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Promises, promises; can anyone really save the NHS?

With days to go before the UK once again goes to the polls and a large number of voters still undecided on how to cast their vote, there is still a huge amount to play for in the General Election 2017. The handling of the NHS is critical to any party’s success, so we have scrutinised the Conservative, Labour and Liberal Democrat’s offerings in the lead up to June 8th. If you don’t have the time or energy to trawl through hundreds of pages of manifesto pledges, read below for a helpful summary of NHS commitments.

The Commitments

 

The Conservative Party

 

1.       A commitment to the founding principles of the NHS; a service that meets the needs of everyone, based on clinical need not ability to pay and care should be free at the point of use.

2.       Spending will be increased by £8 billion in real terms over the next 5 years.

3.       Create a “truly seven-day healthcare service”, with GP weekend and evening appointments for all by 2019. Hospital consultants will be supervising patients every day, with weekend access to key diagnostic tests.

4.       Current 95% A&E target and 18 week elective care standard will be maintained.

5.       Prioritise during the EU negotiations that the 140,000 staff from EU countries “can carry on making their vital contribution to our health care system”, whilst continuing to invest in training medical students. Will encourage and develop new roles and create a diverse set of potential career paths for the NHS workforce.

6.       The most ambitious investment in building and technology that the NHS has ever seen, to ensure that care is delivered properly and efficiently.

7.       The NHS will become a “better employer”, strengthening the entitlement for flexible working and introducing better support services for employees.

8.       To implement the recommendations of the Accelerated Access Review to make sure that patients get drunk treatments faster, whilst ensuring value for money for the NHS.

9.       GPs will be expected to provide greater access, more innovative services and offer better facilities. A new GP Contract will be introduced.

10.   The role of the CQC will be extended to cover health related services commissioned by local authorities.

11.   10,000 mental health care professionals will be recruited. The co-ordination of mental health services with other local services will be improved.  

12.   Radical changes to social care for the elderly. Aligning the current means-testing for domiciliary care with that for residential care. The value of the family home will be taken into account, along with other assets and income when assessing the amount of funding that an individual will receive from the state. The current cap of £23,250 will be increased to £100,000. Individuals will be able to defer payments if receiving care at home in order to avoid selling their home during their lifetime.

13.   End of life care will be improved. Families who lose a baby will be offered additional bereavement support.

None of the above pledges have been costed in the published manifesto.

 

The Labour Party:

1.       A commitment of over £30 billion in extra funding over the next Parliament. Paid for through increased income tax for the highest 5% of earners and an increased tax on private medical insurance. Money will be freed up by halving the fees currently paid to management consultants.

2.       A new office for budgetary responsibility will be introduced to oversee health spending and scrutinise how it is spent. “Sustainability and transformation plans” will be halted, and a review undertaken, asking local people to contribute, considering patient need rather than available finance. A new regulator “NHS Excellence” will be introduced.

3.       Privatisation of the health service will be reversed. A legal duty will be introduced on the Secretary of State to ensure that excessive private profits are not made out of the NHS at the expense of the patient.

4.       Promise investment to give patients a modern, well-resourced service. Guaranteeing access to treatment within 18 weeks, taking a million people off the NHS waiting lists by the end of the next Parliament. Patients will be seen in A&E within 4 hours. Mixed sex wards will end.

5.       The Cancer Strategy for England will be fulfilled by 2020.

6.       Funding will be increased to GP services and cuts to pharmacies halted, and the current position reviewed.

7.       Patients will be given fast access to the most effective new drugs and treatments, and “value for money” agreements will be negotiated with pharma companies.

8.       To make the country “autism friendly”; with specialised care plans in place and access to condition management education.

9.       High quality and personalised end of life care.

10.   A commitment to completing the trial programme for PrEP, and rolling the treatment out to high risk groups to reduce HIV infection.    

11.   Free parking for patients, staff and visitors at hospitals by increasing tax on private medical care premiums.

12.   For the work force the pay cap will be scrapped, with an independent review body making the decision. Bursaries and funding for health related degrees will be scrapped (University tuition fees will be scrapped).

13.   The rights of EU nationals working in the NHS will be immediately guaranteed.

14.   The foundations for a “National Care Service for England” will be laid. Social care budgets will be increased by £8 billion. Place a maximum limit on lifetime personal contributions to care costs, raise the asset threshold below which people are entitled to state support, and provide free end of life care.

15.   Funding for mental health services will be ring fenced.  Out of area placements for young people will be ended by 2019. Early intervention for children and young people’s mental health services will be prioritised. Counselling services will be available in all secondary schools.

 

The Liberal Democrats:

1.       Pledge to put a penny on the pound on Income Tax to raise £6 billion in extra revenue for NHS and Social care funding. This money would be directed to key areas, including social care, primary care, mental health and public health.

2.       Commission a dedicated health and care tax following consultation.

3.       Guarantee the rights of all EU NHS and social care staff to remain in the UK.

4.       End the public sector pay freeze for NHS workers and reinstate nurse bursaries.

5.       Transforming mental health care and reducing associated waiting times to no more than 6 weeks for a therapy appointment for depression or anxiety. No young person will wait for more than two weeks for treatment when they first experience psychosis. The focus will be on young people and pregnant women/ new mothers.

6.       An end to out of area placements and improving front line services in schools and universities. Ensure LGBT and inclusive mental health services receive funding and support.

7.       Establish a cross party health and social care convention to carry out a review of the long term sustainability of the health and social care finances and workforce. Introduce a statutory independent budget monitoring agency for health and care, similar to the Office for Budget Responsibility.  

8.       Improving the integration of health and social care; ultimately creating one service with pooled budgets.

9.       Implement a cap on the cost of social care and increase the earnings limited from £100 to £150 per week for eligibility for carers’ allowance, and reduce number of care hours a week for qualification.

10.   Provide more choice of end of life care and move towards free end of life social care. Expanding the work of hospices.

11.   Promote easier access to GPs, expanding evening and weekend opening, encouraging the use of on line appointments, whilst supporting GPs to prevent practice closures.

12.   Using innovative funding to promote GP led multidisciplinary health and care hubs and ensure access to local pharmacies.

13.   Helping people stay healthy in the first place through a National Well Being strategy, including public awareness campaigns on cancer and by developing a strategy to tackle childhood obesity and a sugar tax.

14.   Introduce a minimum unit pricing for alcohol.

15.   Make PrEP for HIV prevention available on the NHS.

What will these pledges cost?

The Institute of Fiscal Studies has undertaken its own review of the funding behind each of the above pledges and state as follows;

The Conservative manifesto:  Would suggest an increase in Department of Health (DH) spending to £132 billion (in today’s prices) in 2022­–23, if the other (non-NHS) aspects of DH spending were frozen in real terms over this period. This would be an average growth in real spending of 1.2% per year between 2016–17 and 2022–23.

The Labour manifesto: promised a larger increase in health funding. Labour would increase spending relative to current government plans by £7.7 billion in 2017–18, rising to £8.4 billion (in nominal terms) by 2021-22. This could take DH spending to around £135 billion (in today’s prices) in 2021–22. This would be an average 2.0% per year real increase in spending between 2016–17 and 2021–22.

The Liberal Democrats: have pledged to increase spending on health and social care in England, Wales and Northern Ireland by approximately £6 billion each year, with £2 billion ring-fenced specifically for social care. This could imply DH spending of £131 billion (in today’s prices) in 2021-22, and average growth in spending of 1.4% per year in real terms between 2016–17 and 2021–22.

However they also conclude that the planned spending of all three parties is well below the historical 4% per year growth in health care spending per year that has been seen since 2009/10. The difference between the parties spending plans is in fact reasonably modest and as such the NHS will continue to suffer financially whoever will win the general election.

Julia Furley, Barrister, JFH Law LLP

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Ortho for Dummys

Orthodontics for Dummies

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Zany Principals

Bosses

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Endowontics made simple

Endodontics for Dummies

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15
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10,000th Daily Digest Email!

10,000th Daily Digest Email!

 

Hello all,

Today (17th May 2017) we will be delivering our 10,000th daily email digest to our GDPUK members. Something we are extremely proud of.

  • Our first daily digest was sent out in 2008 when we built the first GDPUK website (pictured above).
  • Barring one or two hiccups alomng the way.... We have sent out 3 daily digest emails a day since.
  • The emails contain the latest news from the site, plus the top forum posts of the day. This keeps our members engaged with the site and more importantly, what is happening within UK Dentistry.
  • The digest contains advertising banners from our partners, so thanks to all our loyal clients and friends over the last ten years who have made it possible to reach this milestone.
  • In that time we have had 54 different people post over 1000 times on the forum pages. All that posting helped to create the unique content of the digests. So thanks to the 54 people and the thousands of other posters who have contributed to the site.
  • Thanks also, to over 10,000 members of the dental profession who have signed up to the site since 2008.
  • The GDPUK forum continues to thrive on a daily basis. The forum has had over 22,000 threads created and nearly 256,000 replies to those threads. That is 11.5 replies to every thread created. A lot of knowledge and content contained in our forum pages :)
  • You have to be a member to view our forum and daily digests. Register for free here.

Thanks again for supporting and reading GDPUK.

 

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MAY
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Listening, talking and networking:- Dentistry Show 2017

Listening, talking and networking:- Dentistry Show 2017

We enjoyed an extremely busy couple of days at the Dentistry Show on Friday and Saturday in Birmingham. This year we didn’t have a stand, so we did a lot of walking, talking and listening of course…...

A few initial thoughts and products that caught the eye:-

The Full Picture

In a room of a few thousand people, it always intrigues me the different impressions people get from the show. “Fantastic show”, “our stand has been so busy” “selling loads of gear” and then you move about 3 feet to the next stand and the reaction is totally different “waste of time”, “not as busy as last year” “this part of the room isn’t getting any footfall” so when stepping back and looking at the full picture, I reckon it is somewhere in the middle. The show was certainly busy but it is not for everyone.

Takeaway - it is not always about following the crowd. This kind of show works for some companies but not all.

Closer Still

Closer Still Media, have built an amazing business, which is demonstrated by the fact that the show attracts a huge number of exhibitors, speakers and visitors. As you will know from previous blogs, GDPUK have not always had the best experience at the Dentistry Show but we must say that it has a great spirit, atmosphere and 2 days seems a perfect amount of time.

Well done to all the Dentistry Show team and the wider Closer Still Media team which is now over 200 people strong. They obviously understand the formula to produce extremely successful events.

Internet of Things

Last year we reported on Oral-B’s move into connected toothbrushes and now Philips have followed with the Philips Sonicare DiamondClean Smart which not only is incredibly smart with its matt black handle, black brush head and charge in glass technology, it also uses connected technology to inspire and motivate patients to take better care of their oral health. I believe it will be available to consumers in the next few months. Great to see dentistry leading the way in connected devices and improving oral-health at the same time.

Good to Great

“Good to Great” is a journey to greater business prosperity for dentists, which has been underpinned in the last 12 months by the introduction of SoE’s Customer Success Programme. (Software of Excellence). The Good to Great Challenge encourages dentists to think more clearly about how they can optimise their performance and maximise revenue and provides a vehicle by which dentists can track and follow the progress of likeminded dental practices. More information available here - http://www.g2gchallenge.com/ 

Will be interesting to see how many practices get involved in this challenge and what affect it has on their practice over the 12 months.

Social

The show is great for networking which is demonstrated by the thousands of people attending and the huge queues at the Starbucks just outside hall 5! I really enjoyed this element of the show, fantastic to catch up with so many people from all areas of the profession.

A few other mentions and thoughts

  • The Simply Health juice drinks were delicious and perfect after a few beers on the Friday evening. I am sure anyone who attended the Dental Awards or the Dental Circle party also found those drinks refreshing :)
  • Prem at Quick Straight Teeth certainly caught the eye but I know this has been covered elsewhere on social media :)
  • The dental industry certainly seemed positive overall, digital is growing. Innovation isn't always the quickest in dentistry compared to other sectors but some of the options and resources available to a dentist just starting their dental practice journey are endless.
  • The 3M intraoral mobile tablet scanner is extremely clever and could be excellent for interaction with your patient. Info here.

Thanks for reading and hopefully see you at the BDA Conference in a couple of weeks. Get in touch if you would like to meet up or need some advice on the best restaurants in Manchester.

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Assessing Fitness to Practice: what test must the GDC satisfy?

Assessing Fitness to Practice: what test must the GDC satisfy?

There is a feeling amongst dentists on forums such as this that the GDC has become too heavy handed when dealing with alleged misconduct cases.

In March 2017 alone, of the 29 misconduct Fitness to Practice cases heard by the GDC, 9 dental professionals were suspended, 4 had conditions placed on them, 4 were erased and 2 were reprimanded. There were also 4 cases with the outcome still pending. That means of the 25 cases concluded 76% of dental professionals were found to have committed misconduct.

Compare this with the GMC figures for the same month, there were only 6 misconduct Fitness to Practice cases of which only 2 had findings of impairment made against the doctor. Considering there are more doctors than dental professionals registered to practice in the UK, the difference is significant.
 
In November 2016 the GDC introduced Case Examiners in an attempt to help streamline the Fitness to Practice process. Their role is to consider whether a referral should be made to the Practice Committee. Given this new stage is still in its infancy, we are yet to see what impact this will have on misconduct cases within the dental profession. However, it is hoped that as cases will be considered by a lay member and a dental professional, a more proactive approach will be taken at an early stage. This is the approach taken by the GMC and the low numbers of misconduct cases being referred for hearings could be a positive sign of things to come.

Unfortunately there are rarely any consequences for patients who make spurious complaints which are not upheld; however, the same cannot be said for the professional. The time, stress and expense of misconduct hearings can have a devastating effect. Many feel that their stress is exacerbated by an unsympathetic and heavy handed regulator.

If you are facing a misconduct investigation, it will no doubt be a worrying period for you.  It is important to understand from the outset what legal test the GDC will be applying. This way you can properly prepare your defence and gather evidence from an early stage. Proper presentation at the start may well ensure that the Case Examiner determines that a case should be closed at an early stage. If the case should proceed to a hearing you will be armed with the necessary knowledge to put forward the best possible defence, which in turn could help with any later appeals to the High Court.

What test does the Professional Conduct Committee (PCC) apply when assessing Fitness to Practice?

The Test

The test the PCC applies is twofold;

1.       Has misconduct taken place?

2.       Is the dentist’s fitness to practice impaired?

Whether or not misconduct has occurred will depend on the allegations raised and the evidence produced and as such this element of the test will be fact sensitive. The PCC must decide whether ‘it is more likely than not’ that the allegations took place, which unfortunately is a relatively low threshold. However, even if any of the allegations are found to be proved, case law has established that the conduct must be ‘serious’ before moving to the next stage of the test.

Tip. Is this a potential area that can be challenged? Are you able to obtain evidence or refer to previous cases that show the misconduct is not serious and therefore no further action should be taken?

When considering if a dentist’s fitness to practice is impaired, the PCC should look at the dentist’s current fitness to practice? It will not be sufficient to show historic impairment, unless the misconduct is so grave as to warrant it.

It should be noted that impairment is not assessed against any established standards of proof; it is a matter of judgment for the PCC committee. However, a failure to comply with the fundamental standards laid out in the ‘Standards for Dental Professionals’ is likely to lead to a finding of impairment.

Tip. Even if you do not accept the allegations against you, you should consider what actions you can undertake to show your fitness to practice is not impaired. For example, attending training courses, amending your policies and procedures, or being mentored/shadowing another dental professional. This should not be seen as an admission of guilt but a recognition that professionals can always seek to improve. 

The Sanctions

If impairment is found, the PCC will go on to decide which of the following sanctions to impose:

·         Reprimand;

·         Conditions;

·         Suspension;

·         Erasure.

 

In deciding what sanctions to impose, the PCC must apply the principle of proportionality by weighing the interests of the public against those of the dentist.

Tip. This is where you need to put forward your mitigating circumstances so as to reduce the sanction imposed. Also you are allowed to suggest out what sanctions should be imposed and if you are able to give the PCC well thought-out sanctions bearing in mind the allegations, this could prevent erasure or suspension.  

Stage 1 – Case Assessment

When the GDC receives a complaint, it first considers if it is the correct body to deal with it. If so, it will obtain more information from the complainant to assess whether one of the ‘Standards for Dental Professionals’ may have been breached. It is important to note that the Case Assessors do not make any findings of fact.

You will be asked to provide:

1.       Evidence of your indemnity insurance cover;

2.       Details of your current employers/anyone you are contracted to provide services to;

3.       If the complaint is about dental treatment, the patient’s medical records.

Tip. At this stage do not provide any further information than the above. Whilst it will be tempting to explain what has happened, at this stage the GDC has not set out what the allegations are against you, so you do not know what you are responding to.  Any statement given could later be used against you.

Stage 2 – Case Examiner

If the Case Assessors consider a dentist’s fitness to practice may be impaired the case is referred to the Case Examiners; the case will be considered by one lay person and one professional. At this stage you will be sent details of the specific allegations against you and it is at this stage you will be asked to respond. The Case Examiners are not making findings of fact. Their role is to consider whether there is sufficient information to make a referral to the Practice Committee.

Tip 1. If the allegations are not clear, seek clarification. If evidence is referred to, ask for copies of that evidence.

Tip 2. Whilst the Case Examiners are not determining the case, if you can show there was no misconduct, we would recommend responding fully to the allegations and providing evidence to support your assertions. However, if you think there may be a case against you on the evidence received think very carefully before making any admissions at this early stage. It may well be worth seeing the extent of the case against you before admitting any wrong doing.

Stage 3 – Hearing

Should the case progress to a hearing then you will need to fully prepare for the same bearing in mind the test set out above. Consider:

·         What evidence do you need to rebut the allegations?

·         Are you able to show the misconduct is not serious?

·         What have you done to show your fitness is not impaired?

·         Will other dentists/patients provide statements as to your character?

·         What mitigating circumstances are there?

·         What sanctions should be imposed?

Tip. If you are not happy with the GDC’s decision you have the right to appeal to the High Court within 28 days. We set out the circumstances when you can appeal in Issue 2 of our dental bulletin.

If you need advice on a current Fitness to Practice investigation or appealing a decision of the GDC, please contact Laura Pearce on 0207 388 1658 or by email at lpearce@jfhlaw.This email address is being protected from spambots. You need JavaScript enabled to view it. for advice.

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Believe

Believe

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Dental Conspiracies

Dental Conspiracies by @DentistGoneBadd

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8274 Hits
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White fillings - - for Dummys

White Fillings - Theory & Practice

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What is GDPUK?

What is GDPUK?

 

 

GDPUK.com is for dentists and dental professionals to discuss all aspects of their profession, their practice and their business, centred on the UK. Subjects dissected have been diverse, from tips on simple techniques to guidance on buying major equipment, to discussions on the various practice management software packages, and of ongoing developments in British dental politics.

Established since 1997.

Moderated in Manchester, England by Dr Tony Jacobs BDS, the Group was started in Summer 1997, and continues to grow rapidly. Tony continues to work in his family general dental practice in Manchester.

Dental News

GDPUK.com also publishes UK dental news, and has had many exclusive stories, as well as being able to publish the latest news relevant to dentistry before other dental news providers. Latest news.

Blogs

In addition GDPUK blogs, both editorial and product updates are well read throughout the dental profession and industry. Latest blogs here.

GDPUK Forum

The group now has over 10,000 members, and attracts interest and sponsorship from major companies involved in the dental trade. The forum has had over 22,000 topics created and over 254,000 replies. That is 11.5 replies for every thread created! A huge amount of content and information.

Joining the Forum

The site remains free to join for all members of the dental profession. Register here.

