The fog is burning off.  The focus is clear.  And so it should be for you.

On balance the case swings clearly.  We are part of Europe. We are European. And yet we should not be part of the political and fiscal force majeure that is the EU.

So I urge you to vote, and if you are open to simple argument, I urge you to vote Leave.

The time has come to lead Europe from outside the EU, not from within.

This Thursday is the most important in the political life of this nation to date. Please make use of your democratic right, to maintain those same rights.

?

Tony Jacobs BDS, dentist, publisher of GDPUK.com

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

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

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

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

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

Do we? Have we?

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

https://leave.eu/

http://www.voteleavetakecontrol.org/campaign

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

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

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

http://www.theguardian.com/politics

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

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

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

Polls

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

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

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

Firstly, the present political leadership must go.

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

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

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

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

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

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

Whatever you do, Vote

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

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

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

And good luck, friends and colleagues.

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

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

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

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

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

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

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

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

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

Duncan Scorgie is a dentist practising in Midlothian

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

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

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

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

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

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

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

Neil Martin is a Special Care Dentist in Northamptonshire.

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

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

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

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

Dr Alisdair McKendrick is a GDP in Northamptonshire.

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

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

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

Once upon a time someone started to blow a bubble.

All Pixar films have a simple story structure which can be summed up as:

“…Once Upon a Time…

Every Day…

One Day…

Because of that…

Because of that…

Until Finally….”

So if Pixar did the story of recent Dentistry, here’s the movie storyline.

Once upon a time nearly every new dentist went and worked as an associate in General Dental Practice with an NHS contract.

Every day, 5 days a week, they worked for 8 hours and had an hour for lunch. Some of them were better than others and some were worse. Some were faster than others and some were slower. The faster they worked the more they earned. Every month encouragement came from the practice owners, “get your backside in the air and get your gross up”. Every dentist in every practice did the same thing - they repaired broken and diseased teeth. Some liked to spend half a day a week making dentures or braces or using a scalpel - but that was just a diversion from drill’n’fill.

At the end of the month the owner let the associates keep half of what they had earned. This was often a lot of money for a young, newly qualified person. Their friends from university who had studied medicine, accountancy and the law couldn’t understand how dentists could justify the amounts they earned when they were so young and inexperienced and were envious. Secretly many young (and old) dentists agreed, but they couldn’t bring themselves to suggest a change. These were the golden years, there was lots of disease, plenty of patients and the Prime Minister’s purse was bottomless. In fact there were too many patients so in some places people queued to have their teeth out or tried to do it themselves, or so the TV said.

One Day the Prime Minister, Mr Blair, an ex-lawyer, said, “This is not good enough, something must be done”, and he decided that market forces must be applied. But firstly he made the NHS the National Religion and everybody must be an acolyte, for to speak against the NHS was sacrilege. Then he applied the rule of supply and demand, so he opened up lots of new dental schools where intelligent young people could become noviciate monks and nuns of the NHS. Although the words “private” and “dentistry” were considered blasphemy “private” and “university” were compulsory so the novice dentists were made to pay for the privilege of half a decade of confrontation and humiliation. Saint Tony also sent messengers out to all corners of Europe welcoming dentists to England and Wales where the NHS was the envy of the world and the dental streets were paved with gold.

Next his Grand Vizier, HenHouse and his Lord High Chancellor, Broon, said that the purse was closed, there would be no more money, each dentist must make do with what they had last year and the year before that.

Because of that even the fastest of new dentists were not able to get their backsides in the air and the slow ones earned the same as the fast ones. The practice bosses saw that where there had been queues of patients there were now queues of new dentists who had to repay their loans and were competing to work in the NHS churches. Some of these bosses saw this as an opportunity and competed to see who could pay the least. Some were allowed to keep a quarter or a third of what they earned. In his retirement villa St Laurence de Lando looked down, smiled broadly and said, “I told you so”.

Because of that lots of young dentists said, “We must buy our own businesses. We shall become dental entrepreneurs, what ever that is.” So they hocked the family silver, mortgaged their future earnings and sold their soul to the NHS (praise be its name), and in the subsequent sales frenzy this let St Laurence’s contemporaries buy much bigger villas on golf courses than they had ever dreamed possible. “We are the bosses now” trumpeted the new owners, “we shall buy lots of practices and screw down those associates who were not clever dental entrepreneurs like us. Then we shall sell out at the top of the market and make a shedload of cash.”

Meanwhile many quiet, thoughtful young dentists took a long view and worked at their skills. They saw that in the long term the religion would be exposed for the sham that it was and patients would choose between private practices with personal service and Nash clinics where they chose a number and waited their turn for the announcement, “dental cubicle number thirteen please.”

Until finally, one day the bubble burst, NHS dentistry was handed over, lock stock and barrel, to Tesco and many churches became empty shells, a testament to a great failed experiment.

Image credit - Isabelle Acatauassú Alves Almeida  under CC licence - not modified.

Every dental practice knows that it can take years to build up a loyal patient following but a matter of days for this to be destroyed by an ex-associate. Normally, a practice seeks to protect its goodwill by adding restrictive covenants into an associate, or even an employee, contract.

However, will your covenants stand up in court if you need to enforce them further down the line?

Most practice owners are under the impression that if a covenant is in the contract and the ex-associate breaches that covenant then they will be able to enforce the agreement. However, this is simply not the case.

Enforceability 

In order for a restrictive covenant to be enforceable you must show that:

1. You have a legitimate business interest that needs protecting; and
2. The protection is no more than necessary in all the circumstances.

A patient base is more than likely to be a legitimate business interest, as it provides the main income for any dental practice. However, you must remember patients are free to choose who treats them and so you cannot completely restrict an associate from treating those patients.

When determining if a covenant is necessary a court will consider the reasonableness of it taking into account factors such as; the duration; the geographical area covered; the patients it refers to and the seniority of the person who is subject to it. This is not an exhaustive list. Given that the courts will consider each case on its own merit, it is difficult to provide specific advice in this article on each of these points.

The courts are very wary when it comes to enforcing restrictive covenants, as they do not want to restrain trade and prevent a person from being able to earn a living. Therefore, if a clause is drafted too widely, without consideration for the business interest you are seeking to protect, it is unlikely that it will be enforceable.  

It should be noted that a court will not amend a clause to make it more reasonable and therefore enforceable; they will simply reject it altogether, leaving you totally unprotected.

You therefore need to carefully consider which covenants are required to protect your business interest, and that the scope of those covenants are neither too wide nor too narrow. 

Types of Covenants

The main types of restrictive covenants are:

Non-solicitation. This prevents a positive act by the associate of contacting former patients of the practice, or making an initial approach, with a view to obtaining their business. Merely informing a patient that they are leaving, and even providing their new address, is unlikely to be seen as solicitation.

Non-compete. This prevents an associate working for a direct competitor. Such clauses are harder to enforce than non-solicitation clauses, given the courts reluctance to restrain trade. However, one must bear in mind the skills of a dentist and the time it takes to build up the goodwill of a practice. We would therefore recommend adding such a clause to a contract, providing it is well drafted.

Non-dealing. This prevents an employee dealing with any customer or potential customer of a business. Given that a patient is free to choose who treats them such a clause is likely to be unenforceable in an associate contract.

Non-poaching. This prevents an associate from taking staff with them to a new practice. The idea behind this covenant is to ensure a stable workforce. In the dental industry, a practice will want to ensure that Specialist Dentists are not enticed to a new practice by a member of staff who is leaving.

You can use just one restriction or you can use a combination, depending on the business interest you are trying to protect.

Practical Tips
The most important piece of advice we can give you is not to use standard clauses for all staff members no matter what their position and situation; this is giving no consideration to the test ‘necessary in all the circumstances’.

You can create standard clauses for each level of staff, but you also must ensure that when you offer a new contract to a new employee or associate you consider whether the covenants are reasonable in their circumstances. For example, if you know an employee cannot drive and you live in a small town with no public transport, stating that this employee cannot work in that town is unlikely to be reasonable; especially if a non-solicitation clause could be used in the alternative.

You need to be able to explain why the covenants are for a certain period, cover a specific geographical area or are in relation to a set of patients. It is also worth periodically reviewing the covenants to ensure they are still fit for purpose (although see below in relation to seeking to amend a contract whilst it is still in force).

Normally, restrictive covenants will be contained within the contract. This means an associate has to agree to them in order to secure work. Consider instead having a separate document containing the covenants and paying for the associate to obtain legal advice on them. If an associate has been advised as to the effect of the clauses and signs to confirm their agreement, this is likely to make them more enforceable. However, you will still need to bear in mind the above tests and ensure the covenants are necessary; this will not give you carte blanche to insert anything into the contract.

If you seek to change the covenants part way through employment, recent case law has confirmed that unless you give some consideration to the other party for signing the new covenants, such as a pay rise, the covenants may not be enforceable even if signed.

No article can ever replace legal advice, and this is even more true in the case of restrictive covenants, which are highly specific to the facts and circumstances at hand. If you are considering using restrictive covenants, we strongly recommend that you seek legal advice.  As the text above demonstrates, merely having them in place will not necessarily protect you.

Last week saw the launch of the latest Oral-B toothbrush at the BDA Conference and I am pleased to see that they have gone even further down the path of the “internet of things” and improved their technology even further with the latest Genius brush.

Previously I wrote a blog in 2014 entitled “Dentistry embraces the Internet of Things”, when Oral-B launched their first brush connected to an app.

So 2 years on, the boffins at Oral-B have taken all the best features of the Bluetooth brush and made a number of considerable improvements.

• The brush still works alongside the App. The app now tracks brushing habits and shows the user how to brush all zones in the mouth equally and evenly, which is a real game changer. No longer do you have an excuse of missing an area of your mouth.

• The app has gamification, the user gets challenges to improve brushing habits.

• Each users can partner with their dental professional through the Professional Guidance feature that provides customised care and a user can share data with their dental professional.

• The app, also contains in-app entertainment, the app provides news, weather and oral care tips.

• The brush comes with a stylish case, as well as a smartphone holder that fits to the user's bathroom mirror and lets the user know how they are doing via the app. The app is therefore straight ahead of the user’s eyeline.  

• The lithium battery offers longer battery life and a lighter toothbrush!

• The Triple Pressure Sensor technology protects gums from over aggressive brushing.

• The brushes are now customisable with 12 colours available, except red which is used when the user applies too much pressure.

• The user tells the app which hand you use to brush your teeth because they will then analyse the data accordingly and the app will understand why certain areas are missed.

All these clever features are an exciting way for you to help your patients improve their oral care and with some of the features you can even check what they are doing and which areas are being missed!

Further information about the brush can be found here - http://oralb.com/en-us/GENIUS

It is very exciting to see that dentistry has continued to embrace the internet of things and that toothbrushes are part of the connected home that we will see more and more over the next few years. This new brush is not only easy to use and lighter to hold, it also has a number of benefits that help improve our oral health…. Which is always a good thing.

The brush really is “Genius by name, Genius by nature”.

The Oral-B Genius will be available to the public from July.

Is the GDC a sort of Beaurocratic Supertanker, steering a steady, slow path to its chosen destination, slow to change direction and similarly hard to stop?

Or is it akin to a Bull in a China Shop? – breaking everything it touches in an out of control display of unnecessary strength?

You decide.

There have been a number of recent high profile GDC cases which have caught the eye of any casual observer.

By far the highest profile, in terms of reflective blogging and reporting, is that of Dr Colin Campbell, a colleague who has a practice and training facility which offers implants as a special interest and is generally regarded as being state of the art and second to none. As good as you can get. If you have not read his reflections on his experience at the receiving end of the GDC systems, I have linked them below. It makes painful, perhaps stimulating reading.

You will I am sure be left with one driving question.

Why?

Why does one case drive such a vindictive, damaging process?

There was another case which was even more worrying: This case of a colleague in the south west went all the way to an FtP hearing before the Panel finally nailed it with ‘No Misconduct Found’.   In this case there was NO patient complaint – it was the Charity, the “Good Thinking Society”, founded and led by journalist Simon Singh, who contacted the GDC based upon a web trawl. Having discovered concerns with some web site material, the Charity chose NOT to contact the practice at all.

But then again, neither did the GDC who took it all the way to a Hearing… at a cost of about £200,000 all in [Registrants costs, GDC costs  etc].  The case revolved around some web site wording which was changed before the process truly got under way, after a request from the GDC!!

You will I am sure be left with one driving question.

Why?

How can some contentious wording on a web site, which can be changed overnight, where NO patient has been involved, and where NO attempt at local and direct resolution has been attempted, possibly justify a full hearing?

What is in it for the GDC ? Justification of their work and justification of their ARF Fee?

These are not cases which need ‘the law changing’ to avoid being taken so far. S60 orders have nothing to do with this fiasco.

This is pure vindictive incompetence. 

It is a regime of Regulation by Fear. At a team level, the GDC do engage, and apparently learn, and we must be grateful that the PR teams of the GDC do come out and meet and greet.

But despite all that hard work, we continue hear the dulcet tones of the limp rag of leadership that is Dr Moyes, and still the Bull rages in the FtP China Shop. Still we see NO evidence of proper oversight by the Council. Still we see the Registrant members of the Council taking their expenses.

