, on Friday 27th January 2017 from 08.30 to 17.30pm.

Concerns are being expressed across the dental sector about the delivery of Professional Indemnity cover and what is and is not included in the various offerings from the MDO’s. As a result, and in conjunction with many key decision makers, it has been decided to hold this 1-day seminar to look at the current situation, with much time for Q&As.

Places will be limited and are expected to be in high demand so, to avoid being disappointed, contact Rodney Pitt, Editor and Conference Organiser at This email address is being protected from spambots. You need JavaScript enabled to view it.

Well that all makes for an energetic start to 2017.

It must be time for another letter to educate the public again, if the recernt rubbish written  by Hunter Davies in the Times is anything to go by!

I suggest we all turn to our loved ones and count our blessings.  In the year that we have lost Leonard Cohen, AA Gill and Greg Lake, we will not be short of words and music.

Put your practice to bed, and come back refreshed after a nod to the year, raring to go – unless of course you rely on Southern Railway in which case, the very best of luck!

If Christmas is your celebration, may yours be peaceful and joyful. That much we can be assured of

http://campbellacademy.co.uk/blog/failed-hurdle/
Dr Colin Campbell – the GDC have failed at their first hurdle

https://www.gdpuk.com/news/latest-news/2403-henrik-gives-update-on-prototypes
Henrik Overgaard-Nielsen, Chair, BDA General Dental Practice Committee, has posted an update about the prototype contracts on the BDA website

Also here for BDA members
https://bdaconnect.bda.org/dental-contract-reform-an-update-on-prototypes/

http://www.content.digital.nhs.uk/catalogue/PUB22526  for NHS report of Motivation

Dental Working Hours, 2014/15 and 2015/16 Motivation Analysis, Experimental Statistics

Missed opportunity?

The Chief Dental Officer for NHS England recently found herself at the forefront of dental media storm. Playfully referred to as “Recallgate” her reported comments drew widespread criticism across a range of the profession’s leading Clinicians, and a lame response through her PR Outlet, Dentistry Online.

All this arose from her presence at the NHS Expo on a stage with some leading colleagues of the Medical and allied professions for a question and answer session.

Expo is an interesting gathering of the great and the good from the world of the NHS and industry.  The proudly proclaim

Health and Care Innovation Expo 2016 is a unique event that showcases innovation and celebrates the people who are changing the NHS, with high-profile speakers and a real focus on learning and sharing.

The NHS you’ll see at Expo on 7 and 8 September is a forward-thinking organisation, staffed by clinicians and managers who welcome innovations in technology and information because they recognise the difference this will make to their patients’ lives. Expo also welcomes and involves partners from across the public, voluntary and commercial sectors, recognising and promoting the role they play in keeping people and communities healthy.

Health and Care Innovation Expo attracts around 5,000 people across two days, the majority of whom are leaders and managers with real ability to lead and drive change in health and social care

So when the opportunity for Dr Hurley to speak, she chose to focus on  one of the most exciting developments in dentistry.

The Recall Interval.

What she said of course was hardly earth moving.

Ration the availability of NHS dentistry for the healthy in order to create space in the system for those who are not healthy and have higher needs.  This is hardly big news, is certainly not innovative, and of course was not presented as rationing by the back door. Instead it was reminder of the NIHCE Guidelines and an opportunity for some predictable side swiping at dentist.

In particular Roy Lilley made the really quite amusing quip that “Dentistry has become a rich man's hobby” The former NHS trust chairman Roy Lilley went on: “It has gone off the high street into lavish surroundings.”  

Thanks Mr Lilley, if your understanding in depth of dentistry reflects your understanding of medicine, the NHS is safe in your hands.  Oh, you are not a manager anymore?

You may follow Mr Lilley on Twitter at https://twitter.com/RoyLilley and contact him direct at @RoyLilley. Judging by his response to the leading BDA member Dr Eddie Crouch taking him to take, he only has a sense of humour on a public stage. Judging by his activity, he has given up NHS Management in favour of tweeting …  83,300 in 7½ years and counting!!

But look: there is a serious point here

Dentistry needs a Cheerleader

Mr Lilley is patently one of many self-appointed cheerleaders for the NHS and its achievements. Good on him. Nice money if you can get it

Dr Hurley had half a chance to really put out there what dentistry as a microbusiness, brimming with technology, can achieve for people. She could have even homed in on the Infant Caries crisis and its attendant GA costs. But no… she chose …. RECALLS!! 

The media just loved her use of the MOT analogy and the Car Mechanic.  If that is the case, I presume that Dr Hurley sees herself as in charge of Service Reception.

On a quiet news day, just feed the hacks a dental story. Works every time!

While smoking is on the decrease, and lifestyle amongst the healthy is improving, there is a section of the population who do not see a dentist and for whom Oral Cancer is a rising trend. If you are going to keep your teeth for 80+ years of adult life, getting the health of the mouth optimal and the habits established when young are critical.

What opportunity did we miss?

No mention of 3D CAD CAM Dental technology [self-invested by the laboratories and dentists – no Government subsidy there]

No mention of the investment dentist as business owners make in their facilities – no government subsidy there, and by and large no financial crisis inflated by excessive management layers.

No mention of the amazing results being offered to rehabilitate oral function using all-on-4 and all-on-6 techniques.

No mention of the amazing dental implant industry. Not a Government subsidy in sight.

No mention of the predictability of endodontics and periodontics being driven by technology of instrumentation and scientific understanding of the biology, and the ever stronger links to general health.  Little Government input there.

No mention of the aesthetic desire of the wider public now being met by a host of non-invasive whitening systems allied to orthodontics. No Government funding there.

No mention of the unsung achievement of orthodontics in lifting the psychologic wellbeing of younger patients by creating the smile that allows a young person the mature into a confident go getting adult.  OK some Government input here.

No mention of the parafunctional diagnosis meaning that dentist can frequently solve chronic pain issues long before the team of neurologists, physicians and chronic pain clinics with their MRI scans and raft of blood tests fail to diagnose and simply write the patient off to a lifetime of expensive medication.

No mention of the almost eliminated need to use mercury containing restorative materials nowadays.

No mention of the fact that Caries is preventable, and excessive sugar for infants is akin to smoking.f course no mention of all of this occurring painfree on nervous patients in one of the most difficult to access, most biologically hostile  parts of the body.  Diistinct lack of real funding here.

No, our CDO in her massive role on that stage at NHS Expo chose to ramble on about a 2-year recall.

We may think Mr Lilley is a “bit of a plonker Rodney” but dentistry needs someone like him.

Dentistry needs a cheerleader to shout our achievements from the roof top, and remind people that nearly all of them are self-funded by dentists and not subsidised by the government at all.

Sadly, Dr Hurley has missed her vocation in the role, choosing instead to follow her Civil Service guide on “How not to rock the boat”

I wonder if there is someone out there , possibly many of you, who could cheerlead our profession? Someone who, like Mr Roy Lilley, is so noisy, so irritating as to be impossible to ignore?

Please step forwards if you are those persons ...

So it’s down to you.  Will YOU be the professions cheereleader?

Have YOU done your bit to cheerlead for our proud profession today?

If not, crack on.  Our younger colleagues will depend on it in the future.

The origins of the something-gate language
https://en.wikipedia.org/wiki/Watergate_scandal

https://www.gdpuk.com/forum/gdpuk-forum/cdo-honeymoon-is-over-22896#p253148
Since the recall speech last week ["recallgate"], the profession has realised who's side she is on, who pays the salary and benefits of the CDO.

The honeymoon period is over.

GDPUK has blogs from
Alun Rees
https://www.gdpuk.com/news/bloggers/entry/1738-cdo-shows-her-true-colours

@DentistGoneBadd

https://www.gdpuk.com/news/bloggers/entry/1741-the-cdo-speaks

Simon Thackeray
https://www.gdpuk.com/news/bloggers/entry/1742-the-honeymoon-is-over

Political leaders are often said to have a honeymoon period at the very beginning of their new post. At a time where their political capital as at its highest, there tends to be a degree of ‘benefit of the doubt’ given and political opponents treat them well. I get the impression that due to the lack of political opponents to currently wrestle with means that Theresa May has had less of a honeymoon, and more like a ‘swift registry office wedding and straight back to work on Monday’ type of period. There has been no particular need to allow her into the post gently, and indeed she hit the ground running it appears.

It wasn’t quite the same with the new Chief Dental Officer. An initial period of cautious approval and hope that the new incumbent might be a less dogmatic and more approachable one than previously was supported initially by in increase in visibility, and the right kinds of sound bites the made many think this could be someone who is more in tune with dentists than was previously the case.

Well, it certainly looks like the honeymoon is over for our new Chief Dental Officer after the comments this week about routine examinations is anything to go by. Once again it appears the CDO has trotted out the underlying political message desired by the paymasters at DoH. What appeared to start out as a marriage that could work with the profession now appears to be heading for a divorce already.

The comments that were published in the Telegraph and the Daily Mail appear to rehash of those made in 2004 by Raman Bedi, and again in 2011 by Barry Cockcroft, both gleefully published by the Daily Mail, and no doubt trying to reinforce the opinion that the majority of the profession are money grabbing charlatans. The same old mantra is being rolled out by yet another incumbent of the CDO post, which despite its downgrade by government now to a junior supporting role, is nonetheless listened to by the press and therefore the public in order to give more ammunition to the incessant deprofessionalisation of dentistry as a whole. (Or so it seems to me).

In addition, the comments by former NHS Trust Chairman Roy Lilley in the same article that dentistry has become ‘a rich mans hobby’ provided in ‘lavish environments’ would be quite frankly laughable if it weren’t for the fact that they are so offensive. I’m sure he didn’t sit in an office furnished from a secondhand furniture store in a cold draughty office block, so why the hell should we? I could wax lyrical for a long time about my opinions of such people in NHS high office, but I’m sure much of it would give the legal profession many hours of extra work. Suffice to say the ignorance of comments such as this are what I would expect from a member of the ‘profession’ that continually commissioned excessive amounts of UDA’s year on year from D’Mello, and oversaw the disasters at Stafford amongst other things. Perhaps Mr. Lilley would be happier receiving his routine dentistry in the kind of environment that charities such as Bridge2Aid find they have to work in? Perhaps then he might be grateful for the small luxuries his salary allows him to experience. I would suggest he puts some of his money where his mouth is and donates to such deserving causes so they could ever hope to achieve a level of care that even the worse off in our society take for granted.

But I am more concerned the comments made by Col. Hurley seem to go deeper and are potentially more damaging to the profession than any crass comments made by an NHS apparatchik. Comparing the profession to garage mechanics is crude and whilst part of me can always find parallels with any other industry, it is highly disingenuous to make that comparison without thinking more closely. The analogy can be torn apart so easily on many levels.

