Kevin Lewis: dentistry's challenges in 2025

How will we measure the successes and failures of the new year? Kevin Lewis suggests some answers and points to some challenges.

Albert Einstein knew a thing or two, but if every quote attributed to him was correct and accurate, he wouldn’t have had any time left for physics.

But who cares? A good quote is a good quote in any language and irrespective of its provenance. Einstein may or may not ever have uttered the immortal words: ‘Many of the things you can count, don’t count. Many of the things you can’t count, really count,’ but I wholeheartedly agree with the sentiment even if the attribution is popular myth.

Some people view the new year as a wiping clean of one year’s slate, and the unveiling of a new one. Others prefer to dial down the drama and significance, and treat it as just another day and another month in the continuum of life. Many don’t care one way or the other, just as long as they are in convivial company at the stroke of midnight on New Year’s Eve. Or Hogmanay, if you prefer?

For the rest, it is enough that they wake up the following morning with all their faculties intact. But your view as to the transition from any one year to the next is likely to be coloured by your experience of the old year, and your hopes and fears for the new one.

Life without targets

By the time you read this column, we will be at least 10% of the way through the term of office of the present government and you could be forgiven for wondering what has changed.

In fairness, Keir Starmer has already brought a whole new meaning and flexibility to new year resolutions, with new and modified pledges rolled out before the ink is dry on the previous ones, but never with any hard measures attached to them.

The home secretary is playing an even cannier game, learning from the painful experiences of a long line of her Conservative predecessors, in that her only resolution on illegal immigration and net migration is a firm resolution to do better, with no targets being set – which ensures that no targets can be missed. It is clear that she plans to turn things around, but less clear as to whether this includes turning any small inflatables around.

As if NHS dental practices didn’t have enough to deal with, all dental practices will have been hit financially by the chancellor’s autumn mini-budget and it is a matter of record that some practices – like so many other businesses – will have closed their doors and others have laid off staff.

Eyebrows were raised by Wes Streeting’s categorical assurance, when speaking on the BBC’s Question Time panel in early December, that no patient receiving NHS treatment on his watch will ever need to worry about the cost, because the NHS will remain free at the point of delivery, with no exceptions. When will politicians learn the lesson that this is not true of dentistry and hasn’t been so for many, many decades – in fact since more than 30 years before Wes was even born?

These ill-considered, headline-grabbing statements simply serve to emphasise that in the eyes of politicians, dentistry somehow doesn’t count because it is invisible and irrelevant on the extreme outer fringes of the NHS radar. It is a valued part of the NHS during election campaigns, but not otherwise.

It was ironic that Wes Streeting was provoked into making this defensive mis-statement by a suggestion from a fellow panel member that his unspoken plan was to privatise as much as possible of the NHS by stealth – which is precisely what is happening for as long as dental contract reform is talked about, and loosely promised, but still not delivered.

I actually welcome Wes Streeting’s stated appetite for using available capacity in the private sector, at a cost, to eat into the growing NHS backlogs and expedite treatment for patients on long waiting lists – an approach which places him ideologically at odds with certain other cabinet members and (to an extent) with the prime minister. But I see and hear no evidence that he is planning to use this approach in dentistry any time soon and continuing the NHS ‘new patient premium’ is not the same thing at all.

Meaningful change

In this and other respects, we arrive into 2025 with a growing impatience for genuine evidence of any meaningful change or improvement, or of genuine action rather than fine words.

And to fill this vacuum, desperate measures appear to have been signed off at a high level; one cabinet minister whose constituency is not a million miles from where I live made the mistake of pointing to the opening of a new non-urgent planned care centre in her city as a shining example of the speed at which the new government has rolled up its sleeves to deliver on its pre-election promises.

It aims to deliver 100,000 extra appointments per year, a number which sounds vague but impressive in equal measure – until it was pointed out that all the work to design and create this timely new facility took place under the previous government, starting two-three years ago, while many clinicians and support staff have been moved across from other local units in order to get it open and reported upon before the end of 2024.

I think we need to brace ourselves for a lot more ‘delivery’ numbers to be thrown at us, but I hope that they do not prove to be a smokescreen to obfuscate the slowness of other critically necessary changes beneath. We are told to expect another big plan in the summer, and asked to keep ourselves occupied having ‘the big conversation’ until then.