Advertising

Advertisers can look forward to their banners being displayed thousands of times in a verified manner, using professional banner server software, to a targeted group of UK dental professionals.

Media Pack

Revenue is generated on the site by companies in the Dental trade, advertising on the site. More information about what GDPUK can offer our advertisers, can be found in our latest media pack. Please This email address is being protected from spambots. You need JavaScript enabled to view it. for the latest media pack.

Further Information

For further information on what GDPUK can offer, please This email address is being protected from spambots. You need JavaScript enabled to view it.. Jonny will be attending both the upcoming Dentistry Show and BDA Show, get in touch if you would like to arrange to meet up.

20 Years of GDPUK

The site was established in 1997 and this year marks the 20th year anniversary of dentists talking to each other using the GDPUK medium. To mark the occasion we will be hosting a conference on Friday 17th November in Manchester. More details to follow.

 

20th Anniversary Publication.

We are currently putting together a publication that will be published in digital form in November 2017 around the time of the conference. If you would like to contribute to this please get in touch. We will also have advertising opportunities available at the conference and in the publication. For further information, please get in touch.

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Ask Auntie

Ask Auntie

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Labelling Patients

Labelling Patients

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Recent comment in this post
Julia Easton

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Couldn't find these on SOE! My favourite in the days of paper notes was CPITN (complete pain in the neck)
Monday, 17 April 2017 08:41
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Final Exam MCQ by @DentistGoneBadd

Final Exam MCQ by @DentistGoneBadd

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Liar Liar

Liar Liar

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Part 10 - Digital Can Help Your Non-Digital Media Channels

Part 10 - Digital Can Help Your Non-Digital Media Channels

 

In a 2014 study commissioned by Brand Science and Microsoft, the study shows that not only does online advertising deliver excellent ROI efficiency, but it also provides extra value to your other spend in the media. Can be read here [PDF].

In basic terms the report shows that the difference in ROI is striking when a campaign has an online element against those that do not have any online element. When online advertising is added into the mix, the return on investment is much improved.

From a dental point of view, this means that when a brand sponsors an event or runs a conference for their clients, the marketing campaign needs to cover all mediums.

Over recent years, this is the way the online marketing world has evolved. Brands within dentistry have been hesitant to spend all their budget on online marketing but will often use some of their budget online, to compliment campaigns in magazines, events they are hosting or to promote attendance at an exhibition.

Businesses can see that they need coverage across all mediums, their customers are constantly using and sharing digital content and therefore digital is becoming as important as non-digital channels when looking to achieve maximum ROI on their marketing spend.

Therefore, digital is certainly important in the marketing cycle and plays a part in helping produce results from non-digital media channels. This is another reason that online marketing is here to stay. 

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Dentistry - The Thief of Time

Getting Your Timing Right

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April & May Offers on GDPUK

The dental exhibitions are approaching in May.
 
So we have put together some offers for you.
 
Reach thousands of dentists on a daily basis. Established since 1997, GDPUK has over 10,000 members, who are part of the dental profession. 
 
Publish content to the most read dental online publication in the UK. Over 22,000 threads created. Thousands of readers of our daily news and blogs. 
 
Even get content shared on our forum thread for advertisers. 
 
Banners appear on the forum, news and blogs.
 
Excellent value, you can publish more than one banner ad at a time. Ask us for more details. 
 
Limited space available on our featured email banner slot in April and May. Email arrives in your target audience's inbox, 3 times a day. Opened over 120,000 times a month.
 
For April and May 2017 we are offering buy 2 months and get an extra month free. You can choose your third month at your own discretion. Terms and Conditions Apply. Email below for further info.
 
Get in touch today for more information and pricing. This email address is being protected from spambots. You need JavaScript enabled to view it..
 
 
 
 

 

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Part 9. Engagement

Part 9. Engagement

 

In Part 9 of this series, we take a look at engagement and the number of options we have to engage with potential customers. 

Online advertising lets you know a customer's exact level of engagement. You can see how many impressions and clicks an ad has and where the ad has been clicked. This again gives you the marketer, a lot more information than ever before.

Although the click to a landing page is a form of interaction and engagement, the measure of engagement is often based on other criteria and seen as a compliment or an alternative to measuring the traditional click which has been historically the first form of engagement taken into account. So this means this could be via content, ads or audience interaction.

You therefore can see what has been effective for your product or brand in achieving engagement; comments, impressions, shares, recommendations, social media, contact forms, competition entries etc

You might have circulation and readership data for a print publication, but you can’t know how much time customers spend interacting with your ad, how much time they spent on your website, if they researched more of your products, and whether that ad led to conversions. In fact, with print it is impossible to even see if someone has seen the ad in the magazine. Print advertising is often just following the old adage of “Half the money I spend on advertising is wasted; the trouble is I don't know which half.” (John Wanamaker (1838-1922) At least with online ads, you get to see how much engagement there has been.

An online presence gives you all of a whole range of valuable data and places you in a position to learn where your most engaged prospects live, work or interact. With a bit of research you can find out where your potential customers congregate, whether that is a forum, social media or a marketplace like Amazon or Ebay.

This access to data means you can start to reach people where they are most engaged and where they are genuinely interested in receiving your message.

When using social media, online ad engagement can then be used for engagement retargeting, which is now used by all major retailers and marketplace sites.

To summarise this part  of the series, online advertising has all the right skills not only to attract your potential customers but to get them properly engaged and totally involved in what product or service you are looking to offer. Online advertising opens a world or opportunity and options to get your client engaged within your story. 

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The whole tooth and nothing but the tooth - criminal investigations explained.

The whole tooth and nothing but the tooth - criminal investigations explained.

 

 

If someone makes a criminal allegation against you, whether true or false, you will be subject to a police investigation. This will no doubt be a daunting experience for you. In this article we guide you through the process and give you some important advice to help you protect your registration as a dentist.

At the police station:

It is a fallacy that only those who have done something wrong need to seek the advice of a lawyer. If you are facing criminal allegations the first thing you should do is seek legal advice from a criminal defence specialist solicitor. Good representation at an early stage will ensure your rights are protected, and can in some circumstances even prevent criminal charges being pursued. Facing a criminal allegation can be one of the most stressful events of your life, you do not need to face it alone.

The police can choose to either conduct an interview following arrest, or on a voluntary basis – commonly referred to as “caution plus three”. An interview after arrest means that you will be detained at the police station and are not at liberty to leave until the police or courts allow it. Under “caution plus three” is less draconian, and means that you are free to leave at any time as you will not be arrested. Everyone who attends for a police interview, whether, voluntary or under arrest, has the right to free and independent legal advice.

Can I choose my own solicitor?

Yes, if you are given notice of the interview it is important to research and identify an appropriately qualified lawyer.  However, if you are arrested unexpectedly and are not able to request your own lawyer, you will be offered the assistance of a “duty solicitor”. There is a duty solicitor on call at all times to provide assistance in the police station.

When you are arrested, and again at the beginning of your interview, you will be read the police caution:

“You do not have to say anything. But it may harm your defence if you do not mention when questioned something which you later rely on in Court. Anything you do say may be given in evidence.”

There may be circumstances when it is appropriate to answer “no comment” to questions being asked by the police officer. For example, where there is in fact limited evidence that you were present or have participated in a crime and the police are essentially “fishing” for incriminating information. Alternatively, if you do not feel comfortable or confident in answering all questions put to you, it is possible to provide a prepared statement setting out the terms of your defence. If this is done properly then it is unlikely a jury would be invited to draw an adverse inference as a result of your failure to answer all questions put.

Whilst legal advice and assistance is free and available to everyone in a police station, regardless of their means, you can choose to instruct a solicitor on a private paying basis, if for example you wish to have a consultation with them in advance of the interview.

It is very important that you make clear to your solicitor that you are a dentist, and that any police action against you could have serious consequences on your registration with the GDC. You must bear in mind that what you say to the police may be used in any later fitness to practice hearing. It can be a difficult balance to strike in providing information that offers a defence to a criminal allegation, but will not inadvertently leave you open to disciplinary action with the GDC. A defence of innocent incompetence to an allegation of fraud for example, may amount to a breach of the GDC Standards for the Dental Team.

If you did use the duty solicitor at the police station but were not happy with their service you are not obliged to continue to be represented by them.

Court Proceedings

Low level offending, such as common assault, shop lifting and traffic offences are all dealt with at the magistrates’ court. Your case will be heard by either 3 magistrates (lay people) or a District Judge. There is unfortunately very limited rights to anonymity before the criminal courts, and your name will appear on the court lists regardless of whether you are found guilty or not guilty.

Legal aid is available in the magistrates’ court, but it is both means and merits tested. The threshold for automatic financial eligibility is income under £12,475 per annum, as such most dentists will not be eligible for legal aid. When paying privately, it is important to bear in mind that even if you are found not guilty you will not be reimbursed for all your legal costs. Any reimbursement is at the legal aid rate, which is very low, and is dependent on you having applied for and been refused legal aid at the outset. Some insurance policies will cover criminal allegations, particularly where they are related to professional misconduct charges. It is always worth speaking to your insurers to find out what they will cover at the outset and remember you have the freedom to choose your own solicitor to represent you under such cover, you do not need to rely on the solicitors appointed by the insurers.

In the magistrates court you can be represented by either a solicitor or a barrister. It is worth considering very carefully the trial experience of the person who is going to represent you. Do not be afraid to ask what their experience is and whether they have dealt with similar cases in the past.

More serious offences are dealt with at the Crown Court. Legal aid is technically available for everyone who appears before the Crown Court, however, applicants have to make a contribution towards their legal costs of up to £900 per month, which is capped dependent upon the seriousness of the offence. For more serious offences you are likely to have the benefit of both a solicitor and an advocate representing you; this can be either a barrister or solicitor advocate.   Your solicitor should discuss their choice of advocate with you before they are instructed to ensure that you are happy with their choice of representative.

If I have been arrested but not charged with any criminal offence should I notify the GDC?

If you are arrested but not charged with any offence there is no obligation to inform the GDC. However, if you are charged, but not yet convicted, of an offence anywhere in the world, you will need to inform the GDC. Similarly, if you are given a formal ‘police caution’ (not the same as the caution above, but a warning from the police regarding behaviour following an admission of guilt), or accept a penalty notice for disorderly behaviour, then you will need to let the GDC know.

If you receive a fixed penalty notice for a driving offence or antisocial behaviour order, you will not need to inform the GDC.

When do I need to inform the GDC of criminal convictions/cautions?

Generally dental care professionals do need to inform the GDC immediately if they are convicted of a criminal offence. However, if you are registering with the GDC you do not need to inform them of a conviction if it is considered “protected”.

  • This means it is not a “listed offence” under S2A(5) of the Rehabilitation of Offenders Act 1974 (amended)
  • A custodial sentence was not imposed
  • The individual has no other convictions
  • It was received either when the individual was under 18 and at least 5 years and 6 months has passed, or it was committed when the individual was over 18 and at least 11 years has passed.
  • If you have a police caution that does not relate to a listed offence, and was given either when the individual was under 18 and at least 2 years has passed, or it was committed when the individual was over 18 and at least 6 years has passed.

If I am convicted of a criminal offence will I automatically face fitness to practice proceedings?

All criminal convictions and cautions will be referred to the GDC Fitness Practice department for consideration. The GDC will then consider whether the offence committed involved a departure from the high standards required of dental professionals and whether it impacts on their fitness to practice. Consideration will also be given to the dentist’s character and conduct since the commission of the offence. The GDC will assess the level of risk that the conviction or caution will have on protecting the public and maintaining confidence in the profession.

Do I have to declare my conviction to future employers?

Whether you need to declare your convictions to your employers will depend on whether it is considered ‘spent’. The rules are complicated and vary depending upon the type of conviction you have and the reason you are being asked to provide the information. For instance, an enhanced criminal records check is usually required for all jobs that involve working with children, so any convictions, including those that are ‘spent’, will usually have to be declared. If in doubt, ask an expert!

If you or someone you know has been contacted by the police, or faces criminal charges, call our criminal team on 020 7388 1658. Our dental experts work in conjunction with our criminal lawyers to ensure you have the best possible representation to protect both your personal, but also your professional life.

Julia Furley, Barrister

 

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Part 8. Reach

Part 8. Reach

 

 

The image above greeted me this morning in an email from Google. The email read “With last week's announcement of YouTube TV, the lines between TV and online video continue to blur.”

Read more here. I thought this was perfectly linked to part 8 of the blog on Reach and how attracting interest in your product or service needs to incorporate so many different mediums to be effective. 

So according to Google, people are watching less live TV and turning to their computers, smartphones or tablets for their favorite shows, music, and to access their news.

Marketing professionals therefore need to make sure that they are staying in front of their customers and tracking their behaviour. So as all the latest stats suggest, your customers are online, so you should be too, and sooner rather than later!

Moving online gives you access to a global audience (if that is your target) and it means your ads can be working for you 24 hours a day. The options are practically limitless when it comes to your reach capabilities when you take your campaign online.

This means that your reach increases dramatically once you start the online advertising journey, as discussed previously you have a lot more control over your ads and they are building up impressions and clicks 24 hours a day, reaching unique 

Online advertising enables you to promote your products and services locally, or even worldwide. With the print media you can only reach fix number of customers limited to a certain location, but online offers you a global opportunity and certainly a larger number of options than has ever been possible before.

So with a modern marketing plan, your reach can be greater than ever before. Your online advertising plan can incorporate social media, video, blogs, plus of course specialist sites for your particular niche. Utilising all these methods of retargeting, means you can reach your target audience a number of times a month and hopefully get your message across to your desired audience.

Thanks for reading.

 

Part 7 on Affordability Here.

 
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Dental Occupational Health Risks

Occupational health

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22,000 Threads Created

22,000 Threads Created

 

Established since 1997, GDPUK.com continues to go from strength to strength. 

Since moving to our present site in 2008, the forum has had over 22,000 topics created. The 22,000 topics have received over 250,000 replies! That is 11.3 replies per topic created, which is something that is quite incredible and shows the amount of knoweledge and opinion shared on the forum pages day in and day out. This makes the forum, unique in UK Dentistry. It is also all fully searchable. 

GDPUK also continues to post daily news and a number of weekly blogs which receive thousands of readers. We love keeping UK Dentists, upto date with what is happening in UK Dentistry.

Thanks again to all our readers who help to keep the site growing and improving.

The site continues to be a fantastic resource for the whole dental community and is free to join. Register here and join over 10,000 colleagues in discussing Dentistry in the UK, whilst also learning and sharing about everything Dentistry.

 

We are currently running an offer for advertising on GDPUK in April and May. This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Follow us

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Register for Forum.

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Fake News and La La Land

Fake News and La La Land

“The NHS is safe in our hands. The elderly are safe in our hands. The sick are safe in our hands. The surgeons are safe in our hands. The nurses are safe in our hands. The doctors are safe in our hands. The dentists are safe in our hands.”

Margaret Thatcher, 1983.

I remember thinking that when Margaret Thatcher said those words, written by speechwriter John O’Sullivan, that it was thoughtful of a politician to mention dentists. Thoughtful and unbelievable.

The use of the ‘Epistrophe’, the rhetorical tool of repeating of a word or phrase at the end of each sentence was used to echo Churchill’s ‘Anaphora’ of “We shall fight them etc”. Rhetoric has given way to the sound bite of, “The NHS is safe in our hands” which has always been Fake News or as my schoolteachers would have called it “Lies”.

The majority of politicians when given the opportunity have repeated the “safe hands” mantra. I wondered if it was a stock phrase they taught you at MP elocution school along with, “Hard working families” and "Education, education, education”.

“La-La Land” has been defined as “a euphoric dreamlike mental state detached from the harsher realities of life”. Few dentist fall into that category but I believe there are many who may hope: “To think that things that are completely impossible might happen, rather than understanding how things really are”.

A definition of madness is to do the same thing again and again hoping for a different result. Since Mrs Thatcher, governments of every hue have sought to undermine the dental profession by repeated assaults and insults both specific and general.

In the UK, like the majority of countries, most routine dentistry is provided by small businesses with the owners taking the financial risk of failure but also any profits from success. For years there was a 3-way set up, patient, dentist and NHS; the first paid the second the fees that were decided by the third that also set the rules. There was the possibility of competition, expansion and genuine entrepreneurship within the system. 2006 changed much of that.

The 2015 saw the Tories return to government free of their Lib-Dem coalition partners with talk of SMEs (Small and medium sized enterprises) being the “lifeblood of the economy”. Promises were made of more investment in super-fast broadband for entrepreneurs, a review of benefits for the self-employed and a trebling for the start-up loans programme.

A commitment was made by Prime Minister David Cameron (remember him?) to, “slash red tape” and to change employment laws to enable greater competition. One promise that was kept was for referendum, an excuse for any and all procrastination for the foreseeable future.

Cameron not only promised “the NHS is safe in our hands”, but also, “there will be no top down re-organisation” before letting Andrew Lansley set about things like a drunken bull manoeuvring a JCB in china shop.

The (genuine) news that the Inland Revenue’s “Make Tax Digital” (MTD) plans will mean all self employed individuals and small businesses having to make some form of tax return and payment on a quarterly basis hardly bodes well for dentists looking to reduce their costs. It will involve far more time and increase accountancy fees.

Changes in Business Rates will have a profound effect on many businesses, with London rates set to rise by 35.5% over the next two years. The fact is these changes should be made every 5 years but were delayed from 2015 so as not to interfere (i.e. prove unpopular) with the general election is further evidence of interference with the truth. Mrs May quickly promised help, then admitted there is no more money.

For years the GDC said that they could not make any changes and an act of parliament was required. This happened in late 2015, I am not sure that anyone has felt the benefits of “a more streamlined complaints system with timelier decisions, and with appropriate safeguards for both patients and dental professionals”.

Finally on the Fake News front that (new) NHS contract. As the BDA says, “The 2006 dental contract is not fit for purpose. It rewards dentists for hitting government targets for treatment and repair, not for improving their patients’ oral health.

In the 2010 general election, the opposition Conservative manifesto pledged a new dentistry contract. The coalition agreement – struck between the Conservatives and Liberal Democrats – pledged the contract would be introduced by the next election, in 2015.

In August 2016 Lord Prior said, “I believe that we expect the new contract to be introduced fully in 2018.”

And lawyer, John Grant ,wrote after yet another debate on the proposed contract.

At some point there will be a new contract, but at present no one knows at all what this is going to look like.

When it does come in the government – no matter which party is in power – is going to want an awful lot more from dentists and in return is going to pay significantly less.”

If you think things can only get better (see 1997) then you are not only living in La-La Land but still expecting it to win the Best Film Oscar.

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© Alun Rees, GDPUK Ltd, 2017.

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Train Your Dentist

Train Your Dentist

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Part 7: Affordability

Part 7: Affordability

 

 

Compared to TV or print ads, online ads are still relatively low-cost for companies who are looking to reach their desired market.

Additionally, online advertising tools give you the ability to lower your budget or even stop your campaign within a few seconds. Print or TV operates on contract basis, and when you are in a contract, things are not always as flexible.

Because you are spending less with online ads and have the flexibility to reduce costs or spend more instantly, advertising online gives you a loads of options for your marketing campaign.

With the added flexibility that online ads provide, the amount of options you suddenly have are a huge advantage. The ability to publish a number of ads at once, or change the ad as often as you want is a huge advantage. This flexibility is all part of the package and therefore the costs don’t rise. If you advertise on a billboard or in print, you can’t adapt your message instantly and you certainly can’t change the message as you go along.

According to this article on whether online advertising is expensive, which I have to say does go off some generalisations and is US centric they sum up their article with the following statement:- “Offline, traditional marketing costs an average of $22.00 per impression as opposed to $3.45 per impression with online marketing.”