Why?

It’s perhaps a reflection perhaps of the mind-set of the GDC in the past, and their reluctance to act in any way which might be regarded as agile or rapidly adaptive, that still we have no specialisation for implantology.

We continue to see quite extraordinary cases heading out to an FtP hearing based on dubious investigative methods and a sense that the charges are trumped up come what may to try and make some mud up, let alone make it stick. There is a sub-genre of course of expert witnesses who have questions to answer in this respect.

The case of a retired Orthodontist and a single patient, with his long spat with the 'establishment'  has become so embroiled that the 5 days of the initial hearing proved insufficient, and an adjournment was taken. For what possible benefit?

But most important you will I am sure be left with one driving question. Why?

Dr Colin Campbell of course took an unwittng starring role in Manchester last week

It’s a [Conference] Wrap

If you are a member of the BDA you may well have heard from the dentists present at the recent Manchester Conference that Dr Campbell’s presentation pretty much stole the show. It is also fair to suggest that Alistair Burt MP, the Health Minister certainly spoke eloquently the necessary words in respect of the scandal that is Infant Dental Prevention, and the scandal that is GA Admissions.  Finally, of course the FGDP are coming of age, and in particular engaging down in the mud with us wet fingered souls, and re-publishing their guidance on Record Keeping, which will be Open Source. That is a very welcome move, Sirs.  The GDC of course is off limits for a Minister.

Which will happen first? NHS Change or GDC change?

If one has to speculate, I reckon we will still be talking in 6 years [when the ‘Newish Prototype Contract Version x ’ emerges] about child dental treatment & prevention as funded by the Government because there is no more money to deal with these matters.

Whereas, I suspect that the passionate and motivated colleagues in self-funded dental practice who are feeling the cold hand of the GDC will be effective in their lobbying for significant change.

The GDC will change.  How and when is to be decided.

No one objects to the idea of a regulator for the industry that is dentistry. It is the quite surreal high cost, psychologically, professionally, financially, and in time terms of the blunt instrument that is FtP, allied an unaccountable Interim Orders Committee that is objectionable. 

It is the idea that the GDC are a first line Complaints Handling Agency. 

It is the idea that all dentists are out to harm their patients and lessons must be public, humiliating and disproportionate.

The salt on the professional wounds is, in case after case, Dr Campbell’s being but one, and our colleague in the Southwest who fell victim to the dubious Charity The “Good Thinking Society” being another, where the GDC blankly refuse, or have wilfully chosen not to, force any complainant to seek local resolution first. 

That is a choice the GDC make.  Why?

Do they do that because they truly believe a £200,000 process cost is a better and more efficient form of justice? Or they do that because they are incompetent and simply have no idea how to be frugal with the resources placed at their disposal by Dentists and DCPs in the form of the ARF?

The New Team

So… it’s the end of the season, and there is new management in place.  It’s not just in the national game that management is brutally changed!

Mr Brack’s first job as substantive CEO at the GDC is clear – stop feeding the monster. Sedate the Bull.  Perhaps after the events of a US Zoo at the weekend, shoot the beast dead.

Perhaps … stop FtP until it is reconfigured?

Stop the Bull wrecking the china shop.

So as we head for the ARF setting for 2017, what has changed? We have a new Chief Executive in Mr Brack.  And a new Director of FtP in Mr Green.  And old hand in the shape of Dr Moyes.  These three have the future of dental regulation in their hands. Dr Moyes having proved reluctant to grasp the mettle with his Council team, so it must be Mr Brack, in partnership with Mr Green.

That’s it.

So no pressure gentlemen. The survival of your organisation and Dental Regulation as we know it depends on you calming this raging beast that is FtP, and it looks doubtful that your Council will be much help.

The clock is ticking and many professional eyes are on you.  Indeed, some are still weeping from the whipping that presently is FtP

FGDP(UK) The Open Standards Initiative (OSI) 

?BDA: Government still lacking ambition in fight against decay

Dr Colin Campbell My GDC case and more important matters… part 1 – Friday night

Dr Colin Campbell My GDC case and more important matters… part 2

Dr Colin Campbell My GDC case and more important matters… part 3

Dr Colin Campbell My GDC case and more important matters… part 4

Simon Singh’s “Good Thinking Society”

I’ve been at the BDA conference in Manchester last week, and as usual have thoroughly enjoyed the networking that this event always brings. I’ve finally met people who have been virtual friends for some time and caught up with those who I’ve known for years. However for me there were two distinct highlights to the whole event.

Firstly, there were two people who I really did not expect to bump into, let alone have a conversation with. We have for so long been under the thumb of an unapproachable and unrealistic regulator that it took me by complete surprise to see that both the new CEO of the GDC Ian Brack, and the Head of Fitness to Practice Jonathan Green were not only present, but actually in the bar of the Hotel where I was staying. Given the previous CEO’s somewhat adversarial attitude towards us lowly insects trying our best despite the ever increasing pressures on us, and her distinct lack of engagement with the profession, to actually see the new CEO of the GDC present at the conference was a positive revelation.

Obviously me being the shrinking violet that I am (and fuelled a little bit by the generous BDA Drinks reception), I felt I had to speak to him. Now, I’m sure many of you would expect me to have launched full tilt with a somewhat barbed attack at the legion failings of the GDC management structure over the past years, but I’m afraid I have to disappoint you all.

I actually thanked him.

I thanked him for taking a step in the right direction and showing his face at the conference, because this is a step that was NEVER been taken by his predecessor (and also not by Moyes to my knowledge) and in my opinion showed that he might just possibly be aware of the damage that has been created by the culture so apparent over the last years.

Its early days I know, (and the jury will be out for some time yet) and I had only a few brief words with him, but in that short conversation I was left with the overriding impression that this might be someone who is prepared to work WITH the profession instead of against it. Since the care of patients is a joint responsibility of both the profession and the regulator, he agreed with the sentiment that therefore we are effectively ‘in it together’. Not only that, but there was an approachability and an authenticity that came across very swiftly in a short time.

Now, before you all start thinking that I’ve been somehow subsumed by the GDC into changing my tune completely, I can categorically assure you I have not. In the week that a FTP over homeopathic dentistry was thrown out after 2 years of stress for the practitioner, when it could have been dealt with by a swift letter saying you’ve got a month to remove your claims, then it shows things still are far from right. But we have a huge backlog of cases some of which are only now surfacing. Like a supertanker, the GDC isn’t going to turn round quickly, and I think there is still more that can be done publically by them to build some bridges. For instance, where was Chairman Moyes? Shouldn’t he do something to try to learn about the profession he regulates, or was he busy learning about washing machines and other consumer products since he thinks dentistry is so closely related?

Perhaps we are approaching the time when the GDC changes from a reactive organisation to one that is proactive (like the GMC). Where does it say that the GDC can’t give us advice in a positive and supportive manner? Rather than building their remit as Bill’s complaints handling super empire, why not give some more vocal and obvious guidance on how we can avoid the wrath of the regulator? Being proactive to prevent problems will be surely less expensive than reactive and shutting the stable door once the horse has bolted? It should also cost us far less in both the ARF and Indemnity. After all, this is what patient safety is all about, and that is their remit as set down in law.

I think that the growth of the FTP Division of the GDC was (and maybe still is albeit more slowly) growing at such a rate that it would be unsustainable within the next 5 years. There would have to be an ARF of such a huge amount that it would result in it being almost as ridiculous as some of the indemnity figures out there (another sore point) and there would be none of us left allowed to practice if we didn’t pay. I suspect there are people at the GDC who know this, and that there might now hopefully be a concerted effort to get back on track. Perhaps a raising of the bar where misconduct is concerned would be a start.

But getting it back on track will need the concerted effort of many people. This brings me to the absolute highlight (for me and I know many others) of the entire weekend. The presentation by Colin Campbell regarding his fitness to practice experience with the GDC.

Such a passionate, humble, ego-less, and at times emotional presentation has not been witnessed at conference for many years, if indeed ever. But it was not a dig and a rant at the GDC. Far from it. It was a clarion call for the profession to unite to change the status quo we find ourselves in. A call to develop a working discourse with the GDC (and NOT behind closed doors or behind the scenes). A suggestion to develop standards of dental care that can be defined in the literature that we can all follow, including the Expert Witnesses, some of whom still seem unaware of their duty of impartiality, and the correct standards to apply. A request for a meeting of the minds of the profession to leave their societies, their egos, and their self-interest behind and to unite for one cause.

To Protect the Patient.

Never has a focus on what is the singular most important thing in our profession been so starkly and beautifully pointed out to an audience.

Using data from a survey of almost 1500 dentists that had been offered to (and declined by) the BDA previously (and correctly statistically analysed so it was robust), in conjunction with live voting from the audience using the latest app technology, it confirmed not only that 90% or so of us felt the GDC wasn’t helping patient safety, but that the majority of dentists practice defensive dentistry. What was probably more embarrassing for the BDA was the fact that the majority of the audience, who were all members of the BDA, felt their trade union was not doing enough.

This blog is too brief to describe the entire lecture. However, the electric atmosphere in the largest hall of the conference must be mentioned, when at the end of what must have been an emotionally draining time for Colin, the entire audience stood and gave a standing ovation. Never in all the years of attending conference have I ever witnessed such a phenomenon. Such was the power of the presentation and how hard it hit home. Never has an audience been so united by one person so humble and considered in what he said.

So the message is simple. We can begin to elicit change now. The smouldering match has been lit, and the kindling has been placed. All that is now needed is for the entire profession (and in this I include those at the GDC who have an appetite for doing the right thing) to unite and fan the flames. Any egos will extinguish the fire, and so will the draft from the closing doors to rooms where traditionally the discussions have taken place. The positions of those straw men and women of the General Dental Council who have been nothing more than puppets to the Guy Fawkes will not survive the gathering heat.

This tiny glimmer of hope can become an inferno of change.

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

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

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

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

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

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

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

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

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

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

Jonny Jacobs

Digital Dentistry Blog on GDPUK.

Over the years, I have mentioned that online advertising has a number of advantages. You can read those articles here and here.

In 2016, we started using DFP, which is a Google programme that serves ads for our clients on to our main site.

One of the exciting features of this software is the ability to serve more than one ad at a time for our clients, to more than one URL. This is a great way of advertising a number of your services or products at once via one booking of a slot. It also has the added advantage of keeping the ads fresh and distinctive for the audience, who may not have interest in one product but an advert for something else from the same company may catch the eye. So a win/win for both the advertiser and the audience.

Yes it can mean more banner designs are needed but the advantages far outweigh this extra work for your design team.

So as you can see this is an amazing advantage compared to traditional advertising, not only is your advert seen thousands of times a month but when compared to print, you can display more than one advert in one position. Another example of modern technology improving the experience for all.

For further information about working with GDPUK and how we can help you reach thousands of dentists, please This email address is being protected from spambots. You need JavaScript enabled to view it.. We will be glad to help.

GDPUK will also be visiting next week's BDA Conference and Exhibition in our home city of Manchester. Get in touch if you would This email address is being protected from spambots. You need JavaScript enabled to view it..

Cheers

Jonny

Digital Dentistry Blog on GDPUK

April was a busy month in Fitness to Practise.  Unlike March where there was something for everyone, April saw mainly dentists and dental nurses on the proverbial naughty step.  Of these 21 had their favourite things taken away from them, 29 were put into time out, and 2 were sent to their rooms indefinitely.  Drilling down into the outcomes further, the final statistics for April were as follows:

Interim Orders held 20 new hearings and 15 review hearings resulting in:

• 18 suspensions or suspension extensions;
• 12 conditions orders or conditions orders extensions;
• 4 no orders and;
• 1 adjournment.

14 registrants were not present +/- not represented at their IOC hearing, and were mostly suspended with a couple kept on conditions.

Practice committees held 29 new hearings and 9 review hearings resulting in:

• 2 erasures;
• 6 new suspensions, 1 suspension extension and 1 suspension being revoked;
• 8 new condition orders, 1 extension of conditions orders and 3 conditions orders being revoked;
• 1 reprimand;
• 3 postponements and 2 adjournments;
• 1 case concluded (the incident was historic and there was no current impairment);
• 1 no impairment;
• 2 registration appeals (1 granted, 1 refused);
• 1 restoration hearing (refused);
• 4 health related hearings with all registrants kept on suspensions and;
• 1 no case to answer

By registrant type, dentists were the clear sinners with 57, followed by 15 dental nurses and a single dental technician.

Cases of interest in April

The restoration hearing heard in April was refused for the second time due to a lack of insight by the registrant into why note tampering is serious misconduct rather than a silly mistake.  The GDC request to indefinitely suspend any further applications due to the costs involved, was not upheld by the panel who, like a Buddhist monk in meditation, felt that insight might be obtained at some point, and directed the erased registrant towards obtaining representation and taking relevant courses into ethics and personal responsibility before making any future applications.  Said registrant will no doubt benefit from such wisdom and gain mindfulness as a result of the teaching!

