a dentist's life..

The Times...

noreply@blogger.com (Adam Randall) — Tue, 25 Nov 2008 13:53:00 +0000

Apologies for reproducing this article in full..

From The Times
November 25, 2008
Fears that more dentists will quit NHS as thousands billed over missed targets
Nick Daley, at his practice in Liverpool, was forced to repay £75,000 after the introduction of the dental contract
David Rose
Dentists will be required to refund £120 million to the health service because they failed to treat enough NHS patients last year, The Times has learnt.
About half of dental practices have fallen short of targets for NHS treatment agreed with local health authorities, meaning dentists will have to pay back tens of thousands of pounds each.
In the latest repercussion of the troubled dental contract, clawbacks are threatening to put some practices out of business and may persuade many more dentists to leave the NHS, the British Dental Association (BDA) says.
Thousands of patients across England are still said to be struggling to find NHS treatment, and yet about five million fewer treatments were carried out in 2007-08 than were budgeted for by the health service, figures show. This represents a 5 per cent rise in the amount that dentists will be expected to pay back, in the second year of a new pay contract that has been heavily criticised for creating a “drill and fill” culture and failing to improve access to NHS treatment.
In the past dentists were paid a fee for each treatment they provided but, under the dental contract introduced in 2006, they receive an annual income for carrying out an agreed amount of NHS work, measured in “units of dental activity” (UDAs).
Dentists, however, say that the only way to reach targets is to take on quick jobs, such as extracting a tooth rather than carrying out root canal surgery to save it, because both treatments have the same UDA value.
About 1,000 dentists opted out of providing NHS services when the new contract came into force, meaning that 900,000 fewer patients were seen in 2006-07 than under the old system, a report by MPs found this year.
The Health Select Committee suggested that dentists were being set unrealistic targets for NHS work and that a failure to meet targets in the first year of the contract meant a loss of revenue for the second.
The latest figures, obtained under the Freedom of Information Act by DPAS, a company that provides private dental plans, suggest that some regions have experienced particular problems.
In Leicester, for example, more than 50 per cent of UDAs have not been delivered and 21 dental practices face repayments of £50,000 or more.
Across the country, 89 per cent of primary care trusts responded to a survey that found a total of 411 contracts where targets were missed by £50,000 or more.
Peter Ward, the chief executive of the BDA, said that dentists who failed to meet their targets in the first year were likely to have failed to do so again last year, creating a “roll-over effect”.
He said: “Once again this highlights problems with a target-driven contract that contains one crude measure of performance, which has long been criticised by the profession and patient representative groups.”
Quentin Skinner, the chairman of DPAS, said: “For those dentists who fell rather short of the mark, the future for them in the NHS certainly looks bleak.”
Barry Cockcroft, the Chief Dental Officer for England, said: “The Government is committed to growing NHS dental access year on year. This is why increasing the number of patients seen has been made a national priority for the NHS – and backed up by an uplift in funding of 11 per cent (£209 million) this year.”
“The increased focus and funding is already starting to show results, with 655 more dentists working in the NHS in 2007-08 than the previous year and 36 million courses of treatment delivered compared with 35.1 million in 2006-07,” he added.
Mike Penning, a Conservative health spokesman, said: “It is extraordinary that [these clawbacks are] happening at a time when over one million people have lost access to their NHS dentist in the last two years. These figures show, yet again, why we need to rip up Labour’s botched contract and move towards a registration system based on clinical need, one that is targeted at preventing dental ill health rather than reacting to it.”

What the future holds

noreply@blogger.com (Adam Randall) — Sun, 23 Nov 2008 21:37:00 +0000

We’ve had our first official presentation. A team of four of us, Gaynor, Dominic, Katrina and myself had to present our plans for a new three year tranche of extra NHS funding for Newquay. We’ve all worked very hard but sadly were beaten by a Devon based company. Still the Primary Care Trust were complimentary about our plans, which included a very comprehensive school visiting scheme, a hoist for severely disabled patients and a large increase in the number of NHS patients that we can help. Still our presentation which was all computer slides and budget predictions is hopefully good practice for when we have to re bid to continue looking after our existing patients. Who could have guessed when I qualified that managing spreadsheets would be as important as nicely repairing a tooth..

Technology (again)!

noreply@blogger.com (Adam Randall) — Sun, 23 Nov 2008 21:17:00 +0000

I would hate you to think that I am anti technology... Just frustrated by items that are badly programmed or badly designed. However one area has revolutionised what we do and that is in the area of magnification. Dentistry really has become micro surgery and it is common now to blow up x-rays to 200 times normal size, and for labs to blow up photos of teeth by the same amount while making a crown for example. We have much more predictability and consistency now in what we do, but inevitably as standards rise so does the time it takes to get things done. Even some difficult fillings now will be done under magnifying loupes. These higher standards should be reflected in increased longevity and reliability of patients treatment, hopefully saving patients money on replacements in the future.