With the GDC and CQC breathing down the necks of professionals all the time, I’m sure many of them would wish to have a working environment more akin to the relaxed nature (comparatively) of working in a garage. I can’t quite remember the last time the General Garage Council struck a mechanic off for using the wrong oil, or not explaining the different kinds of windscreen washer fluid before servicing a car. In addition, Col Hurley seems to forget that likening the situation to an MOT is also a bit silly, since it is a legal requirement that you have to submit your car for that test every year. Her comparison fails hugely at this point. Perhaps the situation with dental problems (especially that of the huge number of children admitted for GA’s) wouldn’t be as bad if people were compelled by legislation to see a dentist yearly as part of their responsibility to the others contributing to the cost of state run care? But then of course the state wouldn’t be able to afford it and would have to admit as such.

On the other hand, whilst continuing the garage comparison, preventative maintenance is the responsibility of the driver, and there is indeed a whole host of legislation in place to ensure this happens.  So if my garage (ethical and professionally run) recommend I get something rechecked in a period because the vehicle might be dangerous, then I would be foolish to ignore that advice both from a safety and legal point of view. I’m also not likely to blame the mechanic if my car breaks down because I haven’t looked after it.

That there are dodgy garages will be no surprise, but then we all know there are dodgy dental practitioners who, amongst other things, blatantly game the system because the lack of clarity in the current contract makes it possible for them to do so. I suggest however that there are a higher proportion of mechanics that are not ethically guided than dentists due to their lack of professional regulation, and to make an analogy between them therefore is somewhat clumsy and misguided.

Comments like these have more than likely damaged the working relationship between the CDO and the profession in my opinion, and shown that her

Honeymoon period is well and truly over

The open letter to the profession published in January in Dentistry from Col. Hurley suggested that budgeting the NHS funds appropriately was at the forefront of all the planned changes that she would suggest. No one would argue that this is appropriate and should be the way forward. In an era of austerity we have to look at how the finite funding is spent, and I personally agree that much of the NHS budget could be better spent than recycling the same healthy patients.

However, these are often those patients who take an interest in their dental care. When we have 50% of the population not attending a dentist at all, then the budget is going to be spent on those that do. Couple this to the failed UDA system that makes it a financial risk to take on too many high needs patients (who are often those who don’t value the service and miss appointments), then is it any wonder that the small businesses of dental practices need the repeat business of regulars to survive? The screaming lack of clarity that is present in the current contract, and in my opinion will remain in any new contract (purely because of the benefit to the Government and no-one else) is not likely to be addressed anytime soon. There is no appetite for the Government to officially admit dentistry is rationed, yet we all know it is, and instead a press release such as this could have helped both the patients and the profession by being honest about the amount of money the NHS has to spend on routine examinations.

For the first time, it appears an NHS manager (Chris Hopson writing in the Observer) has this weekend finally admitted that that aspirational wishes of the NHS are not met by the funding needed to provide them and rationing is likely in the future. Perhaps the ‘worried well’ that Col. Hurley is referring to as being seen so regularly should actually make way for those who cannot access treatment. Perhaps by publically endorsing a core service that is equitable for all would go a long way to meeting her desire to target the resources of the NHS more appropriately rather than once again making it the dentists fault as usual for the perpetual lack of funding to provide ‘world class’ healthcare for everyone.

So, instead of therefore criticising the dentists for seeing patients more often ‘than needed’, why didn’t she take the opportunity to actually say that the NHS can’t actually afford to fund this type of regular recall, and that it only has the funds to see patients once every two years? A comment such as this is more likely to get the support of the profession since we all know how poorly funded the system is, and yet it doesn’t alienate the profession so much. Suggesting then that the patients are still free to see their dentist 6 monthly, but under a private arrangement, would both inform the public of the truth about the parlous state of NHS funding, and gain the support from the vast majority of dental professionals by talking it out of their hands. Instead of encouraging the patients to question the integrity of the professional caring for them this would be more appropriate surely? It is a chance for her to stand together with the profession she is part of whilst still fulfilling the government need to obtain value for money with its funding.

What is amusing is the same papers ran a story only the week before stating that soldiers face a week in jail for missing dental appointments in a bid to reduce the amount of personnel unavailable for military deployment due to dental disease. Is this a not double standard? Coming from the military back ground she does, I’m sure Col. Hurley was aware of this issue before she became CDO. So when the public read these conflicting stories, how are they to make a decision? Is it that dental problems can be so bad that the army punishes offenders who don’t take responsibility for their dental care with jail; or that you don’t actually need to go to the dentist for 2 years? Which is the message about dental health that is correct?

We all have cases to robustly shoot down the 2-year interval theory. For instance, I have a low risk patient who I have been seeing for many years now. Probably one restoration every 6 or 7 years, good oral hygiene etc., and is in the early 40’s. At a routine 6 monthly I spotted a lesion under the tongue. This turned out to be a squamous cell carcinoma. It wasn’t there 6 months previously. They would be one of the patients that fit in the criteria of a biennial examination. I’m sure that would be of great help to a spouse and children if the patient had listened to the advice. Fortunately for the patient we expedited the referral appropriately. However, at the next 6 monthly, there was still some nodal involvement that we picked up. This fell between the review appointments at oncology, was pointed out to them, and now a neck dissection has been performed. Once again, the DENTAL problems were minimal.

What about the increase in the HPV+ types of Oral Cancer that are now being seen in younger lower (traditional) risk patients? Or subtle diet changes that misguided approaches to a healthier lifestyle involve that create more dental problems and more long term cost to the state? I can go on, and I’m sure there are many other examples that people can give.

I can think of NONE of my patients that I would be confident leaving for 2 years without some form of assessment. When you ‘get out of the mouth’ and look at patients as a whole it is astounding how many things can impact their oral health in so many ways, and 24 months is a long time indeed…Whilst I admit there are those patients who never seen to need anything doing, how do we know they won’t suddenly suffer a need for medication or have health issues that change their dental risk? Since the Government seem to fail to take responsibility for educating the population about the risks of the links between health and dental issues then many patients will not automatically seek our advice. When they then return with a mouthful of problems because of some misguided attempt to save the state money because we’ve had to accept the demand for a longer interval between assessments, then I know that we are going to get the blame, and the GDC and ambulance chasers are going to be rubbing their hands together in glee, whilst the DoH wash their hands of the responsibility.

I unfortunately have to keep hammering out to many of my local GMP colleagues that we are not blacksmiths any more, but highly trained medical and surgical colleagues who take a full view of the patient in a holistic manner, but concentrating on the head and neck. It would appear that solely concentrating on just the teeth and gums is what even our CDO feels we are doing given the tone of the comments in the press. I wonder when the last time she actually fully assessed and treated a patient from start to finish, and whether of not the pressure of a real (and not with an institutionalized cohort of patients) dental practice has been experienced.

The BDA press release the same day was suitably pithy; but in reality the message wont be important to the public given they usually jump on any chance to further hate our profession.

But if the headlines actually said something like ‘Dental Trade Union refuse to negotiate with Government’s ‘Top’ Dentist’ then this might allow us to start to get our message across. The DoH is perfectly happy to sensationalise headlines to further their own ends, so it’s about time we did.

Insight is a wonderful thing

It carries so many meanings.

The GDPs view

Many of you demonstrate it in your daily work, by understanding what makes patients tick. They say one thing to you and you apply years of experience, so that after a few moments of reflection, you translate what the patient just said into a proposal for treatment with a couple of options. Our younger colleagues of course find this the hard bit of clinical practice, but with experience time and dedication all Dentists and DCPs in patient contact can become masters of this art.

At the other extreme, when it all goes wrong and some of our colleagues face GDC proceedings, the ability to reflect upon your circumstances is critical. The ability to show insight at the events that led to the GDC may be critical to a Panel taking a benevolent view.

Insight is an essential attribute for any dentist.  For sure, lack of an ability to apply insight will often lead to trouble. It may compromise your relationship with your patient. You may finish up treating a patient despite the warning signs being there perhaps in the body language, or in the tone of voice used during a conversation.

Time? Not a lot of it about!

We recognise the application of insight as a skill and an attribute amongst our colleagues, and we admire those who have mastered the art of its use.

Of course the need to reflect and to gain insight require something that your NHS masters are reluctant to give you too much of: time

Even the GDC require time to reflect and gain insight. 

So why is it that I think the top of the GDC may lack leadership, and the insight that is required to be effective?

There are at the GDC six Registrant members of the Council and numerous panel members who all, in their work and their practice have to find time to reflect and develop appropriate insight into their cases of regulatory work.

The Times -  6^th August 2016

So it was with some surprise that the Chairman of the GDC, a certain Dr William Moyes PhD Esq, found himself demonstrating what seems to be a surprising ignoranceof the workings of NHS funded dentistry at the weekend, if The Times quote is to be believed.

Many of you will of course regard the summer as the season of slow news and will know that dentists are an easy target.  If I were you I should take it as a compliment.

What never fails to amaze me though is how the media absolutely fail to gain any true understanding, insight dare I say, of the problems associated with the Government offering for the nations dental care

And so it was in last Saturday’s edition of The Times. Front page news no less. It was probably pure coincidence that the de Mello case was about to be started at the GDC.  In fact, it was – a leading colleague single-handedly was trying to have the issue properly addressed. It is now behind a pay wall, but I have copied it below.

The Thunderer bellowed …

The article so nearly nails the issues, and in many respects it almost goes so far as to highlight “The Big Lie” and identify the lack of “Clarity of the Deal”.  A big up to our colleague, Dr Kotari, for getting “High Street Dentistry” on the broadsheet agenda. Patently he did not write the copy.

The message was clear though. Even someone without deep insight into the NHS Dental Service can see it is trying to do too little for too many.  There is only a certain amount of money, and the way it is spent simply does not allow for the provision of a broad range of highly complex procedures for everyone.  There is a very good blog on the BDA site reflecting after this article by a young colleague Dr Robert Chaffe at https://bdaconnect.bda.org/bad-dental-press/ .  The BDA through Dr Mick Armstrong were pretty robust in their reponse at  https://www.bda.org/news-centre/press-releases/bda-response-to-the-times .

And as FtP numbers prove, the dentist’s lack of time to reflect and develop insight into the problems of a patient cause that patient to feel abused and make that first GDC contact.

It’s not a difficult loop to get your head around, is it Dr Moyes?

Clearly, it’s about clarity

Anyone with half a brain can see that the future must involve a clear demarcation of what is and what is not available as NHS treatment. The post-code lottery that is exemplified by the extraction -versus- endodontic treatment fiasco reveals the problem that everyone is shouting about.  The only people who will not engage on this matter for no other reason than political fear are the dunderheads at the Department of Health.  Even the BDA recognise that it will have to come - but everytime it is mentioned at DH or NHSE level senior officials shake their heads. "Can't be done dear chap".