Not long after, a dental nurse who was not engaging in her on-going hearing relating to failures in decontamination procedures, was kept on suspension by the panel.   She had not turned up again; perhaps having realised that she could earn as much if not more as a domestic cleaner given the average wage of a dental nurse, with the added bonus of not having to be answerable to a regulator.  I need to do some further reading into whether the Fitness to Practise Rules have any mechanism to bring an on-going cycle of hearings for the above scenario to an end.  Let us not forget there is no statutory limit to the amount of money that can be collected from registrants to be spent on Fitness to Practise hearings.

Interim Orders met to discuss keeping a registrant who was in prison for fraud and false accounting on a suspension.  If this is not a waste of everyone’s time and money I am not sure what is, unless there is scope for him to be employed as a prison dentist without an interim sanction.

My other conundrum this month with Interim Orders is in their role of risk assessment and the concept of innocent until proven guilty.  By putting the allegations against a dental nurse as a statement of fact (‘misappropriation of funds’ into a personal account including the practice name, the exact amount of money and number of patients involved) into the public domain is she going to be able to have a fair hearing?  It rather reads like the IOC have accepted her guilt, yet there is no mention of any admission or criminal conviction for this alleged theft in the public determination.

Experts were on good form throughout April.  When we thought we’d seen the last of them after Dental Protection’s reassurance that there is no legal or regulatory requirement for it, the dreaded failure to record LA batch numbers were back, making it into a charge sheet via GDC expert witness Conor Mulcahy.  Perhaps someone can point him in the direction of this useful position statement for any future cases:  http://www.dentalprotection.org/uk/publications-resources/updates/briefing-documents/2015/11/09/local-anaesthetic-batch-numbers

Aside from the batch numbers of local anaesthetics, sadly there were no other particularly curious or intriguing charges put forward this month.  There were however, some thought-provoking conditions in one case which restricted the registrant from sending abusive or offensive communications.   One of the erased registrants was in jail having been convicted of fraud and deception, and the other was voluntarily not present but faced a raft of serious clinical deficiencies which were found proved, including using a block of bone that had dropped on the floor on a patient.

In the ‘No case to answer’ case, expert witness Robert Bland scored an own goal and had his evidence set aside by providing superficial evidence, changing his mind at a late stage on fundamental matters relating to the case, and most importantly exhibiting a ‘lack of impartiality’ by failing to include ‘evidence that was potentially exculpatory’ to the registrant.  This registrant and his wife are seriously considering leaving the profession despite the no case to answer verdict; this is exactly why the GDC must be taken to task for the style and method of its prosecution of cases over many years, and for the failings in its expert witnesses.  I’d also like to make the point here that pathologist Alan Williams who failed to disclose potentially exculpatory evidence in the Sally Clarke cot deaths case, was later found guilty of serious professional misconduct and banned from court work for 3 years.  The past 12 months have now seen 3 cases slung out because the experts appointed by the GDC have shown a lack of impartiality.  Experts also need to remember they are not immune from a civil lawsuit, and frankly it is probably only a matter of time until one is sued, or sanctioned.

Whilst I am on the subject of bias, it also isn’t appropriate for experts to advertise themselves in a manner that suggests they are employed by, or otherwise working as an expert witness purely on behalf of the GDC.  You cannot be impartial if you only do work for one side and I am amazed that this has not yet been picked up on and challenged by any registrants’ legal teams.

In recent years, Dental Practices have noted a rise in the number of requests for patient records being received, especially from legal services. It is probably no coincidence that this rise has corresponded with an increase in adverts for ‘no win no fee’ solicitors encouraging patients to come forward if they have received what they perceive to be poor dental treatment.

In this blog I set out the legal framework in relation to keeping and disclosing dental records and provide some practical tips on how to respond to requests for the same.

Record Keeping

As you all know, whether you work in a private or NHS practice, the Standards for the Dental Team, Standard 4.1 applies.  It states:

‘You must make and keep contemporaneous, complete and accurate patient records’.

Furthermore, various pieces of legislation also require dentists to keep records, including Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which is monitored by the CQC.

Those who work in an NHS practice will know that the NHS contract has a contractual requirement for dentists to keep patient records.

However, there is no hard and fast rule for how long you should keep the records before destroying them.

The NHS contract only requires you to keep patient records for two years. Given that a claim for clinical negligence can be issued within three years of the date of knowledge of the injury, a claim for breach of contract within six years of the breach and a claim for defective products within ten years of the defect, two years will be insufficient should you need to rely on such documents to defend a potential claim. The dental records may be the only evidence of what was discussed during a consultation and what consent was provided by the patient; they are therefore crucial in helping you to prepare a defence.  

The Department of Health’s ‘Record Management’ code recommends community records are kept for a minimum of 11 years after the date of the last entry. For children, it is 11 years or up to their 25^th birthday, which ever period is longer. For hospital records the recommendation is a minimum of eight years. The maximum recommended length for retention is 30 years, unless otherwise required by law or some other circumstance.

If you have received any complaints or there has been an adverse incident with a patient, we would recommend keeping the records indefinitely, even if the complaint was resolved satisfactorily. Whilst there are time limits for bringing claims, the courts have the power to extend those limits. This does leave a dark cloud hanging over you; never knowing what might come through the post. However, being prepared with ‘contemporaneous, complete and accurate’ records will help ease the stress of dealing with any complaint or claim.

Please note that if a patient has a disability as a result of an ‘unsound mind’ the normal time limits for record retention do not apply. In these cases, the records should be held indefinitely.

On top of your professional duties, dental practices will also be covered by the Data Protection Act 1998. This requires anyone who holds sensitive personal data about an individual to ensure that the data is accurately created and carefully and securely maintained. Ensuring records are kept securely includes keeping them confidential. The Data Protection Act also states that data should be retained for no longer than necessary. You can find further guidance about your duties under the Data Protection Act in this helpful guide for businesses produced by the Information Commissioner’s Office.

Disclosing Records

Both the Data Protection Act and Access to Health Records Act provide patients with the right to see their dental records.

If you receive a written request from a patient for their dental records, this must be dealt with as quickly as possible but in any event within 40 days. We have set out below under ‘practical tips’ the fees you can charge for providing the documents and what to do if the request is from a third party.

The request must be to the person who controls the data, and it must contain information such that the data controller can be satisfied as to the identity of the person making the request and provide information as to the data sought.

You cannot refuse a patient access to their records unless one of the following applies:

1.       Disclosure would be likely to cause serious harm to mental or physical health of the patient or any other person;

2.    Disclosure would require you to provide information about a third party (other than the dental team providing the treatment) unless the third party consent’s to the disclosure. (Please note that if you can easily redact such information you should do so, rather than refusing the request.)

Once you have received a request you must provide the patient with a copy of all the information you hold about that patient.

If you have destroyed records and a patient subsequently asks to see their record, under the Data Protection Act it is reasonable to say that it was destroyed because it was no longer necessary to be kept.

Breaches of data protection laws can result in criminal as well as civil liability (not to mention adverse publicity, which is increasingly the likely result of non-compliance) so it is not advisable to ignore requests for personal data.

Practical Tips

Identity. You must ensure that the identity of the patient is correct and that you are sending them their patient records. If you are in any doubt ask the patient for more information to help identify them. If you send the wrong records you will be in breach of the Data Protection Act and, as stated above, this could result in criminal or civil action against you.

Consent. If the request is from a solicitor, ensure that the patient has consented to the records being sent to the solicitor and that they understand why the records are being sought. Most solicitors will use a standard form, because it sets out all the relevant information, but there is no requirement to do so.

Fees. The fees that can be charges for copying records are as follows:

Please note that the fees are the maximum you can charge and you should be able to justify them. They are meant to cover your costs for reproducing the records. For example if the patient only has around 10 pages held manually, charging £50 for administration and copying charges is unlikely to be deemed reasonable.

X-rays and scans can be transferred onto a CD and then disclosed rather than copying them onto film.

Opinions. A legal representative may also seek your opinion on the patient’s treatment and prognosis. Unless you are being asked to provide an expert witness report for court purposes (which you would only be able to do if you had never treated the patient in question) we would recommend that you avoid providing any comments. Any comments could later be used against you in respect of a claim.

If you do provide an opinion, you can seek a separate fee for this, as this is a report and therefore not covered by the Data Protection Act.

Potential Claims. If you receive a request from a legal representative, we would not recommend seeking clarification as to the reasons for the request, simply respond to the request and notify your indemnity insurer or defence union, so they are on notice should anything arise in the future. Providing the medical records may be enough to show there is no claim and nothing further may come of it.

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

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

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

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

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

Forgiveness is motivating ?

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

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

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

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

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

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

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

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

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

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

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

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

CQC – Motivating better regulation

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

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

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

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

Now that feels better!!

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

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

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

Where shall we start?

Have great one.

LINKS IN DETAIL

SPRING MEETINGS

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

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

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

GDC

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

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

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

COMPASS LINKS

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

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

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

CQC

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

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

Do you need the penetration test?

Don’t worry, I’m not about to delve into the wet fingers stuff – this is a different penetration test (no smirking at the back). The idea came to me after hearing a radio programme about cyber crime. They interviewed someone who had been employed as a Penetration Tester. A penetration test (a.k.a. pentest, intrusion detection and red teaming) is, it seems, a well-known and recognised process in the worlds of cyber security and IT governance. Essentially, it is an evaluation of the security of IT systems by trying to exploit vulnerabilities before hackers and criminals can. It goes beyond looking at operating systems and software to include improper configurations and risky operator or end-user actions.

A dentest?

My idea is that dental practices should evaluate their governance vulnerabilities by what I’m calling a ‘dentest’. In other words, before CQC inspectors mark you down, the GDC writes a disapproving letter or a patient uses your complaints procedure you should check whether your systems or staff can be faulted. There might be several ways to do this. In the wider world reformed hackers and fraudsters are often employed for such tasks. However, I don’t recommend scouring the GDC’s list of erased dentists. Much more sensible to keep it in-practice.

This is where that irritating team member who is always finding fault and asking endless questions comes into their own. Divide activities in the practice into manageable chunks and set them the task of ‘penetrating’ them one at a time. In theory, they need expertise in an area to be able to exploit any vulnerabilities. Otherwise, how will they know whether, for example, decontamination procedures are being followed correctly?

A journalistic trick

Fortunately, such in-depth knowledge is not required. How do you think Jeremy Paxman managed to get politicians to squirm night after night? How does the team on Channel Four News report on a variety of different topics with apparent authority? The answer lies in what journalists and reporters learn on their first day at university – the ‘5 W’s’ – Who? What? When? Where? Why? and How? (yes, I know there’s also an ‘H’). Ask these questions persistently enough and you’re bound to get the answers (or not) on virtually every topic.

For example

Take decontamination procedures. Your ‘dentester’ needs to be given half an hour during which they ask the 5 W (and 1 H) questions of, initially, virtually anyone in the practice. Anyone? Yes, because they might start by asking the practice manager: “Who is responsible for decontamination?” With that answer, they could ask the person or persons named: “What is the decontamination procedure?” Then follow up with: “Where is it done? Why? How?”

Any “I don’t know”, “I’m not sure”, “I’d have to ask”, “I can’t remember”, replies suggest a vulnerability.

If they began with a receptionist, they might get the answer: “I don’t know”, which they can follow up by asking: “Who will know?”. If the receptionist says the practice manager, the dentester is off and running. If the receptionist doesn’t know, that suggests a vulnerability – each member of the team should know what roles and responsibilities other members, especially senior staff, have.

Another example

Now the dentester, or another member of staff with an equally enquiring mind, could play at being a patient. They could ask any team member: “How do I make an appointment?”, “How do I make a complaint?”, “When is the hygienist available?”, “Where is the nearest car park”, “How much do implants cost?” Depending on whether they questioned the part-time Associate or a receptionist, they should be given either the name of the person who will know or the actual answer. The dentester proceeds to ask more questions, as before.

The learning points

The dentester’s work is, of course, wasted unless you ensure the vulnerabilities he or she uncovers are shared with the team and corrections discussed and implemented. Also, a dentest is neither a one-off exercise or a standalone one. With new compliance requirements coming on stream all the time, new systems being introduced and new staff joining the team, vulnerabilities may surface again – so regular dentesting is required.

Also, you may wish to enlist a ‘secret shopper’ to check for vulnerabilities. Obviously it needs to be a person your can trust and who will respect confidentiality. Perhaps someone from your plan provider or the dental lab you use or, better still, your favourite dental business management consultant…

Image credit -Andy Maguire under CC licence -  modified.

I have been keeping an eye on the cases emerging from the Fitness to Practice and other committees of the General Dental Council [GDC] for some time, I am sure other GDPUK readers will be interested to know what goes on each month. So, the aim will be to write summary monthly, in what we hope is a short lived blog.

Monthly breakdown of case types and outcomes

The month of March saw 59 hearings scheduled after one was moved back to start in April.  There was 1 registration appeal which was granted.  Of the remaining cases, 18 were new Practice Committee hearings, 6 were Practice Committee review hearings and 2 were health cases.  Interim Orders held 14 new hearings and 18 review hearings.  Broken down by registrant type, there were 48 dentists, 4 dental nurses, 4 dental technicians, 2 hygienists and 1 clinical dental technician involved in hearings.

