As a kid, I was scared of riding on the pavement. I lived in the middle of Birmingham and there were always beat policeman around. One evening, I cycled back from Scouts. It was quiet and there were few people about. As I reached my home – on a busy main road – I experienced a sudden surge of bravado and chanced cycling across the pavement to my door, when a copper emerged out of nowhere from an off-licence. He gave me a five minute dressing down regarding how I was endangering human life and how I had disgraced my uniform.

By Chris Tapper

Six years ago, I attended a two-day residential course. It was a CPD course I hasten to add, not the usual anger management or ‘appropriate behaviour in the workplace’ type of thing I used to have to attend before they found the right tablets for me.

Anyway, it was very interesting, although I freely admit I never put a single thing I learned into practice – mainly because the dental corporate I work for wouldn’t shell out for the equipment I needed unless I could produce a business plan that proved I could earn them at least a tenner for every quid they invested. But that is by the by.

On the evening of the first day (a Friday if I recall correctly), the ten participants plus the lecturer and two representatives of the sponsoring company, enjoyed a meal in the hotel where the course was being held. After a very pleasant starter and main course, I moved to where a gaggle of four youthful dentists were sitting and enquired as to where they were in terms of their careers. It transpired that all four had graduated from the same Northern dental school and had all been qualified roughly two years. They were all general dental practitioners and had all taken up associateships in NHS practices.

As the most experienced dentist on the course – actually, why mince words, the oldest – I was interested to see if the youngsters were enjoying their chosen profession so far. I think I was trying to vicariously re-establish myself with my early enthusiasm for dentistry.

I posed, what I felt, was a fairly innocuous question to the group:

"How’s it going?"

One female dentist confessed that she cried every night when she arrived home from work, and sometimes did it during surgery sessions. One of the males said he was so anxious about work that he threw up most mornings and that brushing the lingual aspects of his teeth was impossible, while the other female said she had trouble sleeping and had been put on antidepressants six months earlier.

Perhaps the most troubling response was from the other male, who confessed that he had on a number of occasions, thought of ‘ending it,’ having realised that he had made a dreadful mistake in going into dentistry, and couldn’t see any way out. My concern for him diminished a little when I saw that he had an incredibly healthy appetite, demolishing his own rhubarb crumble and a female colleague’s lemon sorbet in less than three minutes.

When I questioned them more closely, the reason for their universal despair was not down to the pursuit of ridiculous UDA targets or the student debts they were saddled with, but the fear of dental litigation.

All four were constantly worried that they would see their careers end either in a GDC meeting, or more likely, through the bad publicity and financial ruin brought about as a result of a civil action facilitated by a dental litigation firm. They felt that the chances of those events happening to them were high, since one of their fellow students had already found himself in the middle of litigation as a result of an NHS root-filling having not worked.

Now that was six years ago, and I would argue that since then, the UK dental profession has slipped into a febrile anxiety that I have never previously witnessed in the 30 years or so that I have been working in dentistry.

Never have I seen dental colleagues (and even strangers) so jaded and so preoccupied with fears of dental complaints and ‘the dreaded letter’ from a certain Northern dental litigation firm.

I will freely accept that I have no scientific evidence for my observations and that my views are based purely on the empirical, but I personally know of no dentist who has not recently entertained thoughts that a patient might ‘turn legal’ if the wind blows the wrong way.

Over the past 18 months, I have been offering support to a close young colleague, being pursued by an extremely aggressive young solicitor (she IS young, I looked her up) who is alleging ‘negligence’ after her client developed dry socket after a routine extraction of an upper first molar. Rightly or wrongly, my colleague decided she did not want to consult her defence organisation and so I have been (rightly or wrongly) equally aggressive in demanding expert witness or consultant reports in support of their absurd claim. So far, the solicitor has failed to provide any evidence of negligence or give any reason why an expert assessor’s report has not been provided. All I know is, it has been fun ‘having a go’ back, but it to me illustrates a sad fact – nobody in the UK-based dental profession is safe from opportunistic punts from patients who want to make a quick quid from the no-win-no-fee mob.

