Kevin Lewis: the successes and failures of 2024

Tempus fugit: Kevin Lewis offers his seasonal retrospective on the year’s successes and failures, arrivals and departures, events and non-events.

Any reader who is sad enough to have read (let alone remembered) my column here a month ago, may remember that it started and ended with the phrase ‘sod it’.

You could be forgiven, then, for wondering if the title of this column (especially the second half ) may be heading in a similar direction – but fear not. It’s just that as a regular career-long scribbler on dental matters – this being my 43rd consecutive Christmas column if my sums are right – these yuletide columns do seem to come around with remarkable regularity and there is a limit to how often you can jingle all the way or ding dong merrily – on high or at ground level.

But we can probably all agree that time flies, or fugit irreparabile tempus as my old mate Virgil used to say when we were both young lads.

You may have noticed that we had a general election halfway through 2024. Any change of government provides the politicians with precious time and let-out options. The outgoing administration can point to all the promises that they were about to keep, key decisions that they were about to announce, or game-changing initiatives that they were on the point of launching.

This gets trickier, the longer you have been in power of course… but it’s always worth a try. And the incoming administration usually enjoys a honeymoon period during which they consult widely, listen intently, meet and photo-op with lots of stakeholders, plan great and wonderful things, and announce lots of initiatives which sound like action right up to the moment when you scratch the surface and realise that nothing much is actually happening at all.

Tempus certainly does fugit and while it is true that we never get the time back, once the sand has passed through the hour-glass, the enduring charm of dentistry is that we do get the policies back. Again and again. Indeed, we seem destined to be trapped in a revolving door of policies that keep coming back without ever touching the sides of the real, underlying problems.

In a year that featured an underwhelming Dental Recovery Plan (uDRP) from the Conservatives, then a party political broadcast from Lord Darzi on behalf of Wes Streeting and the Labour government, the big picture got bigger and more distant. What a pity that dentistry was pretty much airbrushed out of it, and out of His Darziship’s diagnosis and blueprint too, although it is quite sweet how some observers have since attempted an imaginative ‘read-across’ to dentistry.

Both reports headlined a greater emphasis on prevention, and reincarnated other well-worn paths as if nobody had thought of any of them before. Lord Darzi spoke of moving from analogue to digital, while uDRP had spoken of moving from static to mobile, in the shape of the caravans being driven to car parks in dental deserts and under-served coastal communities.

The zenith of déjà vu came with the plan for supervised toothbrushing sessions for four- to six-year-olds. To pass the time while they are sitting in the local A&E department waiting for their toothache and abscesses to be treated, presumably?

Metrics

As if that wasn’t exciting enough, Wes Streeting has since announced the groundbreaking idea of NHS league tables to introduce some internal competition, aspiration and naming/shaming of poor performers.

The profound disquiet regarding over-simplistic OFSTED ratings for the performance of schools, and the similar failings and distortions caused by the NHS’s discredited use of targets and unadjusted league tables for the past two decades suddenly seem to count for nothing.

But this time many of the same (or similar) performance measures will be re-named performance metrics – which will make all the difference, we are told.

There is nothing remotely analogue about metrics as I’m sure you will agree. Digital and the use of metrics is so tomorrow and/or on trend, and analogue is so yesterday so the wordsmiths and spin doctors seem to have been working even harder than the real doctors.

But the threatened zero tolerance of poorly performing NHS managers with the promise that in future they will be ‘performance managed out’ and no longer be quietly recycled to another lucrative NHS position elsewhere, is genuinely a groundbreaking prospect. If it ever really happens, that is. And assuming they don’t get re-appointed as a lay member of the GDC or another healthcare regulator instead.

I wouldn’t hold your breath on that one. I do hope there will be some extra presents under the tree for those little boys and girls who have been especially good this year (and many previous years too, for that matter).

Stephen Hancocks, long-time editor-in chief of the British Dental Journal (BDJ) deserves special mention here as he hands over the BDJ mantle – as does Trevor Burke as he in turn steps back from a long and glorious shift editing Dental Update. Dental publishing with be the poorer for their departure.

Roshni Karia has deservedly become the president of the College of General Dentistry, just 14 action-packed years after graduating – the first female president in the 32-year history of CGDent and its predecessor organisation FGDP.