Interim Orders handed out 8 new suspensions and 8 continuation of suspensions, placed 1 registrant on conditions and kept 7 on conditions.  One suspension was revoked, 1 suspension was downgraded to conditions and 5 cases had no order.  Of the new suspensions 6 of the 8 registrants were not represented and not present.

The Health Committee suspended 1 registrant and placed another on conditions. The Practice Committee erased 1 registrant, issued 2 suspensions, 2 extensions of suspension, and placed 2 registrants on conditions whilst 2 had their conditions extended.  Four suspension orders were revoked, 3 reprimands were given, 3 cases were adjourned, 3 registrants were found not impaired, 1 case was referred back to the Investigating Committee, and in 1 case no misconduct was found. 

March’s cases of interest

The erased registrant was neither present nor represented, but the case mainly related to failing to take appropriate radiographs, failures in treatment planning and record-keeping, lacking indemnity cover whilst treating patients on 4 days, and a failure to cooperate with the GDC.

In the ‘No Misconduct’ case the registrant essentially faced charges which related to not providing an estimate of costs for root canal treatment (although he did not actually invoice the patient for any of the treatment provided), not informing the patient of the risks of the proposed treatment and therefore failing to obtain informed consent. In fact, the registrant had only provided emergency treatment to try to relieve pain and infection.  This was ultimately not successful and the tooth was removed by another dentist. The patient/witness actually complained to the GDC about something else, but this was not worthy of any charges so how this case actually came about is not clear from the determination.  Despite having a confused recollection at times, the patient was still described to be a credible witness. Another matter which is not clear in the determination is why there were 3 experts involved - 1 for each party and a joint expert statement.   The registrant admitted all the charges, but the panel found some aspects not proved and despite both the GDC and defence counsel accepting misconduct and impairment, the panel found neither on the basis that the treatment was emergency in nature rather than a definitive RCT procedure, and the failings not so serious as to be considered deplorable.  A happy outcome here with the lesson of not assuming that because you have not charged a patient they won’t complain about you.   

The case referred back to the Investigating Committee involved fissure sealants on a single patient, which the GDC-appointed expert Professor Deery (who is a paediatric dentistry consultant and Dean of Sheffield School of Clinical Dentistry) had concluded were appropriate after he had examined the patient, and that wear on the patient’s teeth was due to erosion rather than damage caused by the registrant.  It was submitted that this evidence would change the view of the IC and that no realistic prospect of a finding of misconduct existed, begging the question did one exist in the first place?  How the case came about, and on what the basis of the patient complained is not explicit in the determination but it is implied that the registrant may have perhaps been accused of creating damage in which to place fissure sealants or otherwise creating unneeded work for themselves.  This case highlights the inherent issues with the lack of a clinical examination until a late stage, (if at all) in the FtP process and how assessors and experts creating charges purely on clinical records is a flawed concept.  This case will have involved a significant waste of registrants’ money in reaching a Practice Committee that could have perhaps have been avoided with an earlier examination of the patient. Hopefully with the recruitment of dentally-qualified caseworkers cases like this can be avoided in future.

Mr N, who was neither present nor represented, was suspended following his hearing which included 73 individual heads of charge, many of which had several sub-headings.  The GDC-instructed barrister may have missed Jonathan Green’s presentation at the Dental Protection Study Day last October where he stated that no over-drafting of allegations would take place following the embarrassment of the Kirschner case.  In the determination the GDC-appointed expert, Professor Morganstein seems to advise that linings ought to be placed under amalgam restorations.  With no representation there is no means of contesting such a view even though many GDPs would now not line amalgams, nor is there any conclusive evidence that they need to be.  Professor Morganstein is apparently the Dean of the dental school at the University of Buckingham (I know what you are thinking…. and I’ve not heard of it either).  I feel this case nicely highlights the problem with the GDC using experts who are focused on academia or in specialist practice opining on GDPs, and is directly contributing to the stealthy moving of standards in an upwards direction.

Finally, the long-running Carew case which I have been watching with interest due to the charge of:

·         you failed to adequately record the clinical reason why a try-in was required……

has left me somewhat disappointed as this charge was withdrawn on day 1 of the hearing. It looks like we will never get to find out why this element of record-keeping was considered to have been essential.  

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The new Minister was being briefed by the new Permanent secretary, Lady Arabella Sternchin.

“Good morning Minister.”

“Good morning Arabella - it is OK for me to call you Arabella I hope? “

“Quite acceptable Minister.”

“Good I didn’t want to get off on the wrong foot. I heard that old Humphrey could be a stickler for protocol.”

“I never worked directly with him, Minister, so I was never more than ‘my dear girl’.”

“Well that’s all clear then. Now as we’re both new boys, what are we going to do to get rid of the dentists Arabella?”

“Ah yes, I have done some research.”

“Splendid. Burning the midnight oil what?”

“No Minister. Burning out interns. It seems that one your predecessors thought they had things sorted out a decade ago.”

“What was the intention?”

“Well they imposed a new contract that was so ridiculous, so half baked and so poor for all parties that no-one with any common sense would sign it.”

“What happened?”

“The dentists signed it. They ignored advice and signed in their droves. Now the doctors, as Mr Hunt is finding, love a fight, the BMA is a nasty opponent and of course people like doctors. We presumed that as it was so obvious the dentists would lose their clinical freedom and wouldn’t be able to do clever work they would say no and head for private practice. But no such luck.”

“That was 10 years ago though Arabella, haven’t we tried anything since?”

“We got this chap Cockcroft to tell everybody that everything was wonderful.”

“Oh yes I met him once - the shifty one who can’t look you in the eye?”

“That’s him. Well in spite of the fact that nobody ever believed a word he said, indeed quite the opposite, they all opted for to jam today instead of no bread tomorrow.”

“Didn’t we try anything else?”

“Yes we opted for ‘death by acronyms’, the civil servants’ foolproof fallback.”

“What did we use?”

“First there was something called HTM01 oh something, it was all to do with cross infection. We put it about that dental practices were death traps and full of all sorts of bugs. We backed it up with lecture tours by a couple of burned out bug counters and some research work by the manufacturers of some extraordinary things called washer disinfectors. They were really souped up dishwashers but had the lifespan of a mayfly. Did no end of good for our German chums who sold them and made the fang farriers pay for servicing. Fact finding trips to the Black Forest all round!”

“I remember that. What else?”

“Then we thought we would trial the CQC on them - totally inappropriate for their industry of course but it helped us prepare for the real targets, the GPs. We made them pay for our mistakes too - what a naive bunch these are.”

“Didn’t they smell a rat?”

“Sadly not at all, in fact they kept coming back for more. A bit like dental Oliver Twists, “give us more UDAs”, they said.” Then a stroke of genius, they sent Bill Moyes to the GDC.”

“What madman Moyes? He’s not still at large is he?”

“Oh yes indeed Minister and he’s on our side now.”

“So let me get this straight, the original plan was to freeze them out of the NHS, into the good old private sector. How would we placate the voters, you know the Daily Mail reading “we support the NHS” brigade? They vote for us you know.”

“Privatisation minister.”

“Shhhh! Keep your voice down. How?”

“You remember the Carlyle group?”

“What the chaps who sell guns and ammo? They’re so bad even the Yanks don’t like them. How did that work?”

“We arranged for lots of little practices to be bought by Carlyle.”

“Goodness that’s cunning - what did the dentists do?”

“Some of them especially those growing long in the tooth - if you’ll excuse the pun - hated these “corporates” with a vengeance, but they hated the CQC, GDC and so on even more.”

“That doesn’t sound too good.”

“Bear with me Minister.”

“Chance would be a fine thing.”

“Cheeky. It seemed that once these upright, responsible members of the profession saw the colour of Carlyle’s cash they couldn’t wait to trouser the money, roll over, mutter “what principles?" and head for the golf course to blow their lump sums on Rory McIlroy clubs and Audi estates”.

“Gosh - I wondered where old Keith the teeth went. He was my constituency’s BDA rep and a right royal pain in the posterior.

So where are we now?”

“It has proved such a success that the first thing on your desk - once we get rid of this Brexit thing of course - is to consider the idea that we let the Carlyle conglomerate have the whole dental, err, shooting match. It will stop us having to pretend to deal with that dreadful Armstrong man from the BDA, apparently everyone preferred Martin as he knew how to make a decent G&T but this fellow just drinks pints of real ale and keeps nipping out for fag breaks and, by the look of him, the odd pie or two.”

“Isn’t that a bit drastic?”

“Not at all if the Mancs can manage health care, then Dentistry is just nickel and dime stuff as the cousins would say.”

“Just like that?”

“Indeed, Brexit may be a fly in the ointment, however.”

“How so?”

“Keeping these dental sweat shops, sorry surgeries, manned depends upon foreigners who can’t find work in their own lands. At the moment they can get work here easier than our own graduates.”

“Is that fair?”

“What’s fair got to with it? When was a dentist ever fair with you?”

“Sorry Arabella, do continue.”

“Our graduates are so in debt, what with £45k of tuition fees and much the same in beer loans that they are starting to undercut Johnny dental foreigner.”

“Maggie would be proud.”

“Indeed Minister. But it doesn’t stop there. We have plans for the private dentists too.”

“What now?”

“The Dutch control the fees that these cruel b****** can charge so we plan to do that and also to introduce a compulsory insurance plan to match the fees. We started talking to Wesleyan and Simply Health a couple of years ago and they have been very active and are readying themselves.”

“Goodness you have been busy.”

“That’s just the start minister. Your next meeting this morning is with Nigel my colleague from education. We intend to liberate the dental schools from University control. It’s something that we have been working on for a decade - it was Blair who originally got the ball rolling.”

“You know Tony was a good man really, a shame he pretended to be a red and a bit too keen to press the button. But ethically one of us.”

“Instead of teaching the new dental apprentices in ivory towers they will go to urban silos or, as Peter Mandelson christened them, “outreach centres”. These will be run by Carlyle, using their new branding of “ToothSkool”, and the apprentices will learn on volunteer patients for the new three year course. The volunteers will get rewarded with beer vouchers and the children a sticky bun. We have no end of great people coming on board to sponsor these places. Coca-Cola, Tate & Lyle, Kraft Food, Tesco.”

“What fun….good lord Arabella there’s a seat in the Lords waiting for you if this works out.”

Yes Minister.

It would appear that I have to make an unreserved and wholehearted apology to the entire profession. You might have read my blog of the 1^st April, and for those who didn’t realize it, this was an entirely tongue in cheek observation of the profession in general.

However, in my attempt to take a humorous look at dentistry and so e of the characters that inhabit it, it appears that I was closer to the truth than I thought. It appears someone has taken it a little too seriously as only a couple of days later the real life manifestation of ‘Speedy Smiles’ seemed to appear in the guise of http://straightteethdirect.com. I didn’t bother patenting the idea as I thought it was too far fetched, but obviously someone saw more potential in it than I did.

Now many of us felt that this was someone just perpetuating my joke a little longer, but alas, it seems that this is a real defacto business.

I am aghast. I must apologise unreservedly that my joke has become someone’s new business plan.

I’m all for innovation in dentistry and long been a supporter of it, but it has to be in the patients best interests and above all ethical and moral. There are some true innovators out there who combine aspirational patient care with inspirational treatment ideas, and the profession and our patients are all much richer for that. In fact, there has always been a trend for the true innovators in business do something totally ‘disruptive’ to the models that we know. Apple have built an entire lifestyle culture around their products and their innovative ideas of how we do things such as listen to music and purchase software. So much so, many of the old media systems are becoming defunct. And what about the rise of Uber? Having a disruptive view of the taxi service has lead to the inexorable rise of this new service provider, and certainly divided opinion in the sector. Whilst it can be argued that a new way of providing dental care to the masses is precisely one of these types of established market disruptions there is an enormous difference in our market over that of taxis and phones; that of patient safety and our ethical responsibilities.

I’ve long been arguing that we seem to be in a race to the bottom, and it appears to me that we are now plumbing some new depths that I even I thought our profession would never reach. For me to invent a company one week and then find my overactive and warped humour has actually been closer to the truth than I thought has been a shock to me. This new company has very little information on its website, so there are many questions that need answering. I have indeed tried to ask them, but lo and behold, the ‘contact us’ link doesn’t work. How better to avoid having to answer awkward questions than to have a dead link on your website?

A bit of digging reveals that this business venture is actually headed by a UK dental registrant. I can only assume that they have been in some form of suspended animation for the last couple of years whilst the GDC has trundled its way through the profession like a bulldozer in the Amazonian rainforest. Only someone who has been on a retreat to the deeper depths of another planet without any form of contact with the UK dental market could actually think this is sensible move.

This raises so many important questions that I’ve tried asking but had no reply. For instance:

• How on earth can an entirely remote system of diagnosis and treatment planning meet with any of the GDC standards?
• Where is the duty of care?
• Does a specialist diagnose the malocclusion?
• Are all the technicians GDC registered? (I am lead to understand it is a UK laboratory providing the service)
• Who will be stupid enough to provide IPR on a patient who you have no relationship with, not knowing the final treatment plan?
• When some dentists can barely take impressions, how do you expect patients to do this?
• Who is responsible when (not if) the treatment goes wrong or doesn’t meet expectations?
• How are the distance selling rules and cool off periods dealt with?
• How does the legal responsibility to determine the material risks to a patient we now have because of Lanarkshire v Montgomery square with this?
• Who are the ‘assigned dentists’ who oversee the cases? Are they orthodontists or graduates of the Academy of Seen One Done One Taught One?
• Is this actually a ploy to drive the patients to affiliated dental practices for the work?