A few months ago, a solicitor I know told me that during a local meeting of his legal colleagues, a speaker said that a lucrative and growing new source of business was dental litigation and that it was “something to think about” since the clampdown on spurious ‘whiplash’ claims and ‘Benidorm Belly’ – where package holiday tourists claim compensation for stomach upsets caused by dubious calamari and fries - had resulted in less opportunity for successful claims.

Recent experience has taught me that dental litigators are a tenacious and avaricious species and are unlikely to give up easily on an area of medical law that they consider to be easy pickings. Certainly, according to my legal friend, lawyers see it as a much easier area to be successful in than medical litigation.

Soon, the cost of dental defence subscriptions will be prohibitive to viable practice, and the profession, once all our European colleagues go back home, will find itself unable to cope with patient demand. What is the answer? Your guess is as good as mine.

Until then, I am going to have a rhubarb crumble and some sorbet.

John Grant of Goodman Grant Solicitors explains the difficulties that NHS orthodontists may encounter when the time comes to sell their practice…

It is often the case that the majority of NHS orthodontists will have a Personal Dental Services (PDS) agreement rather than a General Dental Services (GDS) contract, which, unfortunately, can make it difficult for a contractor to sell.

This is because PDS contracts are time-limited; at present, the longest contracts are being renewed for three years. While LATs are likely to grant this, there is nothing obliging them to do so. Indeed, if an LAT were to decline a renewal request, there would be nothing an orthodontist could do.

The second issue is that, unlike GDS contracts, PDS contracts cannot be transferred  using the partnership route . Since 2006, NHS practices have been bought and sold by introducing a partner to the contract with the seller subsequently retiring – resulting in a  smoothish transition from one principal to the next. As this is simply unavailable for PDS contracts, on the face of it they are unsalable.

In 2006, there was a change in the law that allowed dentists to incorporate their businesses. After years of uncertainty in 2013, NHS England introduced its incorporation policy – effectively making incorporating possible – if by no means guaranteed. For orthodontists, this created the opportunity for the sale of their contracts: by transferring the practice’s assets, including the NHS contract, to the limited company. Then, by selling the shares in the company  the value of the practice could be realised.

Nowadays, however, the LATs’ attitudes towards incorporations have changed. More and more often, they are requesting tangible benefits – and the focus tends to be on the patients. Typically, their requests manifests as a request for extended opening hours; a recent case saw an incorporation application denied because the practice refused to commit to more than an extra hour a week, showing how stringent the LAT can be in this regard.

Of course, assuming the LAT does agree to the incorporation in principle, the problems for the contractor will not suddenly cease. At this stage, the LAT will produce a Deed of Novation – which operates to transfer the NHS contract to the limited company. Included in this document are two sections of which practitioners must be particularly aware.

The first is that the LAT will require a guarantee from the contractor that the contractor will personally guarantee the performance by the limited company of the NHS contract. This does not represent a problem whilst the contractor holds the shares in the limited company – it places them in no worse position than they were prior to incorporation. Complications arise, however, after the sale of shares, due to the way in which the deed is drafted unless amended the personal guarantee will continue even after the contractor has sold their shares.

Secondly, a Deed of Novation will include what is known as a change of control clause, which subjects any transfer of shares  of 10% or more in the Company (which obviously will be the case on a sale)  to the approval of the LAT. This essentially puts the decision as to whether the principal can sell in the LAT’s hands – and if they were to refuse it would be extremely difficult to challenge that decision.

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

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

www.goodmangrant.co.uk

A NASDAL and ASPD MEMBER

A Tesco store recently made the headlines when an employee posted on Facebook about how the company had gone above and beyond contractual obligation to provide her with the facilities to breastfeed her new baby in comfort and privacy.
 

