Hi Everyone,
Hope you are all well and managing to keep going under the tremendous pressure of Dentistry in this present climate.
Firstly, I would like to welcome you to the new format of the Blog. We are now expanding our contributors to include other members of the LASC LDC Executive Team - so may I take this opportunity to introduce some of our Team Members:
We have three members of the BDA General Dental Practice Committee (GDPC)
John Edwards - also Chair LASC LDC Exec and Chair Coastal LDC
Andy Harvey - also Chair East Lancs LDC
David Tsang - also Secretary Central Lancs LDC
We will be getting regular updates from these three on what is happening at the centre. In addition our Political Lead is Noel Bowen, who has a good grasp of the Political Scene and will give us regular political updates. And besides our Exec Member features we will also be getting regular insights from David Bradley our Dental Practice Advisor with a range of topics being placed in "Dental Advisor's Spotlight".
As always the Blog will be put together expertly by Zoë from the LASC LDC Executive Comms Team.
So let us now set the scene for the Autumn season with our first Blog outing...
Just as the leaves fall from the trees, the flowers wither and animals hibernate for the winter, in dentistry we have our own version of Autumn. Practice profit margins fall, hard working dentists start to wither under the pressure and all those people at the centre bury their heads in the sand. What the heck is going on with those who hold the future of NHS Dentistry in their hands? There is a total lack of respect and support for those practitioners who toiled through the dark days of Covid, stood up to the pressure and delivered as necessary. The BDA have worked extremely hard to get what is a simple message across, but still it seems to just fall on deaf ears - (possibly this is related to the aforementioned issue of having their heads in the sand!)
The really irritating thing is that this sort of situation and behaviour at the Centre is not new - it has happened a number of times over my working career and those who are a similar vintage to me will remember. Therefore why these people do not learn from their mistakes really is beyond me, as all the ideas suggested by the BDA going forward are completely sensible and workable. The really sad outcome is that an extremely well qualified and dedicated profession who supported the population through the dark times is treated in this way. The potential outcome of all of this may be that there is a massive move away from the NHS into Private Dentistry. Now let's be clear on this point - any move over to Private Dentistry will not be randomly taken by the Dental Profession - it will be a move that has been forced onto Practices due to the Centre being pig headed and stubborn.
I add the caveat that these circumstances stem from Central action only. Local and Regional Commissioners have a completely different approach because they do understand how Primary Care Dentistry works, and also what is needed to keep NHS Dentistry going.
Exec Actions
In order to keep our heads above the parapet and to keep banging on at the various powers that be, we at LASC have regular meetings with both the CQC and the GDC. We are due to meet with the CQC in November, and then with the GDC in December. As providers of comprehensive Practitioner Support we are keen to keep in touch with the Regulatory Bodies in order to bang the drum with respect to GDPs at the Dental Coalface; to try our level best to ensure all processes are fair and equitable.
The CQC are more straightforward, as they are led by John Milne who is well known to many and is a stalwart of LDCs as a proactive member of his home LDC over in Yorkshire. We can always have a good down to earth conversation with John.
The GDC however are more suspicious and want to know the questions we are going to ask before the meeting! We have a list of questions so far, but I am happy to receive any others before the meetings. Just email your questions over to me on:
Now over to my colleagues for a picture of dental life from their perspectives...
A View from the Centre
Have we reached the point of no return?
Are we witnessing the end of NHS Dentistry as we know it?
I think this is certainly true and I’m sorry that I have no better news. Despite a tremendous amount of work put in by our negotiators and tireless campaigning, we have made little progress to reform this awful NHS contract which we said wouldn’t work for the majority of Practices (and from which the BDA withdrew from negotiations back in 2006. It’s unfair for everyone; the Dentists and the Patients the latter of which now being faced with ‘Dental Deserts’ on our patch.
We have seen Practice income drop by 30% during this time and it simply can’t go on without an injection of additional money and riddance of the UDA. Sadly there is little or no chance of this in the prevailing economic mess that the Country finds itself in. In fact, I suspect that we in fact facing further spending cuts.
We have seen a very successful media and press campaign with keynote appearances on TV by our leaders. As a result, the general public in the main, are on our side and appreciate the problems are not our fault. They now appreciate that it’s not just the ‘Greedy Dentists going Private’. We have told our task masters repeatedly in no uncertain terms that the service is on a cliff edge and very shortly at a point of no return. In response we have seen some minor tinkering around the edges by the DoH which has been a political sop (a much-heralded measure to appease the public) that has made little or no difference and may actually have made things worse. NHS dentistry is simply no longer attractive to work in for Dentists and their staff, and we face a resulting recruitment crisis on top of everything else.
We are seeing a gradual, but accelerating exodus of Practitioners from the NHS. A staggering 90% of dentists nationwide are not now accepting new patients on the NHS. They are simply exhausted and fed up with the failing system. Contract delivery is failing with a Nationwide shortfall of around 30% on targets with the resultant claw back and breach notices being faced by Practices next year, a ‘final nail in the coffin’ of NHS Dentistry.
I predict the DoH will do very little with respect to reforming NHS dentistry. We say if there is no more money then let’s revert to a ‘Core Service’ where simple treatments and pain relief only are available on the NHS. We have proposed these measures to the DoH, but they have been rejected out of hand. They want access, we’ve told them there won’t be any more access without more funding.