I am sincerely hoping that the indemnifiers for once use their discretionary power to withdraw any support from this venture if it is as ill advised and crass as it appears.  Certainly I hope that none of my money will be used to defend such a venture, so one can only hope the person behind this has enough personal wealth to back it themselves if patients suffer, and not ‘Cameroned’ it all off into an offshore haven.

If I may give a medical analogy, would this company jump on the opportunity to allow one to buy a kidney on line and cut out the middle man? Is that ethical or even legal? Would they offer to deal in controlled medicines direct to the patients without proper prescription? Because this is in reality no different to what is being offered. A set of pictures and models looked at remotely are NO substitution for a full examination, and that should be from an experienced practitioner in the field. The provision of dental care is like any medical specialism and as such is governed by legislation in order to protect the patient. It is just like any other form of treatment, and whilst I’m in full support of marketing and the development of new initiatives to allow patients to seek treatment more easily (so I’m no dinosaur) this is a step into the black hole of dubious ethics and seems driven more by the financial gains than the desire to help patients. And on the subject of Dinosaurs, just because the technology probably exists to recreate one of those genetically, that wouldn’t make it right. Technology needs ethics and a moral compass to be used for patient care, and this venture doesn’t seem to have either from where I sit. I know many people that agree given the chatter on social media.

Whilst it sticks in the throat to admit it, one only has to look at the crass forms of marking that sometimes occurs in dentistry to have to sometimes agree with the GDC that its pursuit of the profession is justified, because there really are some people who should be ejected from our profession forthwith. When you have aggressive tag lines such as ‘Click Convert Sell’, (which is also something to do with the same registrant behind this venture), and things like ‘Best of the Best’ awards for ‘piratical’ dentists,  one only has to recall the mis-selling of PPI in the 90’s to think this is probably going to visit our profession very shortly with this sort of venture. We will all suffer then, but usually the main perpetrators of these things get away with it and it’s the rest of the profession that has to pay.

The Orthodontists and GDP’s have long been at loggerheads, and will probably remain so, but this really is something that they should now get their heads together over. It appears to me that most of the time they seem to argue about the evidence base for this that and the other, and rarely come to any conclusion other than the other side is wrong. But I think they both might be able to pull together on this one, and agree for once that there probably really isn’t much in the way of proper studies that show the success of a self administered orthodontic alignment system that would stand up to peer review of any kind.

Perhaps the BOS can therefore simultaneously build some bridges and produce a press release and advert this time that would be also supportive to GDP’s in their condemnation of what appears to be a dangerous venture. At least if a GDP goes on a weekend course for the latest fad system, the patient has recourse to a real indemnified person (the dentist), and there is a human input for the patient to discuss issues with. A duty of care has been established and the refined law of this land will recompense for any negligence that ensures. With an entirely digital system (and one that doesn’t seem to have the ability for you to contact easily) then where is the necessary communication that patients will need when things go wrong? Who is responsible? Will it all be down to a dodgy impression the patient sent? Will it therefore always be the patient’s fault?

I would like to formally invite the person behind this venture to enter into a public discussion on this forum as to the business plan, the problem solving modalities, the indemnities in place, and the ethics and morals backing this new venture. I’m more than happy to be proved wrong (as I’ve spent my entire marriage being wrong according to the wife!), and it might just be my ignorance that is making me have these concerns. Perhaps we can invite some of the indemnifiers and maybe even borrow one of the attack-dogs of the GDC (once they’ve sated their appetite on a single issue complaint of course) to referee the discussion and give us their input.

So come on. Lets discuss this professionally. Surely we haven’t reached the point where the profession has eaten itself?

Image Credit: Emily Davies

With it being Masters week, I thought it would be the perfect excuse to use a golf analogy for my current blog!

Little Red Golf Book by Harvey Penick is one of the most influential golf instruction books of all time. The book has a number of short and quick messages for the reader to understand and digest easily which are centred around Harvey’s learning and observations after a lifetime in the golf world. A chapter that I have always remembered can be found on P.45 titled “Take Dead Aim”. Harvey says he tells his students to take dead aim, “Shut out all thoughts other than picking out a target and take dead aim at it.” As an avid golfer, it is a great piece of instruction which is simple and works! I believe it can actually be applied to all walks of life.

In all areas of business we are given targets or we are looking to reach target audiences and we usually need to focus our thoughts or energies on these targets.

Reaching a target audience is now the cornerstone of all successful marketing whether we are using social media, the adverts during Coronation Street or a professional network to get a message across. Whatever area we are looking to reach, we want to reach our target audience and if we can take “dead aim” it works even better.

Reaching work targets also shares similarities, as long as the targets are realistic, you have to take dead aim and focus on reaching those goals. Focussing on the small targets then leads to the bigger prize in the end.

In life we also need to identify our target and then aim for it.  It is good to set specific goals and avoid the distractions. If we are distracted by too many goals or by short term projects and lesser opportunities, we will probably not achieve the important long-term goals that we should all set for ourselves

Are you taking dead aim?

Reach your target audience on GDPUK.com. Get in touch today - This email address is being protected from spambots. You need JavaScript enabled to view it.

What else does Harvey do so well to get his message across in this book that has sold millions of copies…… he always shares a story in each chapter! This makes the audience relate to the chapter and remember the piece of wisdom in the book. This shows the immense power of telling a story. That thought can be discussed another day :)

Further reading on Harvey can be found here - 

http://www.golf.com/instruction/golf-teacher-hall-fame-harvey-penick

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

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

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

You remember the GDC?

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

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

Seconds away … Round 4  -  Dentistry versus the GDC

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

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

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

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

Why all the fuss?

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

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

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

What's the problem?  This is the problem:

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

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

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

What "Point of Principle" causes them to stay?

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

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

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

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

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

Whom should be first?

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

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

JUST DO SOMETHING

DO NOT BE SILENT.

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

May all of you have Spring in your steps.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In a parallel universe….

We have recently learnt of a new entry into the burgeoning short term orthodontic market in the UK. Due to launch on the 1^st April 2016, this news comes as a GDPUK exclusive.

Speedy Grins is a system designed to fit as seamlessly in to a practitioners armoury in the same way as 12lb lump hammer would in a florists. Based on a revolutionary bracket design, where the individual brackets are made from papier mache and dissolve after 3 months whether the teeth are straight or not, the system is backed by 12 hours of extensive research from the Baywatch University Lifelong Learning Self Help Institute of Technology. The unique selling point is that it is the first system to guarantee no extractions will ever be needed for treatment to work. As a result they claim this will make GDP’s ‘experience the same joy as orthodontists do at never having to take out teeth anymore’.

There is a sister product called Slanted Smile which is exactly the same as Speedy Grins, and only comes into being at the end of treatment when the analysis of the smile is done; if the teeth are straight then the patient had the Speedy Grin treatment, and if the teeth still look they were thrown at the face and stayed where they landed then the patient bought the Slanted Smile Product. The company claim this is the first example of a “Patient Responsive’ system. Dentists upload a drawing of the patients teeth, and using their patented treatment planning system called the ‘Central Responsive Analysis Program’ which is designed to give the patient an indication of what someone else’s teeth would look like in their mouth, a treatment plan is formulated by the company, and then the components are sent back for fitting. The company obviously take full responsibility for the treatment planning result, making this ideal for the beginner to ‘orthomadontification’, as the company have called the technique.

The company is headed up by entrepreneur Rolf Pialo who realized there currently aren’t quite enough orthodontists angry with GDP’s at the moment and he saw a hole in the market which he swiftly stepped in to fill. Claiming the system will move teeth ‘faster than a speeding hedgehog’, the brackets come pre-glued with a revolutionary 76^th generation cement which only has to be held next to the mouth for the bracket to automatically find and attach itself to the correct tooth. A bond strength ‘stronger than wet tissue’ is also claimed.

The training is a 22 minute FacetwitTube video which is presented by the celebrity dentist and system endorsee,  Dr Sean One-Dunnwan, who was recently voted the 945^th most influential person in Ovine Dentistry in the Falkland Islands after qualifying last week. Apparently there are only 11,782 places left on the next course so people need to hurry before it sells out completely. In an exclusive interview recorded from behind the wheel of his new rented 701 ½ bhp Porshabentlighini, the celebrity toothsmith explained why he got involved with the new system. “It’s basically the best thing since the last best thing before the previous best thing I was involved with so that’s good enough for me.” Unfortunately he had to cut the interview short as his tea was ready according to his mum.

There has been some controversy (as there always is when these new systems come out) that this will affect the business models of the specialist orthodontists, but the company behind Speedy Grins are adamant that given their experience in the Oral Surgery Sector with their MegaSupaImplant system and the huge increase in workload for Oral Surgeons now taking out simple retained roots and mobile teeth so the delegates on their Advanced Implant technique 1hr course can start placing their products means that the Orthodontists should have nothing to worry about. So much so that they have also added a free refresher course to their portfolio to enable orthodontists to fill the gaps in their books with premolar extractions instead.

As part of the package, delegates will also get free marketing materials endorsed by Marketing ‘Guru’ and failed Seal trainer Billy Bull consisting of a badger suit, 3 stuffed gerbils, a tin of lilac paint and a pink biro. There is also a version with a costume of a Parus Major as well for those who want to make a great tit of themselves.

The system is already accredited by a new regulatory body, the General Expert Specialist & Technical Amalgamated Professional Organisation who have already started recruiting case handlers from Costa and Starbucks in anticipation of the increase in patient complaints arising from the use of such an advanced system. We understand they think the patient is unlikely to be able to consent to the treatment without a 17 year cooling off period and explanation of the procedure in Andalusian interpretive mime with Gaelic Subtitles. Work is well underway to ensure the ‘Organisation’ meet their new targets. As a result, their new gallows facility will be constructed from a variety of materials, including the finest aged mahogany and oak (although pine would have been sufficient). There will also be one made from Meccano for the implantologists so they feel at home before their final drop. Any registrant caught gaming will be hung in the same way as anyone else, but they will now have to pay for their own rope as that is only available privately. Their new Head of Corrective Discipline Mme Prila Olof was said to be most excited at the news of the Speedy Grins announcement as there were still some registrants who had not been ‘disciplined’ yet and she was described as being ‘positively moist’ at the thought of more business for the ‘Organisation’.

The announcement has also been broadly welcomed by a new professional association for dentists, the Association Somehow Leading Everyone Everywhere Professionally, the spokesperson for which was quoted as saying ‘Baaaaaaaa’ and making a sound like a wet fart in a colander before flouncing off in a puff of talcum powder.

All persons depicted in this article are entirely the product of the author’s imagination and bear no resemblance to any person living or dead. Any similarities are therefore entirely coincidental. Any organisation or company is also entirely the product of fiction and again is not intended to represent any current or past organisation or business. Any similarities are entirely coincidental. This article is for the reader’s entertainment and is not intended to be representative of any situation real or otherwise in any way shape or form.

[This blog was first published on the morning of 1st April 2016]

We all know what fight or flight means. We all know the situations where you feel the rush of tension before you panic and go one way or the other.

The third response, freeze, is often overlooked. But freeze is exactly what I did, day in, day out, for years.

I froze. Standing, at the counter in my local big name coffee shop, for what felt like an hour. In reality it was only a second. What had caused this rush of fright?

The barista repeated. “Do you have a busy day?”.

That was it.

This wasn’t in my mentally rehearsed plan. I was ordering a cappuccino, the same as I did every Thursday in the morning, part of my weekly coping strategy. Going out of the house, doing SOMETHING, was better than sitting at home, waiting for the afternoon shift to start. I had become accustomed to going to the coffee shop, ordering the same thing every week, and gradually became more and more comfortable with my surroundings. And then this happened. I couldn’t go back. Well, at least not for a long time. I was comfortable, and she had ruined it by asking a straightforward question that any reasonable person would have answered without hesitation.

Social anxiety is a problem I’ve had since I was 8. I don’t remember exactly how it happened, but I was never really comfortable around people. Having someone who was obviously uncomfortable around other children drew the bullies out like flies to a turd. So I was a very obvious target of bullying. I froze, all the time. I couldn’t do anything. It got worse and worse, every time I was asked anything by an authority figure, I ground to a mental halt, unable to answer and unable to move. Rabbit in the headlights.

I was pushed into social events by my parents, who were clearly at their wits end and thought that forcing me to go to interact with other people would help. It didn’t. It made things worse.

As a teenager I got great solace in music. The louder the better. By putting earphones in, I could block out the cacophony of the outside world, and if anybody tried to talk to me, the brief time it took to take the earphones out gave me a fraction of a second to steady my nerves.

And then I discovered alcohol. I went to university, unable to feel comfortable when surrounded by anybody, and I found that at first beer took the edge off, then it became whisky. At the same time, I started smoking cannabis. Cannabis was wonderful. My anxiety was gone, I could be much more “myself” and it even allowed me to sit in a room and have no nerves at all.