UDA Targets are set by …

The message is equally clear about high levels of UDA targets – the dentists do not set these. The Local Area Teams do.  In cases such as that of Dr de Mello, these colleagues may genuinely think they are doing the Governments dirty work for them in an efficient manner, bringing access to the masses at minimal cost.  That is what the Government want, isn’t it?  Dentistry is a broad church and while I would not poersonally be able to cope with a high UDA contract requirement, I know some can.  Does that make them wrong in themnselves?

When I wonder will NHS management be called to account instead of the dentist who is the low hanging fruit of accountability? 

What’s that you say? Never?

Soundbites

So when Dr Moyes, as GDC Chairman is reported in The Times as stating on behalf of the GDC, and I quote from the article:

The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.

What exactly can he mean? Is he saying there is a massive problem? Or is he demonstrating considerable ignorance similar to that which his infamous Pendlebury Lecture highlighted? Shall we assume Mr Chris Smyth, Times Health Editor, is including a quote relevant to the thrust of the article for now.

Can Dr Moyes really have so little insight into the working of dental practice?  It certainly looks like it.

Did Dr Moyes not reflect upon the magnitude of the meaning of his comments?  It certainly appears not. With that one comment Dr Moyes has revealed all that is wrong with his Chairmanship of the Council.

We now have a decent working team in the GDC Executive Leadership. But the Chairman has revealed that he is not neutral, and strategy driven. Instead, he appears to be a simple supporter of that broad-brush vox-pop opinion that “all dentists are trying it on”.

Last call for Dr Moyes…

The time has come for the Chairman of Council to shape up, learn about the long standing problems of NHS funding of dentistry and take on the causative Department of Health as part of the GDCs Strategic role.

Or he must step aside and let a more capable person take the role on. 

It IS clear that it is time for Dr Moyes to reflect upon his position, for the sake of the profession he seeks to regulate and yet for which he patently has scant regard.

Slow news day my foot – have a great break if you are away.

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TIMES INVESTIGATION
The great dental rip-off
Thousands of teeth needlessly extracted as surgeries accused of putting profit before patients

Chris Smyth, Health Editor | Katie Gibbons
August 6 2016, 12:01am,
The Times

Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service

Thousands of people are losing teeth needlessly because it is more lucrative for NHS dentists to take them out than try to save them, an investigation by The Times has found.

Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the health service. The investigation has also found that some dentists earn almost £500,000 a year in a system that rewards them for cramming in as many patients as they can.

Dozens are claiming for the equivalent of more than 60 check-ups a day, in what has been condemned as an unethical conveyor-belt approach to patients. The upper limit is considered to be 30 a day for one dentist.

Under reforms introduced a decade ago, dentists are paid about £25 for every “unit of dental activity” (UDA) that they carry out. Each check-up, or simple examination, is classed as one UDA; tooth extractions count as three, along with fillings and root canal work, irrespective of how long the treatment takes. Root canal treatment usually lasts more than twice as long as an extraction.

NHS figures seen by The Times show that 30 dentists were paid for more than 15,000 UDAs last year — the equivalent of about 60 simple appointments a day over a standard working week. Ten dentists were paid for more than 18,000 UDAs, equivalent to about £450,000.

Alex Wild, of the TaxPayers’ Alliance, a public spending watchdog, said: “The amount of work dentists do will obviously vary significantly, but the figures at the top end appear totally implausible . . . an urgent review is essential.”

Dentists routinely weigh up how much time and treatment a patient needs against a desire to maximise earnings, say professional leaders who concede that the payment system is causing an “ethical compromise”.

The warning comes before the disciplinary hearing next week of the dentist responsible for the biggest patient alert in NHS history. More than 20,000 people treated by Desmond D’Mello, 62, were called for HIV and hepatitis testing after he allegedly failed to change gloves or clean equipment between appointments in an attempt to see as many patients as possible.

Mike Waplington, president of the British Endodontic Society of root canal specialists, said that extractions had jumped by a fifth and root canal treatment had fallen by almost half after the contract that paid the same for both was introduced in 2006. Root canal treatment could take three times as long as an extraction. “There is an incentive from the system and some dentists may say to patients ‘I can take this tooth out simply’.”

More than two million teeth were taken out on the NHS last year, but Mr Waplington said that many could have been saved, estimating “over the lifetime of the contract it would have affected tens of thousands of teeth”.

Many dentists also feel more comfortable taking teeth out, as only 277 out of more than 40,000 are registered as specialists in root canal work.

Trevor Lamb, co-founder of the Saving Teeth Awareness Campaign, said: “The public are too quick to accept that teeth should be removed. They are unaware of the alternatives and some dentists exploit this. You wouldn’t go into A&E with a broken arm and expect it to be amputated.”

At least 2,000 dentists claimed for more than 8,000 UDAs, equivalent to the upper limit of about 30 check-ups a day. Neel Kothari, a Cambridgeshire dentist seeking reforms, said that it was difficult to do more “in any ethical sense”, with 60 patients a day impossible without cutting corners.

He warned that dentists intent on maximising income might skimp on treatment as well as hygiene. “It’s as if you went to a top restaurant and they served you a Big Mac disguised as a gourmet burger,” he said.

Nigel Carter, chief executive of the Oral Health Foundation, said: “To do a proper assessment of the patient would probably take 20 minutes. But that hasn’t been what the health service has been paying for. There is a bit of an ethical compromise.”

The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.

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GDPUK Topic

https://www.gdpuk.com/forum/gdpuk-forum/the-saturday-times-front-page-the-great-dental-rip-off-22696?start=50#p250635

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Letter to The Times, Tuesday 9^th August

Sir, Your report and editorial suggest that dentists can claim as many UDAs as they like. On the old system, dentists could earn more by carrying out more treatment, and the annual dental budget could only be estimated. The current contract was designed to allow a budget to be set in advance. Each dentist is contracted to carry out a certain number of UDAs a year. If a dentist exceeds the number of UDAs contracted to them they get no additional pay. If they fail to complete the contracted number, their fees are clawed back. The dentists have to tender for contracts each year. Whose fault is it if dentists are paid for a large number of UDAs? However, to claim that the upper limit of patients is 30 per day is unrealistic. In the 1990s I used to work with three staffed surgeries and treated 70 to 80 patients a day. That would equate to more than 30,000 UDAs a year. On a four-day week, I hardly ever ran late.

William Eckhardt

Retired general dental practitioner

Haxey, S Yorks

In this blog we look at two recent cases, one before the Fitness to Practice Committee of the GDC and one before the Health, Education and Social Care first tier Tribunal (‘HESC Tribunal’), and consider what lessons dental practitioners can learn from them.

Darfoor –Fitness to Practice Hearing  

Dr Darfoor, a dentist, was before the Professional Conduct Committee (PCC) on 18^th January 2016. The allegations against him concerned the treatment of three patients during the period 2011 to 2014. The charges against Dr Darfoor ran over three pages of the judgment and included allegations of failing to adequately explain and/or record explaining to the patients the treatment they were to receive and thus failing to obtain consent.

The most serious allegation against Dr Darfoor was an allegation that he had failed to obtain consent and was dishonest in his failure to do so. It is this allegation we are going to focus on in this article.  

Dr Darfoor was carrying out treatment on Patient C for composite restorations and bone grafting. Dr Darfoor informed Patient C that the bone would be “synthetic”. In fact the bone was xenograft, which as you all know is bovine derived. Dr Darfoor had made the same assertion to Patient B, however, what made this allegation against Patient C more serious was the dishonesty element. Patient C had informed Dr Darfoor on a couple of occasions that he was a vegetarian and would not want animal products to be used on him.

Dr Darfoor denied knowing Patient C was a vegetarian but the Fitness to Practice Committee found that he did know this but went ahead with the procedure using xenograft in any event. The allegation of dishonestly failing to obtain consent was therefore found to be proven.

On 22^nd April 2016 the Fitness to Practice Committee was reconvened to consider if Dr Darfoor’s fitness to practice was impaired as a result of his dishonesty. Dr Darfoor had previously been before the GDC before in relation to allegations of failing to obtain consent and this factor was taken into account. The Fitness to Practice Committee determined that Dr Darfoor’s fitness to practice was impaired and he was suspended for 12 months.

Every dentist knows the importance of obtaining consent from a patient. In Issue 5 of our Dental Bulletin we set out the legal issues surrounding consent.  Essentially, in order for consent to be valid it must be given voluntarily and freely, by an informed person and by a person who has capacity to give consent. In the recent case of Montgomery the court put a greater burden on dentists when obtaining consent in that it held a medical professional will need to look at what a reasonable person in the patient’s position would consider was a material risk and this places a duty on the medical professional to advise on that material risk. Therefore if the dentist has knowledge of a patient’s wishes or beliefs he must take this into account when providing information as to the procedure that is being undertaken.

Dr Darfoor had also failed to provide Patient C with other information about his treatment. However, it was the knowledge of Patient C’s vegetarianism and his failure to inform the patient he was using animal material that made his actions dishonest.

This case highlights the importance of ensuring you have an open and frank discussion with patients about the treatment you are providing. Make sure you listen to any concerns or queries raised by the patient, as this could affect the information you provide to them. Dr Darfoor also failed to keep adequate notes. Therefore, if a patient does raise an issue, make sure this is in your notes along with any advice you have provided in response and the patient’s final decision. 

If you would like to read the judgment in full you can find it here.

Mr Corney and Mrs Webb v CQC

This is an interesting case, in which the CQC’s decision to cancel registration was challenged at the HESC Tribunal. It highlights that the CQC’s decision is not final and can be reviewed by an independent body.

However, we would not recommend following the path of Mr Corney and Mrs Webb when deciding if you should challenge the findings of an inspection report.

The couple purchased a care home in 1994 and described their philosophy of care as being based on the ‘European Style’, which they say meant living in the home with the residents and caring for them as if they were their relatives.

The home registered with the CQC in October 2010. Between January 2013 and April 2015 there were six inspections carried out. Each recorded a finding of ‘inadequate.’ In fact on the last visit by the CQC the couple and staff refused to speak to the inspector or show him any documentation; his visit lasted 17 minutes! If only all inspections were that quick. In August 2015 the CQC issued a notice of proposal to cancel registration.

In addition to the action taken by the CQC, in November 2013 Dorset County Council ceased to commission the care home due to safeguarding concerns they had with the home.

Mr Corney gave evidence on behalf of the couple. He was adamant that the findings of the CQC were wrong but produced no additional or expert evidence to support his case. He maintained throughout that the CQC and the local council were working together to shut his business down. The couple failed to make any changes to their practices or procedures despite having clear recommendations from the CQC.

The HESC Tribunal found that the couple were unwilling to change and to keep up to date with current standards and regulation. They went so far as to say ‘Mr Corney also has an unmoveable conviction that he is right.’ The cancellation of registration was therefore upheld. The full judgment can be found here.

