Gone, but not forgotten

I have to be honest with you, I won’t be sorry to see the back of 2009. It started off nicely enough – for me at least – but, by the time it’s done and dusted, it will have left us with many unanswered questions about the future direction of British dentistry.
Almost unnoticed, we are ripping through its fabric with the unthinking ferocity of a chainsaw operator in a South American rainforest – so it will be a difficult year to forget. But well worth the effort.
To drown out the sound of the advancing chainsaws, you may care to join me by the fireside for a seasonal rendition of that old favourite The Twelve Days of Christmas. Usual tune. To save time and valuable column inches (rest assured that they will be recycled), I will cut to the final verse.

‘On the twelfth day of Christmas, my true love sent to me..
Twelve consultations
Eleven UK graduates
Ten paedodontists
Nine veneereologists
Eight performers’ lists
Seven outreach programmes
Six audit cycles
Five gold crowns
Four wisdom teeth
Three UDAs
Two sinus lifts
And some verifiable CPD.’
Let me explain…

‘Twelve consultations’
These are the consultations that some body or another announces most weeks of the year. It is relentless. If we continue down our present path, more of the UK
profession will be responding to consultations at any moment in time than the total dental
workforce of some countries in the world. As you will know, if you have ever tried it for yourself, the normal result of responding is a deafening silence, and nobody seems to take a blind bit of notice of what anyone says or thinks. Even a simple acknowledgement of your response is often a bonus. But the consultation process has to be done and/or must be seen to be done, even when the decisions in question have already been pretty much taken. Very often, the purpose of
the consultation seems to be to glean some soundbites to quote in support of this already-
determined policy direction. We saw several examples this year.

‘Eleven UK graduates’
The ones who will be successful in securing a vocational training place for themselves within a three-hour flight of their preferred location. The huge expansion in the influx of non-UK graduates seeking training places, on top of the upcoming ‘bulge’ in the number of dentists graduating from UK schools, and with Foundation Years (F1, F2) training unfolding, is all stretching resources to the limit.

‘Ten paedodontists’
These will be the ones left to treat the UK child population once the criminal records checks, the Child Protection Register checks, the good character references, the fit and proper person checks and various other screening exercises are complete.

‘Nine veneereologists’

These are the ones still doing smile makeovers when we finally run out of endodontists to do all the subsequent RCTs. But I do like the idea of installing traps in the suction system, so that all the enamel and dentine dust can be recycled and put to good use. The current widening of the northern loop of the M25 owes a great debt of appreciation to the dental profession, without whom it might never have been possible.

‘Eight performers’ lists’
Represent how many attempts you might soon need to make in order to find a PCT that has the funds to contract with you.

‘Seven outreach programmes’

These are a new spin on a sound approach with proven benefits. Seven UK dental schools will soon be hosting open days so that students get to see the inside of the dental schools that they are training at. That’s if they can find it, of course.

‘Six audit cycles’
These will soon be the minimum requirement before any UK dentist can actually commence a second course of treatment for the same patient. The scheme has the full and enthusiastic support of the Department of Health – can’t imagine why. Some people still believe that audit cycles are the things that clowns and other performers use in circus tents. NHS performers do use them, it is true, but not in tents because the Care Quality Commission considers tents to be an unacceptable environment in which to deliver healthcare. And another key difference is that nobody is laughing.

‘Five gold crowns’

Something of a mystery these. Clearly they can’t be NHS crowns – at least, not all on the same patient in a single course of treatment – but there is a rumour that these five crowns are all that’s left of every 100 gold crowns that UK labs used to be asked to make. And four of them were ordered by mistake because of poor hand-writing on the lab ticket. 

‘Four wisdom teeth’
These are the ones that many young adults in England and Wales still have. The jury is still out on whether this is due to the NICE guidelines, or the disappearance of fee-per-item.

‘Three UDAs’
…or about £60 in old money – and is the entirely ‘reasonable’ recompense for a highly trained professional person to receive for several hours of work on multiple root canal treatments, numerous fillings, extensive periodontal treatment, minor oral surgery etc.
In some cases, it will come perilously close to the minimum wage, especially given that it has to pay for the time of several people.

‘Two sinus lifts’
The one on the right, and one on the left are the ones that will be needed when there is no bone left anywhere in the maxilla or mandible where an implant fixture has not already been placed.
Rather like the ‘double decker’ approach being adopted in overcrowded graveyards, this novel approach is currently being trialled by implant manufacturers as the latest stage in the continuum of new places where implants can and should be placed. It is believed that interlocking fixtures (allowing two fixtures to be placed simultaneously into the same hole) are the logical next step.

‘And some verifiable CPD’
I understand that paper CPD certificates will soon be deemed unacceptable. Instead, DNA samples, fingerprinting, retinal imaging and other forms of biometrics will be the minimum requirement to prove that it really was you that attended a course, coupled with EEG print-outs to prove that you stayed awake.
‘Where will it all end?’ I hear you ask. Relax. There will still be no requirement to demonstrate that it made any difference at all to your subsequent performance. 
So, that’s alright then.

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