But illicit drugs and alcohol soon took their toll and were starting to take over my life, as I descended down the path of alcoholism, and being so anxious of normal life that I couldn’t function without the instant and total relief brought on by cannabis.

I decided to stop everything. I stopped drinking, I stopped smoking cannabis. I was left (briefly) with the one drug that provided any form of relief, nicotine, although I stopped that fairly soon after.

Meeting new people was always very tough after that. It went back to how it was when I had been at school. I completely froze. When you freeze and struggle with conversation, people make all kinds of assumptions, with the stories sometimes making their way back to me through friends. If only they had known the truth, I don’t think people would have been so judgemental. The worst experiences were when people talked ABOUT me, to a third party, when I was right in front of them, on one occasion telling the third party that I was “the weirdest person I’ve ever met”, and the other, that I had “zero personality”. That was a trigger for a complete meltdown, and when it happened I struggled to leave my flat for a couple of weeks afterwards on each occasion.

And so on to the world of work. Eye contact became increasingly difficult. I somehow managed to develop a different persona for dealing with patients, and could blag my way through. I was able to talk to patients with comparative ease, but I always kept it very informal. Staff, however, were almost impossible to deal with. The more people tried to assert themselves as an “authority figure”, the worse it became. I once again got labelled as “weird”, got left out of social events, and then told that I made no effort to socialise. I do wonder if they knew how much effort it was to smile and say “Hi” to somebody in the morning, whether the same judgement would be made.

I recently decided to get treatment for this as I was incapable of living a normal life. It’s a lonely existence, plodding through life without any real social interaction. Social media has equally helped and hindered me at the same time, in that while providing an outlet for at least some socialising, it has also acted as a crutch, and got in the way of normal social interaction.

I had 8 sessions with a psychotherapist to try to overcome the social anxiety, and while progress is slow, the realisation that nobody looks or cares about me or what I say, was actually a huge relief. My GMP prescribed some antidepressants that unfortunately made my anxiety worse. However, after nearly a year of pushing myself into more and more uncomfortable situations, I’m much better. I can finally look somebody in the eye, and I don’t freeze when the conversation goes “off script”. I don’t take any medicines and I am no longer receiving any psychotherapy.

My only regret is that I hadn’t been able to access the treatment earlier. 

Image credit -PracticalCures under CC licence - not modified.

Walk down any high street and you’ll likely witness a cornucopia of contrasts and contradictions. Overweight people, painfully thin people. Healthy looking pensioners, teenagers who couldn’t run for a bus. Naturally wrinkly old people, unnaturally smooth-skinned middle-aged people. Adults with bright shining teeth, children with a mouth full of decay.

It’s deeply ironic that in an age when many of us could live to a 100 and all but the most serious diseases can be treated, some people are clearly missing out. As a mother of two and former practice manager it particularly disturbs me to see children with bad teeth. The numbers are staggering. According to the Health & Social Care Information Centre recent report NHS Outcomes Framework for England, tooth extractions due to decay in children admitted as inpatients to hospital, aged 10 years and under were at the rate of 462.2 per 100,000 population in 2014/15. That’s about one in every 216 children.

That’s an average for England, in Yorkshire and The Humber the figure was about one in every 112. The report also showed that: ‘Nationally, there is a strong correlation between area deprivation and the rate of tooth extraction. As deprivation increases so does the rate of tooth extraction. The rate of tooth extraction in the most deprived decile is almost 5 times that in the least deprived decile (808.7 compared to 167.5 per 100,000 population).’

What does Google say?

To attempt to answer the question posed in the title of this blog I decided to post it into Google. The result was many references to information on children’s oral health and an article in the Daily Mail with the headline: ‘The lazy middle-class parents who don’t teach children to brush their teeth: By a teacher who’s seen the horrific consequences’.

The article claimed that parents were too busy to show the children how to brush their teeth and when the teacher opened a pack of tiny toothbrushes and tubes of toothpaste in her class of four-year-olds ‘the children were saucer-eyed with curiosity.’

An article on parents.com claims: ‘Many parents are surprised to learn that kids need help brushing their teeth until at least age 6. Young children simply don't have the manual dexterity to do the job well.’

In October 2014, in guidance aimed at local authorities, NICE said: “Schools and nurseries should run tooth brushing schemes to help standardise the oral health of younger children.”

In an article about this guidance in The Telegraph, Joyce Robins from Patient Concern was quoted as saying: “Nice has often been accused of pushing nanny state measures but this is more like a ‘supernanny state’.

“What will they suggest next, that parents can drop their children off at school naked and unwashed, and leave the state to step in and do the rest?”

Oh dear.

There is an answer

So if parents are too lazy, too ignorant, too impoverished, living in area of deprivation or are combination of some of these factors, what is to be done? The answer comes from the USA. Tegwyn H Brickhouse D.D.S., Ph.D. Department chair, research director and associate professor in Pediatric Dentistry at the Virginia Commonwealth University was the lead author of a paper presented to the IADR/AADR/CADR conference in March 2013. In it she wrote about a study into a scheme to decrease the number of low-income children in the Roanoke Valley with long term dental disease. The Child Health Investment Partnership of Roanoke Valley (CHIP) provides in-home preventive oral health services designated as the Begin with a Grin Program. The paper states: ‘In the context of a home visit, Community Health Nurses (CHNs) and Pediatric Nurse Practitioner (PNP) apply fluoride dental varnish (FV) to the teeth of CHIP-enrolled children from tooth eruption to 36 months. They educate the caregiver in preventing tooth decay and the importance of a dental home.’

The study found that: ‘Two applications of FV to the child’s teeth significantly reduced the likelihood of having any decay.’ The conclusions were: ‘Home visiting programs such as CHIP’s Begin with a Grin serves as a model to improve the oral health of high-risk children. The CHIP program provides an innovative solution for providing oral health care to the nation’s medically underserved populations.’

NHS Choices states: ‘From the age of three, children should be offered fluoride varnish application at least twice a year. Younger children may also be offered this treatment if your dentist thinks they need it.’

That presupposes a parent takes their child to a dentist. The CHIP Begin with a Grin programme avoids that requirement. However, dental practices would need to be informed when children are born in their area.

Is this something the GDC and NMC (Nursing & Midwifery Council) should be liaising about? Another question seeking an answer…

Image credit -Tiffany Terry under CC licence - not modified.

In my last blog, I noted a developing Critical Mass for change in how we address infant caries and its consequences. And barely a month later, the steam pressure has been increased once again.

The Chief Dental Officer Dr Sarah Hurley, is starting to make public inroads into her role, and recently delivered the 2016 Pendlebury Lecture. It was in stark contrast to the one delivered in 2014, demonstrating a wide understanding of the playing field that is dental health.

Critical Mass 2

It comes at the end of a week in which the state of children’s teeth once again was publicly pilloried, on the back of the General Anaesthetic numbers.

While it remains a problem in England, just look at Scotland. After many decades when Scotland has been spiritual home of the UKs dental problems, it suddenly produces numbers through its Child Smile initiative that suggests significant inroads are being made to improve the health of children’s teeth and prevent dental caries [and thereby reduce the costs and morbidity of unrestricted dental breakdown]. It is not really rocket science, they have just been investing in infant dental health.

So we in England [and Wales and Northern Ireland to a similar extent, but out with the CDO[NHSE]’s remit] have a problem.

We know the target population for any changes must now be parents and infants in equal measure.  There seems to be ample evidence that parking the dental professionals in discrete buildings, called Dental Surgeries, is simply not working, and it is evidence that Dr Hurley seeks.

We know that the medical stakeholders are now on board, as obesity and diabetes rear their heads with all the long term cost implications. Indeed it is the medical drive for a sugar tax to discourage the dietary shortcomings that is also driving the publicity that emerged in the Daily Telegraph over the weekend of the 26^th February, and was subsequently widely discussed on broadcast and printed media.

Follow the money

So increasingly the priority is being defined. But the thorny issue will arise of funding.

Which Departments will pay?   How will we [the public] pay for the inevitable targeted measures that are due to follow, as day follows night?  A sugar tax undoubtedly could easily raise the funds but the political will in the chaos pre-Referendum is clearly not there.

There is a serious danger in the current fiscal period of restraint that the HM Treasury will insist on a cost neutral option.  Maybe not, but we must for now assume that.

Could it be that the GDP Budget is being eyeballed [at £3.4Bn] as the low hanging fruit of funding that could or perhaps should be used to address the issue of infant dental health?

The Chief Dental Officer is clearly leading dental health to a better place – but who will pay for this Piper’s plans?

The role must soon change it seems to that of Chief Decision Officer.  

Interesting times, but the sooner we address the issue of Dental Health for the young child, the sooner we can restore some pride to our profession.
 

As a GDP you would do well to plan for big changes. Not sure what but for sure very significant.
 

Have great Easter, assuming the snow has eased back!

2016 letter to Telegraph http://www.telegraph.co.uk/comment/letters/12077501/Letter-The-NHS-dental-health-system-is-unfit-for-purpose.html

Dentistry response http://www.dentistry.co.uk/2016/01/11/nhs-dentistry-letter-published-in-the-telegraph-unhelpful/

Feb 26 article DTel  http://www.telegraph.co.uk/news/health/news/12174796/Thousands-of-children-have-decayed-teeth-out-in-hospital.html

BDAs Press release  https://www.bda.org/news-centre/press-releases/tooth-decay-stats-should-offer-wake-up-call-on-prevention

GDPUK News https://www.gdpuk.com/news/latest-news/2151-gas-for-dental-extractions-in-children-on-increase

GDPUK CDOs response https://www.gdpuk.com/news/latest-news/2152-strong-response-to-child-ga-figures

GDPUK Scan of other media [Dr Tony Kilcoyne]  https://www.gdpuk.com/forum/gdpuk-forum/telegraph-third-world-dentistry-crisis-in-engand-21379?start=130#p239340

Scottish example  http://www.child-smile.org.uk/professionals/childsmile-core/toothbrushing-programme-national-standards.aspx

·         Since 2011, all elements have been delivered in all Health Board areas throughout Scotland.

·         "As a result of our efforts, dental health in Scotland is improving, particularly in deprived communities. In the Primary 7 age group dental health has never been better and on a Scotland level the target of 60 per cent of this age group having no obvious decay has been met. This is a fantastic success story."

Summary of 2016 Pendlebury lecture http://www.fgdp.org.uk/content/news/synopsis-of-the-2016-malcolm-pendlebury-memorial-l.ashx

As an online publisher we like to keep an eye on the stats on the site, how the banner ads are performing and also hope to increase the number of visitors and users of the site.

We publish a number of news and blog pieces a week, which all help to bring a steady stream of the target audience to our website.

The daily email digests, which get sent three times a day also keep our members engaged with what is happening on the forum and ensures the community spirit is maintained.

Since our mailing list was turned into a website and forum in 2008, we have seen the site evolve and grow. In early Jan we went past 20,000 threads created since mid-2008. Screenshot below of the most recent threads created and forum posts received.

The 20247 topics have received 229387 replies, which is around 11 replies to each topic, an amazing amount of input from the members of the site.

Below we can also see the amazing growth of the site in numbers since 2013, by using the month of February as a comparison, the growth in unique visitors and total visits made in each month demonstrates the popularity of the community.

As the site continues to grow year on year we have now also moved the serving of our banner ads to Google Doubleclick for Advertisers which we have found improves the serving of the banners and isn’t as susceptible to click fraud as other software. It has a number of advantages, with the main one being that an advertiser can book a certain space for a month and then advertise more than one thing in that space, with each banner getting an equal share of the impressions. Useful for a dental business that wants to advertise a new product as well as an existing service. You can promote both!

There are many ways we can work together to use differing formats for banners, HTML 5, video ads, and we have space ready for a new size banner, the Super Leaderboard.

Advertising is also available on our email daily digests which is sent three times a day to thousands of dentists, who have voluntarily subscribed to the list and use the digests to look at the latest news and forum posts on the forum.

For further information about GDPUK and what we can offer companies looking to reach dentists, please This email address is being protected from spambots. You need JavaScript enabled to view it. or give Jonny a call on 07786571547.

Thanks for clicking through to find out more about advertising your course, conference or website on GDPUK.com.

Get noticed by the thousands of Dentists on GDPUK every month.

Below we have put some excellent pricing for advertising on the site from April 16 onwards. We believe the site is an exceptional place to attract dentists who are interested in learning on your course or conference in 2016.

Advertise your course one month at a time, improved pricing offered for 2 or more months booked. Please get in touch for more information.

All advertising includes 2 PR pieces per month published on the site, which we share on social media to our 5,000 + followers.

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get your course advertised in front of your target audience.

Trade media has been slow to embrace digital but below you will find 8 compelling reasons why now is the time to embrace digital media. The way we all use and share content has totally changed, with the large majority of people under 40, using only digital mediums when looking for news, information or opinion. Dental publishing is no different.

This change is now picking up speed, with the number of dentists reading and joining GDPUK growing all the time. The start of 2016 saw the site go over 20,000 threads created on the forum, which has produced an impressive library of content and knowledge. As dentists spend the majority of their time online, the companies looking to reach dentists will also do so.