We consider this is a rare case; most providers when issued with an inadequate report will do all they can to improve standards. Not wait for a further five inspections to take place. However, what it does highlight is that if you can challenge the CQC’s findings, with say additional or expert evidence, you can pursue the matter via the HESC Tribunal.

It also shows the importance of accepting where errors may have been made and looking to improve on standards or change procedures. Mr Corney clearly did not like change and we consider this factor and his failure to work with the CQC played a part in the removal of the couple’s registration.

We would comment that with the new regime for inspection that came into force last year for dentists, there is less of a focus on a ‘tick box’ exercise.  Inspectors have five key questions to consider and should be taking into account all relevant factors when assessing if the regulations have been met. 

Image credit -Tori Rector under CC licence - 

So…
Two weeks after our vote, give or take and it has been an interesting period to put it mildly.
If you voted Leave, it has been quite hard to lean on the positive, but that is changing. The FTSE 100 is back up, the ‘250 is trailing but improving, and while the Pound has taken a hit, many would argue that has been a trend waiting to happen. Despite Mr Osborne using this week as an excuse to drop his 2020 Deficit promise, the fact is he was a million miles off the mark BEFORE the vote. And then there are the personalities and the power broking.

Non, je ne regrette rien
As a GDP who voted ‘Leave’, do I have regrets? No. Perhaps in future, politicians will take their people seriously instead of overriding our worries with their ‘we know best’ soft speak.
Viz, Mr Cameron, who failed to take Referendum matter seriously enough to have a plan in place, it appears. Similarly, I am surprised to say, the Leave leadership who I suspect were as surprised as the PM that the vote went 52%:48%
I did suggest that it would be a revolution and I do think that is exactly what has happened. About time too, many might suggest.

So what has changed?
Nothing, in the next two years and in reality some greater time than that actually changes. We remain in the EU bound by EU Treaties and Law, making our payments and presumably supplying our MEPs
Now call me cynical.
No sooner had the count been completed than the EU declared that Mr Cameron’s ‘EU Deal’ negotiated in February was declared invalid and was withdrawn! So much for the EU being on Mr Cameron’s side.
Is it me? The EU cannot wait to be shot of us anyway. They have been waiting for this to happen for years.
Where were the ‘Remain’ MEPs during the Referendum campaign? Where were the EU Officials, doing a Grand Tour to report what they the EU does do for us? Quite.
Of course, there has been a huge amount of posturing, and superior sounding comment made by all parties. But the dust is slowly starting to settle and realpolitik is starting to become the accepted wisdom.
The chase for the top job in the Tory party is underway; surely a Brexiteer has to take the job?

The outlook for Labour is unclear as I write this, it appearing that Mr Corbyn feels he does not need the Parliamentary Labour Party on board for him to have another go at winning the leadership.
Just when we need a strong Opposition, they decide to go to the beach!!

A mandate for change, or a vote for planning change?
Now there is a valid point that only 38% of the Electorate voted Leave. There is widespread concern about the Union, given Scotland’s quite specific vote to remain. There is the Irish matter of how to handle and nurture the peace, allied to the thinning border.
It is all very well to say ‘” We voted exit” but accepting that logic recognises that any way forwards has to take account of the 62% of the Electorate who did not vote or voted Remain, it has to take account of Scotland, and it has to take account of Ireland.

That is not a circle that needs squaring – that is a complex multi axis movement joint with a multitude of ways to be set, and this needs arranging BEFORE Article 50 can be invoked. An inclusive approach by the next PM will be critical.

It is my opinion that the result of the referendum, being notable but NOT a mandate, is only a start to such a process, and we are simply not there yet.

It is my opinion that Mr Cameron was mistaken not to create some strong ground rules for the Referendum, in particular to the nature of the need for a vote of in excess of 50% of the Electorate. In any other Committee the world over, that vote was inconclusive enough for the Chairman [ie Mr Cameron] to place his casting vote for the ante status quo.
Burt what is done has been done. What should not happen now is that there should be a rush to make more political mistakes.

Better preparation, and a proper mandate
Despite what has been suggested only today [Sunday 3rd] by Mrs May, there must surely be a General Election to restock Parliament with MPs based upon a final Leave or Remain campaign, before Article 50 can justifiably be invoked. I say that as someone who voted Leave.
The biggest challenge now is for a leader of quality to unite the country in its way forwards. If Mrs Theresa May is the bookies favourite, and given Tory party leadership campaign history of old, Mrs Andrea Leadsom is a likely bet.
These are by all measure the most extraordinary times in which we live.

Hi ho, Hi ho, it's off to work we go ...
And yet tomorrow, we all go off and drill, fill and bill. Nothing changes, except the mood and the strangely opaque vacuum that is the political parties we see around us.
If the past two weeks have been a Political revolution, we must be careful not to cause a Geographic revolution by poor leadership and ill thought out ways forwards.
The leadership elections various at least buy everyone some time, despite what our huffy and impatient EU Leaders might suggest.
The summer vacations could not come at a better time, to allow everyone to take a deep breath.
Leave? What, now? No, in about 3 years time - perhaps even at the 2020 Election time?

The Autumn is when the real work begins.


http://www.andrealeadsom.com/

http://www.europarl.europa.eu/news/en/news-room/20160628IPR34006/MEPs-call-for-swift-Brexit-to-end-uncertainty-and-for-deep-EU-reform
MEPs call for swift Brexit to end uncertainty and for deep EU reform

http://audiovisual.europarl.europa.eu/Page.aspx?id=2885
MEPs call for swift Brexit
Top Story - 28-06-2016
Official visit of the President of the European Parliament in London. A general view of the EPIO London, Europe House on June 18, 2015 where the President of the European Parliament Martin SCHULZ today visited and gave interviews with selected journalists. UK-European Flags

http://europa.eu/rapid/press-release_MEMO-16-2328_en.htm?locale=en
European Commission - Fact Sheet
UK Referendum on Membership of the European Union: Questions & Answers

Calm Down, Calm Down, Calm Down

The words of Harry Enfield’s bubble permed Scouse's of the 1990’s are perhaps the most apt at the moment to describe how I feel about the outpouring of angst on the result of the EU Referendum.

Alternatively, to plagiarise somewhat Winston Churchill,

            "Never has so little sense been spoken by so many in so few hours"

I am probably about to join that increasing pile of rubbish, but thought rather than add fuel to what appears to be some as a bonfire of Liberalism and Tolerance I’d try to get a bit of perspective back. I’m certainly no political commentator, (and once you read this you’ll probably agree!!) but I do feel quite strongly how this has developed over the weekend. The sheer vitriol that has been produced in such a short time has been nothing short of shocking, but at least we now have got some real political debate and possibly change on our hands. However, we all need to calm down and stop falling out, because BOTH sides have valid points in my opinion and the only way to move forward now is if we calmly look at the big picture once again.

Because we haven’t actually left Europe. Not yet, and we will not in the next few weeks, months, or years. The referendum was a non-binding one, and merely the biggest opinion poll that has been run in this country for years, albeit with slightly more weight than most have. Unlike the Alternative Voting referendum in 2011, which had a legally binding result, there is no legal duty for a Government to act upon the result of Thursday’s result.

That’s right, Government has no obligation at all to actually heed the result.

It’s certainly monumental that the UK has voted in the way that it has, and there are a multitude of reasons why individuals will have done so. Many of them will have been misguided in other’s eyes, but all of them were personally valid ones to the person who was actually entitled to put their cross in the box. But we have seen the biggest turnout for years that has galvanised the electorate in way that I thought would never happen (now if only we could mobilise dentistry the same way…). This was always going to be a subject dear to the hearts and minds of the populous. It’s a shame that many of the most vocal of those who now feel betrayed by the decision were the ones with the lowest percentage turn out (the 18-24’s having less than 40% turnout). Perhaps there should have been a button on Facebook, or Text your Vote to allow that sector to vote? After all, many of them expect instant and easy solutions without having to actually physically get up and do something…. In addition, a democracy can keep continuing to vote and vote and vote until it gets the answer it wants.

Politically, I am of the opinion that David Cameron has played a political masterstroke. Unlike many, I was not shocked at all when I heard of his resignation. This is a man with an exceptionally astute political mind, and the outcome (although unexpected by many) will have been modelled by advisors. If we read into what he has said in the past, he had only alluded to the fact that a leave vote would result in the British public ‘expecting’ the process to leave the EU to be started straightaway.

An expectation by the public is not the same has an obligation by a politician though, and with his resignation, he has delivered what can only be described as a Hospital Pass to his successor as Prime Minister. For the formal process of leaving the EU to begin, Article 50 of the EU agreement relating to departure has to be formally invoked. Now, it is unclear if the invocation of this can be made by only the Prime Minister, or whether (more likely in my opinion) it has to have been voted on by Parliament in order to become formal. However, the result of the referendum, DID NOT invoke this process, and no matter what the EU Bureaucrats say, the UK is the only entity that can start this process.

So, a political hot potato has been deftly delivered by David Cameron as his last act in office. A new Tory Leader from the Leave side will have to either go against the referendum result, which will immediately destroy their personal credibility and therefore the faith of many people in their suitability to be Prime Minister, or they will have to activate Article 50, which then will probably have to go through parliament to be voted on. If they don’t do this immediately, then doubts about the suitability of the new leader to govern will set in as well. Is this not a most beautiful revenge on his once close allies Boris and Michael? In one fell swoop Cameron has called their bluff magnificently. ‘Leave’ now has to put up or shut up, and either enter into negotiations with the EU saying it was all a ploy to get further concessions, or activate the Article 50 clause, which might be their own political suicide if they don’t truly believe in what they have achieved.

I think we will then have the prospect of a snap General Election that could once again change the political face of the UK and re-establish a new political balance. One that might have Remaining in the EU as one of its fundamental promises. That’ll give the electorate who are currently appealing for a ‘best of 3’ approach to democracy to have another go at influencing the decision. However, quite as possibly with be a further endorsement of the desire to leave, but then there becomes a true mandate for a new Government to act upon. It’s like pressing the Reboot switch.

We have now heard that the Scottish MPs under Sturgeon will actively block the departure of the UK from the EU if this goes through parliament for a vote. So nothing at the moment is a given for the UK actually managing to leave the United States of Europe. The majority of the political commentators will know all this but cynically I’m of the opinion it serves the purpose of the media to keep all the froth and agitation going at the moment to confuse the populous even more and influence how they think whilst selling papers.

And the leaders of country with such political ability in the world didn’t see this outcome as possible?????

I suppose I should have a few opinions on what this means in Dentistry then. Well, for a start the GDC isn’t going to be affected by it at all. The Dentists Act 1984 is a piece of UK legislation and whilst it has EU aspects covered by such as the Human Rights Act and Data Protection Act, and has to be compatible with EU tenets of law, nothing within the day to day interpretation of the Act is likely to be affected by what happened last week. The same is true with the CQC. The UK is wonderful at developing infrastructure like this, and certainly doesn’t need the EU to make a business out of bureaucracy. There certainly won’t be a bonfire of the dental Quangos whether we stay in or out is my prediction.

