Sunday, 31 March 2013


Shock and Awe…..
 
 

Who would have thought it, the General Dental Council (GDC) employing Shock and Awe tactics over the issue that is Direct Access (DA); okay, some people that may chance across this blog may wonder what I am talking about if they are not in the UK dental profession. On the 28th March 2013 the GDC voted for dental hygienists and therapists to have direct access to patients without the need for a prescription for a dentist to examine the patient first. Whilst on the face of it this for many was a done deal, it still surprised me in its format.

Predictions....

I predicted that DA would happen in late 2012 at a presentation I gave in 2005 to the SW&Swales BDHA group; so I was off by a few months but a good prediction given how little thought there was about this subject back then. It was based on numerous things I had read from the GDC (in the public domain) that hinted at the discussions that had gone on. I have a letter from Mike Penning MP that categorically states that dental hygienists would get DA if a conservative government was elected; of you want to read it, it is somewhere in the hygienist.co.uk archives.

Remember that around 2004/2005 the GDC was consulting on the current Scope of Practice at this time and the response document actually asked if dental hygienists should be allowed direct access to patients and despite an emphatic YES it was never considered… then we drift back a little further to the Office of Fair Trading report into the super complaint against dentistry…. Oh, and there was discussion in 1999 (if you trawl back far enough in GDC records, it’s there) about dental hygienists being allowed to see hygienists without seeing a dentist (it was not called direct access then)… and then if you go all the way back to the Nuffield Report then…. I will let you find that out for yourselves…
 
 

Not one to sign up to conspiracy theories, but this all makes you think; I once heard a rumour out of the GDC that the then Health Secretary Andy Burnham MP was in a meeting with the President of the GDC and asked the question “how do we give dental hygienists access to patients without the intervention of a dentist?” and I am informed that the answer was “we change the wording of Scope of Practice”… Now, there is the possibility I have this slightly wrong and it was the Shadow Health Minister Andrew Lansley MP…. But you get the feeling yes?

Back to the conspiracy theory; I honestly believe that this was always going to happen and was predetermined some years ago possibly as long ago as the mid 90’s and before the schools started offering Dental Therapy again. When New Cross closed all those years ago it did seem like that was the end of therapy but the phoenix rose slowly and schools introduced the therapy training right through to the evolution that is the BSc honours course in Edinburgh. Why would it be re-introduced? Why would schools offer a free course in something that appeared to have no future unless there was internal pressure for change that had come from Permanent Under-Secretaries in the Health Ministry? Way back, you had better believe it.

If you do not believe me, wait until the full details of the consultation are published; oh, just to make it clear, the GDC had no requirement to consult over this issue as the Law now allows them to make their own rules. Consultation is done as an exercise in showing openness as far as I am concerned; it is irrelevant what was submitted by individuals or representative groups because they do not have to listen, just pretend they are listening.
 
 

Okay, so what will be will be, but I am now worried for those hygienists and therapists out there that cannot find work because the Corporates are sat in the background waiting to pounce on them and put them to work. I am pleased that they will be able to find work but I wonder at what cost? I have read all the discussions about safety and the protectionist arguments that suggest we are incapable of looking in mouths and noticing that something is out of the ordinary and some of these arguments are really well founded; I do think that we will see an increase in litigation against my therapist colleagues. Not for any other reason that they will be working in high pressure environments to work at increasingly fast rates to appease the shareholders need for a dividend and all at the cost of the patient. I will burn my current bridges here with the corporates as I do feel that at the moment they are all that is wrong with the NHS. They are busy trying to take as much money as possible out of the system to satisfy their own greed and the need to show profit to those that fund them and whilst I have no real issue with this on the whole, it does leave a bitter taste in the mouth when it comes to healthcare.

 Will therapists be pushed to the point of no return as they are expected to work at increasing rates? Funny really because I know of two dually qualified hygienist and therapists that are doing BDS and one is wondering why bother when he can have DA? Simple, because despite the doomsday prophecies that are being banded around, we will always need dentists and to my two friends, go on and become the fabulous dentists you will be because you are truly vocational…

 Shock and Awe? It was like a nuclear holocaust and let us wait for the fallout now as the GDC executive function work to create a new set of rules to allow this (DA) to happen….
 
All postings here are my own personal thoughts and in no way reflect any opinions of organisations I may be affiliated with

Saturday, 23 March 2013


Memoirs of a mover (and shaker, so I’m told)

 

I am quite outspoken; you may have noticed. I accept this and know it is true, but I do have a high set of ethics that when mixed with my ability to place my size 9 feet in it, can get me into situations that whilst I do not regret what I say/do it may have consequences. I did this last year and lost a job; I was working 6 day a week and then lost a job and ever since have only worked 3 days. Those more numerically skilled amongst you will notice that this is a 50% reduction in income; a bit of a shocker I promise.