Below are our 8 reasons that you should start embracing digital media.

1. Lead generation / Data

For years advertising in magazines has been based on brand recognition but now with digital you can gather data from who visits your site, or who is interested in your product. The opportunities are endless. We are currently helping with a product trial in conjunction with a leading dental manufacturer who are offering products to our users on a trial basis, in return for feedback on the product. 10 dental practices were successful with their application and have now received the product. By encouraging engagement with our community, the manufacturer is also gathering data and generating potential leads as well as increasing brand awareness.

2. Back Catalogue

Online publishers are constantly publishing content, whether it's blogs, daily news or the 20,000 + threads created by our community. A monthly or weekly magazine, are very rarely stored by anyone for more than a few months and it’s not straightforward to search for a particular article or opinion piece. All our content can be found online.

3. Gain extra exposure

With over 4000 visitors a day to the site, we have a large number of eyeballs looking at our content. Online publishers receive a large number of readers on a daily basis, some of our news articles will receive thousands of views in a week. Instead of a banner being seen once, your ad will get seen numerous times in a month by one user!

4. Visit an exhibition every day of the week!

In the dental industry there are a number of events cropping up on a weekly basis which unfortunately crowd the market for the established shows. Sites like our own often have thousands of visitors a day which is like an exhibition every day of the week, so the value of advertising when compared to exhibiting is exceptional because you are getting thousands of eyeballs on your product or service a day.

5. Measure what works

The ability to be able to measure how many impressions your ad has received or which content is engaging users is an incredible advantage. Digital methods provide real-time results.

6. Experiment with content - Flexibility

Another amazing advantage of digital is the ability to experiment with your ad or content. With our software you can even run more than one ad at a time and advertise two products or services at once. Ads can be tweaked or amended at any time giving tremendous flexibility. Make changes quickly based on real-time metrics and performance. There is no need to wait 12 months to identify what is and what is not working.

7. Community

With a digital community content can be shared instantly. Obviously not everything is going to go viral but when your marketing efforts get shared, it is a great way of increasing engagement and exposure.

8. Control your Sales Funnel

With a well functioning landing page you have extra control in your customer's journey. When an ad appears in a magazine you hope they remember the brand or remember to call you, but with a well designed landing page, you can capture information in a much quicker and less random manner. I have written previously on the importance of a good landing page, read more here.

Thanks for reading, get in This email address is being protected from spambots. You need JavaScript enabled to view it. for further information about GDPUK.com.

The news that the BDA is putting together a Research Project Advisory Group supporting research into the mental health and wellbeing of UK dentists might be greeted with suspicion in some quarters. Not in this one, anything that can look seriously at the causes of frustration, despair and burnout in dentistry must be supported.

Several years ago my accountant, who was married to a dentist’s daughter and had a dozen or so dental clients said to me, “I don’t know how you guys do it. If I have a problem I can close the file, go for a walk round the block and come back to it later in the day. Or I can go down the corridor and talk it through with someone. If you have one it’s right in front of you, living, breathing and, possibly, bleeding. You’ve probably got two more sitting waiting outside as well.”

I remember spending ages formulating this statement when I wrote my first report for a client:

“I need to make a couple of points about Dental Practice ownership. Firstly it can be a solitary place; being a medical professional has pressures upon it, having to make immediate decisions with patients that are awake and where you have a finite time to complete procedures produces even more pressure. Being the owner and main producer of a small business is lonely too.

Next; dentists, in common with a lot of “solopreneurs”, are notoriously poor leaders; they have problems separating management from leadership. They have difficulty in keeping themselves in a position where they are able to make decisions about their businesses in a dispassionate way.”

Mike Wise had taught me that it was OK to repeat the same stock phrases in different treatment plans so, as this applied to most of the reports, I have written it again and again. Firstly composed nearly a decade ago, the pressures have not diminished, indeed quite the opposite.

I accept that many of those obligations are by no means unique to dentistry, everyone who makes a living has to do it in a finite time to turn a profit. Even the biggest movie star, musician or sportsman has deadlines to hit. We all have to please someone at sometime. Human nature says you are a special case and begrudge anyone else’s right to be treated as such.

Dentistry is unique. Of course, in some ways, the business model may be similar to others. The need for systems, HR, financial controls, time management and dedication can be found in many other walks of life.

There’s one big exception. Dental clinicians have the use of sharp instruments with the potential to cause pain and inflict lasting damage. This carries a huge responsibility. It’s this last point, a major cause of stress, that the bean counters don’t grasp - and how could they? You have to be there to know that peculiar feeling of dread before exploring a hot pulp, the uncertainty of trying a perfect veneer or the sinking despair of fracturing a root in a phobic patient with limited opening.

Too many dentists don’t share their experiences, their uncertainties and concerns. Across the country attendances at many courses and BDA section meetings are down. One reason for this is the intrusion of “higher powers” to make CPD yet another exercise in box ticking of having turned up and fed the time in the approved core subjects. By extension, non-core subjects are seen to be less important.

Another reason is the courses, lectures and seminars are accessible on-line so that you can be solitary and get information at a time that suits you.

Often dentists view each other as competitors and are suspicious of others’ motives. I was recently given two separate opinions, “there’s no point in going to our local meetings because they are dominated by 1) the willie-waving early adopters who boast and lie about what they are doing and earning or 2) the patched elbow brigade who only moan about the CQC, GDC, BDA and are hanging on for their pensions.” Take your choice.

What is missed is the sharing of experiences, of being part of a community with mutual support. There’s nothing better than finding out that someone has had an even worse day than you.

Without that where does the frustration go? A fast drive home? Difficult on this crowded island. A fast cycle home? Good. Via the gym? Now you’re talking. What is all too frequent is a stop at the off licence and an evening shared between TV, laptop, iPad, smart phone and paperwork. Or goodnights made to children on the phone after your last patient and before you get on with the next bout of compliance.

Some people grow an outer skin so that the day to day doesn’t get to them, but in many this carapace resists any change and when it finally cracks the result can be catastrophic. The consequences of the pressure are physical and mental ill health, and a poorer quality of life than might have expected. So perhaps those expectations should be tempered or better still there should be training in how to handle the pressures. That has to start at undergraduate level.

Resilience is a word that is often bandied about but not properly understood, applied or taught and I’ll continue with it next month.

Image credit - Kevin Dooley under CC licence - not modified.

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

So is stress bad then?

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

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

How much stress is normal?

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

·        Normal 0-14

·        Mild 15-18

·        Moderate 19-25

·        Severe 26-33

·        Extremely severe 34+

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

No added stress

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

Stress as a management tool?

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

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

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

Image credit -Bottled_Void under CC licence - not modified.

Capacity

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

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

Capacity  
 
A person lacks capacity if:

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

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

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

Assisting Those Who May Lack Capacity

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

Best Interests of the Patient

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

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

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

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

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

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

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

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

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

So what is Native Advertising?

Native advertising is a type of advertising, primarily found online, that matches the form and function of the platform upon which it appears. Most of the time is is produced as an article or a video, created  by an advertiser with the specific intent to promote a product, while matching the form and style which would otherwise be seen in the work of the platform's editorial staff.

Native advertising is the next stage of content marketing. It is a great way to promote the content that brands are creating and an innovative way to reach their target audience where they congregate but in a way that is not seen as being overly intrusive.

Why does Native Advertising work?

• It works for businesses whether small or large in their market.

• Brands always have content to share and native advertising provides them a way to do this, while also monitoring the results of what works and what doesn’t.

• Native advertising works very well in a mobile format. Whether it's a text link, hosted editorial or promoted video, because native content sits in the main part of the site, it is often seen as the same as any other content viewed via mobile.

• Leads to greater innovations, brands don’t have as many limitations as traditional advertising. Anything that is innovative and different is sure to attract your target audience.

• Native ads work best when placed on social media platforms and news focused websites. Site like these (like gdpuk) are built around content, so exciting native ads will attract attention.

Where can we see examples of Native Advertising?

Below are a few examples of native advertising, I have found by utilising google. I have included examples from buzzfeed because it turns out a lot of their content is actually native advertising! From $4 million of revenue in 2011, they were expected to reach close to $100 million of revenue by the end of 2015, primarily from native advertising articles!

1. Netflix on Wired.com - http://www.wired.com/partners/netflix/

2. Nike on SB Nation - http://www.sbnation.com/sponsored/nike-pep-talks/

3. Cancer Research UK on Buzzfeed - http://www.buzzfeed.com/cancerresearchuk/sunbathing-expectation-versus-reality#.vbGDX25oKe

4. Spotify on Buzzfeed - http://www.buzzfeed.com/h2/osmo/spotify/bands-that-wouldnt-exist-without-led-zeppelin?b=1#.mc7Rp2zNQP

5. Call of Duty on Buzzfeed - http://www.buzzfeed.com/callofduty/jokes-only-call-of-duty-fans-will-get?b=1#.ffoNOKPeoj

As we can see in the examples I have randomly chosen, brands have been thinking of some great ways to interact with consumers without appearing overly intrusive. What do you think? Do you spot native ads?

Can this form of advertising be applied to the dental market? GDPUK has recently launched an option available to all potential clients, to do product reviews which gets you interacting with the dental community and getting your brand sampled or tested by our users.

Native advertising could be implemented into GDPUK in a number of ways such as a news story, a regular blog or even a forum post that gets the users engaged. Please get in touch if you have any ideas or methods you would like to try. We are open to suggestions and want to help you get the best experience you can from GDPUK.

Look forward to hearing from you. Contact details below.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Image credit -Gordon Joly under CC licence

There is a concept in nuclear chemistry which many will be familiar with. Critical Mass has been adapted to apply almost any situation nowadays.   When a process of change is beginning, Critical Mass is used to refer to that point when change becomes inevitable.

What starts as a mood that change is needed becomes a minority activity with early adopters, eventually tipping over the edge for widespread general change for the better.

The bigger the system, the more one can see change with necessary Critical Mass at work on a daily basis

Early Years - has General Dental Practice failed?

Is “Early Years” dentistry about to undergo a change of massive significance? Is the state of children’s teeth [as it relates to caries and GA Admissions] about to trigger a political Critical Mass change

The problem of course is this:

£3billion of funding, give or take, by the Government, aims at funding dentists to sit there waiting for patients to wheel their little rug-rats in for a ‘check-up’.

Sadly, two facts suggest this time-honoured approach is a fail.

Firstly only 50% of the population actually go to the dentist, and that is without weighting the numbers towards any problems with new migrant or ethnic groups.

Secondly, by the time the child appears for their check-up age 3-4, the caries is already established, the dietary patterns are embedded and the Prevention horse has, by and large, well and truly bolted.

http://www.hscic.gov.uk/catalogue/PUB17794/prov-mont-hes-admi-outp-ae-April 2014 to March 2015-toi-rep.xlsx  is a spreadsheet of child hospital treatment number suggesting in England alone some 110000 admissions for dental caries at about £670 per admission .

My back-of-my-vape-packet estimate is that some £73Million is spent [in England alone] with hospitals sorting out the fact that community prevention of dental disease in children has failed.  The medics have now woken up to the fact that this same diet is leading to an epidemic of child obesity and diabetes.

This pressure for change, smouldering for some time,  arguably gathered pace with the excellent planning document, Delivering better oral health: an evidence-based toolkit for prevention at

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/367563/DBOHv32014OCTMainDocument_3.pdf

Then we have the January 2015 Faculty of Dental Surgery issuing this report:

The state of children’s oral health in England at

https://www.rcseng.ac.uk/fds/policy/documents/fds-report-on-the-state-of-childrens-oral-health

GDPs do their best - but what is needed?

Patently dental teams who care for caries affected early-years-children do their best, often with imaginative and innovative outreach, but the numbers for GA Admissions suggest the problems fires are still raging despite the attempts to limit the spread by the profession from the GDP model.

Is the demand for planning of a different dental intervention for the first three years beginning to gather momentum? Are we indeed reaching a point where the energy and desire for change to be planned means that significant change will indeed become a priority?

Just look at the last year of public domain comment and criticism of the present status.

The Sugar-Obesity-Diabetes-Caries complex

Sugar is now being discussed in a widespread public debate about obesity [be it child or adult] and diabetes but led his time our medical colleagues. Caries is being discussed too.

Dentistry was the subject of an adjournment debate in the House of Commons this last week

Various media events [including the 3^rd Daily Telegraph Letter] have taken place in which members of the profession have presented the view that the present system of delivery of dental care is simply failing to deliver any effective prevention to the early-years child.

It is also unclear if the new GDP Pilots will change much in the context of a developing problem and reducing financial resources in Government spending plan. It is clear the new CDO [NHSE] has sensed this and is trying to wind the initial changes back and see where the true problem lies an th evidence takes her.

Evidence?

Sadly, there is no real evidence, because we have a problem which requires action for which an integrated approach has never been trialled, let alone undertaken.

One example of the media attention is a recent BBC Look North slot with Dr Tony Kilcoyne.  The BDA it is reported are meeting with the Chief Medical Officer’s team.

Dentistry on its own is a small backwater of medical provision.

But when we start to get frequent interventions by the medical profession, increasing interest by the broadcast media, and an increasing public desire to understand and discuss the situation as it relates to THEIR dental health and that of their children,  … well anything can happen.