Online advertising reflects modern society in being instant, flexible and results driven! If you are looking for value in your marketing, you have to be looking online.

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Room 101

Room 101

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Charitable donations following the GDPUK Conference in November 2016

Charitable donations following the GDPUK Conference in November 2016

 

 

 

On November 4th 2016, GDPUK hosted a conference for our members in Manchester. The day was a fantastic success both educationally as well as socially and the feedback we received was incredibly positive. 
 

 

We were extremely proud to host event that was different in style than your “normal” dental event and we believe that was also something that made a difference to the atmosphere on the day. Thanks again to everyone who attended, our excellent speakers for making the day so enjoyable and our sponsors who supported the day and continue to support GDPUK. 
 

We have now made two charitable donations following the event:-

  • £600 went to a Manchester based charity, close to the Jacobs family, named Prevent, a cancer research organisation, it used to be named Genesis. www.preventbreastcancer.org.uk
  • £400 went to British Dental Association Benevolent Fund, a charity which many of you will know, which supports dental people in times of hardship. www.bdabenevolentfund.org.uk

For 2017, we will be celebrating the 20th anniversary of GDPUK, and we are planning a bigger, even more exciting event in Manchester on Friday November 17th – Please put this date in your diary! More details to follow in next few weeks.

 

GDPUK.com is a social media site for dentists run by a dentist, Tony Jacobs. Established since 1997, there are over 10,000 dental professionals who have joined the community, they use the site to read dental news and blogs, as well as reading and contributing to the GDPUK forum where there have been over 250,000 posts since 2008! GDPUK is a fantastic resource for dentists and a great place to learn about as well as share your own opinion on important matters within UK dentistry.

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Dentist Stuff for Dummies

Everyfing

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Part 6. Flexibility

Part 6. Flexibility

 

"Flexibility - the ability to be easily modified."

Online advertising campaigns can be adjusted with a few clicks or changes to a banner.
You have the flexibility to respond to incoming data and make changes instantly. Similarly, you always have the ability to pause a campaign or adjust your marketing plan within minutes. This flexibility allows you to stay in front of your customers– anticipate customer needs and adjust your ads before anyone even notices.

 

At GDPUK we offer extra flexibility because our software gives the customer a number of options when they book a space on our site. Via our DFP software, our customers can actually run more than one advert at once in a given month. This means one of our customers can actually advertise two things or more from the same booking. One of our clients is currently using this method to advertise a number of offers at once. Added value and flexibility from GDPUK!
 

Having the option to change or adapt a campaign as you go along is another advantage to online advertising. Once you send an ad to a magazine it can’t be changed but with advertising online you can always experiment and adapt as the campaign develops. Online advertising definitely provides flexibility.

Part 5. Brand Awareness can be read here.

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How to fund a legal case without breaking the bank

How to fund a legal case without breaking the bank

Our society has become more litigious over the years; patients are quick to complain to see if they can get a ‘quick buck’ and dentists fear such complaints being escalated to the GDC.

Litigation can be a costly game. For example, it has come to light that the legal costs for the recent 9 day fitness to practice hearing against D’Mello was an average of £10,437 per day. Given the allegations were undefended by Mr D’Mello, who chose not to attend the hearing, this has left many dentists questioning the use of their registration fees and asking why the costs were so high. [ see GDPUK news report].

If a dentist is faced with either a patient complaint or an investigation by the GDC, the traditional course of action has always been to approach their defence union; you pay subscriptions and therefore expect to be represented. However, is the defence union the best and only option to fund a case? What are the advantages/disadvantages with the various funding options?

When deciding whether or not to pursue or defend a claim, determining how you will fund the case will be one of the biggest factors to take into account. Knowing what options are available will make you better informed and can help you with this difficult decision. Here we consider those options and the pros and cons of each. 

Pay Privately. You may choose to pay privately for the legal costs. However, this is often the most expensive way to fund a claim, as it is likely you will be paying the solicitor on an hourly rate basis for all work done to prepare the case, unless you are able to negotiate a fixed fee agreement. The benefit of this is that you can pick an expert in the field and someone you can trust to do the best for your case. The old adage that you get what you pay for is particularly true here. The down side is that due to the very nature of litigation it can be hard to say from the outset the likely fees, as this can change depending on how the case progresses. A solicitor should however be able to give you a ball park figure and may agree to cap costs for you based on this or in respect of various stages to help you manage funds.

If the claim is in the civil courts, you may be able to recover some of your legal costs if you succeed. However, if you lose you could be liable for the other side’s legal costs. Unfortunately, in relation to fitness to practice hearings, you cannot recover your legal costs. Similarly, in the Employment Tribunal you can only recover costs in very limited circumstances and as such it is rare that costs are recovered.

‘No win, no fee’. These agreements are more normally found when one is pursuing a claim rather than defending it. The benefit to you is that there are no solicitor’s costs unless you win; this usually means a solicitor will be confident in the prospects of success of the claim, as otherwise they could do a considerable amount of work for no money. The down side is that as a result of you not paying up front, the solicitor will take a success fee from your compensation if you win.  Also check the terms of any agreement before signing, as there may be hidden costs if you lose or in other situations, which may mean you do have to pay some costs even if you do not recover any monies.

Legal Expenses Insurance Policy. Such policies are normally attached to other insurance policies such as employer’s liability or home contents insurance. The downside to legal expenses insurance is that you often have to meet certain criteria before funding is agreed. They also normally only apply once a dispute has arisen, and do not provide legal assistance to help you resolve a matter before getting to this stage.  The benefit is if funding is approved for your claim your legal costs and disbursements are covered, and often that of the other party’s should the case not succeed. There are different types of legal expenses insurance and it is often worth shopping around to find one that suits you; for example some will cover your legal costs no matter what and some will cover any compensation payable if you lose. Obviously such policies are likely to attract a higher premium. Remember, if you have legal expenses insurance, you have the freedom to choose your own solicitor and do not have to use the panel solicitors instructed by your insurance company.

Defence Union. If you are part of a defence union you will have access to a number of services including legal representation. However, the defence union are not obliged to follow your instructions, and can decide, due to commercial reasons, to settle a claim that you do not what to settle. This can leave you with a sense of injustice and frustration. Another consideration when choosing a defence union over standard indemnity insurance is that you will have no freedom of choice when it comes to choosing the solicitor or barrister that you want. Non-discretionary insurance policies are legally obliged to give freedom of choice in this regard.

After the Event Insurance. As the name suggests this is insurance you purchase after the dispute has arisen. It will normally cover your disbursements and the other side’s disbursements and legal costs should your claim fail. The policy therefore does not provide cover for your legal costs, which you will still need to fund. However, if your claim is in the civil costs and you succeed then you will recover some of your legal costs and disbursements from the losing party.

Do it yourself. There is always the option of representing yourself in proceedings. The benefit is you have complete control over your case and you do not have any legal costs. Beware; if the claim is in the civil courts and you lose you could have to pay the winning party’s legal costs. If you do represent yourself, remember to take a step back from the case; it is all too easy to get caught up in proving every wrong or to throw every allegation into the mix, which can often detract from the strengths in the case. You can consider instructing a solicitor to give you an initial advice so you know what direction to head in. You can also seek advice from a solicitor on an ad hoc basis to help you at various stages which can help keep the cost of litigation down.

How you fund a claim will depend on the type of claim being pursued. A solicitor has a duty to provide you with advice on your funding options, not just their fees, so you can ask them to explain the options available to you. Also make sure you understand any potential costs consequences of losing a claim, as you may want to seek insurance to cover such costs.

Laura Pearce, Senior Solicitor

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Patientspotting

Patientspotting

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What's New for 2017

What's New for 2017

A number of new features and opportunities on GDPUK in 2017. Get in touch if you have any questions. Contact details below.

Satisfied customers

We have had a number of satisfied advertisers recently, which pleases us immensely. Thanks to all our customers for their continued use of the site and all the new clients we have taken on recently. We wrote about an extremely satisfied client a few weeks ago, you can read it below, their offer was extremely well received and resulted in a number of sales, which is very pleasing to hear.

Blog on a satisfied GDPUK Client.
 

New refreshed website

As you will have noted, our website is refreshed and less crowded which we believe makes it look clearer and hopefully easier to navigate. If you have any feedback or would like to provide feedback - please This email address is being protected from spambots. You need JavaScript enabled to view it..
 

20th Year Anniversary

2017 marks the 20th anniversary of GDPUK, something we have mentioned a number of times and will keep mentioning! We are close to putting together plans for a 20th anniversary Party and Conference in November and it is something that we would like as many of our members to attend as possible. Would be fantastic to celebrate with as many people as possible.
 

Super Leaderboard

Our leaderboard banner continues to be extremely popular with our advertisers. It is 728x90px and appears at the top of all our pages as you can see above. A recent option that we added to the site, is the super leaderboard which appears in the same space as the leaderboard but is super sized - 970x90, giving you even greater brand awareness and exposure on every page of GDPUK.
 

Number of banners at once

Via our DFP software, our customers can actually run more than one advert at once in a given month. This means one of our customers can actually advertise two things or more at once. One of our clients MC Dental / Repairs is currently doing using this method to advertise a number of offers at once. Added value from GDPUK!
 

News and Blogs

We continue to publish daily news and blogs, that get read by thousands of healthcare professionals on a weekly basis. Via our daily emails, tweets and facebook posts, we help to educate and inform our readers with the latest dental news and opinion. Something we are very proud of.

Banners are now appearing on the right hand side of the news and blogs. Considering the articles attract plenty of readers on a daily basis, it provides even more exposure for your brand.

As you can see GDPUK continues to evolve and improve, even in its 20th year! Thanks for reading.

 

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Part 5. Brand Awareness

Part 5. Brand Awareness

In part 5 of the blog series, we are looking at brand awareness and its part in the online advertising journey.

Online advertising can be used to drive traffic to your site and build brand awareness. Effectively targeted campaigns can create brand influencers and reach complementary audiences.

The online space that gets booked, helps to establish your online presence, and get your potential customers / consumers excited and interested about who you are and what you have to offer. As mentioned in previous blogs, online advertising enables brands to focus on their ideal audience and tailor messages that improve both recall and engagement with the brand.

To be easily recognisable has to be the aim for every brand within their sector, which then builds your brand awareness. Creating brand awareness is one of the key steps in promoting a product. Brand awareness is particularly important when launching new products and services; and for a company to differentiate similar products and services from its competitors.

So using online advertising can be part of building brand awareness and making your target audience more aware of your brand. The more aware your audience are of your brand, the easier it is to convert the awareness into sales.

What options do we have available to create and improve brand awareness?

  • Traditional advertising
  • Online Advertising
  • Sponsoring an event.
  • Publicity stunt
  • Word of mouth
  • Reviews / testimonials
  • Content / Blogs


So as you can see when building a brand, we have a number of options to play with but  what is the role of online advertising?

Online advertising plays a critical role in brand management and awareness whether at the corporate, retail or product level. With the help of advertising you can increase your brand's value and then it helps you to gain the new customers that we all look for :)

The end goal of any online advertising is to eventually convert all leads that you gather to actual sales. Whether it be an awareness or educational campaign, all businesses engage in advertising to ultimately generate sales! By creating a strong presence online, with whatever medium you choose, your investment in advertising and marketing will produce results and ultimately bring the extra revenue we all strive for.

So online advertising becomes a major part of building a brand and brand awareness. Online needs to be taken as seriously as the other more traditional mediums in helping to build that ultimate goal we all share of making your brand synonymous with the product or service you offer.

Thanks for reading part 5.

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GDC- Time for change

The GDC - Time for change

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Body Odour in the Workplace

Body Odour in the Workplace

If your best friend won’t tell you what do you do? A different problem.

“I’m feeling a little bit under the weather”. Another vague absence. Karen was good team member, a hard worker and, with the exception of a couple of days a month, punctual and reliable. The principal and the practice manager didn’t know what to do; they had tried the usual approaches mixing concern and compassion but had got nowhere.

A recent survey of 10,000 office workers has found that most one-off sickies are due to hangovers with “just hating the job” coming in second. Neither was the case with Karen, she never drank and clearly enjoyed her career.

“Alun, I wonder could you do her appraisal when you’re next visiting the practice? We’re struggling with what to do about her absences.” Sometimes a different face, voice or ear will bring results. This time was a success and I was able to get to the heart of Karen’s problem. I found her to be a sensitive soul, caring and concerned but in the horns of a dilemma.

The practice consisted of six surgeries with one principal, four full and part-time associates and part-time three hygienists. They operated an egalitarian system where, in order to ensure their were no opportunities for favourites or cliques, the nurses moved around on what appeared to be a fairly complicated rota. This way they worked with associates, principal, hygienists, did their turn in the LDU and had a share of being a “float”.

It turned out that Karen’s absences always coincided with her being due to work with Pam, one of the associates. Pam was experienced, had worked in a variety of practices, hospital departments and had also had a spell working in the community. It was acknowledged she could be a bit brusque with both patients and nurses, but her work was good, she ran to time and grossed well. She was recently divorced, had no children and lived alone.

I managed to get to the heart of things when I met Karen. She was under the impression that the visiting Business Coach was there to see her for some sort of disciplinary matter but I soon disabused her of this and she relaxed. We proceeded with her appraisal, which went well, and having gained her confidence I introduced the matter of her absences. She eventually shared with me the fact that Pam suffered from what used to be labelled as “B.O.” - in other words she was smelly. All the nurses were aware of it but for some reason Karen was particularly sensitive and had needed to run to the toilet to be sick the last time that she worked with Pam. She had now got herself into a real state in case the same thing happened again. She had started to believe that she was the one with the problem and hence the absences.

When I asked the principal and the practice manager they both admitted to having noticed Pam’s odour but had presumed that it was a rare event. Bromhidrosis or body odour, is a common phenomenon in post-pubertal individuals and can rarely become pathologic if it interferes with the life of the individual concerned.

So far, so good we had a diagnosis, but how to treat the problem?

As I was there, and Pam was there that day, it was felt that there would be less of an embarrassment if I were to broach the subject with her. Fine I thought, the client is always right and I have to earn my corn. It wasn’t something that I had done before and I am all for new experiences, if it went badly then I would get the blame and could walk away for another three months.

We met after work and I gave myself 15 minutes to achieve the objectives which were, to point out to Pam as subtly but effectively that there had been comments, to find out if she realised that there might be a problem and then work out a way to deal with it.

Her reaction, thankfully, was not one of denial or to attempt to blame someone for “sneaking” on her. She was horrified and visibly upset. It turned out that she had rather “let herself go” (her words) following her divorce and some days it was all she could do to drag herself out of bed and often didn’t get round to showering or bathing. She wore a tunic at work but wore it over clothes and we agreed that a change to scrubs might help. Most, but not all, of the clinicians wore them and as they were laundered by the practice it removed any home washing. An easier conversation than I feared with, hopefully, a positive result.

When I checked in with the practice owner during our regular coaching calls Pam had obviously had a bit of an awakening. The odour problem had gone and she had taken ownership of the problem by taking the time to ask each nurse at the start of her next session with them to please tell her if there was any recurrence.

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© Alun Rees, GDPUK Ltd 2017.

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The Only Way is Ethics

The Only way is ethics (2)

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Copyright

© DentistGone Badd, GDPUK Ltd 2017

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JAN
23
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Part 4. Creative Opportunities

Part 4. Creative Opportunities

Your ability to target goes beyond reaching just your target audience. Online also offers advertisers a limitless creative canvas.

For some reason, there is a common misconception that online ads are of poor quality, when in fact digital advertising provides the opportunity to be highly engaging with video and other rich media. Using flash and in-banner video ads can increase brand recognition and highlight your competitive edge. In the instance, when one of your ads is under-performing  A/B test your copy, your image, your headline and serve ads that are as dynamic as the online space in which they are living. A well-designed banner ad can turn your digital campaign from good to great.

At the beginning banners were extremely basic but now the digital landscape is incredibly clever and innovative. Below is a link to some amazing online campaigns from the last year or so. Some of the designs and creativity on show is breathtaking and shows how clever a banner ad can be made, which certainly helps to catch the attention of your target audience.

This Audi banner ad is fun and engaging - https://digitalsynopsis.com/audi-curves/

Or a GSK one which will remind you of your party days! - https://digitalsynopsis.com/glaxosmithkline-party/

The full list can be found here.

Plenty of information from Google about creating compelling content here.

Thanks for reading. I hope this has got you thinking of the possibilities for your next marketing campaign.....

Part 3 of the series on Targeting can be found here.

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3900 Hits
JAN
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In-house patient plan: Yes or No?

In-house patient plan: Yes or No?

Patient Plan Direct’s commercial director, Simon Reynolds, discusses key considerations in managing a patient membership plan ‘in-house’

Often the rationale for a DIY project is the perception that doing ‘it’ ourselves is likely to be lower cost and will enable us to achieve our desired outcomes in line with specific objectives. We adopt the mind set of “how hard can it be” and get to work.

In some instances, with the right planning and commitment a successful DIY project can be highly rewarding. However, in other cases we can be left to reflect on blood, sweat, tears and challenges that were far greater than we had anticipated. In hindsight, perhaps it may have been a better option to have turned to professional support in the first instance.

When it comes to patient membership and capitation plans many practices may have considered, or have already adopted, administering their own patient plans ‘in-house’. Let’s face it, when stripping back to its bare bones the work involved in administering a patient plan, it isn’t rocket science. The basics being; determining the care and benefits included in your plans, setting plan prices, collecting regular payments from patients and promoting your plans effectively to encourage uptake from patients.

However, as with many things in life the devil can often be in the detail and there are important considerations that may be overlooked when opting to administer a patient plan in-house rather than the outsourced option of working with a plan provider.

Direct debit vs. Standing order

Often mistaken as the same thing, there are significant differences between standing order and direct debit payments – the most likely means of managing regular plan payments. A standing order is an instruction set up by the payer i.e. your patient via their bank, which can limit the ease of patients joining your plan in practice. If a patient cancels their standing order you will not be notified, instead you’ll have to perform manual checks every month. Moreover, managing periodic plan price increases can prove somewhat challenging as a change to the value of a standing order requires each patient to amend their individual standing orders – a tedious task for patients that is not under your practice’s control.

Managing plan payments by direct debit on the other hand offers the beneficiary (your practice) greater control. This is an instruction by the payer giving permission for your practice to collect a regular amount, which can be amended with advance notification to the payer. However, obtaining sponsorship in to the direct debit scheme via your bank can be a lengthy process and thereafter you’ll have to utilise some form of Bacs approved platform to manage collections. This can prove complicated and costly in addition to the processing charges your bank is likely to apply.

Admin: Time versus Real cost

Time is money. Often the reality of managing a patient plan in-house can be more administratively demanding and time consuming than you may think. Preparing and submitting collection files, identifying payment cancelations, managing plan related communications to patients, creating promotional material, training your team in promoting your plans and so much more can be a real bind on your time. No matter who takes on the role of managing an ‘in-house’ plan, there’s every chance this time could be better spent elsewhere in delivering first-class care and building a successful practice.

When you come to sell your practice

In consideration of the complexities that can be involved in managing a plan in-house, when you come to sell your practice potential buyers may be put off. Moreover, in some instances if you have your own sponsorship in to the direct debit scheme, it is not a given that the new vendor will be able to obtain their own sponsorship via their bank to take on the goodwill of plan patients. Finally, historical records of plan collections via a third party can prove more favourable throughout any due diligence processes.