There are a significant number of EU graduates working in the UK, and I don’t see any evidence that coachloads will be shipped back through the Channel Tunnel before it is bricked up overnight. What might actually happen though is that the corporates might find their supply of naïve EU dentists dries up due to the uncertainty of the future direction of the UK, and they might actually have to pay a competitive income to get people to work for them. This will no doubt affect their bottom line somewhat, and they might actually find they are now susceptible to the same pressures that normal practices are under and have to adapt the same way as we have all done. This can only be a good thing in order to restore the competitive balance in our profession.

What also might be beneficial to dentistry from leaving is the restoration of parity to our own graduates. Those who graduate from the UK have to complete foundation training before being allowed to work in the NHS, yet those from the EU don’t. Not only that, because the EU training is seen as equivalent to the UK, we cannot impose requirements like the ORE on them. Are all the EU Dental training courses the same quality? I think some of us might disagree that every single course is.  Surely this has benefitted those from the EU more than our homegrown graduates, and this potential discrimination can be possibly now be addressed in the future.

We still don’t really know what will happen with the prices of dental goods in the long term. Much of it is indeed made in the EU, but the USA and Asia are also vast markets, and not necessarily unified like the EU. China as an emerging market has already rocked the world of the dental technicians, and there is no reason why that cannot happen in the rest of dentistry. Admittedly controlling quality is going to be the issue, which worries me, but there are also some highly ethical businesses there that would work well within dentistry. There will be inevitably be some adjustments of prices because of the strength of the pound, but equally there is now an opportunity for entrepreneurs within the dental supply chain to start ‘disrupting’ the usual model.

The one thing we are unsure of is the overall effect on the general public and their incomes. Potentially this is huge, and the instability that is coming will affect them to an unknown degree. It is notable that the professional advice from the likes of the Bank Of England is to keep calm, whereas those who have a self interest, either towards the EU, or financially, in keeping the markets volatile is to Panic and Run Away. I know what I shall be doing. At times like this speculators usually manage to be the overall winners anyhow, so it’s in their interest to keep earning their money how they always have done.

But all this pre-assumes we will actually leave. I’m afraid I don’t believe the upper echelons of political power (and by that I don’t mean government but the high level civil servants who are in post despite what political flag is flying over Westminster) haven’t already worked out what their long game is and planned their chess moves accordingly.

So, we need to keep calm, because we haven’t actually left yet, and I personally don’t think we were ever going to….

Though the real question is can we trust any of them anymore?

Image credit - Muffinn under CC licence - not modified.

During May I spent some time reading the Medical Practitioners Tribunal Service hearings list.  MPTS deliberated issues including inappropriate relationships with patients, physical altercations with patient family members and performing inappropriate intimate examinations of patients without chaperones.  Comparably, the FtP panels of the GDC were reconvened to consider the issues that NHS England probably ought to be dealing with.  Charge sheets were littered with allegation minutiae of the usual failures in record-keeping, and whether bouncing balls made of impression material in corridors might contribute to a finding of misconduct.  It’s not specified if the balls were alginate, addition or condensation-cured silicone, or Impregum, and they may or may not have been bounced in front of colleagues or patients and the date of the alleged bouncing was unknown. But those facts aside, I am sure it was fairly clear-cut!

If anyone is interested like I am in comparing the differences between the MPTS and GDC FtP charge sheets to see how MPTS put theirs into the public domain, let me give you an example:

MPTS announcement:
‘The tribunal will inquire (note the inquisitory tone) into the allegation that in April 2014, whilst working as a Specialty Trainee in Obstetrics and Gynaecology, Dr X’s actions towards a patient were not clinically indicated and were sexually motivated’ (and then some further housekeeping information and notes for interested journalists).

GDC announcement:
‘Charge (note the accusatory tone) that……..(insert pages and pages of specific individual allegations painting a poor picture of the registrants practice and behaviour)......
And that, in relation to the facts alleged, your fitness to practise as a dentist IS IMPAIRED (note the suggestion that the outcome is already proven) by reason of your misconduct +/- deficient clinical performance’ (and if only deficient clinical performance then perhaps add some dishonesty for good measure).

I know which presentation of the forthcoming hearing sits better with Article 11 (presumption of innocence).   Furthermore, if the charges are not meant to be taken literally (as I am advised they should not be without knowing the relevant context of the case), then it begs the question whether they ought to be made public?   Dishonesty I will touch on later but I feel the GDC ought to be looking at how they present their charges of these public hearings and I believe that a new approach to how the charge is put into the public domain is needed.

But back to last month’s cases of interest of which there were a few:

Interim Orders acted extremely swiftly to curtail two attention-grabbing business ideas with potential to breach GDC standards, or encourage UK registrants to. One related to provision of orthodontic aligners direct to the public without a prior examination and the other was referral incentives for implant treatments referred to a clinic abroad.  Both registrants had conditions imposed clipping their entrepreneurial wings.  I later received an email from another company looking to ‘partner-up’ and offering me payment for helping with certain aspects of their ‘ortho-direct-to-patient’ business.  Possibly the best of both ‘GDC standard-breaching’ worlds in that email, but seemingly no UK-registrant behind it to take through an FtP.

The PSA failed in their appeal of a health-related case.  The PSA alleged that the case was under-prosecuted by the GDC, and that an unduly lenient sanction was given with insufficient reasons.  The registrant, who was placed on conditions by the Health Committee for what appears on reading the determination to be extremely cogent and reasonable reasons, had complied with all the conditions and made huge efforts at remediation.  He was extremely anxious about the prospect of the matter being remitted back for reconsideration and is obviously now very relieved.  He told me that the GDC have been a life-saver to him, and that his case shows how some good can come out of FtP procedures, although the time left in limbo has been tortuous.  Additionally, it is worth giving credit to the GDC for their handling of the appeal, as they described the conduct in broad terms and kept the health condition out of the public view.  The PSA did not however, and some very private material relating to this registrant has now been read out publically in court, which was awfully nice of them.

In the conduct arena, Mr Radeke ‘won’ an appeal in March 2015 against an incorrect PCC decision to erase him over dishonesty and the case was remitted for a new PCC to reconsider the appropriate sanction.  He remained suspended only until the end of May 2016 when the case was finally reheard.  When I say ‘won’ an appeal, this is really in a loose sense of the word.  The wins on appeal are often pyrrhic victories.  Registrants who have gone through FtP and appeals suffer enormously through stress, anguish, accusations (perhaps false), public humiliation, financial turmoil and can still find themselves unemployable after a ‘victory’ not to mention their families breaking down or having to go bankrupt in the meantime.  I do not wish for second that anyone who reads my blog on FtP thinks that any sarcasm or satire is an attempt to trivialise something that I take tremendously seriously and have had, at times, invading my own sleep.  Nonetheless, Mr Radeke’s case involves an unarguably disastrous patient death following treatment, but the original panel had attached incorrect significance to the ASA of the patient prior to treatment and ostensibly decided that the registrant had committed perjury to the coroner; which is a criminal offence.   This case, along with the Kirschner case, suggests to me that dishonesty is something that we need absolute confirmation from the GDC that their selected panel members are capable of handling appropriately, given that the GDC like to levy it at registrants at such a high rate (45% of conduct cases include a dishonesty charge if my memory serves me correctly on that FOI data).  If you are going to accuse, and then find someone guilty of dishonesty, you had better be sure you are getting it right, and that you properly understand the legal test.  Panel member names are redacted from final determinations, but in the interests of transparency ought not those who are the judge have their names kept in the public domain?  We do not see judiciary member names redacted in their judgments.  Perhaps someone in the know can comment on why this is the case?  For those interested in the Radeke appeal judgment to see what the problem was in the PCC decision-making, and it is worth reading just to compare the tone,  it can be found here:

In the ‘no misconduct’ case a registrant was reported to the GDC by the ‘GoodThinkingSociety’ (who profess to ‘encourage curious minds and promote rational enquiry’) for allegedly promoting the dangers of amalgam, misleading patients over the benefits of homeopathy and serving alcohol in the practice, and they are unrepentant about the outcome from the emails I have exchanged with them.  Why this case warranted a full hearing when we have false advertising attracting an unpublished warning in others is not obvious to me.  However, for reasons that evade us registrants who politely entertain patients with ‘alternative’ beliefs, a full hearing was considered justified.  The GDC scored the own goal this month by their appointed expert being shown evidence that changed his opinion at the last minute, and presenting a witness who maybe did not realise they were being engaged as a prosecution witness and seemingly blew the GDC case apart by being extremely supportive of the dentist at the centre of the hearing.  Aside from his obvious incredulity of being called as a witness (I think he may have written to the GDC to complain about the withdrawal of the 15cc of champagne on offer before an examination and then ended up being called) he told the panel that he could make his own mind up on what was good for him…….and if that was a small bottle of champagne before a check up, who are the GDC to say differently?  I am glad to hear that the residual champagne has now been consumed.  Cheers!

Finally, the statistics for May are:

Interim Orders held 17 new hearings and 8 review hearings resulting in:

Practice committees held 28 new hearings and 6 review hearings resulting in:

By registrant type, there were 46 dentists, 11 dental nurses and 2 dental technicians involved in hearings this month.  As far as I could see, only 5 registrants were not present and not represented this month.

?

Tony Jacobs BDS, dentist, publisher of GDPUK.com

Image credit -Fernando Butcher under CC licence - not modified.

As a GDP I am really struggling to focus on what my vote should be. So I have set myself the task of reading across the campaigns this weekend.

It’s a busy week, and you too need to do your final reading. If only this was vCPD eh? 

Well why not?    It’s clear that this affects your dental practice, so go reading, message me privately and I will send you a simple feedback document, and a certificate for vCPD. Allow 2 hours.

What is they say about a divorce? You must have a reason to go and a reason to leave.

Do we? Have we?

Here are your links for the Remain and Leave campaigns [also knon as the  “Innit” and  “Exit” !] and other information sources or repute.  If you read over these there will be lots of facts, and a degree of balance.  I have tried to avoid opinion.

https://leave.eu/

http://www.voteleavetakecontrol.org/campaign

http://www.strongerin.co.uk/

http://www.bbc.co.uk/news/politics/eu_referendum

http://www.telegraph.co.uk/eu-referendum/

http://www.theguardian.com/politics

EXIT  If at the end of this, you vote for the UK to exit, you will be lighting the fuse for the first cannon shot in a bloodless revolution.

No less, no more.  The aftermath will be a change in the political landscape of the UK not seen for centuries. Make no mistake, in the past, civil conflinct started over less.

REMAIN  If we vote to stay in, we will have the same group of leading politicians weakened by the arguments in the campaign, but a stronger case for lead influence in Brussels.  Perhaps a vote to remain is a vote for change we do not expect?

