The departure lounge

I consider myself fortunate that throughout my career I have found myself sitting at the junction of several professional thoroughfares, rather like someone who is seated slap bang in the middle of a busy airport and who watches and listens as the world passes by.

Tearful partings, joyful arrivals, anger and frustration at delays, exasperation and expectation, stress and boredom. A front-row seat for a variety show of human existence.

Through my ‘day job’ at Dental Protection, to all the conversations at the many meetings and conferences, my scribblings in these columns and all the letters, emails and phone calls that have nothing to do with any of the above, I enjoy a similarly varied perspective, talking with people at all stages in their professional careers, when they are up or down. I would like to share a few recent examples that have prompted me to wonder whether they tell a story that we would be foolish to ignore.

One came from a dentist who was just approaching his 60th birthday. He worked four days a week in a small, single-handed mixed NHS and private practice, and was thinking of cutting down to three days with effect from April. His recent encounters with his local PCT have persuaded him that it is really not viable to maintain his NHS commitment at all, and he is resigning his NHS contract instead.


The ‘shopping list’ of building modifications he was being required to make, and the equipment he was told he needed to purchase, would consume two years of his practice profits just when he wanted to maximise them in readiness for a practice sale and retirement. When he asked why all this expenditure was suddenly so urgent when the same PCT had inspected the same premises twice in the past ten years, and once only three years ago, he was told that ‘new legal requirements’ had been introduced and the PCT was now ‘tightening up’ its approach to their implementation.

This practitioner had an extremely attractive (i.e. high) historic UDA value which he could retain if he agreed to carry out the specified work within an agreed time period. If he didn’t, his contract would be renewed provisionally at a much lower UDA value.

A few local enquiries revealed that no such requirements had been made of two large, mostly NHS group practices within the same PCT area (with a much lower average UDA value), but one other local single-handed practice had also been given a similar (indeed, even longer) shopping list and was considering his options. Almost certainly he would be converting his practice wholly to the private sector.

One could be forgiven for wondering whether the PCT’s plan was to put the squeeze on the two single-handed, high-UDA practices. If they closed down or went private it released funds that could then be used to commission more dentistry from the local group practices that were willing to accept lower UDA values. Is this really what local commissioning was meant to be about, or is it another example of an ‘unintended consequence’? If it ends up giving the PCT two fewer
practices to contract with, and gets more patients seen and more dentistry done for the same money, then ‘unintended’ may not be quite the word we are looking for.

Evidence base
I was amused by a recent letter from another dentist who had been told that he needed to acquire a washer disinfector. He was reminded of the ‘evidence base’, and the threat
represented by prions. Being inquisitive, he asked what this evidence was, and was told that prions could not be removed or destroyed by conventional disinfection and sterilisation techniques, because they were proteins not organisms. Prions, he was told by the infection control nurse sent in by the PCT, were impossible to remove from instruments and whatever you did to them the prions would still be there, clinging ferociously to the surface of the instrument and any scratches, grooves or imperfections upon it.

What an extraordinary quirk of nature it was then, observed the dentist, that the iron grip of these prions became immediately loosened as soon as the instrument passed the patient’s lips and entered the mouth. The infection control nurse was asked what the evidence base had to say about that.

Not a lot, I gather. But she apparently exited the practice quicker than an NHS check-up, before she was undone by any more awkward questions. The dentist in question tells me that he had never expected the evidence base to come in so handy, and he now plans to learn more so that he can use it again.

Hardly SweeneyTodd
Registration of DCPs is, as predicted, throwing up its share of anomalies. Not least amongst them is the need for newly registered DCPs to declare any past convictions or other misdemeanours, including those committed in the years before they became involved in the dental profession. Ensuring that the steps up to the playing field are level would make more sense if the playing field itself was level when they got there. But it palpably is not. The pain of dragging up issues of questionable relevance that are buried, in some cases 20 or 30 years in the past, seems to me to be disproportionate in the context of what is meant to be achieved by it all.

Where is the public interest in making public today the fact that, for example, someone who had one too many in a pub 25 years ago and did something daft, is now working as a dental nurse? We are not poised on the brink of another Harold Shipman slipping through a regulator’s hands here, and let’s face it, this is hardly Sweeney Todd territory. But I guess that if some ribbon wax or alcohol-based hand rubs ever go missing, the forces of the law will know where to look first. Quite embarrassing really.

Who would have access to this information, for how long, and what protections would be in place to prevent the inappropriate sharing of the information once gathered? These days, NHS and other public bodies are in more trouble if they don’t share this kind of information.
On a more practical note, I wonder how many people we will deter from pursuing a career as a dental nurse or technician if we pursue the present course?

Parlez-vous anglais?
You just couldn’t make up some of the stuff that is going on. If those responsible for some of this nonsense had enough neurones to make a synapse, it would never get past the starting gate, but the default setting so often appears to be ‘lunacy’ and ‘excess’. As a result of a government initiative, there was a huge influx of immigrants from a certain part of new-Europe into a certain part of the UK. Many of these new arrivals had little or no English at their disposal but when dental problems arose they were soon in the surgeries of the local dentists.

A subsequent complaint arising from a breakdown in communication was an accident waiting to happen,  but when it did the dentist was surprised to be told that it was the dentist’s responsibility to learn the language in question or to enlist the services of an interpreter, not the reverse. Next time the dentist was faced with a patient with whom she could not communicate, she suggested that the patient should seek treatment elsewhere, perhaps from a PCT access centre close by. To her astonishment, the dentist was then told by her PCT that if she refused to treat the patient in such a discriminatory fashion, she was acting in breach of her NHS contract. It’s a pity she was speechless. Her answer, of course, should have been: ‘Contract? Quelle  contract? Je ne comprends pas. En Francais s’il vous plait’. That should do the trick. For a while, anyway.

Au revoir
The point of all this is that, nail by nail, I fear that we are driving dentists and other members of the dental team into the departure lounge. Some have already sought refuge in the private sector but this will be a short-lived respite because private practice is bracing itself for a big shake-up of its own. In Wales, the statutory registration of private practices has already happened and there is only the relief of a limited transitional period before full scale implementation.

I earnestly hope that a degree of sanity, and a return to some kind of proportionality can be achieved before we squeeze the life out of UK dentistry, and indeed, the whole of UK healthcare. Many people are enduring the current excesses not because they feel they are all
justified (quite the reverse I believe), but because they still feel that the upside of a career in dentistry is still sufficient to make it all a price worth paying. I wonder how many new entrants to dental schools really know what they are letting themselves in for?

Long may it continue. But it won’t unless we all keep nudging back the lunatic fringe whenever we see them approaching.

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