In summary

For some practices, managing their patient plans in-house may be the most effective means of offering patients a plan. However, for many, utilising the services of a trusted plan provider is much more likely to be the more time and cost efficient method. Working with a plan provider does not have to mean huge administration costs and overhead. There are more plan providers than ever before to choose from, each offering their unique service proposition, support and fee structure. It is simply a case of taking the time to discover each provider and working out which is the best fit for your practice.

 

 

Patient Plan Direct is a membership plan provider recognised for its low-cost admin fees and is also the winner of the 2016 Dental industry awards – Outstanding Business of the year (under 25 employees). Plan launch, Provider transfer and NHS conversion experts.

www.patientplandirect.co.uk

This email address is being protected from spambots. You need JavaScript enabled to view it.

08448486888

 

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4644 Hits
JAN
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Part 3. Targeting

Part 3. Targeting

As a marketer, do you know the profile of the perfect customer for your business?
Of course you do :)

Online advertising gives you the ability to target and retarget the ideal prospects you identify for your business.

When advertising online, you will choose a website or community where you believe that your perfect customer will be a user or reader. Online ads reduce the chances of advertising to the wrong group of people, thus wasting your budget and time. This means that your campaign can be targeted at your perfect customer and help you reach your desired target audience.

When it comes to social media advertising, retargeting will serve ads based on prior engagement, enabling you to identify your ideal customer profile. Once you know what your customers look like, you will know just who to target and where to find all similar users online, making sure they too are being served your ads. You can focus on customers based on their geographic location, gender, age, behaviour patterns on social media and special interests.

This means that when for example you want to attract women to your latest endodontic course, you have the ability to target a population as specific as women, age 40-65, who have endodontics listed as their profession or an interest. This will help to make your campaign extremely targeted and hopefully successful.

The ability to target your perfect customer, whether through a specific special interest website or through social media, gives you a whole variety of advertising options that have never been possible before. Popular options include display, search, email marketing and affiliate marketing. This gives advertisers the chance to communicate with the audience they want to target, using the right technique, whatever their particular objectives are for that campaign.


Thanks for reading.

Part 2 of our series on Online Advertising can be found here.

Part 4 - Creative Opportunities.

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4548 Hits
JAN
15
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Crisis? What Crisis?

Crisis what crisis?

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© DentistGoneBadd, GDPUK Ltd 2017

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JAN
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GDC Watch Winter 2017 - Sexual Misconduct

GDC Watch Winter 2017 - Sexual Misconduct

Recently, I have been mulling over issues of personal conduct.  This has led me to the specific topic of this blog which is sexual misconduct or otherwise inappropriate sexual behaviour. It looks at historic and current cases and I hope is just as interesting and thought-provoking for you readers.  Before anyone accuses me of misandry, I will state that I did not come across any examples of ‘females behaving badly’.

From discussions with colleagues and on other platforms it appears that the reason why the GDC have a mandate over personal conduct is not well understood.  The Standards relevant to personal conduct and behaviour are:


Principle One

  • 1.3.1  You must justify the trust that patients, the public and your colleagues place in you by always acting honestly and fairly in your dealings with them. This applies to any business or education activities in which you are involved as well as to your professional dealings.
  • 1.3.2  You must make sure you do not bring the profession into disrepute.

Principle Nine

  • 9.1  Ensure that your conduct, both at work and in your personal life, justifies patients’ trust in you and the public’s trust in the dental profession.

 

There are some difficulties here that need consideration:

  1. Whether the relevant standard is breached is ultimately partly dependent on the personal and moral views of the GDC employees and committees as the case progresses;
  2. Where can the line be drawn on what is an acceptable personal behaviour or boundary to maintain? Do we even know? Or is it rightly kept vague to move with our ever-changing world?

From a legal point of view case law dictates that surgeons, dentists, journalists, headmasters and even professional footballers are role models whereby ‘higher standards of conduct can rightly be expected by the public’.   This statement came about as a result of an unfaithful footballer involved in a threesome wanting to keep it out of the media believe it or not.  I’m not sure that Lord Woolf, when he made his judgement anticipated that today’s role models would also include reality TV stars who happily have sex on live TV but there we go.

The Indicative Outcomes Guidance (IOG) is always worth a read to understand how sanctions are arrived at and the reasoning behind it.  The purpose of a sanction is to both protect the public and the wider public interest.  What may on the face of it seem draconian and intrusive to a registrant’s right to a private life actually stems from GDC working extremely hard to maintain the reputation of and public confidence in the profession and they actually deserve credit for this.  Poor behaviour, even if it does not involve any patients has the potential to seriously undermine public confidence in the profession and bring the profession into disrepute.  With regard to sexual misconduct the IOG says:

 

So essentially, sexual misconduct allegations are likely to progress to a full hearing.

Sexual misconduct is essentially an abuse of power:



With all that in mind, here are some relevant case examples:

Dr AB kissed a dental nurse on the back of the neck without consent, and this was determined to be sexually motivated.  Dr AB denied the charges, gave inconsistent evidence, maintained that his actions had simply been misunderstood, accused the nurse of being racist and of wanting money from him as well as thinking he would just turn up and have his side of the story accepted as the truth.  This didn’t impress the panel and he was suspended with immediate effect for 12 months to hopefully give him enough time to have a really good think about all of this.  The Committee felt that the registrant lacked any insight, and pretty much knocked out all the defence submissions.  A couple of interesting lines from the determination are:
 

“The Committee was also aware that you are older than Dental Nurse A and in a position of professional power over her………

It [the committee] considered that dental nurses and colleagues do form part of the public and are included in the considerations of protecting the public.”

Therefore, professional boundaries do not just apply to Principals and patients.  Associates must also maintain professional boundaries with their supporting colleagues.

Mr CD was sentenced to three years imprisonment for sexual assault on a female; a conviction that was upheld on appeal.  The events surrounding the assault were the heads of charge and the FtP hearing considered both this misconduct and subsequent criminal conviction.   Misconduct was easily established, and the committee rejected the sanction of a suspension on the basis of no apology or demonstrable remorse from Mr CD and he was erased.  Placing your penis toward a patient’s mouth without their consent is possibly the most serious breach of professional boundaries, however it is interesting in this case that the sanction of erasure is automatically 5 years, which obviously exceeds the duration of his criminal sentence. Whether he ought to be allowed the chance to even reapply to the register is debatable.

Dr EF accepted a caution for kerb crawling but failed to report this to the GDC.  The panel disregarded the difficult personal circumstances reportedly faced by this registrant at the time of the incident as they did not mitigate against the seriousness of the conduct.  They also said:


“The Committee noted that the matters before it were not clinical in nature. It noted that there had been no harm to patients. However, it bore in mind that its primary function is not only to protect patients but also to take account of the wider public interest, which includes maintaining confidence in the dental profession and the GDC as a regulator, and upholding proper standards of behaviour.”

Dr EF was given a reprimand which will be on the public register for 12 months and as it will form part of the fitness to practise history it will be always be disclosable to any future employer and authorities in other jurisdictions.

A consensual sexual relationship with a patient can cost you a 3-month suspension as Dr GH found out not to mention on-going negative PR with the story still being available on Google many years later.  Dr IJ also knows only too well the damage that can be done after being reported to the GDC by a disgruntled ex-husband of a patient who lied in his witness statement about having seen ‘explicit’ text messages such that the case progressed to a full hearing before it was concluded with no case to answer. Press stories with a ‘guilty as charged’ tone to them relating to his case pre-hearing are also still available online. 

Are we beginning to see the problem with reputational damage to the profession yet?  The press can quite easily defame registrants with their reporting of potentially salacious cases before and during a hearing, and those pages will remain online even when a registrant is vindicated.  For this reason, relationships with patients are just somewhere no dental professional should ever go, aside from the fact that it is seen as being totally unprofessional and a serious abuse of position.  If you find you are heading down the route of a genuine relationship with a patient for goodness sake find them another dentist PDQ.

Moving on from relationships with patients, another potential danger zone is with employees and students.  When they rely on you to pay their wages or pass their finals there is a clear imbalance of power. If you have a fling with an employee be prepared for the risk of sexual harassment claims and grievances forever more. University lecturers may be accused of offering grades for sexual favours or bias (either positive or negative).  Having a relationship with a student is often considered a gross misconduct offence these days.   If you are a partner and you start fooling round with the staff on the quiet prepare for a total breakdown in trust.  It is just best not to go there and if you don’t believe me or feel I am being overly alarmist, ask any employment lawyer about historic compensations awards for harassment claims spanning back over years and years and partnership disputes.

At the time of writing a university lecturer is awaiting a hearing facing allegations of engaging in sexual activity in his office, and then being dishonest about it during the University investigation. We will have to wait to see if this would have made it to the GDC save for the dishonesty aspect.

For those who think that a fumble on the dental chair with one of the nurses is acceptable I am sorry to disappoint you but it is not, and it never was.

In the Mr EF case part of the charges included:


7. Whilst working with Miss LM, you had a consensual sexual relationship during the course of which on one or more occasions on Practice premises during surgery hours or shortly thereafter you:

(a)  exposed yourself wearing a thong;Admitted and proved
(b)  exposed your genitals;Admitted and proved
(c)  engaged in oral sex;Admitted and proved
d)  had sexual intercourse.Admitted and proved

8. Your conduct as above at 7 was:

(a)  unprofessional; Admitted and proved
(b)  inappropriate;Admitted and proved
(c)  indecent.Proved


The Committee found Head 8(c) proved because, by your admissions, other people were present in the practice and therefore you put yourself at risk of being discovered."

The determination also says:

The Committee has found that you behaved inappropriately and unprofessionally towards four dental nurses who worked with you, and that your behaviour towards three of them was indecent. As a partner in the practice, working directly with these dental nurses, you were in a position of authority over them – which you abused.  Furthermore you conducted sexual relations with Miss B in the practice, at times when you could have been discovered.

Mr EF was erased for this and whole host of other sexual misconduct misdemeanours including touching and making inappropriate comments to other nurses.

So even though many feel that consenting adults are entitled to some degree of privacy, the simple fact that they might be discovered in the act by a member of the public is enough to take things to the level of indecency.  Oh dear. This also makes it clear that consent has absolutely no relevance in excusing occurrences of sexual misconduct or otherwise inappropriate sexual behaviour.

Wherever there is a hierarchical relationship or an imbalance of power there is potential for actual abuse or allegation of abuse of power.  An allegation is all it takes, and I know of 2 instances where registrants have faced criminal charges based on false allegations.

Personal conduct involving sexual behaviour has an astonishing potential to bring out the widest range of opinion on what is acceptable or not if the recent debates on Facebook are anything to go by!   I am sure we all know of successful relationships between dentists and employees, lecturers and students, even dentists and former patients.  But this is really an area in which to tread extremely carefully as if you get it wrong the consequences are huge.

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© Victoria Holden, GDPUK Limited, 2017

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JAN
09
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Satisfied GDPUK Client

Satisfied GDPUK Client

We recently received a call from a client, that ran an advertising campaign last year on GDPUK. They were offering free trials of their new product for members of our community to try in their practice and also to provide constructive feedback on this particular product to the manufacturer.

Ten units were sent out by the manufacturer and each dental practice was given a couple of month's trial to see how the product performed.

Rather impressively, 8 out of 10 of these trials turned into a purchase of the product, which obviously shows the confidence the manufacturer had in giving the dentists a trial and also that the dentist received impressive results when using the equipment, that they knew the product would help improve patient care and safety.

From our perspective, it shows that an attractive offer, catches the attention of our 10,000 strong community and leads to sales for the manufacturer. The advertiser found their target audience, produced a campaign that caught the attention of our readers and turned it into sales.

Always great to receive positive feedback from our clients.

If you would like further information on how we can help you reach your target audience, This email address is being protected from spambots. You need JavaScript enabled to view it.

www.gdpuk.com/more/about

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4301 Hits
JAN
09
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Part 2. Insight

Part 2. Insight

Insight: - "The capacity to gain an accurate and deep understanding of someone or something."


Welcome to part 2 of our series on online advertising. In this second blog, we look at insight and what an important element of advertising it is. Insight in advertising is seen as a huge advantage of modern day advertising.

We all strive for more insight in our lives, working out why things have gone a certain way, a certain decision has been made and looking to understand things fully. This is also true in relation of social media and advertising. The modern world strives for insight and analysis into everything we do and think.

Online advertising provides you with endless insight allowing you to become a more effective marketer. Marketers went from having no data 20 years to more data than we know what to do with. Online advertising has helped solve this problem because of the visibility and access to data and of course reminds us of the famous line from John Wanamaker:

 

Half the money I spend on advertising is wasted; the trouble is I don’t know which half.

With online advertising you begin to get an idea of where your traffic is coming from and who is clicking on the banners or social media posts. This is the first major advantage of online advertising, it provides us with incredible insight and a stronger knowledge base than ever before.

Therefore, this makes online advertising unique. Running a campaign online provides us with the chance to show activity throughout the entire online consumer journey. Common activities include sales, newsletter sign-ups, the number of times an advert is displayed (ad impressions), the number of times people click on an advert to visit a microsite or landing page (click through), the number of times people have interacted with an advert, sign-ups and how much they have interacted on social media.

Although having more knowledge is not always beneficial, when we are looking to market our brand or product we want as much knowledge as possible. So therefore having access to a range of data and information about our campaigns is a fantastic improvement on marketing in the past and gives online advertising a huge advantage.

Thanks for reading.

Part 1 Here.
Part 3. Targeting.

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4952 Hits
JAN
08
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Going Rogue

Going Rogue

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Copyright

© DentistGoneBadd, GDPUK Ltd 2017

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JAN
03
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Part 1: Introduction

Part 1: Introduction

About GDPUK



As mentioned previously, 2017 marks the 20th year of GDPUK.

GDPUK.com is for dentists and dental professionals to discuss all aspects of their profession, their practice and their business, centred on the UK. Subjects dissected have been diverse, from tips on simple techniques to guidance on buying major equipment, to discussions on the various practice management software packages, and of ongoing developments in British dental politics.

Moderated in Manchester, England by Dr Tony Jacobs BDS, the Group was started in Summer 1997, and continues to grow rapidly.

GDPUK.com also publishes UK dental news, and has had many exclusive stories, as well as being able to publish the latest news relevant to dentistry before other dental news providers. In addition GDPUK blogs, both editorial and product updates are well read throughout the dental profession and industry. A unique feature is the @DentistGoneBadd visual blog.

The group now has nearly 10,000 members, and attracts interest and sponsorship from major companies involved in the dental trade.

Blog Series

To mark this anniversary, we thought we would put together a 20 (get it!) part series of blogs about online advertising and all the advantages of it. Over the next 19 blogs, I am going to look into detail at the reasons that online advertising is effective and why a medium like an online community can be perfect for your brand …. Especially If you are looking to reach a target audience.

Over the series of blogs, we will explore all the elements of online advertising from how you can be creative, the opportunity to increase brand awareness, plus the adaptability and flexibility of online advertising.

Advertising online can no longer be viewed as a new medium, it is extremely well established but we hope this series can convince the sceptics but also prove useful to anyone who is looking to do some powerful marketing of their brand or product in the year ahead. Please get in touch we any queries or questions.

Hope you enjoy this series of blogs. Thanks for reading.

Happy New Year.

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3746 Hits
JAN
02
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Dental Wishlist for 2017 by @DentistGoneBadd

2017 - A Dental Wishlist

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© DentistGoneBadd, GDPUK Ltd 2017

7461 Hits
DEC
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Time to question the Holy Cow

Time to question the Holy Cow
Image Alt here

Discussions on GDPUK forum often stimulate my thinking and my thoughts in this blog are for the nation to consider in 2017. This blog uses dentistry for some of its examples, but is about the future of the NHS, and asks if the marketplace could help development of a different type of health care system, funded not just centrally. I have tried to keep this a short piece, so I have abbreviated the steps for my intelligent readers.

Continue reading
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© Tony Jacobs, GDPUK Ltd, 2017

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DEC
22
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The case of the missing F mug, how it has devastated JFH Law, and how you can prevent it happening to your practice

The case of the missing F mug, how it has devastated JFH Law, and how you can prevent it happening to your practice

At the start of 2017, we thought we would take a look back at one of the major events of the past year, and the dramatic effect it has had on both us and …the World.

When the team at the JFH Law’s offices were asked for their views on what this should be, everyone was in agreement that ‘Mug Gate’ was that very event.

‘Mug Gate?’ we hear you all asking, ‘how did I miss that?!’

Fear not; in this blog we will set out the issues surrounding the controversial ‘Mug Gate’ and how you can prevent it happening at your practice. 

It all began on 14th December 2016, when John Howey, Partner at JFH Law, announced he had broken a J mug washing up. ‘The handle just came off when I was washing out the inside’ he confirmed. At first we all laughed and there was some light hearted banter about Mr Howey not knowing his own strength; but things then took a turn for the worst.

Julia Furley, Partner at JFH Law, recalls:

At first it was all a bit of fun. We were laughing away, but then I looked around the room and noticed that everyone was drinking from a J mug. It became immediately clear to me that John couldn’t have broken a J mug. I therefore made the management decision to investigate further, attending the kitchen and conducting an audit of the firm’s J, F and H mugs.”

After Ms Furley had completed the stock-take it was discovered that all of the F mugs had mysteriously disappeared. It might be helpful at this point for the reader to note that we have a variety of mugs with the letters J, F and H on them. With the F mugs all gone, we no longer had our identity!

On 15th December 2016 Ms Furley vigorously interrogated all the staff as to their movements over the previous year and whether they had had any accidents involving an F Mug. Everyone denied having broken a mug. The plot thickened.

Anges Biel, paralegal, was tasked with making enquires with the cleaner, after completing her investigations she confirmed ‘the cleaner is denying any breakages but I have my doubts. I found out his name is Franz Ferdinand’. We were certainly suspicious. Could it be that Mr Ferdinand supplementing his own collection of mugs with our Fs?  

Whilst we now have the expense of re-stocking our kitchen with F mugs, we are also left wondering; what if M&S no longer stock lettered mugs?

Everyone at the office has been left unsettled by these unfolding events. Jigna Verakia, solicitor, provide us with this quote:

I just don’t know why someone would want to take all of our F mugs. We are a close team but I am now left suspicious of those around me. I have my own mug and I now take this home to protect it. I just don’t know what I would do if anything happened to it.

The mystery continues here at JFH Law but what lessons can your dental practice learn from Mug Gate?

Laura Pearce, employment solicitor at JFH Law, advises:

The morale of this story is; don’t trust your staff. Theft is theft is theft. Make sure all surgery property is under lock and key and only the managers can access it. Have a signing in and out form for each time staff members want to use a mug or a pen. Search bags as staff are leaving and undertake random stripe searches. If you find that anyone has taken anything, shout very loudly ‘you’re fired’ and escort them off the premises.

We also spoke to Duncan Roberts, criminal solicitor, to get his take on the situation:

Don’t bother phoning the police; deal with it yourself. An eye for an eye, a tooth for a tooth has always been my motto.

If you need any advice about marching staff of your premises or medieval punishments, please do not hesitate to contact us for assistance. And if anyone sees any of our F mugs, please let us know immediately; there will be a reward for anyone who helps in their safe return.

How to deal with gross misconduct

On a more serious note, dealing with gross misconduct can be difficult; when you work in a small practice, if a member of staff has taken something that does not belong to them, trust can break down and emotions may run high.

Before you jump the gun and start firing staff, take a step back and follow this simple 3 step process to help you avoid landing in hot water.

Step 1 – Investigate

Call the employee into a meeting and question them about the incident. This should be informal and a meeting to gather information not make allegations. You do not need to write to the employee beforehand inviting them to the meeting. They do not have any right to a representative at the investigatory meeting.

After the meeting, consider whether you need to suspend the employee. This should be a last resort and not an automatic response to allegations of misconduct.