If you want to delve more deeply into the current central discussions then I'd recommend the following articles;
Contract Reform:
https://www.nature.com/articles/s41415-022-4919-x
https://www.nature.com/articles/s41415-022-4918-y
Marginal Changes Implementation and what we still need NHSE to clarify:
https://www.bda.org/news-centre/latest-news-articles/Pages/England-Marginal-changes-update.aspx
BADT on the marginal changes:
https://twitter.com/BADT1963/status/1576171758326927361
Recent engagement with the Minister:
https://www.bda.org/news-centre/blog/Pages/Fighting-the-crisis-in-NHS-dentistry.aspx
To try and lift the mood, Dentistry will always continue, and it's only Dentists who can provide it. Simple economics say that, yes, it will cost more to those who can afford it, however I sincerely hope that those who can’t will be protected.
John Edwards
Chairman, Lancashire and South Cumbria LDC Executive
Chairman, Lancashire Coastal LDC
Elected member BDA General Dental Practice Committee, Associates Committee and BDA Principal Executive Committee.
A view from the ever changing Political Landscape
As you are aware, we as a group of LDCs have become ever more concerned with the collapsing morale of the whole NHS dental team. I have been asked to sum up what is occurring politically. My first response was “WE’RE DOOMED!” looking at the news today, but that probably isn’t the best way to start!
Since the collapse of the reform programme and the default move back towards the loathed UDA system, we feel that the NHS is basically sat in front of Wallace Hartley waiting for the inevitable ending. We have an underfunded service stretched beyond breaking point leading to dentists, DCPs, receptionists and businesses leaving the NHS in droves.
I personally feel that everyone in the country should be entitled to high quality care regardless of their social economic position in life; maybe a naïve, idealistic utopian view I know, but why not aim for the stars? After all, isn’t that what the NHS is for in general? So rather than moan to my wife, or yell at the radio when Jeremy Vine is on, I decided to discuss this with the wider LDC and get us to contact our local MPs. After all, we pay the MPs their wages, so let’s get them earning it!
We have contacted many local MPs from all parties and even had “Face-to-Face” discussions with several of them over the last 12 months. These weren’t just moaning sessions (although they were cathartic), we illustrated to them how we try to make a “silk purse out of the sow’s ear” of the NHS system. However, we set out plainly to them the affects the delayed reform to the contract is having in real terms, on recruitment, morale, businesses and communities and that they must act now to change this situation.
So far, we have had some lovely platitudes and soundbites, but no sign of action. I know dentistry is not high on anyone’s agenda, but when it costs votes in election you can be sure an MP will listen (Latest News Articles England: Dentistry top issue as government defeated in by-election (bda.org)). I truly believe that if everyone contacted their MP (and encouraged their staff and patients to follow suit) our voices will be heard. Whether they listen is a different question, still with the speed of politics today who knows who will be in positions of power tomorrow!
Noel Bowen
Political Lead, Lancashire and South Cumbria LDC Executive
Treasurer East Lancashire LDC
DPA Spotlight
The past couple of years have been stressful for dentists in maintaining their contractual obligations and the last thing that a performer wants is a complaint that is referred to NHS England, which could lead to a referral to the Performer Advisory Group for investigation.
Complaints do happen, and responding promptly and in an empathetic way can greatly reduce the impact of a complaint. Reflecting on the complaint and identifying any issues that could be improved or changed, again goes a long way to reducing the impact, and also how the PAG views a performer referral and any outcome.
The PAG has a leaflet that explains the process when a performer is referred to them there is support that can be made available to the performer. You can access the leaflet on the LASC LDC website here;
https://www.lasc-ldc.co.uk/practitioner-support
However, it doesn’t always require a referral to the PAG to access that support, and any dentist that is feeling that they have a problem can self-refer to the support that is available.
Initially, with a self-referral, I would advise contacting your Local Dental Committee who can provide help in the form of the DPASS. The LDC will be able to signpost a performer to the most suitable support to address and hopefully remedy the issue.
The leaflet also gives contacts for services that are available to dentists through NHS England.
I would commend dentists to read the leaflet and remember there is help out there that can make a situation much more manageable and provide support to help a dentist getting back to practise.
David Bradley
Dental Adviser
NHS England, Lancashire and South Cumbria
One more thing
Buying stuff through Amazon is simply amazing. How the heck can you order something at 11.55 at night and it appears the following day?! One thing is for certain, and that is that whatever you have ordered will arrive in a cardboard box ten times the size it needs to be! I suspect that Amazon have been responsible for the loss of several rain forests with this excessive use of cardboard, but the matter is out of our hands. The other interesting aspect to Amazon is that when you look at your account to see whether something has arrived it often will say - “delivered - handed to resident” and this is whether you were there at the time or not! Let's hear it for Amazon - from a personal point of view they have saved the day in the Alston household on many occasions and I am sure we are not on our own!
And another thing
Some couriers have a habit of sending out an unbelievable number of emails to let you know where your parcel is up to in the delivery process saying things like:
Preparing your order
Order is with the courier
The courier is in your area
Your parcel will be delivered at 12.35
Your parcel has been delivered
Feedback requested - how did we do?
How tediously boring can you get? Who the heck has the time to read all this information and then have time to feedback on the “delivery experience”? From my point of view I see it like this. All couriers have a straightforward role in their job. They bring stuff to your house and then they leave it there. Why does life have to be so complicated?
That's all for now folks. The next Team Blog will be the New Year edition
From all at LASC LDC Executive have a Merry Christmas and a Happy and Prosperous New Year!
Bernard,
Bernard Alston
Secretary LASC LDC Executive
Secretary Lancashire Coastal LDC LASC LDCs Practitioner Support Lead