 

The world of dentistry is flat; I mean this in an economic way. There is no growth in general dental practice and jobs in dental hygiene are few and far between. It is not so much that people are losing jobs (although you hear stories) more that most of us are staying put and the dynamics that were present 5 or 6 years ago are not there. Remember those days when you could leave a job on Monday and be in a new one by Friday? Not anymore.

 

Let me make this clear, this is not a sob story and is more a story of opportunity and change. My predicament has presented me with opportunity that I never dreamed about, Despite outward appearance I am not that good at self-promotion and have no entrepreneurial skills and whilst I have lots of good ideas I never develop them so I have not perhaps been as pro-active as some think I should but hey, I am happy.

 

I have, as I get older, realised that I am not as motivated by money as I once though I was; I currently have none. I moved the last few hundred pound I had in savings into my bank account a few days ago so the house is now on the market and has to go before the repossession order arrives; priced to sell, if interested give me a buzz…

 

Okay, perhaps a bit pessimistic but facts are facts; there is work out there but it is predominately in the south and it appears that the rich are getting richer. I cannot afford to move “down south” and I have a huge network of friends and colleagues and I am truly grateful for their support and whenever work comes up they immediately contact me; brilliant, but every alternate Tuesday in Bracknell is no good to me. I have scoured the job sites, journals and other sources looking for suitable work but all in vain, that was until January 2013….

 

In the British Dental Journal “community appointments” I espied an advert for an employed position in the Shetland Islands; that’s correct, you read it correctly and yes, it is in the most northerly outpost of the United Kingdom and it really appeals to me. I have, over the years spent time in remote places and enjoyed it immensely; I lived for 6 months in Port Stanley in the Falkland Islands and count this time as amongst the best experiences of my life…. I digress as I reminisce

 

Anyhow; nothing ventured, nothing gained so I applied for the position. Imagine my surprise (and delight) when I was offered an interview and perhaps fate was smiling on me as I had the week crossed off yet had no firm plans. Frantic planning was required as getting to the Islands requires a little bit of co-ordination but needless to say, I booked flights, taxis and accommodation and confirmed my attendance at interview.

 

I went on my merry way and as the very small aircraft started its descent into Sumburgh airport I was mesmerised, the islands looked just how I imagined them and I knew it was for me, forever. I attended my interview but I will not bore you with details but it was a pleasant experience and I had some time to explore Lerwick and its surrounds which I happily did. I was disappointed that my pre-conceived ideas  were shattered as there were not endless bearded crofters in Arran jumpers carrying crooks, quite the opposite as Lerwick is a thriving and busy modern small town.

NHS Shetland is unusual in many respects but more so that most of the dental provision in the Islands is provided by salaried practitioners yet the practices take fees from patients; let me make this clear for those in England and Wales that may not understand this. It is NOT a community job, but it is salaried services. Shetland has a population of 22500+ a figure that is slowly increasing as more choose to select a more peaceful life. I want to be part of this close community that supports itself from within rather than looking outwardly all the time.

 

This is a concept that I really feel our profession could benefit from and perhaps looking inwardly and seeking knowledge that is inherent within is something we should be doing but that is another 3 or 4000 word essay…

 

Well, back to Blighty I arrive and get on with things and I, like most people think nothing of the interview yet wonder if there will be a job offer at some point. A few days goes by then BHAM… out of the blue a phone call offering me the job. Oh me, oh my; what to do? I have the Dentistry Show hygienists and therapist’s symposium to chair and so much to do. Like the White Rabbit from Alice in Wonderland I am somewhat flustered by this and ask if I can consider for a few days? “of course” comes the reply, so much to think about eeek.

 

Okay, pros and cons list made and worked on and I fail to see any drawback; really I am struggling. Reasonable pay, pension, great stable working hours, clinical freedom great well equipped surgeries. That said, the Islands have the most expensive petrol in the UK which is a bit ironic given that much of the North Sea crude oil passes through terminals here but such is life. The cost of living compares well with mainland UK otherwise and there is, in Lerwick 2 curry houses, 2 Chinese restaurants, a large Tesco superstore and a large Co-Op supermarket as well as great restaurants, bars, coffee houses so here we come.

 

I have accepted the job and now the chess pieces are falling into places; the formal offer has arrived, the forms are filled in, HIV test booked (got to be clean), already got a goatee so the full face beard not difficult. As I continue with my preparations I will write again. As Del Boy often said “He who dares…”