I am not sure that Wes would approve of some of the big conversations I am hearing amongst impatient patients who would prefer more results, solutions and treatment, and fewer reports and think tanks.

Stakeholders

In my December column I expressed my deep concerns about the GDC’s performance across a range of issues. This will be Tom Whiting’s first full year as chief executive and registrar and there are some positive early signs, but is it fair to judge him and his management team (and the effectiveness of the council itself) after having given them an opportunity to acknowledge and rectify what is still so obviously amiss?

Lord Toby Harris will be stepping down as (lay) chair during 2025, after a single term in office, which adds to the relentless and destabilising churn of recent years. As highlighted in his own most recent blog, he has during his tenure placed great emphasis on stakeholder engagement and understanding perceptions, and he stresses that this is not done for the purpose of burnishing the GDC’s own external reputation.

Putting aside the fact that activity of this kind does precisely that by helping the GDC to meet one of the required standards set by the Professional Standards Authority (Standard 5), engaging with and listening to a wide range of stakeholders (wholly funded by just one set of stakeholders, ie registrants) is not quite the same thing as hearing, understanding and acting upon what the stakeholders have told them.

Criticism

Unfortunately, since writing my December column, there has been yet another withering criticism of the GDC’s ‘lamentable ignorance’ (sic) of the law in the conduct of its fitness to practise (FtP) investigations – this time, from the High Court, and this time, as it relates to the confidential nature of documents within Family Court/Court of Protection proceedings. This is hardly the first time that the golden question of how and why this was allowed to happen, has remained unanswered.

Stephen Henderson wrote a characteristically superb blog on the topic from his GDPUK platform about a month ago, and all I could usefully add to that tour de force is to ask why the GDC never feels the need to fess up publicly and apologise – not only to the parties and registrant(s) most directly affected, but to all the registrants whose ARF fees are being squandered as a result of the GDC’s incompetence.

They can blame ill-fortune, junior staff, managers, the solicitors and barristers that they pay significant sums to, their appointed legal advisers and (in some cases) the individuals that they choose to use as expert witnesses. The courts at various levels have certainly delivered some excoriating criticism of these experts recently in both GDC FtP and civil claim proceedings. But sure as hell, one or more people have not done their job and/or have come up short. Yet again.

These are moments for someone at senior level to look registrants in the eye, demonstrate insight and admit fault and not least to apologise – not a reason to draw the over-used and heavy GDC curtains over the whole sorry issue and return to business as usual. If registrants acted in this way they would be struck off without a backward glance.

Mutual respect

The GDC is very eager to share details of any alleged or actual, proven or unproven failings of registrants with the media – in the public interest, and the interests of transparency of course – but curiously much less eager to share the many examples where the GDC itself has screwed up, whether allegedly or spectacularly.

I think we could all be forgiven for having lost count of how many FtP cases in recent years have been mismanaged by the GDC in one way or another, and there’s no point looking on the GDC’s website for a running total of how many cases, or how much money (your money) has been involved. Even in the GDC’s Annual Report and Accounts you would be hard pressed to get even close to the true cost of FtP – and within that, the cost of the GDC’s errors – because the associated internal and external costs are buried in so many places. One would like to believe that someone, somewhere in the GDC is keeping count and knows the answer, or is at least asking that question.

One would also like to believe that the chair and other 11 council members are asking that question too, and kicking up a fuss if they don’t get clear and satisfactory answers. Our worst fear, I think, is that nobody feels the need to count, nor ask too many awkward questions because the inexhaustibly deep well of ARF revenue remains a gift that keeps on giving.

But what would really make a difference – what would really count – is for all of us to commit ourselves in 2025 to being better in a way that matters; being fairer and kinder, showing more mutual respect, tolerance and understanding, concern and compassion, focusing on our common purpose of caring for patients and leaving them better off than when we started. It would also help if those surrounding the profession could understand that the profession is not the enemy.

Something that Einstein really did say was that: ‘Blind belief in authority is the greatest enemy of truth.’ Smart guy, was Albert.

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