Polls

http://whatukthinks.org/eu/opinion-polls/poll-of-polls/

But if the polls are to be believed there is a groubndswell of decided opinion forming. Watch out - the UK electorate has a habit of suprising the pollsters.

If we do indeed vote to exit the political treaty that is the EU two things have to happen.

Firstly, the present political leadership must go.

Secondly, therefore, by any logic,  there must be a snap General Election.

And there begins 5 years hard work to re align our political and trading arrangement with the EU and the world, under new elected leadership.

And, guess what happens if we vote to remain?  Exactly the same.  UK politics will never be the same for this generation.

This is  a big job and on Thursday when you vote, you are not voting for no change.

You are voting for how you want the change to occur and when.

Should we lead from outside the EU and try and lead from within?

Whatever you do, Vote

Whatever you do, respect your neighbour and his or her opinions.

That right to vote is something we have taken for granted these last hundred years.

It’s a new privilege and a new right in many of our Eastern European neighbours home states

And good luck, friends and colleagues.

This really is a momentous event, in which you are free to both witness and partake.

Go use your your freedoms, as wisely as you can, and we will met on the other side.

It’s no secret that I’m firmly in the Remain camp.

Until recently, the EU was a largely irrelevant part of my life; something that is there, that I don’t need to worry about, that was barely noticed in the background. But the claims by those wishing to leave have turned passing indifference into passionate support.

I am strongly pro-free market, I believe in personal liberty, and in economic liberalism, but with fairness for all, meaning the removal of artificial barriers and monopoly trading. The EU has delivered this in spades; we know that if we buy Romanian pork, it is made (or rather should be) to the same standards as pork produced in the UK; we know that if we travel abroad, we will be treated according to over-arching laws.

The EU provides regulatory framework; it makes sense that where trans-national trade is concerned, the rules are arrived at through trans-national organisations. But we must also place human rights into the fray – it is not right that a company in one country can produce an item using labour that is forced to work 60 hours a week whereas another country can only allow 35 hours. Trade is increasingly globalised and our companies compete with companies from all over the world. What the EU promotes is a level playing field for all companies, allowing survival of the fittest, while ensuring that competitive advantage is not derived by transferring the costs from company to workers. If we all play by the same rules, only the strongest company will survive. If the rules are different, then one country can make their workers’ pay for the success of their businesses.

We also have harmonisation of regulations. This means that our companies have access to other countries’ internal markets that could otherwise be blocked through unnecessary or discriminatory legislation – perhaps the best example being the German purity laws, which created an artificial barrier for non-German beer to be sold in Germany. The EU forced Germany to remove these barriers for imports, and as a result, you can buy a can of Tennent’s Super in a supermarket in Bremen, should your fortunes be so unkind.

Britain has always been a trading nation, from the tea clippers in the days of empire, to the financial trading of the 80s and the digital marketplace of the naughties. We must remain relevant. We must modernise as life changes around us. We are better placed to trade as part of the EU, we are stronger in the EU and we share a bright future trading with our European brethren.

I have already voted to stay in the EU, not because of what I fear we will lose if we leave, but because of what we stand to gain by remaining part of the EU.  

Duncan Scorgie is a dentist practising in Midlothian

Image credit -Abi Begum under CC licence - not modified.

“Patriotism is the last refuge of a scoundrel,” stated Samuel Johnson.

We have seen England football fans with their aggressive displays of false patriotism, Nigel Farage with his “blokey” 1950s English image, both suggesting that the past was some sort of rosy era that we can head back to. The whole Brexit campaign smacks of a distasteful arrogance that the British are better than the continentals.

I am a Special Care dentist, and I remember being startled and gratified in equal measure to find that a profoundly autistic non verbal man presents exactly the same dental treatment challenges in Ireland as in France as in Greece.

Your non verbal autistic man has no concept of Brexit and Patriotism, but maybe he can teach us how shallow, ignorant and superficial our debate and thinking has become on this issue. 

I have many friends as dentists whose origin is from countries such as Bangladesh, India, Spain, Ireland, Italy and Greece. We have far more in common being dentists than our national and cultural differences divide us.

My late father landed in Normandy on D-day plus six, and often told me he never wanted to experience war again. The EU has many failings, but has kept the major players in Europe from warring with each other. That is why I would vote to stay in.

Neil Martin is a Special Care Dentist in Northamptonshire.

Image credit -Abi Begum under CC licence - not modified.

We must stay in!
We are the civilised and ancient democracy!
We must strive to exert change from within.
Our mistake was not joining at the beginning and before you start I know it was personal politics De Gaulle etc!

The whole argument has horrified me because...there are NO Facts just subjection!!!

I feel we are in a smaller world with more connections..why do I want to leave and become smaller??
I like my European family and think they have so much to teach US!!
We should be paying MORE because we are so lucky!
We should be caring for the less fortunate!
In fact I think that we should STAY BECAUSE IT IS RIGHT!!

Dr Alisdair McKendrick is a GDP in Northamptonshire.

Image credit -Abi Begum under CC licence - not modified.

Regardless of the outcome on this very important choice presented to the British public, it is unlikely that a seismic shift will happen. The UK will not collapse if it leaves the EU or decides to stay within. I fear a large amount of campaigning already underway and yet to come, is riddled with slick speeches oiled with dubious premises and unsubstantiated claims. Exaggeration and obfuscation are rife and even an alert and politically savvy observer will struggle to separate the wheat from the chaff.  

Image credit -Abi Begum under CC licence - not modified.

Social media is now part of all businesses marketing efforts but below you will find 4 reasons why using an online community as part of your marketing plan can also be extremely valuable.

Likes don’t automatically translate to more sales, so when using social media for your business you need to start measuring engagement - how often your audience is interacting with posted content and of course each other through your channel.

With Facebook, Twitter and Linkedin you are faced with a number of challenges, how do you get more visits to your page? Once they do visit, will users engage with a status update, or discuss content you have posted.

Online communities on the other hand, don't have an identity problem. Online communities are organised around clear defined goals and values. Imagine what an established online niche community offers to the business trying to reach a clearly defined audience. By engaging with a targeted community you are filtering out all the white noise and interacting directly.

So why can an online community be a valuable marketing tool for a business?

1. You are marketing your business to your actual target audience. Unlike social media, you know that the audience has interest in the content or message you are trying to get across.

2. When users use a community site, they are doing it for a particular reason, they are interested in the subject and want to learn or share information. There is no distraction of their favourite comedian or band also shouting for their attention. Reaching your audience in a targeted environment, means you can catch them when they are receptive to receiving your message.

3. Engaging on an online community can be risky but if you are seen to offer good service and advice, it will win you plenty of fans and impress the whole community. Communities dislike being sold to but they like being given good customer service and expertise.

4. Being seen to interact with a community that contains your potential customers is extremely important, online communities are a form of social media so marketing your business within a community needs to be a part of your marketing strategy. Anywhere your potential customers engage, has to be seen as a potential medium to increase sales.

Thanks for reading, please let me know your thoughts or get in touch to discuss things further.

Jonny Jacobs

Digital Dentistry Blog on GDPUK.

Motivation is funny old thing. What is that makes you get up and go to work? In amongst the demands of family life, most of us have to insert some productive hours to generate income to fund the lifestyle of our choice. So be it. But dark winters, both meteorologically and professional with persistent bad news, take their toll.

So as the days lengthen, the earth continuing to tilt on its axis, and the temperatures rise, notwithstanding the unusual nature of May snow !]  you feel the burdens of winter lifting. So let the sun warm your face and raise your spirits. It makes a change from rust and frostbite!

May and its adjacent months are the period of Dental Shows, and Conferences. The Dentistry Show in Birmingham, an acclaimed success, despite the fact that only 5% of the registrant population attend. Then the BDA Conference in Manchester takes place at the end of May and the LDC Conference 2 weeks later, in Manchester too. The Scots LDC Conference took place at the end of April.

These events are a chance to catch up, network with colleagues, and begin to feel good about your profession.  Feel the draw of the latest technologies and equipment, dream, perhaps plan, the next big step in your professional life.

It’s not too late to drop into the BDA Conference and call your Representatives to account. 130 Sessions over 3 days. The link is below.  Manchester in May? Blazing sunshine, darling.  If you have not been, give it some thought. Motivate yourself.

Forgiveness is motivating ?

Motivation in its widest sense might mean, for example, that past misdemeanours of our lead regulator fade into a forgiving memory. Sadly recent events mean I cannot avoid mention our old muckers, the "Wimpole Street Stasi".

Spare a thought for the situation of our colleague Dr David Lee, whose wellbeing and reputation have been unnecessarily tested to breaking point by an FtP Hearing at the GDC which was not just thrown out, but was found so wanting that there was NO CASE TO ANSWER. In other words the GDC simply drove an FtP case on a spurious basis.  I urge you to read the hearing while you can, and gasp in anger and sympathy that such events can even be commenced, let alone taken to this £1/4M expensive debacle.

The GDC Chairman, Dr William Moyes, has only last week had the gall to stand up at the Scottish LDCs meeting [linked here to a GDPUK thread] and state that  he is not resigning because, in essence he is part of “The Solution”.  So much for accountability for his Councils distinct lack of proper oversight.

Dr Moyes may be part of some perverse Final Solution but I am not sure that is part of what he has in mind.

For me and my colleagues such as Dr Keith Hayes it is a motivating feeling to think that Dr Moyes is still in post and still does not get it.   Time for a Spring clean? 

So does motivation really increases your capacity to forgive or does it merely allow you to feel justified in moving on in respect of matters about which, in truth, you can do little?

“Whatever, no worries” becomes your daily Gallic shrug.  It’s sunny and the days are long, do I care?

Good job really if you are NHS funded.... Read on ...

Lost you way? You’re not the only ones…

The perils of the all new, singing and dancing Government computerised support in the form of Compass is just ‘one of those things’. Oh for a paper FP17 – oh wait they have changed them, slotted in some extra data collection but failed to print them in time. Online advice on their filling-in is there – but no FP17 other than a sample version!  So use the old ones for now – which Compass of course cannot process properly!

The stories of struggles with Compass are now becoming more than irritating – it is beginning to feel like the software has not been properly specified and it may, if the present shambles is anything to go be, be at least one financial year before all the errors and omissions are corrected. Indeed, Compass and its pointed failures  have been a feature a long thread on GDP UK recently if you have not read it.

Meanwhile, if you are spinning your Compass to see which way it points, Good Luck!   You are not alone…  This was a Government Spring Clean which does not appear to have worked well.

CQC – Motivating better regulation

On the other hand, compliance is never an easy activity. Let’s face it we are all dragged to the altar screaming. The CQC, in particular now they have Dr John Milne in a leading role, barely a year after his Chair of the BDAs GDPC ceased, are actually evolving fast and well and now leading the future of Regulation in the wider sense.