If someone else reported the incident, obtain a statement from them too. Is there any other evidence you can obtain to help you make a decision?

At the end of this process gather together the information you have and decide whether there is sufficient evidence to take the matter via a formal route.

It is at this point you can weigh up the seriousness of the allegation and decide whether an informal chat with the employee would be enough to rectify the behaviour. Some companies take a hard line and consider any theft amounts to gross misconduct, whilst others may view the theft of a pen as less serious and give a simple ‘slap on the wrist’ warning not to do it again. Remember whatever line you take make sure you treat all employees the same.

Step 2 – Disciplinary Meeting

If you consider the allegation is serious enough to take formal action, write to the employee and invite them to a disciplinary meeting. The letter needs to clearly set out the allegations and state that if found prove it could result in summary dismissal. At this meeting, the employee is entitled to be represented by either a trade union representation or work colleague, and you should remind them of this in the letter. Finally, make sure all evidence you have obtained is sent to the employee so they can comment on it.

You should give the employee time to prepare for the disciplinary meeting; how much time you give will depend on how much information there is. 

At the meeting put the allegations to the employee and give them a chance to respond.

We would recommend adjourning the hearing to make your decision. If you do this and carry out any further investigations, you will need to re-convene the hearing and give the employee a chance to comment on any new information that comes to light.

Write to the employee with the outcome. Set out in detail why you have come to your decision. If you do dismiss the employee, offer the right of appeal.

Step 3 – Appeal

If the employee appeals the decision, you should invite them to an appeal meeting. This should be heard by someone different to the disciplinary hearing and more senior if possible.

Again the employee is entitled to be accompanied at this meeting.

Hold the meeting and let the employee put forward their grounds of appeal. Following the meeting, write to the employee with the final outcome.

The above three step process is based on the ACAS code of practice, which you should always look to follow. You should also consider what your own policies say and try to follow them where possible.

If you need advice or assistance on dealing with a disciplinary procedure, please contract Laura Pearce on 0207 388 1658 or email her at This email address is being protected from spambots. You need JavaScript enabled to view it.

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All I Want...

All I want for Christmas.

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DEC
13
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Rearranging the Deckchairs on the Titanic...

Rearranging the Deckchairs on the Titanic...

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.

 

 

 

 

 

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'tis the Season....

'tis the Season....

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

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8906 Hits
DEC
12
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Weasel words by @DentistGoneBadd

Weasel Words by @DentistGoneBadd

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7619 Hits
DEC
06
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Tweets

Don't Tweet & sniff the hand rub

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8347 Hits
DEC
05
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GDPUK Media Pack 2017

GDPUK Media Pack 2017

Advertising opportunities are now available on GDPUK in 2017.

Please get in touch to be sent our latest media pack and we will be glad to send all the information over. This email address is being protected from spambots. You need JavaScript enabled to view it.

As part of the advertising experience, we feel we can offer you more than traditional advertising mediums. GDPUK offers a value added experience.
 
  • Exposure on the site or daily digest for a full month or as long as you want. Pricing is on a per month basis. This generates a large number of impressions of your message.
  • Opportunity to post PR or blogs onto the site to accompany your campaign, these are then shared with our thousands of followers on social media. So as well as reaching our community audience, you are reaching another audience through social media.
  • By posting content and information to our blog pages, you can be seen as an opinion leader in your sector.
  • Our ad serving software can display more than one ad at a time, instead of having all your impressions on one message, you can split the exposure between as many messages as you want. This works well for a dental business that has a number of product or service offerings eg. a business that does dental repairs and sells equipment, can advertise both services at once. This is a fabulous way to test what works and experiment with which ads gain the best response.
  • Click throughs can be to a dedicated landing page on our website, where you can collect data or provide further information to the audience.
  • Advert can appear on our front page and our news / blog pages, which get viewed thousands of times in a month.

How can you use GDPUK to reach your target audience?

  • Promote a course that is looking for dentists to attend.
  • Launch a new product or service to the dental sector.
  • Special Offers.
  • Make dentists aware of a service your company offers.
  • Brand Awareness.
  • Surveys. We can host surveys on our site.
  • Promote attendance at a trade show.

To be sent a copy of our latest media pack, please This email address is being protected from spambots. You need JavaScript enabled to view it..

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DEC
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Challenging mainstream Media? CNN buys Beme

Challenging mainstream Media? CNN buys Beme

 

I have mentioned Casey Neistat and his interesting YouTube channel in the past. A year on, he has 5,902,950 subscribers which is a rather impressive following! Last week he announced that he would be ending the daily vlogs that documented his life and will now be focusing on a new project. This was obviously big news and dominated social media for a few hours.

 

Casey has always been consistent in always striving forward and taking on new projects. He often talked on his blogs about being fiercely ambitious.

 

On the back of his “retirement” from YouTube, on Monday it was announced that CNN would be buying the social media platform owned by Neistat called Beme and the 11 person team that run the app for a reported $25 million. But the really intriguing part is that CNN plan to shut down the app and allow Casey to create a new project to attract his 6 million followers to this new media company. Neistat will have full creative control, that lets the audience share “timely and topical videos” and start conversations around current events.

 

“Casey has tapped into nearly six million really powerful viewers, most of which do not tune into CNN,” Andrew Morse, global head of CNN Digital, told NYT. “To build this audience authentically, we believe we need to build something new.”

 

Casey will attempt to build engagement around news topics.

 

“It’s going to be very different from Beme and bigger than a single product,” Neistat told The Verge in a phone interview.

“There is a tremendous distrust between the audience that watches my content online and the information that is put out by traditional media. Our broad ambition is to figure out a way with tech and media to bridge the gigantic divide.”

 

Along with his own video projects, Neistat wants to find more opportunities to help his audience learn more about the world and how they can help make it a better place. He's already done this to some extent in the past, such as in 2013 when he used the $25,000 budget from 20th Century Fox to help with typhoon relief in the Philippines. He also wants to come up with a way to help the next generation of content creators use technology and find their voice.

 

So why am I writing a blog on this?

 

Younger generations do not believe everything in the mainstream media as past generations certainly did and so what intrigues me about this latest move from Casey is how will he present news / stories in a way that engages people and gets them interacting with the latest news from around the world.

 

Video is proving a very popular medium, as the number of subscribers to Casey’s vlogs demonstrate but I certainly can’t wait to see how he will take the opportunity of working in a big mainstream media organisation and put his unique spin and perspective on things. As a major cable TV news channel, CNN is likely trying to formulate content in a way that speaks to younger, more cynical audiences and based on his previous form of effortlessly appealing to his viewers, Neistat seems the perfect man to reach the younger audience.

I am looking forward to seeing how this devolops and if Casey can truly produce something different that influences and engages his followers.

Below I have included one of his famous YouTube productions. Looks like fun to me :)

His Youtube channel can be found here.

 

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12 days

the 12 days of Christmas

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NOV
22
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Update your team with mobile software by @DentistGoneBadd

If you could fix dental staff with mobile software

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NOV
15
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G.D.P.U.K

G.D.P.U.K

Welcome to our latest blog. Below are 5 reasons that we believe make GDPUK a unique place to market your business and reach your target audience of dentists. G.D.P.U.K.

 

 

 

G = Growing

 

Established in 1997, GDPUK continues to grow

 
  • 20 years of hosting dental discussion chat and opinion

  • The home of dental opinion in the UK

  • Just under 10,000 members, who are all part of the profession

  • Since beginning of 2014, we have had 3500 new members, the site is constantly growing.

  • Approx 1,000 different people contribute to our forum discussions in a calendar year.

  • In 2016, we are averaging over 4,000 unique visitors a month to the site.

D = Debate

GDPUK is the home of dental opinion and information.

 
  • The site is proud that it gives a medium for dentists to discuss dentistry in the UK and give their opinion of what matters to them.

  • The site can be controversial but we see that as a good thing. We exist because the content in our news, blogs and forum pages is interesting to read. We continue to attract an audience.

  • This tradition continued at our conference in November 2016 and our 20th anniversary celebrations in 2017.

P = Publisher

Publisher of Daily Dental News and Blogs

  • Large audience follow our news and blogs

  • GDPUK has a news editor, plus a number of paid content writers

  • News stories receive thousands of readers a week

  • A range of blogs are published weekly, full of opinion, humour and insight.

  • Our news is published instantly, so the site carries the latest stories, no monthly deadlines, no print nor post delays….

  • @DentistGoneBadd our comedy blogger attracts around 5,000 readers per week, 100,000 in the last twelve months.

U = Unique Opportunities

Reach your target audience

  • GDPUK offers unique advertising spaces to get in front of your target audience

  • Dentists are reading our site every day of the week.

  • The site is like a dental exhibition every day!

  • Feature on our daily digest email, which gets sent 3 times a day, every day

  • Ask us about what we can offer for a 12 month marketing campaign.

K = Kinship

Become Part of the GDPUK Family

  • We are a small, close knit group and business at GDPUK

  • Work with us and we can help any problems or issues and come back to you instantly

  • We can provide full accountability on everything and we are always available to speak or help.

  • GDPUK loves to build close relationships, with our users, colleagues and also our customers who help to keep the site running.

For more information about GDPUK and how we can help to market your business, please This email address is being protected from spambots. You need JavaScript enabled to view it..

Thanks for reading.

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NOV
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Mysteries of The Prototypes Explained

The New Contract

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NOV
11
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Uber drivers found to be workers: What are the implications on the dental world?

Uber drivers found to be workers: What are the implications on the dental world?

Uber drivers scored a massive victory against their bosses last week, by challenging the company’s assertion that they are self-employed. However, the London Central Employment Tribunal were not determining whether Uber drivers were employees or self-employed, but rather whether they were somewhere in the middle; were they in fact “workers” for employment law purposes. And the answer was yes.

Uber now faces mass litigation as drivers are being advised to issue claims.  Deliveroo staff are jumping on the band wagon too; they are taking legal steps to unionise and gain worker status. And these are not the only companies that are likely to have claims issued against them. With an ever expanding GIG economy the Uber case is of huge importance.

It also highlights the importance of categorising staff correctly from the outset of any contractual relationship and ensuring contracts are not drafted by lawyers to merely try to avoid claims but are drafted to reflect the reality of the situation.

The distinction between employees, workers and the self-employed is particularly relevant within dentistry. Dentists engaged as associates have traditionally been labelled self-employed, however, the contractual reality is often very different. Practices must now review their contracts and ask themselves what it is they want to achieve from their working relationships. As a practice owner, if you do not want to be liable for employment rights such as sick or holiday pay, now is the time to act. Some simple changes in the way you run your business will make all the difference.  As for associates, it is now worth considering your status to see whether you have been missing out on some of the paid benefits that come from being a worker.

Remember; simply because an associate has signed a ‘self-employed’ contract without complaint for a number of years, does not prevent future claims being issued against your practice.  

This decision is also likely to have a massive impact on the dental community and in particular the classification of associates, especially with the rise of corporates. Here we look at why.  

Decision

On 28th October 2016 the London Central Employment Tribunal sent out its long awaited judgment in the case of Aslam & ors v (1) Uber BV (2) Uber London Limited and (3) Uber Britannia Limited.  The Tribunal held that Uber drivers should be considered workers, as opposed to self-employed contractors.

Uber has already confirmed its intentions to appeal the decision, and the case is expected to go all the way to the Supreme Court given the huge ramifications of the decision, and the implications on a number of business models based on a similar ethos to Uber.

Legal Definition of Worker

Firstly, it should be noted that the Uber drivers were only seeking to establish themselves as workers; not employees. As such we are only considering this category here. For detailed guidance on employment status you can read our October 2016 blog here.

Workers lie in between employees and self-employed contractors, gaining some rights afford to employees but not all of them. This table steps out the rights of each.

To determine worker status, the Tribunal will ask:

  • Personal service: Did the individual undertake under the contract to personally perform work or services?
  • Business undertaking: Was the status of the ‘employer’ under the contract that of a customer of a business undertaking carried on by the individual?
  • Mutuality of obligation: was there mutuality of obligation between the individual and the ‘employer’?

The courts have made it clear that ‘the question in every case is…what was the true agreement between the parties.’ It is therefore the reality of the situation that is analysed in line with the above three questions, not just the contractual documents.

Key Findings

  • Personal Service. It was not disputed that the drivers undertook to do the work personally. In any event the Tribunal found that the essential bargain between the parties was that, for a reward, the driver makes himself available to carry passengers of Uber to their destinations.

 

How is this relevant to dentists?

This is similar to a contract between associate and dental practice, in that the associate must make himself available at agreed times, and for a fee, to treat the patients of the practice.

 

  • Business Undertaking. Uber argued that it was not in business as a supplier of transportation services. It was merely a platform which connected passengers to drivers. Uber claimed to be a a customer of the drivers, as drivers paid a fee to use the platform. However, the Tribunal disagreed. It found that Uber offers a range of services, UberX, UberXL, UberEXEC, UberTAXI and UberWAV. Whereas the drivers only offer one of the services. Crucially, Uber marketed itself as offering a range of transport services, not as a platform service. This was for its benefit; not the benefit of the individual drivers. The Tribunal therefore held that Uber is a transportation service and not a customer of the drivers. Interestingly this is a similar argument Uber put forward before the North California District Court, namely that it was a technology company and not a transportation services. This argument was resoundingly rejected by that court too.

 

How is this relevant to dentists?

Dental practices are not a conduit by which patients access their dentists. Instead they market themselves as the end supplier of a range of services, such as hygienists and therapists or specialists and dentists with specialist interests, whereas not all staff will be providing those services.

 

  • Mutuality of obligation. Once an individual becomes a driver, they have access to the App, which sends passenger requests to available drivers. A driver is not required to turn the App on but when they do there are certain requirements that the driver must adhere to, including the number of cancellations they can make, the number of fares they reject when online and in terms of their ratings. The Tribunal found this meant the drivers were required to work for Uber when online and that Uber had an element of control over the work the drivers carried out.

 

How is this relevant to dentists?

Dental practices must have associates in place to undertake dental treatment on the patients booked into the surgery. As such the practice requires the dentist to be available during surgery opening hours. This is even more applicable in relation to practices with NHS contracts, where the practice will require associates to complete a minimum number UDAs per annum. Associates also must comply with the practices policies and procedures.

 

  • Reality of the relationship. The contract and agreements between Uber and the Drivers referred to Uber providing platform services to connect customers with drivers. Of this the Tribunal said ‘the notion that Uber in London is a mosaic of 30,000 small business linked by a common ‘platform’ is to our minds faintly ridiculous…Ms Bertram spoke of Uber assisting drivers to ‘grow’ their businesses, but no driver is in a position to do anything of the kind, unless growing his business simply means spending more hours at the wheel. The Tribunal went on to state how Uber do not supply leads for drivers, as drivers are not free to negotiate a deal with the customer.

 

How is this relevant to dentists?

Often Dental Practices set the rates for the dental treatment offered and dentists are not free to negotiate those prices.  Also dental practices will often promote the services they offer as a whole and the associate is therefore not free to grow their own business. However, if an associate has their own client list, sets their own hours and/or is able to send a locum in their stead without restrictions, then the reality of the relationship is something different.

We feel that the tide is turning against the broad brush approach to defining ‘self-employment’ and the Tribunals and HMRC will be considering how to crack down on employers seeking to avoid their duties. In a nut shell, in order to protect your practice from costly litigation, make sure your contracts reflect the true relationship of the parties and if you are not sure, then seek advice from an expert.

Laura Pearce, Senior Solicitor

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9142 Hits
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Market your business online, work with GDPUK in 2017

Market your business online, work with GDPUK in 2017

 

Ask us, How we can help you?

 

There has been a recurring theme this week (other than the US Presidential Election) and that is clients or prospects asking how we can help them in 2017?

We see GDPUK as an integral part of a dental companies opportunity to market themselves to dentists in the UK. We believe we have a large, active and engaged audience on the site, which we are very proud of. This is important because dental professionals in the UK are using social media more than ever and GDPUK is at the centre of that.

So we have put together a short list of the ways in which we can help our clients engage with potential customers.

 

  1. Banner Ads - We offer a range of banner ads on the site and our daily digest emails. Further info can be found in our media pack and by getting in This email address is being protected from spambots. You need JavaScript enabled to view it..

  2. 12 month packages of advertising. We have a number of deals with clients that run for 12 months, which offer the client excellent exposure, good value and builds a great working relationship between GDPUK and the client.

  3. Product / Service Launches - We can help launch a new product into the market, with blogs, news articles and banner ads.

  4. Special Offers - Entice new or old customers with a special offer / or sample offer

  5. Case Studies - We can publish case studies for you of products that are working for patients in dental practices. A case study can be a great way of demonstrating how your product works and how it will help the dentist improve his or her skills.

  6. Forum Reviews / Tests - Put your product to the test, use members of the GDPUK forum to test your product and receive honest reviews that can be shared on the forum and published as a blog post.

  7. Surveys - Run a survey, which can be hosted by our site or your site. Use it to do product research etc

  8. Social Media Competitions - Combining promotion on GDPUK and other social media channels, we can run a competition that helps collect data and potential new users of your product.

  9. Promotion of Courses / Events - There are a large number of events, meetings, courses that are scheduled in the UK dental calendar on an annual basis, we can help with promotion and even the sale of the tickets.

  10. 2017 Conference. Next year we are pleased to be hosting an event to celebrate our 20th year of a space for dentists in the UK to talk and share opinion. This milestone, will be marked with conference towards the end of next year. Exhibition and sponsorship opportunities will be available.

 

If you would like to try any other marketing ideas on our site, we are always interested in new methods and always looking to learn. Look forward to hearing from you soon, helping your business thrive in 2017.

Thanks for reading.

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GDPUK Conference 2016 - A Huge Success - Join us in 2017!

GDPUK Conference 2016 - A Huge Success - Join us in 2017!

 

 
Over 60 members of the GDPUK Community gathered at Hotel Football in Manchester on Friday 4th November to enjoy a day of learning, networking and thinking time away from the dental practice!
 

The mix of education, personal stories and music made for an incredibly diverse and interesting day.

 

 

Chris Tavares remarked;

“Thanks to the GDPUK Team for the absolute wonderful day I had today. Dentistry's been tense lately due to 'non-dental' things. Usually when I go on a course I'm really tired at the end of day due to the intensity of the lectures. Today was different. I really needed a chill out day and today absolutely nailed it. The speakers did a fantastic job keeping to their remit and the delivery was excellent. The topics were all very relevant to dentistry but in, oh so different a way, than the usual intense clinical procedures lectures. It's what I call the 4th Dimension of educational topics. The outside of the box topics. Each speaker spoke for the right length of time and kept us all very much glued to our seats. There was education, there was humour, there were personal journeys, there was music. Very much how the humanity of being a registrant is all about. Each topic was very 'functional' in creating a great chill out, educational and social event. Also great to put so many faces to posters. Unfortunately did not manage to meet everyone.”
 

 

Mike Powell via the GDPUK forum stated:-

“An excellent day with a variety of topics covered, not all "look how excellent my work is"......The catering was also massively better than the norm, fillet of beef with peppercorn sauce anyone? Thanks Tony and all the others involved in organising the day.”
 

 

Tony Jacobs, MD of GDPUK was really pleased with the outcome of the day:-

“We are so pleased with the positive feedback from everyone who attended the conference. As always, it was fantastic to meet old and new faces from the forum. We believe the mix of speakers from within dental circles and a couple from other sectors, helped form a day that was insightful, entertaining, unusual and thought provoking. We look forward to hosting another conference in 2017, which will mark the 20th year of GDPUK.”
 