Now what happens to the GDP’s element of the  NHS Budget on the back of such changes is, of course, a separate discussion.

But can all this really happen? Will we really witness 2016 as the year that Critical Mass for real change will be reached.

Dentistry and Medicine united?

I suggest the need for a “National Early Years Preventive Strategy” will be crafted which integrates medicine and dental care into a program targeted at mothers and their children and wider families that will aim to influence the diet and dental care of the under 3’s.

We as a profession have arguing this case for years and the Department of Heath have merely sat by.

I sense the medical profession are not going to sit idly by and watch the sugar/obesity/diabetes/caries scanal  wreak further havoc, be it to personal heath or their budgets.

We can but hope. 

We can hope that as a profession we are included in the delivery of a  solution.

We can but hope that something better comes out of it for the wider work of Geneal Dental Practice.

Every dentist knows how important it is to obtain consent from a patient before conducting any physical examination or undertaking treatment on a patient. In this blog we look at the legal issues surrounding consent, namely the definition and the consequences of not obtaining it.

Valid Consent

There is no statute setting out the definition of consent; the principles for consent have developed through case law.

For consent to be valid it must:

1.       Be given voluntarily and freely; 

2.       By an informed person; and

3.       By a person who has the capacity to give consent.

Voluntarily and freely means the person giving consent must not be put under any undue pressure or influence to either accept or reject treatment. Such pressure may come from partners or family members. If you have concerns about this, you should see the patient alone in order to obtain valid consent.
 
A dentist must provide the patient with all the necessary information about the treatment so the patient understands the nature and purpose of it. If it is alleged by a patient that proper informed consent was not obtained, the Courts will consider whether the dentist has taken reasonable care to ensure the patient is aware of the material risks of the treatment and of the reasonable alternatives to the treatment. The Courts look at what a reasonable person in the patient’s position would consider was a material risk, by looking at whether a reasonable person in the patient’s position would attach significance to it. The Courts will also consider whether the dentist had knowledge, or should reasonably be aware that their patient would be likely to attach significance to the risk.

This test follows the decision handed down by the Supreme Court on 11^th March 2015 in the case of Montgomery v Lanarkshire Health Board, which has been a feature in a recent forum discussion on GDPUK.com. As pointed out by many of you, the discussion in Montgomery simply re-iterates what best practice is, as advised by the GDC.

Prior to this the leading case on consent was Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital or, as it is referred to, the Bolam test. The decision said it was a matter for clinicians to judge how much information was to be disclosed to a patient. Provided the doctor explained the risks of a given treatment, to the extent that it accorded with a responsible body of medical opinion, liability would not attach.

However, Judges had been moving away from the Bolam test in any event, but these cases had not reached the highest court in England, so they did not overturn the Sideway’s decision.  

Given the decision in Montgomery, it is now advisable for dentists to give information to patients about all possible outcomes and make a record of the information given. Furthermore to engage in an open dialogue with their patients regarding any treatment offered.

Other Issues Surrounding Consent

Consent obviously needs to be obtained before treatment is performed. When the treatment is intrusive the consent should be obtained well in advance to give the patient time to ask questions and you to provide the information.

There is no set form in which consent must be obtained, but it is always advisable to have the consent confirmed in writing, usually by signing a consent form, as this can be used as evidence should any questions arise.

Consent will normally last indefinitely, unless new information comes to light that could affect the patient’s decision or the patient’s health has changed such that the risks have changed. A patient can withdraw consent at any time, even part way through treatment. In these circumstances, the dentist should stop treatment to see what concerns the patient has and should only continue if consent is re-established. Unless to stop the treatment would cause the patient greater harm.

Legal Consequences

There are two potential legal avenues a patient could take if consent is not obtained or not obtained properly.

Firstly, touching a patient without consent can constitute both the civil and criminal offence of battery, namely unlawful physical contact.

Secondly, if a healthcare professional fails to obtain proper consent and the patient later suffers harm as a result of any treatment, the patient may have a claim for negligence.

It should be noted that informing people of the nature and purpose of treatment is likely to be sufficient to defend a claim of battery. However, a failure to provide all necessary information about the treatment could lead to a claim for negligence.

Remember, alongside these legal principles, there are also ethical principles surrounding consent. Whilst there will be some overlap between the two, you should refer to the GDC guidance highlighted above for more information. As you all know, failing to follow the Standards for Dental Professionals may result in an investigation by the GDC in relation to fitness to practice.

Image credit -Quinn Dombrowski under CC licence - not modified. 

What a day! Traffic jams, a flat battery in my mobile, a parents’ meeting tonight and I’ve still got to write this blog about being stressed.

Ah, that’s better. It’s another day and instead of writing the blog when I was tired and grumpy, I wisely left it until now. If only all stress would dissipate so easily.

This is not an examination of stress in dental practice. For that, I recommend an excellent study on the Yorks and Humber Deanery website.

And this is not about managing stress because I agree with dentist and communication coach, Brid Hendron, who says we need to be eliminating stress.

This is also not a guide to stress relief. There are plenty of those available and the Stress Management How to Reduce, Prevent, and Cope with Stress article here is better than many.

So what is this blog about?

Oh dear, I can sense you’re become a bit stressed reading this, so I need to get to the point. Which is to ask: are you the source of stress in your practice?

Can you honestly say you don’t ever put stress on your subordinates/superiors/equals? Think carefully, do you bang on endlessly about problems that cannot be solved within the practice (government policy, for example)? Do you set your staff unnecessarily tight deadlines to complete work? Are you careless about returning equipment so that colleagues can’t find it? Do you leave an empty loo roll in the toilet and a dirty mug in the sink?

#LoveYourImperfections (not)

Such behavior may, according to the online dating service TV advertisement, result in you finding true love but that won’t be in your practice. Instead, it will result in stress, which will have consequences. According to the HSE, 9.9 million working days were lost to work-related stress, depression or anxiety in Great Britain in 2014/15.

Just stop

Like ceasing smoking or the consumption of alcohol in too large quantities or (as in my case) pigging out on cream buns, stopping causing stress is easier written than acted upon. Here’s what you should do. Suffers of stress are advised to keep a stress journal. Do likewise but instead of recording stressors on a daily basis, you should identify ‘stressees’ (the colleagues to whom you’ve caused stress). This won’t be easy. Not everybody reacts to stress by pigging out on cream buns or bursting into tears. Quite probably, you won’t witness the effects of your stressful action within the practice. So here comes the clever bit.

Stress balls

At a team meeting, explain you’ve read an article about stress in the workplace and want to learn how many people in the practice feel it. Now place a bowl of marbles, walnuts or (if you are in an upmarket practice) Ferro Rocher chocolates in the tea room (staff lounge) with a mug (porcelain cup) beside them. Ask your staff to place one of the items in the mug (cup) at the end of each week if they’ve felt stressed.

Self-regulating stress reduction

Once this has been done for a few weeks (so that staff have become comfortable with it), explain that you’re keeping a stress journal and would like others to do likewise (anonymously, of course). While there is no direct correlation between what people note in their stress journals and the weekly marbles/walnuts/chocolates ‘score’, it is in everybody’s interest to reduce the stress they place on colleagues in order to decrease how many ‘stress balls’ are in the mug (cup) at the end of the week.

Let me know how you get on with this exercise (and perhaps you can come up with a name for it).

Today we are proud to have reached 20,000 topics created on the GDPUK Forum since mid-2008. An incredible achievement from all involved. Thanks everyone for all the contributions to the forum pages over the years and the many interesting topics created. The site continues to foster a special atmosphere and relationship between dentists throughtout the UK. The forum exists because of the community, the many different contributors to the site (979 different ones last year) plus of course the thousands of dentists who read the site on a daily basis.

As you can see from the image above, there has also been 226,000 posts on the 20,000 topics created, which means on average there are just over 11 replies to each thread, which again demonstates how much everyone cares about dentistry in the UK and how it is natural for colleagues to want to help or guide each other. We hope all this help over the years has improved the level of dental care and professionalism and that the forum continues to be an incredibly useful resource for many years to come. 

Thanks to all the moderators of the site for keeping on eye on any controversial threads, thanks also to our webmaster Steve, who keeps all the forum software ticking along. A huge thanks, to the site owner Tony Jacobs whose vision and passion for dentistry in the UK, has kept the GDPUK community together and reaching amazing landmarks like today!

Bring on the next 20,000 topics :)

Rather than my usual look at what’s going on at the Schloss Moyes on Wimpole Street, I just thought I’d just ask a few questions this month, and leave the reader to think a bit about the possible answers.

I’ve become aware recently about the sheer scale of the money spent by the GDC on the whole PSA situation. The chances of getting answers from our arrogant and out of touch regulator are about the same as getting to watch the Titanic arriving in New York next week, carrying Lord Lucan, with Glenn Miller playing mood music in the bar whilst Elvis sings to Shergar on the top deck, but we can live in hope. Surely all that has now happened over the last few years with the GDC must start to bring some change.

1. How is it possible for the GDC to spend £735,000 of registrants money on the legal fallout of the Whistleblower affair and not have to answer to the profession or parliament for this?

2. Since this includes the GDC having to respond to ‘Letters of Claim’ involving members of the GDC, exactly how many of them are being sued and why are registrants picking up the bill for the actions of individuals?

3. Since the BDA know of this why have they not told the profession of the sheer scale of this use of registrants money?

4. Does this figure appear publically in the accounts of the GDC? If not, why not?

5. Why did the GDC spend £230,000 on the recruitment or ‘refreshing’ of the Investigating Committee in 2014 when it was likely the section 60 order would result in the recruitment of Case Examiners within a short period of time? Why couldn’t the existing members just carry on a bit longer and this money be saved?

6. As the Council members are aware of the inordinate amount of money being spent on what is basically incompetence and a lack of the correct procedures being followed or being in place, why has there been no public criticism by them of this?

7. Do all regulators spend a million pounds with such lack of transparency?

8. Given the ‘Objectionable Practice’ being run by the Investigating Committee Secretariat that lead to this whistleblowing, how many registrants have had the incorrect sanctions applied to them that shouldn’t have been?

9. How many of them have had their careers and personal lives affected by this?

10. Have these registrants been contacted and informed there may have been a breach in the natural justice they have a right to expect? If not why not?

11. Where is the duty of candour from the GDC to tell the truth about this situation involving registrants? Its not even mentioned in the latest Pravda press release or email from Moyes Towers.

12. Has anyone at the GDC been made aware we actually have a Human Rights Act in the UK and this applies to registrants since they are actually Human Beings?

13. Now Lord Hunt has been highly critical of the GDC in the Lords, and it has also been raised in the Commons during the recent Section 60 debate, why have there been no immediate resignations of the Council Members?

14. Does anyone think the Council Members have held the executive to account properly at any point in the last 3 years?

15. If not, why do we actually have a Council?

16. Should the present Chair and Council have anything to do at all with the recruitment of the new Chief Executive?

17. How much has Ms. Gilvarry’s departure cost registrants?

18. Why should her incompetent leadership be rewarded financially at the registrant’s expense with a termination package?

19. When are the BDA, DPL, DDU, FGDP, and all the other groups directly involved actually going to sit down together and PROPERLY talk to one another formally and lead the profession from the front?

20. Have the Executive, the Chair, and the Council actually been guilty of malfeasance in public office?

And your bonus question….

21. Should Bill pay for his own taxi when he leaves for the last time or should we let him have one last final trip on expenses?

Image credit - Colin Kinner under CC licence - not modified.    

1. Landing pages are the key to converting the leads that click on your facebook or banner ad. So whether you are asking for contact details in exchange for a white paper, offering a demo piece of dental equipment, a targeted landing page is going to help you convert those visitors.
2. Using one specific landing page for your campaign also gives you a clear idea if the marketing campaign is working or not. If you are still getting a high bounce rate on your targeted landing page, the page may need tweaking or reworking slightly. If traffic goes to your homepage, it is impossible to see why the leads aren’t taking the next step. The landing page can always be tweaked and then you can see if your results improve.
3. Having one page also lets you narrow your focus and remove the clutter you would expect on a homepage. The page should enable the visitor to find the information a lot quicker. This keeps the visitor focused on the product or service you want them to look at. 
4. Landing pages need to be seen as part of your sales team. Can the page sell your service or product to the level you would expect? You obviously wouldn’t expect your salesperson to convert every single lead they receive but you would expect a certain proportion. You need to look at your landing page in the same way. The page needs to be converting the clicks.

• As destinations for your banner ads.
• To create anticipation for a new product or service you are offering the dental community.
• To promote a special offer that you don’t normally offer. The landing page can expire after one week or a month, it is upto you. 
• To segment your audience. You may want a landing page that is aimed just at endodontists for example. 

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

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

That Letter

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

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

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

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

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

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

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

The PSA-GDC relationship

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

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

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

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

Complacency or Conspiracy? You choose.

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

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

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

The BDA

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

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

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

Not a mention, not a dicky bird.

Complacency or Conspiracy? You choose.

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

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

The GDPC - CDO[NHSE] Relationship

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

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

Transparency is dead.  

Complacency is the food of conspiracy