Not only are their processes actually evolving fast and being targeted where needed, but they are dragging all the regulatory participants to the table to sort out who does what.

They are to be congratulated for their initiative, “The Future of Dental Service Regulation”  a punchy, pleasantly  brief document that has great potential to change dentistry for the better. Read it here.

You can take part – so go to the links and get your say in. It will make you feel better.  The CQC are looking increasingly like an effective strategic ally of the Dental Profession, with scope to act where the Professional Services Authority [PSA] lack the teeth.

Now that feels better!!

The weather? Yeah, motivating, isn’t it?

Good job everything else in life is a motivating force for good.

It seems that some of the leading agencies upon which we depend could do with a Spring Clean.

Where shall we start?

Have great one.

LINKS IN DETAIL

SPRING MEETINGS

Dentistry Show http://www.thedentistryshow.co.uk/

BDA Conference https://www.bda.org/conference

LDC Conference http://www.ldcuk.org/

GDC

GDC Case – Dr David Lee https://www.gdc-uk.org/Membersofpublic/Hearings/Determinations%202016/LEE%20PCC%20Determination%20-%20April%202016.pdf

LDC Scotland Moyes encounter https://www.gdpuk.com/forum/gdpuk-forum/thoughts-on-an-encounter-with-dr-moyes-22119

Dr Keith Hayes  http://www.rightpath4.com

COMPASS LINKS

GDPUK Compass thread https://www.gdpuk.com/forum/gdpuk-forum/compass-21660

FP17 R9 Guidance http://www.nhsbsa.nhs.uk/Documents/DentalServices/Completion_of_form_guidance_-_FP17_-_England_(V5)_-_11_2015.pdf

FP17 R9  sample form http://www.nhsbsa.nhs.uk/Documents/DentalServices/20160216_FP17_Proof_Sample.pdf

CQC

Consultation on Regulation: http://www.cqc.org.uk/content/future-dental-service-regulation

The Document http://www.cqc.org.uk/sites/default/files/20151207_future_dental_service_regulation.pdf

Welcome back. I think Easter if officially over, just watch the traffic next week!

Your regulator, the GDC, is trying make the news again.  Perhaps in that ironic respect, it is very successful.  I suggest the smell is not good.

However, perhaps not in in the way it might be hoped. The GDC is spinning the facts to serve its own interest. Again.

You remember the GDC?

It’s that organisation for whom you pay the best part of £900 per year as a work tax.  If your business also funds your staff registration, you will be paying well over £1000 per year. 

It’s that organisation, paid for by you, that squanders money on frippery and self-serving PR, accountancy consultation and £9M building expenditure.  Prudent management of other people’s money is not part of its remit, it would seem.  Your money is used in part for its role as a World Class Complaints Agency [remember all those outrageous FtP cases? …  they are still coming through!].

Seconds away … Round 4  -  Dentistry versus the GDC

It is the latest bleating of the Chairman that should catch your eye and stir your loins with a sense of disbelief and injustice. It certainly has for the BDA [ are you a member - £30 a month for the fighting fund, get on with it!] who have returned to the ring for another fight.  We can but hope that Big Mick is aiming to knock over Chairman Bill and obtain the final ‘fall’.

If you have not taken great interest so far, I am sorry to lean on you again, but please – without YOU taking a simple action, nothing will happen.

As a wet fingered GDP, you CAN make a difference.

The BDA alone cannot clean the stable on your behalf.  The smell and the excrement remain, and it “All hands to the brooms”

Why all the fuss?

You will, I hope, have noted the PSA Report before Christmas.

Finally some three months later Dr Moyes, Chairman of the GDC sticks his head over the parapet. Writing in his Blog, you could take a rosy view of the world in Wimpole Street. This Blog is seemingly the first of many. Boy, I look forward to those … the excitement is too great.

I suggest to you that these are the words of a professionally dying man.  If you read the minutes of the 3 March 2016 GDC Meeting, to which Dr Moyes makes reference, it is clear that the Executive Management Team [EMT] of the GDC have been explicitly humiliated so that the Council can remain in post.

What's the problem?  This is the problem:

• The Council of the GDC have completely washed their hands of any responsibility.
   
• There is no mention anywhere of the failed oversight of the Council
   
• The Council have abjectly failed and yet remain in complete denial.
   
• The Council have been explicitly criticised to an unprecedented level by external bodies from the PSA to Parliament, and yet they hold their heads in the air singing “La La La”.

The BDA are to be congratulated for shovelling more coal on the fire, but I think more is needed yet.

If you know a Council Member, ask them why they have not resigned? If you know of them, write to them and ask them the question.

What "Point of Principle" causes them to stay?

Dr Moyes may think he has got away with it but I think we must all prove him wrong. So very, very wrong.

Until this Council are forced to resign en-masse, nothing will change because it was Dr Moyes and his merry band of Members that oversaw the woeful actions of Ms Gilvarrie, and it is the GDC Council which will design the Job Spec for the new CEO.

If you mix your cake with a poisoned spoon, the cake will always be poisoned.

The GDC have fallen  - The political referees should end it now

The Council of the GDC should resign. The Chairman should already have gone. It is an amazing arrogance of unholy magnitude that he and they have not.

Whom should be first?

It is clear the Chairman has the skin of a rhino and so it is down to the Council to consider their positions based upon the principle of what is right.

Your profession needs your help. Support the BDA. Write to your MP. Write to the Registrant members of the Council. Phone people.

JUST DO SOMETHING

DO NOT BE SILENT.

There is a sense that the BDA have started the final round. You need to shout and holler’ your support.

May all of you have Spring in your steps.

https://www.bda.org/news-centre/press-releases/Pages/New-era-at-GDC-comes-with-0.5-million-cleaning-bill.aspx
BDA: ‘new era’ at GDC comes with £½ million cleaning bill

https://www.bda.org/news-centre/press-releases/Documents/Mick-Armstrong-Bill-Moyes-letter-01-Apr-16.pdf
Mick-Armstrong to Bill Moyes letter 01 Apr 16

https://www.bda.org/news-centre/press-releases/Documents/BDA-GDC-FOI-response-18-Mar-16.pdf
GDC response to BDA FOI request

http://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/Bill-Moyes'-Blog;-Learning-the-lessons-of-the-past.aspx
Bill Moyes' Blog; Learning the lessons of the past

http://www.gdc-uk.org/Aboutus/Thecouncil/Council%20meeting%20documents%202016/20160303%2005%20-%20PSA%20Investigation%20Report.pdf
GDC Council Meeting 3^rd March 2016 Discussion about the PSA

https://www.professionalstandards.org.uk/docs/default-source/psa-library/investigation-report---general-dental-council.pdf?sfvrsn=6
A report on the investigation into the General Dental Council’s handling of a whistleblower’s disclosure about the Investigating Committee
21 December 2015

Spring is finally here, but with it comes the first wave of new UK legislation for 2016.

So what key changes do you and your practice need to be aware of?

National Living Wage. From 1^st April 2016 any worker who is 25 years old or above will be entitled to the National Living Wage, which is initially set at £7.20 per hour. The National Minimum Wage will continue to apply to workers under the age of 25. In addition, the penalty for employers who fail to pay the minimum amounts to workers has doubled from 100% of the underpayment to 200%. This, along with the introduction of Pension Auto Enrolment (which for many practices is due to take effect this year), will mean further increases in the cost of running your business. There is therefore little comfort in the 1% pay rise announced by the DDRB (for more on this see below).

Apprenticeships. As part of the Government’s drive to create more apprenticeships for young people, they have abolished the requirement on employers to pay NIC for apprentices under 25. This comes into effect from 6^th April 2016. In addition, although not yet in force, the Government wants to ban organisations from using the term ‘apprenticeship’ unless it is a statutory apprenticeship. In order to be a statutory apprenticeship, there are certain legal requirements that must be met.

Zero Hour Contracts. It is unlikely that these contracts are common within in the dental community. However, if you do employ staff on a zero hours contract, for example bank nurses, if those contracts contain an exclusivity clause, stating the employee can only work for you, the employee can now seek redress against unfair dismissal and detrimental treatment following a breach of such a clause. 

Hazadous Waste. From 1st April 2016 dentists in England, who produce or store waste of 500kg or more per year, will no longer have to register with the Environment Agency. Dentists in Wales still need to register with Natural Resources Wales. This will mean slighlty less adminsitrative paperwork for dentists in England. 

Immigration. From April 2016 tier 2 skilled workers from outside the EU who have been in the UK for 5 years or more must be earning £35,000 or above to remain in the UK. This will not affect workers on the Shortage Occupation List, such as nurses, but could affect teachers and IT workers. 

Pension. From April 2016 there will be a new flat rate pension; as opposed to the lower basic rate pension and secondary and additional payments. 

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

TEXT TEETH TO 70660 TO DONATE £5

Plus your standard network rate

www.dentaid.org/get-involved/fundraise

My previous post about stress was posted here on 28 January. This time, I’m attacking (more accurately, sneaking up on) stress from a different angle. And I’m starting by going back in time. Way, way back to pre-CQC. It seems prehistoric man suffered stress, would you believe? And guess what – we know it from their teeth! In 2010, George Armelagos, an anthropologist from Emory University in the USA, discovered enamel defects in teeth dating back one million years indicating that, ‘During prehistory, the stresses of infectious disease, poor nutrition and psychological trauma were likely extreme.’ This stress reduced life expectancy – remains from Dickson Mounds, Illinois, showed that individuals with teeth marked by early life stress lived 15.4 years less than those without the defects.

So is stress bad then?

Not necessarily; read on. According to the Mental Health Foundation: ‘Some stress can be positive. Research shows that a moderate level of stress makes us perform better. It also makes us more alert and can help us perform better in situations such as job interviews or public speaking. Stressful situations can also be exhilarating and some people actually thrive on the excitement that comes with dangerous sports or other high-risk activities.’ The Foundation does point out that stress is only healthy if it is short-lived.

Stress causes a surge of hormones to better help you deal with ‘fight or flight’ situations. According to NHS Choices: ‘Once the pressure or threat has passed, your stress hormone levels will usually return to normal. However, if you're constantly under stress, these hormones will remain in your body, leading to the symptoms of stress.’

How much stress is normal?

Now we come to the science – specifically the Depression, Anxiety and Stress Scale (DASS). This is a self-report questionnaire whereby you answer questions, add up the score and convert these to severity ratings for depression, anxiety and stress. There are two versions – DASS and DASS 21. The former has 42 questions, the latter 21 (so you multiply the scores by two). Ignoring depression and anxiety for the purposes of this article, the severity scores for stress are:

·        Normal 0-14

·        Mild 15-18

·        Moderate 19-25

·        Severe 26-33

·        Extremely severe 34+

DASS is not a diagnostic tool. If you are feeling anxious, depressed or stressed, you should see your GP – even if you get low DASS scores. However, if you wish to get some idea of how stressed you are and so gauge whether it could be considered healthy, go to https://www.cesphn.org.au/images/mental_health/Frequently_Used/Outcome_Tools/Dass21.pdf for DASS 21 (remember to double your scores for the full DASS severity ratings.