 
Thanks to all our members who supported the event and thanks to all the sponsors for taking part. Dental Elite, Denplan and DDU all enjoyed the day thoroughly and we appreciate their support which makes a conference like this possible.
 
As you can see the 2016 GDPUK Conference was fantastic but 2017, promises to be even better!
 
If you would like to join us for the 2017 Conference for what will be an awesome day, please follow this link and book today. Further info on speakers can be found on the site.
 
 
 
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Unreasonable behaviour - dental students in the 80s

How did we survive without GDC guidance

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How The Other Half Live

How the other half lives

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Recent comment in this post
Graham John Nichols

This is so true

An amusing blog except it is so true. I also work for a corporate and recognise the scenarios. I wonder how they get away with it.... Read More
Sunday, 06 November 2016 07:42
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Caring for the Dental Team

 If You Find An Injured Co-Worker, Ring 011 456 5674

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NHS Dental Stats made simple

Statistics

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Stories

Stories

 

 

Previously on this very blog, I have written about the power of storytelling but how we use stories and imagery are still incredibly important when we get up in front of an audience.

If you want people to remember what you say, tell a story. Paint a big visual picture. Don’t just say you deliver great customer service, find a surprising or funny story about how you delivered amazing customer service. Link it to our emotions.

This evening is the Day of Atonement or Yom Kippur, which is a 25 hour fast that commences at sunset. The central themes of the day are atonement and repentance. At certain points of the service (both tonight and tomorrow) there will be a sermon from the Rabbi or Minister of the Synagogue. At every synagogue around the world there will be similar themes. From experience of some bad sermons over the years, those that keep the attention of the audience will involve a number of stories that can be linked together to form an overall message that the speaker wants to get over to their audience or congregation. If parts of the biblical texts or transcripts are just read out then people will just switch off. Stories will keep the hungry audience, entertained and engaged!

Groups don’t need more facts. We definitely need more stories – especially good ones.

So with 4 weeks to go to the GDPUK Conference, I want to remind you that all our speakers on the day will have excellent stories to tell, that we believe will keep you engaged and interested. The conference promises to be slightly different to a normal day at a dental conference. Why not come along and join us. We look forward to seeing you on the 4th of November. There will be plenty of chance on the day....for us all to share our stories.

Thanks for reading :)

 

Speaker lineup - www.gdpuk.com/conference/speakers

Conference and ticket information - www.gdpuk.com/conference/overview

 

Quote taken from this link https://www.flickr.com/photos/coolinsights/16461066958

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Balancing Probability

Case Examiners

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Employed or self-employed, that is the question

Employed or self-employed, that is the question

The question of employment status regularly crops up amongst the dental community. Most consider associates to be self-employed because that is the industry norm and how HMRC view associates. However, that may not always be the case.

It is a common misconception that because a contract states it is ‘self-employed’ that will be the end of the matter. However, from an Employment Tribunal perspective the question is a question of fact; not just what is set out in the documents; meaning your contract may not be worth the paper it’s written on.

Given the vast amount of employment rights that employees have, getting this wrong can be a costly mistake to make.  

In addition to ensuring you get it right from the outset, in a modern society people want more flexibility in how they work; as a result hygienists, technicians and therapist are seeking self-employed opportunities. Being able to offer such roles could make you more appealing as an employer, helping you attract and retain the best possible talent for your business.

In this blog we take a look at the legal test of employment status for the purpose of an Employment Tribunal, the common pitfalls and how to avoid them.

The question of employment status is a minefield.  It is therefore not surprising that this issue regularly pops up before Employment Tribunals. There is no hard and fast rule that can be used as the issue is always case sensitive. Judges have tried to give guidance and here we set out the points you should ask when considering the position within your practice. 

It should be noted that the test for employment status for the purposes of employment rights is different to the test that HMRC use. In addition, HMRC allow some professions, such a dentistry, to utilise self-employment status, even if the Tribunals may not agree with this. This article only deals with the question of employment status for the purposes of employment rights.

Types of Employment Status

There are three types of employment status:

1.      Employee:

2.      Worker;

3.      Self-employed.

Employees have the best employment protection, workers have some protection, and those who are self-employed have very little protection. However, those who are self-employed have much more freedom as to how and when they work, compared with employees. As such there are pros and cons with each category, and which is right for you will depend on individual/business circumstances.

You can find out what rights workers and employees have here.

Identifying Status

When looking at whether the individual is an employee, Tribunals will ask:

  1. Must the person personally provide the service or can they send a substitute?
  2. Is the company obliged to provide work and is the person obliged to accept it?
  3. How much control does the company have over the individual?
  4. Who has the risk in relation to the business?
  5. Who provides and maintains the tools?
  6. What degree of management does the individual have in the business?
  7. Does the individual profit from performance?
  8. How is the individual paid?
  9. Does the individual receive holiday and sick pay?

This is not an exhaustive list and the Tribunal does not approach it as a tick box exercise. They consider all the facts and then determine the point. This is why following the industry norm may not always be the best approach, especially with the introduction of corporates and chains.

For worker status there are just three questions:

  1. Must the person personally provide the service or can they send a substitute?
  2. Is the company obliged to provide work and is the person obliged to accept it?
  3. Was the status of the "employer" under the contract that of a customer? 

There is no definition of a self-employed person. They are simply anyone who doesn’t fit into either of the above two categories.

In Issue 12 of JFH Law's Dental Bulletin we highlighted the case of the Hospital Medical Group Limited v Westwood [2012] EWCA Civ 1005 in which the Court of Appeal held that a GP working as a self-employed independent contractor for a private clinic was a worker, even though they had two other positions elsewhere. In our opinion, this case has a lot of similarities to dentists and highlights the dangers of getting it wrong.

Avoiding the Pitfalls

First and foremost make sure the contract reflects the true position of the relationship between the practice and the individual. If you try to avoid the question and/or use pro-forma contracts, the Tribunal will see through this and will scrutinise the matter in detail, potentially leaving you with a hefty legal bill and a payment of compensation to make. Many pro-forma associate contracts try to deal with all eventualities and refer to both NHs and private work. Remember one size does not fit all.

And vice versa; if you have spent money on a contract to reflect a self-employment relationship, make sure what is said in the contract is actually being carried out. If your contract states the individual can send a substitute then you must allow this. Whether this right should be unfettered is likely to depend on how the clause is worded. Given your duties as a dental practice, you will need some assurances as to who the substitute is. If you can avoid a clause that allows you to vet any locums but states a minimum standard of substitute this will give you less control and will make the contract less likely to be deemed an employment one.

As a dental practice you will no doubt have a number of policies and procedures in place for running your business. Make sure you distinguish the ones that apply to employees (mostly likely all of them) and the ones that apply to those who are workers or self-employed. This may mean having a separate set of documents for those who are self-employed in certain areas, such as conduct or performance. However, overall the cost of amending policies compared to the cost of litigation will be worth it.  

If you want advice on the status of anyone in your workforce or need assistance with re-drafting contracts or documents, please contact Laura Pearce on 0207 388 1658 or email her at This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Image by Caitlin Childs under CC licence.

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GDPUK Conference - Music announced

GDPUK Conference - Music announced
 
The GDPUK Conference in Manchester on the 4th of November was promised to be slightly different to the standard dental conference. We are pleased to announce the addition of the musician and artist Gideon Conn to the lineup on the day. Below you will find a short bio of what he will bring to the event in November.
 
Gideon Conn is a singer-songwriter, originally from Manchester but currently based in London. He tours extensively around the UK, having played at many UK festivals including Glastonbury Festival. Gideon is also an accomplished painter, drawer and sculptor, Gideon sells his artwork and accepts commissions through his website and his official Facebook page.
 
Conn's songwriting combines fingerpicking acoustic playing with jazz-inspired chord progressions and hip-hop rhythms. His vocal delivery encompasses singing, rapping and scatting. His music varies between a synth-laden modern sound and a more lo-fi production. He takes inspiration from a wide range of influences, primarily in soul and jazz music, and has expressed admiration for artists such as Stevie Wonder, Badly Drawn Boy, OutKast, Nat King Cole and The Yeah Yeah Yeahs.
 
At the GDPUK Conference, Gideon will be performing two short acoustic sets where he will showcase his range of talent. He will also be doing some drawings of the day in his unique style.
 
 
For further information on the day and the line up of speakers, please follow this link - www.gdpuk.com/conference/overview
 
If you would like to purchase tickets for the conference - click here
Further information on Gideon can be found on his facebook page
 
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Its OK, I'm listening

What we say, what the patient hears

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Missed Opportunity

Missed Opportunity

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.

 

 

NHS Expo Programme
https://www.eventsforce.net/dods/frontend/reg/tDailyAgendaAlt.csp?pageID=1788724&eventID=5272&page=dailyAgendaalt.csp&traceRedir=2&eventID=5272

The Innovate stage hosted

Sir Bruce Keogh and the Chief Professional Officers
(Main stage sessions)
10:00 - 10:50 in Innovate Stage

Sue Hill - Chief Scientific Officer
Sara Hurley - Chief Dental Officer, NHS England
Sir Bruce Keogh - National Medical Director, NHS England
Suzanne Rastrick - Chief Allied Health Professions Officer , NHS England
Keith Ridge - Chief Pharmacy Officer

 

Sarah Hurley responded
http://www.dentistry.co.uk/2016/09/09/cdo-responds-to-six-month-check-up-media-furore/

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

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Those were the days

Fings ain't what they used to be.

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GDC Watch Summer 2016

GDC Watch Summer 2016

Having been somewhat distracted by the school holidays, my latest blog considers some of the cases that managed to pique my interest, and gathers my collective thoughts during the months of both July and August. So that you are looking through the same lens, I’ll start off with the ‘legal definitions’ of misconduct:

Lord Clyde described misconduct in Roylance v the GMC (2002):

‘misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances’.

This definition was expanded in Nandi v GMC (2004), in that misconduct means a serious departure from the acceptable standard that is not just below the acceptable standard but:
 

‘conduct which would be regarded as deplorable by fellow practitioners.’


It has been further clarified in Meadow v GMC (2006) that misconduct sits at the same threshold for disciplinary intervention as the historic phrase ‘serious professional misconduct’:
 

‘As to what constitutes "serious professional misconduct…..it is inconceivable
that "misconduct" – now one of the categories of impairment of fitness to practise…..
should signify a lower threshold for disciplinary intervention’


On reading some of the recent charge sheets it appears that we have perhaps lost sight of misconduct, and moved on from the days where urinating in the spittoon, assaulting nurses or openly breaking wind in front of staff in the surgery sat at the threshold of deplorable conduct. If you have ever accidentally squirted water from the 3 in 1 towards a patient, you ought to be extremely concerned. We now have examples of unprofessional behaviour individually and collectively leading to a charge of misconduct such as:

  • on occasion spraying water on the patient’s bib;
  • throwing gloves at a patient;
  • drinking out of a glass left in the surgery.

And let’s not forget the beauty from a couple of months ago about bouncing balls of impression material down a corridor. How the panels keep a straight face through these types of charge is beyond me, but well done to them. Truthfully, I feel it is a bit embarrassing for the GDC to have it in the public domain. I may be wrong, but I believe that the barristers instructed by the GDC are involved in setting the final charges. With that thought in mind, I took a look at the Bar Standards Association and barristers’ fitness to practice hearings to see what allegations of professional misconduct are levied against them. Here is an example of a concluded Bar fitness to practice tribunal:
http://www.tbtas.org.uk/wp-content/uploads/hearings/3390/Outcome-Posting-Behanzin1.pdf

Observe how it is kept to one side of A4, extremely succinct, and there is nothing in it that may give any third party reading it anything to chuckle about? I also noted the lack of any published charges before the hearing for the sum total of 3 barristers presently listed as awaiting a hearing. This, along with the MPTS hearings begs the question of why does our regulator operate on a different set of rules that on the face of it appear more punitive to their registrants than those applied to equivalent professionals? Although it may give me nothing to write about, I would really urge the GDC to look at paring down their charge sheets and not making them public until after the facts have been determined in both their interests and those of the registrants facing a hearing.
One hearing saw a registrant face a charge of failing to:

adequately treat an on-going adverse oral hygiene condition.

It may just be me, but I can’t work out what this charge is supposed to mean and there is no explanation in the determination. In 17 years of practise I have not been aware I was obliged to ‘treat’ an adverse oral hygiene condition; I was taught that my duty was to offer appropriate preventative advice and oral hygiene instruction. It is, I believe, the patient’s duty to ‘treat their oral hygiene condition’ and I can think of at least one periodontist who would take issue with this allegation. I am not sure how anyone can ‘treat an adverse oral hygiene condition’ save for pitching up at the patients house a couple of times a day and doing the cleaning for them, or bringing them to the surgery daily to see the hygienist. Nevertheless, as is often the case with these hearings, we are made to feel that we have been doing it wrong all along, and nobody bothered to tell us until a hearing.
On that note, charges relating to alleged radiographic record-keeping failings have also been appearing more and more of late including not adequately or properly recording in the clinical record:
 

  • the justification for taking a radiograph;
  • the grading of the quality of a radiograph;
  • and even: the justification for not taking radiographs.

I looked at IRMER(2000), and the NRPB Guidelines which are the legally authoritative documents on radiation last month having been asked to consider the validity of this type of charge. In my opinion, the charges indicate a misunderstanding of what justification is; because it is not the same as the clinical indication for taking a radiograph. In the words of an RPA (with a PhD in clinical physics) I consulted over the matter of justification:

‘ "Justification" as required by IRMER is the process of weighing the probable benefit of a radiation exposure against the probable detriment. It is quite separate from "indication" - the clinical history, provisional diagnosis and intended treatment - and "authorisation" - the decision by the Practitioner that the proposed exposure is of sufficient merit. Both indication and authorisation must be recorded, because these are data, but not justification, which is an intellectual process.’


And his reply with regard to the question of where does IRMER(2000) state that we have to record QA score in the clinical record?:

'Nowhere. However Clinical Audit 8. The employer’s procedures shall include provision for the carrying out of clinical audit as appropriate. and The written procedures for medical exposures shall include— (e)procedures to ensure that quality assurance programmes are followed; Thus it is incumbent to occasionally review image quality, patient dose and clinical relevance, and since there is no other means of assuring the quality of the next image, it is important to check the quality of each image and resolve any anomalies before taking the next one. It can be argued that in order for audit to be properly objective, there should be no contemporaneous written assessment of quality: you audit by picking past images at random and assessing them "cold"'.

You should therefore record any faults or failures that demand corrective action, to provide an audit trail for that action, but images deemed acceptable should be filed without comment in order not to prejudice the audit.

Interesting stuff. I am baffled as to why anyone should be criticised for not recording an intellectual process. It is also clear that we do not have to record a grade in the clinical record, in fact we do not even have to grade every radiograph it seems, just check that the quality is acceptable in preparation for the next exposure and do an audit from time to time. So not only do we face issues with the bar of misconduct being stealthily raised, we are now also being tried and tested on doing things that are not actually required of us. This is why every registrant should be represented at a hearing in my opinion, and should only agree to charges that are indefensible. To admit to a frivolous or spurious charge purely to be seen to be ‘showing insight’ is not a position registrant should ever be put in, but I sadly suspect that is where we presently are.

There was, however, some positive evidence of a panel flagging up a GDC-appointed expert using non-mandatory guidelines as non-negotiable standards:

‘The Committee considered that Ms K’s approach was, at times, rather academically orientated and inflexible. In particular, she relied on a number of guidance sources, including the Faculty of General Dental Practice (FGDP) 2006 guidelines and the British Society of Periodontology guidelines relating to Basic Periodontal Examination (BPE), which, the Committee noted, are not mandatory. Furthermore, when alternative approaches regarding clinical matters were put to Ms K, she did not seem to acknowledge that it might be acceptable to deviate from these guidelines.’

It was last October I recall that the issue of guidelines and misappropriate use was raised by Dental Protection. This, along with the ‘gold standard bar’ really means that too many registrants are having their careers put on the line when there is a lack of clarity over where the threshold for misconduct really sits, and no universally agreed clinical guidelines. I remain in hope that the GDC FtP department is looking at this closely in the pursuit of proportionate regulation.

Moving on to some other cases, in the High Court, a registrant erased earlier in the year was successful in having his case remitted back to the PCC for reconsideration of an erasure. The registrant had got himself in to bother that might have been avoided by having to reapply to the register after his direct debit had failed, and was found to have been dishonest by fudging responses over two convictions for driving whilst under the influence of alcohol. It was held that the PCC had failed to consider relevant mitigating circumstances, namely that the employer had been informed of the convictions but the appeal failed on the challenge of the findings of dishonesty. You can find the judgement here.


Another noteworthy case involved a newly qualified dentist who wound up at an FtP hearing based on performance issues that arose within months of qualification. The question that I am sure on everyone’s minds is ‘how could this happen when the GDC-accredited dental school have allowed him to pass finals?’. Nevertheless, it is nice to see that whilst the GDC-instructed barrister recommended he should be given a reprimand for being let out of dental school too early, there was good evidence of remediation so no current impairment was found. The chap has now completed his VT year and is understandably ‘elated’.

The final case I am going to look at involved another registrant who was erased. This was the second GDC hearing Mr Idris has faced in his career. Having been told by his indemnifiers team during the first hearing that he was facing erasure and this having come rather as a shock they parted company. He instructed his own legal team and the case concluded with conditions. However, self-funding representation for the next hearing was not viable so after several years of reported wrangling with the GDC Mr Idris declined to attend this particular hearing, advising the GDC by email that he would be cleaning up his dogs’ mess instead. As a dog owner I can empathise with this and agree it is a taxing and time consuming task. Mr Idris’s absence was very diplomatically written up into the determination, but should anyone would like to read the unedited version of the email, it can be found here:

http://drtariqidris.co.uk

I’ll leave it here for now. My dog is barking to go out. Duty calls….

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The Honeymoon is Over

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.

 

 

 

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The CDO Speaks

The CDO Speaks

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CDO shows her true colours

CDO shows her true colours

I wrote a piece for Dentistry magazine earlier this year about the new Chief Dental Officer who at the time was busy on a “fact-finding” tour of her new territory. Sara Hurley’s tour was without doubt planned as a charm offensive, featuring smiling photographs with some of the movers and shakers of British dentistry. When she made an appearance at the BDA conference in Manchester her ad-lib question and answer session on the BDA stand was very successful and she came across as personable, reasonable and eloquent. “Good”, I thought, “here’s someone who wants to make friends”.

After more than a decade of her successor, Barry Cockcroft, who could not be described as any one of personable, reasonable or eloquent she seemed a breath of fresh air. But, let’s face it, the bar wasn’t set very high.

In my article I reminisced about CDOs I had encountered, I would not claim to have known any of them. I encountered Brian Mouatt when I was doing the MGDS pre-exam course just after the Conservative government announced a new dental contract, which was intended to “sort out NHS dentistry for good”.

He gave a talk on the new contract and promised that he would answer our concerns when he had finished. However having completed his prepared address he muttered something about having a previous engagement and headed for the door, our angry comments and questions ringing in his ear.

I only knew Margaret Seward because she was married to my first boss, Professor Gordon Seward, she was in post for two years and presumably wasn’t able to leave much of a mark on things, people I have met who worked with her spoke highly of her.

The other CDO I met was of course the previously mentioned Dr Cockcroft who was the highly visible mouthpiece for the iniquitous UDA system and became the exception after a line of low profile CDOs.

In view of Dr Hurley’s ease with people and obviously understanding the need for good PR I was surprised to hear that the new CDO had been far too busy to answer questions on Channel 4 in the wake of their damning reports on UK dentistry. If an NHS dentist was similarly booked solid for 6 months it would be mismanagement.