The feature truly highlighted how important it is to offer support to new mothers at this important stage of parenthood and Tesco has been rightly praised for its efforts. Unfortunately, however, there are just as many cases that show the opposite – from mothers who have been asked to leave restaurants or other public spaces or who have been shamed into thinking that breastfeeding in public is taboo.
 

Of course, breastfeeding is protected by law – from as far back as the Sex Discrimination Act of 1975 which stipulates that breastfeeding mothers should not be harassed or discriminated against in any situation. This has been reinforced more recently in the Equality Act, 2010 which clarifies that a business must not treat any woman who is breastfeeding unfavourably. Indeed, employers must be aware of these stipulations, since they are required, by law, to provide adequate facilities for breastfeeding mothers.
 

Dental professionals must be particularly considerate of this. In many dental surgeries, space is a rare commodity, so ensuring that there is enough room for a breastfeeding mother – either employee or patient – to rest may be more difficult. The allocated space must be comfortable, private and be large enough to allow the individual to lie down.
 

Other than the requirements to regularly risk-assess the working environment, however, there is no legal requirement to conduct a specific separate risk assessment for a breastfeeding individual – but a prudent employer may wish to do so, to best provide an environment which is safe and comfortable.
 

Employers are not required to provide specific areas in which breastfeeding or expressing can take place, nor do they need to provide paid breaks for this purpose. But they must be aware that sometimes the staff room or the waiting room will be inadequate and the toilet facilities are simply inappropriate to breastfeed. Importantly, they must remember that under the Equality Act they cannot provide a service on different terms; meaning you cannot ask a breastfeeding mother to sit somewhere different than your usual waiting room unless there is a safety concern – so it is better overall to make provisions for a comfortable area which meets the specific legislative requirements to avoid any complications or potential dispute.
 

Not only will this be in keeping with current laws, it will be an effective way to show your support for new mothers – and this can be a particularly powerful tool. Whether it’s online or in person, new mothers will certainly discuss different service environments – your dental practice included – and if you are providing a comfortable, caring environment for them and their babies, they will most likely tell their friends about it. As a way of attracting new patients, new mothers may be a positive place to start.
 

In this regard, providing appropriate areas for breastfeeding mothers is simply the start – there is a myriad of other opportunities for you to take to strengthen the relationship between your business and new parents. Providing information can be another powerful way of doing so. For example, did you know that is has been show that breastfeeding a child will significantly reduce the risk of dental caries, malocclusion and fluorosis – it is also suggested that breastfeeding will promote optimal jaw and tooth development.[1]
 

There is also a helpline available in the UK to check the suitability of certain drugs for breastfeeding mothers; Drugs in Breastmilk helpline is contactable through 0844 412 4665 and is an effective way of staying up-to-date on behalf of your patients.
 

Similarly, it is worth making it clear that mothers are exempt from patient charges under the NHS whilst they are pregnant and throughout the first year of their child’s life.
 

Taking these steps is a great way of providing an excellent service to everyone – offering effective information as well as a comfortable, appropriate environment for breastfeeding patients and employees will certainly attract positive comments, just as Tesco enjoyed recently.
 

Goodman Grant Solicitors are the lawyers for dentists in the UK. With nationwide offices and an expert team, they understand the specific issues that dental professionals are beset with on a daily basis. If you need assistance with any of the legal aspects of running a dental business – from how to best cater to breastfeeding mothers to incorporation or employment contracts and tribunals – they can help. As both NASDAL and ASPD members, they know precisely what dental professionals need to run an effective business and will assist in a positive, friendly manner.
 

Do not risk alienating breastfeeding mothers – make sure you take the right steps to ensure you accommodate their needs just as you would any other.

Nicola Lomas Goodman Grant Lawyers for Dentists

For more information call Nicola Lomas on 0151 707 0090 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk
NASDAL and ASPD MEMBERS