No added stress

In my previous post, I urged you to stop putting stress on others – particularly colleagues and staff in your practice. Now we see that some stress is normal and may well be beneficial. So does that contradict what I wrote before? Not at all. Yes, some stress is normal and healthy but so very few of us lead completely stress-free lives that we need added stress at work. Relationships, health, family obligations, household maintenance, cars, money worries all cause stress. Many of us are also good at getting stressed about things that haven’t even happened yet! So who are you to add to the stress of your colleagues or staff and maybe move them from normal to mild, moderate or severe on DASS?

Stress as a management tool?

Excuse me? Think twice (or more) before you decided to ‘push’ members of your team to make a greater effort. It is far more effective to motivate people to work more effectively or efficiently. People work best through their lunch hour when they don’t hold a grudge at you demanding it but because they genuinely want to get the patient records up to date.

As a manager you should be familiar with the theory of psychological type as introduced by Jung and the Myers-Briggs Type Indicator – so you know how to get the best out of each member of your staff.

This is a topic covered on my courses – come and find out.

Image credit -Bottled_Void under CC licence - not modified.

Capacity

In our last blog we considered the importance of patient consent. One of the key elements of valid consent is the patient’s capacity to give that consent and the Mental Health Act 2005, which came into force in October 2007, deals with all issues surrounding mental capacity.

First and foremost the Act imposes a duty on all healthcare professionals to have regard to the Mental Capacity Code of Conduct. It is therefore important to read and understand this document when considering whether a patient has capacity to provide consent.

Capacity  
 
A person lacks capacity if:

1. They have an impairment or disturbance (for example a disability, condition or trauma or the effect of drugs or alcohol) that affects the way their mind or brain works; and
2. That impairment or disturbance means that they are unable to make a specific decision at the time it needs to be made.

It is very important to note that capacity is to be assessed at the time the specific decision is required. Therefore, a patient may have capacity to consent to some treatment but not to others, or may have capacity at some times but not others.

Under the Act you must assume the patient has capacity unless you can establish that they do not. And simply because a patient’s decision to refuse treatment is unreasonable does not mean they lack capacity.

Assisting Those Who May Lack Capacity

If you are unsure whether a patient does lack capacity, all practical and appropriate steps should be taken to assist the patient in making the decision before you determine they actually do lack capacity. This will mean changing the way you provide information to the patient; giving the patient all alternatives to treatment; considering whether there is a time in the day they have more understanding to make the decision.

Best Interests of the Patient

Under English Law no one is able to give consent to the examination or treatment of an adult who lacks the capacity to give consent, even parents, relatives and healthcare professionals. The exceptions to this are where there is a Lasting Power of Attorney or a court appointed deputy.

However, the Act protects healthcare professionals from civil and criminal legal liability if treatment is provided in the patient’s best interests. The Act states that you must take the following steps before acting in the patient's best interests:

1. Consider whether the person is likely to regain capacity and if so whether the decision can wait:
2. Involve the person as fully as possible in the decision that is being made on their behalf;
3. As far as possible, consider:

• the person’s past and present wishes and feelings (in particular if they have been written down).
• any beliefs and values (eg religious, cultural or moral) that would be likely to influence the decision in question, and any other relevant factors.
• the other factors that the person would be likely to consider if they were able to do so.

         4. As far as possible, consult other people if it is appropriate to do so and take into account their views as to what would be in the best                         interests of the person lacking capacity, especially:

• anyone previously named by the person lacking capacity as someone to be consulted.
• anyone engaging in caring for or interested in the person’s welfare.
• any attorney appointed under a Lasting Power of Attorney.
• any deputy appointed by the Court of Protection to make decisions for the person.

      5. For decisions about serious medical treatment, where there is no one appropriate other than paid staff, healthcare professionals have to              instruct an Independent Mental Capacity Adviser

      6. If the decision concerns the provision or withdrawal of life-sustaining treatment, the person making the best interests decision must not be            motivated by a desire to bring about the person’s death.

Assessing whether a patient has capacity will be a balancing act. You will also need to bear in mind your duties to treat patients with dignity. This may therefore lead to difficult situations; remember to take notes of any decisions made as this will later assist if any queries are raised.   

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Ever since humans started to trade with themselves there has always been the need for them to feel that have got a bargain in some way. It’s human nature to actually feel like you got something worth more for less than you needed or intended to pay, and as such that drives many businesses in a constant battle to attract customers by offering bargains.

There’s a simple explanation for value in any transaction.

• If you pay a lot for something that’s poor quality it then it’s a rip off.
• If you pay a lot for something that is high quality then that is acceptable (and even possibly exclusive)
• If you get something that is poor quality for a low price then that’s called cheap.
• If you get something that is high quality for a low price then that’s a bargain.

Everybody loves a bargain. That’s why sales are so popular all the time, trying to get people to spend money they don’t have on products they don’t need. You only have to look at Groupon and Wowcher to see the type of offers that are touted on there. This is not necessarily a problem in the consumer driven world that supermarkets and retail stores operate in, but caveat emptor is the mantra that we should all employ when looking at this type of trading. Its also the way that our Beloved Chairman would probably like to see in his Red Book of ‘How the Dental market should evolve’, at least according to his now infamous Pendlebury Lecture.

The problem with this of course is that there isn’t a particular need to have ethics in those kind of industries that can price cut and offer heavy loss leading deals in order to get people through the doors and then upsell. It also usually involves already cheap products, or those with artificially hiked prices then given a huge discount, to con the buying into thinking they are getting a bargain.  

The reason for this is if it appears too good to be true, then it probably is (for someone). There stories galore of businesses that have almost or actually imploded due to a demand that they didn’t foresee when offering a ‘too good to be true’ deal. One of the most famous was the Hoover free flights promotion in 1992. Due to a huge surplus of electrical products they needed to sell, they came up with the offer of 2 free round trip tickets to destinations such as America. Somehow they failed to realize that offering tickets that were worth well in excess of the product they were trying to sell (the qualifying purchase only needed to be over £100) would result in an overwhelming demand for their products and hence the tickets. The court cases took until 1998 to settle, and cost Hoover an estimated £50million pounds. It would probably have been less costly for Hoover to scrap the products they needed to sell rather than to retain their market share. They were big enough to survive, but not everyone would be so lucky in a similar situation.

So what has this got to do with dentistry? Well, there has been an increasing trend to offer these kind of deals to entice patients into practices which are probably too good to be true. It’s a matter of contention that this is how some mixed practices operate, by offering certain NHS items to patients and then upselling the options that ‘aren’t available’ on the NHS. Even after 10 years of the new contract I am still struggling to understand the concept of how offering an NHS exam but having to see the hygienist privately works within the contract, and no one at all has yet presented an argument to me that convinces me this isn’t just a form of upselling by getting the patient in on the pretext of NHS treatment and then providing a private upgrade. Whilst business survival is paramount in dentistry in the same way as any other business, some often seem to forget there is a higher ethical plane that dentistry must lie on when running our businesses.

People outside dentistry don’t often get this, and one of those appears to be Mr Moyes, but also there is an increasing amount of people within the profession itself who have, shall we say, ‘flexible’ ethics when it comes to the upselling game and marketing in general, and who seem to forget what it means to be part of a caring profession. Is it any wonder that some GDC cases have an accusation that the financial motivation of the registrant one of the reasons the case is being heard?

Marketing is vital to the survival of dental business, but not at the expense of our professionalism, which is inextricably linked to our ethical compass. Something those who sit on the outside of our profession seem to forget. With the increase in non-registrant owned corporate practices, we have some people who see dentistry as just another business and apply the same rules to it as would be more appropriate for a supermarket. They however don’t run the same risks as those who are regulated do. 

A recent example would be that of the clinics in Manchester and London offering deals on limited outcome orthodontics through Groupon. These clinics now appear to have gone to the wall leaving patients who have paid for treatment up front out of pocket and a significant number of them now facing the prospect of paying more for the completion of their treatment. What their perception of the profession will now be can only be guessed, but it isn’t likely to be good.

And then we wonder why as a profession we get bad press, and are labelled greedy dentists. Even the GDC have got something right recently in the warnings about the use of things like Groupon to promote dentistry. That does actually seem at odds with the beliefs of their consumer-rights driven Chairman. It will be interesting to see how this situation develops, since there is likely to be little or no regulatory comeback against the owner of these clinics, but the full weight of the GDC may be felt by the registrants who were involved with the treatment of those affected.

Selling a product for a price far less than it costs elsewhere will attract people who are after a bargain. Restored implants for £795? Orthodontics for £995? Is it all part of a mechanism to draw people in and then upsell using crass pseudo ‘ethical’ selling (that potentially doesn’t even meet with the requirements of Montgomery let alone those of the GDC) to actually get the purchaser to buy something that actually profitable rather than the offer? But this isn’t a pocket money purchase, and these patients are likely to be attracted by the ability to have something they thought they couldn’t afford. So the business model of upselling is not necessarily going to work, as these patients might not be able to afford a bigger investment. There is then an exceptionally fine line between your bargain purchase becoming a rip off because it doesn’t turn out to be what it was promised to be. Anecdotally, purchasers like these are often the ones who have no particular loyalty to a practice and are shopping on price alone. The same ones who are usually well aware of how to use social media to destroy a reputation, and then take further legal action….

It doesn’t matter that these people will now maybe only end up paying roughly the same as it would have cost to have the treatment provided by a different practitioner in the first place; they have been misled into thinking they could afford something that they wouldn’t normally be able to and their bargain has now become a rip-off. The point is these people have suffered at the hands of our profession and we will all pay the price for that eventually. The owner of the clinic involved appears not to be a registrant, and the business model used to draw people in means that both the clinic and Groupon are likely to have been paid up front which improves their cashflow. But surely the ethics of this type of business are not those of a caring professional? Pile ‘em high and sell them cheap whilst upselling to a customer might work in some industries, but dentistry has the subtle difference of being driven by a core ethical requirement to do the right thing FOR THE PATIENT. With the change in the rules that allowed the increase in corporate dentistry and non-registrant ownership that had been restricted since the 1920’s, one could argue that the good old days were actually better for both the patients and the profession. Were ethics and professionalism more in the forefront of the profession those days?

Whilst all this is an example of what has happened in a case where a non-registrant is involved, I think there are probably registrants who should be taking a long hard look at themselves, possibly both individually and as members of corporate organisations.

I’m afraid that I for once agree with the GDC over their warnings of involvement with this kind of marketing practice.

This is a race for the bottom financially, but more importantly ethically, that I for one am not going to compete in.

Image credit -Gordon Joly under CC licence

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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!