There was something that kept nagging at me and that was the somewhat cynical conclusion we reached after Brian Mouatt’s sudden departure. The CDO is a civil servant and is there to do the government’s bidding. The current incumbent has spent her professional life in the services reaching a high rank, she knows all about chain of command and is used to taking orders.

Her announcement this week at an NHS Expo (whatever that may be) that, “Going to the dentist every six months is unnecessary,” as the Daily Telegraph reported it, only undermines the position of Dentistry.  The other statements attributed to her are more “austerity” fuelled DoH propaganda.

"You don't see your GP every six months so why would you see your dentist?” Dr Hurley said. Well, Sara that is because NHS medicine is an illness driven system that is reactive and gives only lip service to prevention.

“If you go to have your car MOT, and he says, come back in six months, do you blindly adhere to that advice?” Actually Sarah if I’m driving one and a half tons of complicated machinery that I want to be safe yes I do. What does the army do about recalling tanks for servicing at the correct intervals? I would suggest that if you do them “blindly” someone could find themselves being disciplined.

She was joined on the platform by Roy Lilley who described dentistry as  “a rich man’s hobby” as a regular reader of Mr Lilley I know him to be anti-medic, and by extension dentist, who thinks that every ill in medicine can be cured with a “cuppa builder’s and a hobnob”. He criticised improved surroundings for dentistry, perhaps a return to upright chairs, woodchip wallpaper and lino; with queues on the stairs for gas sessions - would this suit him?

It has taken dentistry half a century to get the message across that regular attenders have fewer problems, stay healthier and actually prefer the reassurance. The good practices already tailor their recalls to suit patients and have been doing it for decades. Your statement is irresponsible and only fuels any criticism and scepticism of dentistry. You knew that your words would make headlines and that you were undermining the hard won confidence that most general practitioners face. However as you have never been a GDP how can you possibly understand what that really means?

It would appear that after a year in post gaining the fragile confidence of dentists, the directive has come down to the CDO, “get rid of your camouflage tunic, put on your hard hat and Kevlar, come out into the open and start gunning down your colleagues. That’s what we pay you for, not popularity - oh and Sara don’t forget there may well be a gong in it for you”.

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DBS checks; do you know who you are employing?

DBS checks; do you know who you are employing?

Who do you currently carry out DBS checks on? How often do you do this? Do your contracts and policies ensure staff have an ongoing duty to update you?

It is a CQC requirement that anyone employed by a dental practice is suitably qualified to perform the role they are undertaking. You also have a duty to safeguard the public. Therefore to ensure you are employing the right calibre of staff, you should carry out DBS checks before making any offer of employment final.

However, beware; you need to ensure you undertake the right level of check for the right role or you could be in hot water. The law also protects job applicants and employees in certain situations in relation to information obtained about their criminal convictions. Failing to comply with the law could result in you ending up in an Employment Tribunal.

In this blog we set out who you need to carry out checks on, the different types of checks available and give some practical tips to help you comply with your duties. 

Background

A DBS check, formerly a CRB check, is a check carried out on an individual before they take up new employment.  It provides certain information about that person in relation to their criminal record and whether they are on either the adult or child barring list, which means they are barred from working with these groups.

However, a DBS check is not a routine check an employer can make on any of its job applicants. It is only if one of the exceptions applies that an employer can make a request for such information. There are also different levels of checks depending on the nature of the role.

Dentistry is one of the exceptions in which a DBS check can be obtained.

Who?

The first thing you need to consider is which members of staff do you need to undertake checks on.

·         Dentists and Dental Care Professionals. You need to undertake an enhanced DBS check with barred list check on all dentists and dental care professionals. 

·         Receptionists. This will depend on the type of practice you run and the duties of your receptionist as to which check you need to carry out. The more contact that they have with patients on their own, the more likely they are to require a check.

·         Office staff. The CQC states that there is no requirement on non-clinical staff to have DBS checks. However, we would recommend seeking voluntary disclosure.

·         Practice managers. Given the nature of the role and their responsibilities we would recommend carrying out a standard DBS check, unless they will be in contact with vulnerable adults and children, then the enhanced check with barred list check should be carried out.

Types of Checks

The types of checks that can be undertaken are:

·         Voluntary disclosure. This is where you ask the job applicant to provide information about their criminal record voluntarily. However, there are limits on what you can ask for and what information you can use.

·         Basic DBS check. This contains information in relation to a person’s unspent criminal convictions, conditional and unconditional cautions or that there are none.

·         Standard DBS check. This contains information about a person’s spent and unspent convictions and cautions, as well as police warnings and reprimands.

·         Enhanced DBS check. This will contain information about a person’s spent and unspent convictions and cautions, police warnings and reprimands, and relevant police information. If the enhanced DBS check includes a barring list check then information as to whether the person is unsuitable to work with children or vulnerable adults will also be provided.

How?

The basic DBS check can be obtained by the individual themselves, without the need to be countersigned by the employer. However, the standard or enhanced DBS checks require the individual to make an application, which is countersigned by a registered person confirming their entitlement to apply for the certificate.

There is now also an online service that individuals can register with and keep their checks up to date, so if they move between similar jobs, employers can access this information more easily.

When?

All DBS checks should be carried out on staff once an offer of employment has been made. If the staff member is working with children or vulnerable adults, this will need to be done before they start that role.

If the dentist is on the NHS performers list you can write to the NHS to seek their confirmation that the dentists has passed the relevant DBS checks, to avoid having to go through the application process. If you do this you must ensure that you can evidence that you have satisfied yourself the dentist is fit to work.

What are the consequences of getting it wrong?

Given that it is a CQC requirement to ensure that staff are suitably qualified, a failure to do so could result in you failing an inspection.

What weight you attach to the contents of a DBS check or voluntary disclosure will clearly depend on the role being offered, whether the convictions are spent or unspent and whether the applicant is on either barring list.

Refusing to employ a job applicant because they have a spent conviction, unless there is a legal obligation placed on you not to employ, is not allowed. However, the reality is that, there is little a job applicant can do in these circumstances as there are no penalties for a breach of this legislation.

If you later find out someone has lied about their criminal convictions, then this is likely to be seen as an act of gross misconduct and you should take the necessary action. You should also consider if you have a duty to report the person to the GDC.

However, if you find out that an applicant did not disclose a spent conviction, unless you would not have been allowed to employ them at all as a result of this, you cannot dismiss them for not disclosing this information. Whilst this has not been tested in the tribunals, given the wording of the legislation this is likely to be seen as an automatically unfair reason for dismissal.

Practical Tips

·         Offer letters. When you offer an applicant a position you should state in the letter that the offer is subject to references and the relevant DBS checks.

·         Contract of employment. Make sure your contract places a positive duty on employees and associates to notify you should their circumstances change.

·         New circumstances. If during the course of employment, an employee is cautioned or convicted of an offence, do not have a knee-jerk reaction to this. You need to weigh up the position held, the nature of the offence and your own policies. Again you will need to consider if you need to report this to the GDC.

If you would like to discuss any part of this article or need any assistance with safeguarding issues, please contact Laura Pearce on 0207 388 1658 or at This email address is being protected from spambots. You need JavaScript enabled to view it.

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Strike!

Strike!

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GDPUK Conference 2016 - November 4th - Manchester

GDPUK Conference 2016 - November 4th - Manchester

 

GDPUK are pleased to announce - we are running a conference on the 4th of November in Manchester for the whole of the Dental Community.

We have put together an unusual dental event, with 20 minute timed presentations, with a mixture of discussion provoking speakers.

The aim is to bring GDPUK colleagues together for an educational and a social day, with time for food and drink in a modern setting close to Old Trafford, Salford Quays and City Centre Manchester, with all the transport links and facilities close to the venue.

The day is a great opportunity to celebrate the GDPUK community and dentistry. We also hope it is a chance for Dentists to meet up and spend an invigorating, inspiring and interesting day together. 

Please look at our minisite to learn more about the day. Full agenda and timings can be found on the website. 6 hours of verifiable CPD in a modern, friendly environment.

www.gdpuk.com/conference

 

 

For further information please follow this link - www.gdpuk.com/conference

 

 

 

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Dental Apps for your phone

Dental Apps for your phone

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Reflecting on Insight

Reflecting on Insight

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 -  6th 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.

A spokesman for the Department of Health said that a new contract was being tested, adding: “If a dentist was found to be needlessly removing teeth this would be a matter for the General Dental Council.”

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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 9th 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

 

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Copyright

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Toothpaste is Dead

Toothpaste is dead

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Dental Drama

Dental Drama

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Follow My Leader...

Follow My Leader...

Just recently things have been relatively quiet in the area that I usually write about. The GDC seems to have realized the mistakes of the past, and the new executive appears to be making overtures about re-engaging with the profession. Slowly but surely many think there might be a break in the thunderclouds and a glint of sunlight over the profession where our continued regulation is concerned.


One would like to think that there are significant inroads being made by the BDA on our behalf as a result of the regime change at Wimpole Street. However, I think many will doubt this, especially when the GDC themselves have actually questioned who leads our profession.
Surely this is an indictment of the profile of our Trade Union and representative body if those at the regulator have to question whom is actually in charge of dentists? It isn’t the Chief Dental Officer, who is more of an advisor to Government than a figure the profession can rally round. Its definitely not the Head of the GDC. There are many ‘celebrity’ figures in Uk dentistry who give themselves the title of ‘KOL’ (key opinion leaders) but again they are really not the leaders of our profession, often just opinionated souls who have some form of medium through which to express their thoughts (and pictures of their cars!). It’s certainly not organisations like Dental Fusion (or should that be Dental Futile?) and other professional organisations who have very limited memberships.

It really is quite obvious then that it should be the BDA. Whilst there are some strong figures within the organisation, and the work that is done by the employees is excellent, it still seems to suffer from an apparent inertia and lack of awareness as to what it could actually achieve. Whilst it no doubt provides some excellent member services, (such as employment and general advice and the library) it seems to frequently live up to the expectation of the profession as a body that drives really changes.

Take for instance the removal of registrant addresses from the GDC website. I’m pretty sure this has been on the ‘Work in Progress’ list at the BDA for some time. Yet it takes one petition by an individual and the GDC not only look at it, but actually manage somehow to change the entrenched view of Chairman Moyes himself. Now the BDA can say that they have done lots behind the scene, but there’s no use doing this and seemingly not achieving anything, especially if it has been going on for years. To then jump on the bandwagon and claim that the issue being raised by the GDC earlier this year was solely as a result of the BDA exerting pressure (when I happen to know that people at the GDC acknowledge the pressure came from the petition) is a little bit naughty.

The BDA is also the only dental body invited to the table with the DoH when negotiating a new contract. To give an analogy from mother nature; This is a little bit like a seal sitting down with a Great White shark and agreeing on the least painful way of being eaten alive. Evolution has taught many creatures to not get involved too closely with the apex predators, yet the BDA continues its same path in the forlorn hope that one day the shark might have indigestion and the seals won’t get eaten. It will always argue that it is there because of those of its members who haven’t any option other than to be seals and swim in the same sea as the shark. Evolution by supporting other options for these practices has always seemed to be low down on the agenda. Shouldn’t leaders of the seals be telling its members to try to keep away from sharks? Won’t the sharks have to evolve themselves or eventually starve to death?

Another example is the pressure that the BDA should still be putting on the CQC. The CQC has not been the subject of my blog at all in the past, and given the fact that I have been a huge critic of them has surprised even me that they haven’t suffered from my ire yet. Since the appointment of John Milne as their National Advisor there has been a distinct increase in the quality of the inspections generally. There has also been the publication of the ‘Mythbuster’ series of articles on the CQC Website . However, it is apparent that even these can suffer from misinformation. In particular the one regarding radiation protection is riddled with errors that make the further entrenching of incorrect information more likely to be referred to as absolutes when they are not. The fact that these errors might then be referred to by the GDC as the CQC is seen as an authority when charges are brought against a practitioner mean that there can be potential for miscarriages of natural justice.

Whilst there is no intention to mislead, when there is an incorrect interpretation of the legislation, rules, regulations etc. by such as the CQC (who we can argue should be an authority themselves anyhow and shouldn’t make errors like this at all) then the BDA should be swift to bring these errors to the attention of the CQC and more importantly the profession in general. This shouldn’t be in a ‘behind the scenes’ manner, but much more publically. We would then know what they are doing. This is not to embarrass the CQC in any way, but merely to demonstrate the obvious authority the BDA should be seen to have, and command the appropriate respect. Once again these errors were brought to the CQCs attention by an individual.

There is a quite frankly ridiculous amount of legislation that governs the practice of dentistry these days, so much so that it is virtually impossible for individuals to keep on top of all the different aspects of compliance. It is vital therefore that whoever leads our profession has an organizational structure that should know all the things governing and legislating dentistry so intimately that at the first sign of a new urban myth appearing somewhere (and they should be aware of where all these myths originate – looking on GDPUK r Facebook is usually a good place to start) there should be a very public and robust re-affirmation of the real legislative and regulatory situation, and with absolute authority and clarity such that the myth is immediately disproved.

I’m sure we can already hear the cries from the BDA that they already work in this way at the moment for their members, and this is true to a degree, but this is usually in a completely reactive and individual manner, and you usually have to actively seek out this information yourselves. Given the sheer volume of stuff that is out there to comply with it is very simple to get caught up in some of the less controversial urban myths such that they become the new fact, and thus perpetuated more. So you actually have to know something is wrong before you question it, otherwise you will automatically accept it is true and thus it becomes the ‘done thing’ as everyone ends up believing the myth. Just like the obligation to record batch numbers of LA in the notes is a myth.

What about jumping on the incorrect use of standards by Expert Witnesses when these are used in GDC hearings and further entrenched by the rulings? Why hasn’t the BDA produced a definitive standards document regarding an acceptable (not minimum or aspirational) standard that items like a simple dental examination should include, and be recorded in the notes? After all, there is enough expertise within the BDA that a consensus document could be produced simply enough. If it has (and I may have missed it admittedly), why aren’t the Expert Witnesses then referring to a document like this as authority? Why haven’t the Indemnifiers mentioned the existence of a document like this in the defence of colleagues? (and why haven’t the indemnifiers produced one either, perhaps by working with the BDA on it?).

Why haven’t the BDA come down like a ton of bricks very vocally on those LAT’s that transgress or selectively (incorrectly) interpret the regulations? If they have, why haven’t they shamed them so publically so that other LAT’s know they are a force to be reckoned with and won’t try it on with other practitioners?

Finally, what about the headlines in The Times this weekend about (surprise surprise) dentists ripping off the public? There doesn’t seem to have been any attempt by the journalists to even contact the BDA for a comment. Surely one of the first organisations to be approached for comment on a story like this would be the association that is supposed to lead dentists. Or is it that even the press think that a comment from the BDA would be about as strong as a wet tissue? At such a time there should be an automatic and robust defense of the professionals, whilst simultaneously showing the failure of the SYSTEM that they work within, and laying the blame squarely at the door of the DoH and Government.


The BDA really should sometimes show its teeth much more readily (no pun intended). But the only time they have done anything approaching this was the Judicial Review into the ARF in 2014. Even then there didn’t seem to be an ability to press home the victory and hitting the GDC whilst they were still reeling. Rather it seemed to all be ‘behind the scenes’ as usual and waiting for the Health Select Committee to grill Gilvarry and Moyes. Where was the tactical approach of ‘putting the boot’ in when it was most needed?

I will admit that political activism often needs to be done behind closed doors, but we need to know that when this is what we are told is happening, something IS actually being done, rather than just being talked about. The reputation of the BDA is such that many feel it never seems to be achieving anything, and therefore people think that it never does. There are so many issues in dentistry that appear at any time, and the BDA suffers from having to be everything to everyone. But surely there is a common theme amongst all in dentistry that our professional association should be there to lead the way vocally and proactively. Instead it often appears to be more a reactionary organisation with the attitude of ‘mother knows best’.

Well I’m sorry, but given the achievements that individuals have made recently in engaging more successfully than the BDA have, would lead me to suggest far from ‘mother knowing best’, mother is now someone who needs to realize they might actually be past it and new ideas and a new approach are needed.

There are a few vocal people in the BDA, but there are also others who seem to be anonymous and conspicuous by their seeming lack of inspirational leadership. Leadership means setting a visible and vocal example that others can then assist them in taking things forward and more importantly want to take forwards despite the obstacles in the way. It’s certainly not getting behind other people’s crusades and then saying look at what we did to get this done. I know of a good many people within dentistry, many of them household names (and for all the right reasons) who are disillusioned that there is no flag we can rally round as a profession; so much so that groups of like minded individuals are now beginning to draw together in order to do what the BDA should be out there doing.

 

Which is to Lead the profession.

At the same time, there has to be an acknowledgement of the postion that dentistry is in within the bigger sphere of healthcare. We will never have the public support that the doctors can call on, and we only have to look at the way the Government have played hard-ball with them over the recent contract ‘negotiations’. Lets face reality here. We will not get any concessions, there will be no more money and the conditions will not improve. We have to accept this and move on. The definition of stupid is often said to be doing the same thing over and over again and expecting different results. I think we can quite easily argue the BDA continue to do the same thing over and over again…..

No doubt many of the BDA hierarchy will be offended at this piece; but quite frankly they perhaps need to be. I’m sure there will be suggestions that I should put my money where my mouth is and stand for the PEC. Perhaps they are right. But since I don’t have all the answers I shouldn’t put myself forward as a leader of the profession. But even if I did, the problem with this is that one person will always come up against the establishment, which believes ‘this is the way we’ve always done it’ and ‘we must think of the members’. Paralysis by fear of the unknown results. It would need a radical change to the entire structure and I’m not convinced the more traditionalist members within the BDA would go for that. Open up votes to those disillusioned and no longer members of the BDA then it might be a completely different situation, but then that obviously couldn’t happen.

I’m sure those most annoyed with this blog will be those who have the least reason to be because they probably feel I am not acknowledging the things that the BDA have actually achieved. I’m not having a go at any individuals; but it’s those who wear the BDA badge and don’t do anything vocally, visibly, or productively to manifest change. Being hamstrung by the often archaic position of the trade union often means it is easier to maintain the status quo or just score pyrrhic victories than really trying to elicit the change that is needed.

The recent membership questionnaire is a start to finding out just what members think; the problem is it’s not the members they need to be asking how the BDA can engage more. The very people who are disillusioned with the BDA are not going to be members by definition. Bleating on about joining so your voice can be heard is beginning to wear a bit thin to many of us I’m fairly sure; why join something so you can submit a survey once in a blue moon especially when they refuse to listen to why you might not be a member? It’s a Catch 22 situation that needs to be broken.
 

The BDA needs to ask the ENTIRE profession what it thinks about it. The GDC seems like it is going to try to engage with us as a result of unprecedented problems and the change in executive manpower bringing a fresh look at the issues. If they can do it when constrained by legislation then there is no reason the BDA can’t either.

Its time for the BDA to show just what sort of leaders they really have.

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The GDC Specialist Lists; What does the future hold?

The GDC Specialist Lists; What does the future hold?

The GDC Specialist Lists were introduced in the UK in 1998 as a result of developments in European Legislation. As of October 2015 of the 40,953 registered dentists there were 4342 registered specialists; an increase of 31 on the previous year. A significant number of patients require specialist dental treatment each year; in 2012/13 approximately 3.5% of all NHS outpatient appointments were in a dental speciality clinic. There is no precise data as to the number of private treatments being carried out by specialists each year, but it is likely to be in the millions.

Whilst the state of the nation’s teeth used to be a cause for international mirth, over the last decade our love affair with cosmetic dentistry has blossomed. Implants are so popular that there are now calls for implant dentistry to be added to the already voluminous list of dental specialities; the UK has more recognised specialities than any other European country. On the face of it specialist dentistry is big business, but for who? Is it the practitioners themselves, or those who provide and regulate the training?