Musical chairs

Keeping up with all the restructuring, rebranding and changes in personnel at the GDC is becoming a full-time job, with more churn than United Dairies (as the saying goes). The GDC’s senior management has had yet another ‘refresh’; in March of this year Clare Paget joined the GDC’s executive team, and in June Tom Whiting replaced Ian Brack as CEO and registrar.

Theresa Thorp is now almost an old stager, being a whole 15 months into her role at the head of the merged fitness to practise (FtP) and registration directorates, the former being a longstanding poisoned chalice that seems incapable of improving its performance despite many attempts and new initiatives.

Some of those initiatives are welcome and have been effective to a limited degree. But the shameful truth is that this Christmas there are cases (and registrants) still marooned somewhere deep in the FtP processes that had already been delayed there for too long when Theresa Thorp joined the GDC in September 2023.

It has taken some tragic cases of registrant deaths, by suicide and/or with indirect causation, to carry this slowly towards the top of the GDC’s agenda, and even that has only been achieved under huge pressure after much push back.

The scale of the GDC’s impact on the mental health and wellbeing of those directly and indirectly affected has been ignored for too long and while the GDC should not be blamed for all the other contributory factors that are in play, it cannot be right that so many registrants (especially younger ones) are fearful of their regulator and have little or no trust or confidence in it.

On this and several other matters, the chorus of disapproval has become perceptibly louder from many quarters. We are perhaps not yet at the kind of crisis point reached in 2014/2015 when votes of no confidence were ringing out from all corners of the profession and finally stirred both Houses of Parliament to wake up to the profession’s plight – but we are not far away I fear.

Meanwhile, the confirmation of Jason Wong as England’s new chief dental officer in April was roundly welcomed – someone who understands and has a passion for general dental practice, and the realities of dental practice ownership and with long links with FGDP(UK) and latterly the College of General Dentistry.

I think we can all relate to his frustration in trying to get the needs of dentistry, and especially primary care NHS dentistry heard above the deafening noise of what needs to be done to fix the rest of health and social care. But the mood music is that dentistry’s 18-year-old problems will take some further time to talk about, think about, consult upon and road-test – let alone fix.

Message to Santa

It has been a tough call to decide what to include on my Christmas List to Santa this year and what to place at the top, but like the Spice Girls I’ll tell him what we want (what we really, really want). The profession itself feels that our profession has collectively lost its way, and also its identity (and respect) within the panoply of healthcare. We must collectively take our own share of the blame for this.

The protracted inaction over reforms to the dental NHS contract has rendered NHS dentistry unattractive to more than a generation of dentists and it is to the BDA’s credit that the profession itself has quite rightly not been blamed for that.

Another year has passed with no change to the GDC’s Nelsonian ‘I see no ships’ approach to what is happening on social media, to postgraduate education, professional development and unfettered scope of practice excursions into the unknown, to the emergence of misleading ‘virtual’ qualifications and accolades, to the current wild west in relation to advertising dental services and the obscene prevalence of professional sabotage and ‘blue on blue’ under the pretence of responsible whistleblowing in the public interest.

It gives me no pleasure to say that there is no other dental regulator in the world that has presided to this extent over the demise of the profession it is supposedly regulating, and yet there is a prevailing air of denial, self-satisfaction, smugness and ‘we know best’ that suggests that the GDC does not even accept that there is a problem, even though they have played a central part in having created it.

They have been distracted and preoccupied with issues to which they attach greater importance. So if Santa could kindly hold up a mirror to the GDC and encourage it to show even a fraction of the reflection and insight it demands from registrants, then the lights might just burn a little brighter on next year’s Christmas tree.

But Christmas should be a time of excitement, anticipation, magic and hope, so let us not forget the 2.5 million extra dental appointments promised by uDRP, and then the Angel Wes’s pronoucement from on high that as a matter of urgency 700,000 extra dental appointments per year will be magically delivered by the elves and pixies making themselves available in the evenings and at weekends.

So look out for pigs flying through the night sky alongside Santa’s sleigh, Rudolph et al. Have a good break and prepare for a truly transformative 2025… and if you believe that, you probably believe in Father Christmas too, so please give him my regards when he drops by.

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