Becoming a Specialist:

One thing is clear, it is hard work. To be entitled to enter onto one of the specialist lists the dentist has to complete a recognised training programme, ranging from three to five years, have a National Training Number (NTN) and to hold the agreed qualification awarded by one of the Royal Colleges. In total there are in the region of 500 specialist trainees each academic year; many of whom do sadly not complete or meet the programme requirements.

It is the GDC who set the standards required for specialist training, approving the curricula and quality assurance. The Joint Committee for Postgraduate Training in Dentistry (JCPTD), through the Royal Colleges and the Specialist Advisory Committees (SACs), is responsible for the development of curricula, devising assessments and examinations and making recommendations to the GDC on specialty training.  The GDC embarked upon a review of the regulation of specialists in 2015; our dental bulletin considering this review can be found here. The second stage of the review began in 2016, and the first results are expected in the autumn. They propose creating a generic template that will serve the basis for all the speciality curricula, bringing a uniformity of language and structure.

The alternative “assessed route” is also under consideration by the GDC. This is where an applicant is required to illustrate to the GDC Specialist List Assessment Team that they have the knowledge and experience derived through academic or research work which they might reasonably be expected to acquire had they completed the specialist training. However, there is limited guidance from the GDC as to what this actually means, the approach to assessments lacks continuity, and applications are routinely returned having been deemed incomplete. Many applicants feel that the only way to ensure success is to seek legal assistance. What is clear is that clinical experience is not evidence of equivalence.

The decision of the GDC not to include clinical experience as admissible evidence is a frustrating one for many, particularly bearing in mind that many dentists were effectively passported onto the lists under the “grandfathering” scheme. This allowed experienced practitioners entrance to their chosen list where they could illustrate that they have the requisite knowledge and experience, wherever acquired. The scheme remained open for two years after the formation of each list. As such it is possible for dentists with no postgraduate qualifications and having passed no exit examination, such as the MRD or equivalent mono specialist exam, to hold the title of specialist.

Is this fair?

Patient safety must be paramount in this argument. The assessment of specialist trainees is so rigorous that members of the public can generally be satisfied that they are receiving treatment from an appropriately qualified dentist.  For those “assessed” or “grandfathered”, there is less clarity as the assessment criteria appears to be reasonably subjective, and dependent upon the assessors view of a paper application rather than any face to face assessment over time.

There are also a limited number of training posts available; and recent attempts by universities outside of the “Big Three”, KCL, The Eastman and Queen Mary’s, to increase supply has been met with some resistance.  The lack of available NTN’s has also frustrated many applicants hoping to enter onto a training post. The Dentists Gold Guide (June 2016) states that the purpose of NTNs is for “Education planning and management” enabling Postgraduate Deans to keep track of trainees and “Workforce information”, to document within each country and speciality how many trainees are in each programme and to provide information as to when training is likely to be completed. There is anecdotal evidence that some dentists working in hospitals and universities can wait years for a training number to become available. Whilst there is a clear advantage to requiring a minimum number of placements to ensure there are sufficient specialists available, it is hard to justify a cap on the maximum. A large number of specialists do not practice in the NHS, and commercial interests will inevitably dominate private practice. An increase in the number of specialists would allow greater freedom of choice and drive down costs for patients. Why not simply maintain competitive entry onto programmes and keep a register of all specialist trainees, doing away with the NTN system in its entirety. Thus removing the lottery of when a number may come up.

The inequality of the playing field for those entering training is another problem. A three to five year, expensive training programme and a limited number of NTNs inevitably means that established practitioners, particularly practice owners, can rarely afford to take the time or money out of running their businesses to undertake the programme. Many of these individuals have been honing particular specialist skills in practice for a decade and simply don’t require extensive clinical training; indeed it is not unheard of for dentists who have limited their practice to a particular area teaching on Masters programmes in their chosen field. They missed the grandfathering window, and can’t afford to have a three year career break, but they can’t rely on their considerable clinical experience to show that they are already practicing at the level of a specialist.

A further disparity arises in relation to European dentists registered in the UK. At present a broader test is applied to European Citizens than is applied to UK dentists, who are assessed on the basis of all their experience, including clinical. So whilst an extremely experienced Spanish endodontist may rely on the number of treatments she has completed in practice, her English equivalent cannot. Although the rules were designed to give individuals coming from European countries, that follow different training pathways and recognise different specialities, an equal playing field, they have arguably ended up allowing European applicants an easier ride. Of course, post Brexit, this may all change.

Looking to the future, what could the GDC do to improve the current position?

1.       They could scrap the assessed route in its entirety. This would ensure uniformity across the specialisms and create a clear quality control of all specialists.

2.       Alternatively they could include clinical experience as a factor in the current assessment process, applying the same equivalence rules to all practitioners, regardless of their origin. This would open up the lists to a vast number of practitioners and has the potential to drive up competition in the fields. However this process would be open to criticism as the assessment process is hugely subjective, and there is no hands-on assessment required.

3.       I would propose a third option. The GDC could create a more structured assessed process; mapping an individual’s experience, both academic, research and clinical, against the specialist training programme, require a minimum number of years PQE and the successful completion of the relevant exit exam for each speciality. There would remain an element of subjectivity of course, but considerably reduced, and a candidate’s ability would be appropriately tested through the examination. 

The GDCs 2015 review talked about “tightening up” the assessed access, but gave no guidance as to how this would be done. They also considered doing away with it in its entirety. That in my view would be a mistake. The assessed route allows diversity and experience that would be lost should all specialists follow the prescribed training programme. It would also unfairly discriminate against older applicants who would not have the years of practice ahead of them to recuperate the considerable costs involved. We wait in anticipation of the results of the next stage of the review, and can only hope that good sense prevails and a fit for purpose assessment route is unveiled.  

 

Julia Furley is a barrister with a special interest in dentistry. She has assisted and represented a large number of dentists at both the application and appeal stages of their specialist list applications and has an extremely good record of success. If you are interested in applying for entry onto the GDC specialist list you can email Julia on This email address is being protected from spambots. You need JavaScript enabled to view it., or call us on 020 7388 1658.

 

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GDC Watch June 2016 - The Gold Standard Issue

GDC Watch June 2016 - The Gold Standard Issue

My understanding is that the GDC do not agree with the criticism that too high a standard is being applied in FtP hearings. As it happens, last month I was asked by a colleague for some concrete examples of use of the ‘gold standard’ by expert witnesses, so I went specifically looking for it in my review of June’s FtP hearings.

June kicked off with a performance review hearing of a plethora of clinical issues involving a non-engaging registrant who had neither attended nor provided any representation at either hearing, which is always a bad move in my opinion. The case was initially heard in May 2015. Professor Morganstein was instructed by the GDC in this case, and is still according to Google the Dean of Dentistry of the University of Buckingham Dental School that I’m not sure has any dental students. There was a fair amount of criticism in the charges levied at instances of alleged failed treatment and inadequate discussions which the panel did not find proved, and when an allegation that the registrant had provided inadequate care by not giving a patient with an orthodontic retainer specific advice on using a fluoride mouthwash, tooth brushing and reducing sugar consumption the determination states that the Committee considered the expert had applied the gold standard rather than that of the reasonable dentist.  This registrant was initially suspended for 12 months and then a further 12 months at the review hearing. The panel had no other choice due to the lack of engagement and attendance in the process and had there been any evidence of insight and remediation the registrant may well have been able to continue practising under conditions. It has been demonstrated in a paper written by Professor Kevin Dalton that registrants who do not attend their hearing and are unrepresented face a significantly higher risk of a high sanction being imposed than those who attend or are represented.

In another review case heard this month the GDC-appointed expert was found by the Committee to appear to be ‘applying a ‘gold standard’ with respect to the diagnostic quality of the radiographs’ at the initial hearing in January 2015. The lesson here is that coned off radiographs are not necessarily poorly-positioned if it is possible to get adequate diagnostic information from them. There is also reference to not recording LA batch numbers and expiry dates in this case which another ‘gold standard’ recording is keeping requirement at best.
Next up a Committee was of the opinion that: ‘in some cases, Mr Expert was advocating a ‘gold standard’.

Some examples of the not proved allegations in this case that probably fit into the ‘gold standard’ bracket included:

  • Not recording the clinical process involved to extract a tooth;
  • Not taking radiographs that the Committee considered were not actually clinically necessary
  • Not providing preventative advice (except that smoking advice was given);
  • Not adequately assessing levels of plaque and calculus (recording it is present was alleged to be not enough);
  • Not recording appropriate detail as to why crowns required re-cementing (the committee considered this to be self-evident);
  • Not recording dietary advice provided (the patient was caries-free).

So there are three cases here providing some evidence that the gold standard is/was being used (and being identified by Committees) in a sample of new and review hearings held only during June 2016. 

The statistics for June were:
Interim Orders held 20 new hearings and 13 review hearings resulting in:

  • 7 suspensions or suspension extensions;
  • 20 conditions orders or conditions orders extensions;
  • 5 no orders;
  • 1 conditions order revoked.

Practice committees held 29 new hearings and 4 review hearings resulting in:

  • 5 erasures;
  • 8 new suspensions, 1 suspension extensions and 1 suspension revoked;
  • 1 new condition orders, 1 extension of conditions orders and 1 conditions order raised to a suspension;
  • 4 reprimands;
  • 4 adjournments;
  • 1 not impaired;
  • 2 registration appeals (1 dismissed, 1 decision substituted);
  • 1 restoration hearing (refused);
  • 2 health related hearings with one suspension and 1 set of conditions replaced with a suspension;
  • 3 cases of no misconduct/facts found proved do not amount to misconduct.

Per registrant type there were 46 dentists, 7 dental nurses, 11 technicians and 2 clinical dental technicians involved in hearings this month.
June was a bit bare on any interesting charges such as bouncing balls of impression material in corridors, bringing children to work or having untidy hair. However there were a high number of erasures that month, and dental technicians brought in front of a PC or IOC for acting out of scope in June also featured quite heavily.
Briefly, the main reasons for erasure were:

  • Not having indemnity over an extended period and forging an indemnity certificate;
  • A conviction for fraud and false accounting;
  • Having a sexual relationship with a patient, providing free treatment in return for physical contact and dishonestly claiming to be a specialist whilst not on a specialist register;
  • Making decisions about treatment plans without informed consent, plus failing to engage (note that the registrant was not present and not represented);
  • Working as a hygienist when registered as a dental nurse, plus dishonest behaviour relating to a lack of indemnity and misleading behaviour relating to website material.

With regard to the technicians, pretty much all of these cases related to acting beyond scope; taking impressions when not trained to do so and working without a prescription. This is clearly an area that the GDC are tackling very proactively.
One no misconduct case was particularly interesting in terms of how it ever managed to get so far. It involved a registrant who had sent a letter to some patients of the practice asking for their consent to release their records to the GDC who were investigating a previous partner of the practice over financial irregularities on the basis of concern being reported by the registrant. The letter must have raised a few eyebrows as the GDC alleged that it was:
 

  • Designed to convey the impression that the correspondence was sent with the knowledge and consent of the GDC when this was not the case;
  • Designed to convey the impression that the correspondence was sent on behalf of the GDC when this was not the case;
  • that this was misleading and dishonest;
  • By stating in the letter that the colleague was currently the subject of an investigation by the GDC this was failing to treat the colleague fairly and with dignity;
  • By failing to inform the staff at the practice about the letter, the team members were not treated fairly and with dignity.

It is worth noting that Dental Protection had provided guidance and advice on this letter before it was sent, and the registrant had not discussed it with the staff in order to protect the integrity of the investigation, yet the case still progressed. The patients ought to have been told why their consent was being sought to hand over copies of their records in my view. So all in all, it appears to me that someone who fulfilled their professional duty to raise a concern and assist in an investigation found themselves on the wrong end of the FtP process by way of thanks. It is not clear to me what the GDC hoped to achieve by bringing this case, and how this will encourage or protect those who may need to raise concerns in the future.

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Online abuse

Online abuse

 

As you all disappear on your long errant holidays – take note.

Finally the GDC have issued a small puff of white smoke from their chimney in Wimpole Street.

After much personal hard work by our colleague Dr Vicky Holden, and an uncertain amount of work by our representative body at the other end of Wimpole Street, the Council of the GDC voted to remove all address details from their on line register.  60,000 mainly female DCPs will I suspect be mightily relieved.  20,000 odd female dentists will rest a little easier.

If you have not been on the end of unwanted attention, it can be many things. Embarrassing … alarming … irritating … flattering …  laughable …  but worst of all of course is when it becomes frightening … perhaps even sinister.

Many of us will have had nurse as employees who find themselves on the receiving end of unwanted attention from some admirer- in-waiting.  Some of us may have even had to step in on occasion

How the previous CEO of the GDC even thought there was any justification in the first place remains a mystery.  But then the workings of the previous CEO were a mystery of course.

Our patients are entitled to know we are registered. In fact 99% of them assume we are.

Perhaps we should put our GDC Number on all correspondence … estimates, invoices, letters etc. I know many do. It’s not a secret.

But it is right that patients with ulterior motives should not be able to pursue an alternative and unwanted agenda.

So hats off to our GDC.  Of course you might ask why the Council did not do this 2 years ago when it still scorchingly obvious to anyone with half a brain that the matter needed addressing, so to speak.

The Council

This episode suggests that the new senior executive management at the GDC are quite different. There is a sense that their agenda may well be one we could subscribe to.

But perhaps this whole ‘address’ saga says more about the Council. It was those 12 Members, 6 of whom are Registrants, who ducked the issue 2 years ago.

It rather confirms in my mind that we have a better Executive in place at the GDC but we still lack a strong Council who will do the right thing at the right time.

Ah yes ...  that brings me to ‘ole Billy boy.  The Old Guard still sitting in that position at the middle of the table I see. Still writing twaddle-blogs! 

Good job he has been able to keep his address secret all these last few years what with all the FtP debacle!!  Perhaps we can look forward to a new method addressing Dr Moyes in the near future:  The Former Chairman …  Then we might see some real changes.

Have a great holiday. May your sun shine on your upturned cheeks!

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Holidays

Holidays

Continue reading
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What will happen to associates?

What will happen to associates?

Nils Bohr was a Danish hero who received the Nobel Prize for Physics in 1922. The national brewer, Carlsberg, built Bohr a house. The home was next door to the brewery and allegedly had a direct feed from it, he fathered six children thus providing an early inspiration for the Carlsberg “refreshing the parts” adverts.

He once said, “Prediction is very difficult especially when it’s about the future.” Difficult or not I’m going to look at the future for young dentists in (general) Dental Practice.

It would be wrong to stare into the crystal ball without a quick glance over my shoulder. A sage told me in 1988 that in the future in the UK, “There will be NHS clinics and Private Practices”. With hindsight I’m surprised it took so long to get to where we are now.

Post Brexit, one big hitter remaining in-post is the Health Secretary Jeremy Hunt. There is still no money. The UK doesn’t care what Europe thinks of it, I know, but sometimes you hear the truth. A medic on Irish radio this week said, “The Tories don't like the NHS and Jeremy Hunt is doing his best to dismantle the basic principles of it”. In dentistry many of those basic principles are long gone and the remaining ones are being eroded as we watch.

No more money for education either. University fees and associated living costs are on the rise. Without free movement across borders in the future, university incomes from overseas may fall and UK student fees must rise accordingly. Dentistry is one of the most expensive courses to run, why not make the fees reflect those costs? Dentistry may well become the domain of the privileged, whose parents can afford to subsidise their offspring or arrange the loans for them.

With the recent relaxation of University status perhaps “a large corporate” could create or take over one or more of the Dental Schools to provide cadetships. The armed services have done this for many years. Five undergraduate years in receipt of a bursary and the tuition fees paid. The opportunity for vacation work/internships getting experience of all sorts at flagship practices and the indoctrination / assimilation becomes complete. Post-qualification you commit to, say, 10 years of service or have to repay their investment.

It is possible with this model that corporate dentistry can provide the closest thing to a career structure in general practice, something that the NHS has failed to do and significantly prevented private practice from doing.

The status of NHS associates does not bear close examination. In England and Wales there are fixed targets. Countrywide, associates do not provide their own equipment, are not directly responsible for marketing, wages, materials and so on and by any stretch of the imagination cannot retain the privilege of being self employed for much longer.

A quick flick of the pen by someone senior at HMRC would convert the status of associates to salaried employees. This might be welcomed by many dentists, young and old, especially those who have responsibility for childcare or who have spouses or partners who are in reasonably rewarded jobs.

Time and attitudes have changed and full ownership or traditional partnerships aren’t for everyone. The baby boomers who qualified before compulsory VT/FD and are now the (predominantly) male/pale/stale retiring on the proceeds of the corporate cash which many once derided. They may well be the last of their species.

Many young dentists look at the price of practices, the bureaucracy and the day to day pressure of practice ownership and decide that is not for them. The NHS has evolved into “turn up, get your UDAs, keep your nose clean from the GDC & CQC and go home”. Sounds like a job to me - not a vocation. The millennials are, allegedly, not keen on being tied to one particular practice.

In 2015-16 the admission target, for English dental schools only, was 809, presuming a 10% drop out rate and excluding overseas students there will be another 700 new dentists joining the ranks of the profession year on year. Of these about two-thirds will be female. At present the profession’s mix is 50-50 but it’s a fact that women work less than men over the course of a career, men don’t have babies and predominantly childcare duties fall to mothers not fathers.

This trend started with medicine and has had a profound effect both in   general and hospital practice. Interestingly the sex-mix pendulum has swung back in some medical schools.

One reaction with medical GPs is the change in status in response to the difficulty in recruiting partners by expanding the number of salaried doctors.  The government sees this as easier to control and privatise. Those GPs in favour of becoming salaried has now reached nearly 30%, nowhere near a majority but significant numbers are beginning to think the unthinkable.

In my last piece for GDPUK I wrote, “Meanwhile many quiet, thoughtful young dentists are taking a long view and working at their skills.” They are realising that to escape the mire of the NHS demands a commitment to growing themselves and that the sacrifices don’t stop with a BDS. In fact the years of serious dedication are just starting.

So the future, NHS clinics run by a handful of large corporates with salaried dentists and therapists, and private practices where an M.Sc is the starting point for consideration.

Your choice.

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The Art of Dentistry

The Art of Dentistry

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Lessons to be Learnt from Recent Cases

Lessons to be Learnt from Recent Cases

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 18th 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 22nd 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

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Homeopathy

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The Mail

if the mail online produced your practice newsletters

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Leave. What, now?

Leave. What, now?

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

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Denxit by @DentistGoneBadd

Denxit by @DentistGoneBadd

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Calm down, calm down

Calm down, calm down

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.

 

 

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GDC Watch May 2016

GDC Watch May 2016

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:

  • 6 suspensions or suspension extensions;
  • 11 conditions orders or conditions orders extensions;
  • 5 no orders;
  • 2 adjournments/postponements (1 hearing was postponed due to the registrant having toothache);

1 outcome TBC at the time of publication.

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

  • 1 erasure;
  • 5 new suspensions and 2 suspension extensions;
  • 3 new condition orders, 1 extension of conditions orders and 3 conditions orders being revoked;
  • 3 reprimands;
  • 2 postponements and 6 adjournments;
  • 3 no impairments;
  • 1 registration appeal (granted);
  • 1 restoration hearing (granted);
  • 2 health related hearings with one suspension and 1 set of conditions replaced with a suspension;
  • 1 case of no misconduct.

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.

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Copyright

© Victoria Holden, GDPUK Ltd 2016.

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