Which insurance?

noreply@blogger.com (Adam Randall) — Sun, 23 Nov 2008 21:15:00 +0000

I like the insurance schemes, but not for the reasons that might be obvious. What insurance does is softens the blow when I tell a patient that they need some dentistry. It also stops the cost being an issue, which tends to make patients come a bit more often, which tends to translate into less and simpler treatments being done. For patients who needed to get treatment done, we’ve tended to recommend HSA, which was comprehensive and generally quick to settle the claim. However recently they’re new scheme is less generous and more expensive, so we tend to recommend the Tesco dental insurance scheme about which we’ve never heard of any problems. For patients whose teeth are up to date, Denplan is the best scheme and by far the most popular. They’re good people to deal with and very fair, and with the exception of paying any lab bill offer comprehensive treatment. We are forever being approached by these firms that offer to set up our in house scheme, and whilst they may be cheaper for the Practice this always seems to be at the expense of the cover provided for the patient.

Message from America

noreply@blogger.com (Adam Randall) — Sun, 23 Nov 2008 21:13:00 +0000

Interesting statistic from the US this week. It appears that the American Dental Association has reported that American dentists are becoming increasingly satisfied with amalgam (silver) fillings. This may seem counter – intuitive considering that the US is considered the birth place of cosmetic dentistry. The truth I think is though that the limitations of the composite (white) fillings are becoming apparent. The two problems with these plastic fillings remain that they wear out much more quickly than the silver fillings and that they shrink while setting and gaps can open between the filling and the tooth causing them to fail. On average they only last half as long as the silver fillings. How well they perform is related to their size, which is why I always try to make the limitations known to patients before providing them. Even with this knowledge though a surprisingly high proportion of patients still want the white fillings. Really though if it has to be white it should be inlays or crowns, with the exception of small white fillings. Sadly patients with a mouth full of large white fillings are looking at years of maintenance and replacements..

Will you choose or shall I?

noreply@blogger.com (Adam Randall) — Sun, 23 Nov 2008 21:11:00 +0000

I’ve been vexed this week by what to listen to while seeing patients. To be frank, I’m getting a bit fed up for radio 1. The Chris Moyles show can be crass and some of the other radio 1 DJ’s strike me as not being the brightest button in the box. Imagine my horror though while listening to Radio 4 when listeners were invited to send in pictures of their STD’s for the experts in the studio to comment on. I was in the middle of a long treatment on an elderly lady while various painful sounding conditions were described in detail.. Patients are welcome to bring in their ipod to plug in otherwise we shall have to continue to take risks with public broadcasting

A change is as good as a rest

noreply@blogger.com (Adam Randall) — Sun, 23 Nov 2008 21:09:00 +0000

Nearly there. We’ve had a refurbishment this year and have upgraded the surgeries. Key to which is the new dental chairs which are the last word in patient comfort. Hopefully at least if a patient is having some challenging treatment they will be as comfortable as possible in the surgery. I guess it differs a lot from patient to patient though. Some patients despite coming to see us for years still don’t remember which dentist they see. I suppose amongst the anxiety of coming in, everything else just becomes superfluous.

noreply@blogger.com (Adam Randall) — Sun, 09 Nov 2008 20:20:00 +0000

Technology has been a bit of an issue this week. We’ve updated our software which took a full day to do and have had our email server and X-ray software go down, on top of which my intra – oral camera has packed up, and Katrina was stressed on Tuesday when her mouse failed! Most of it is back up and running now with the kind help of Solsoft, but its interesting to determine just how much of my time has been spent trying to sort these problems out. Technology has greatly improved patient’s treatment in all sorts of ways, but if I’m spending all my time on IT issues who will treat the patients? Either that or we’ll have to get a full time IT guy. Probably be a 9 year old..

noreply@blogger.com (Adam Randall) — Sun, 02 Nov 2008 20:30:00 +0000

Interesting week. We’ve had two of the surgeries completely refurbished. Both of them were fully compliant when installed but regulations are changing all the time and seamless at easy to clean are the order of the day now. Our X-ray machine was moved and the engineers knocked (dropped) it and it hasn’t been well since. As a 30K piece of equipment the builders were looking decidedly nervous as we attempted to get it repaired! Still we think we’ve got it sorted now...

The credit crunch...

noreply@blogger.com (Adam Randall) — Sun, 02 Nov 2008 20:24:00 +0000

The credit crunch is upon us now. We’ve found that demand for cosmetic work has fallen and patients are tending to postpone treatment or are looking for the cheapest solution. I often think there is a comparison between a check up and having your car serviced.. If you miss a service or are late more often than not it makes no difference but occasionally things can go badly wrong if they’re left too long. I just hope that people won’t be storing up problems for the future. We’re trying to do our bit with the launch of the pro – bono scheme which all the dentist’s have signed up to..

Fire

noreply@blogger.com (Adam Randall) — Mon, 11 Aug 2008 13:38:00 +0000

Some dramatic moments at the Practice last week. We had a fire in surgery 2! A casually discarded match in a bin of paper products unfortunately had the effect of starting a fire luckily just after the patient had left the room. Staff reacted rather well I thought and the fire drill went into action as patients trooped into the car park whilst Dominic and CJ tried out the fire extinguishers. Actually I was amazed by the lack of damage – just some scorching to the bin and a smoky smell that lingered throughout the day..

Newquay in the rain

noreply@blogger.com (Adam Randall) — Fri, 27 Jun 2008 14:17:00 +0000

Busy weekend for Michael. He's organising an implantology conference with international attendees from across Europe. Conferences are a great opportunity to showcase Newquay, but I wonder what these oral implantologists will make of the cold and windswept Sands Resort?

Chloe's filling went well and now she's decided that she would quite like to be a dentist, so some good has come out of it. On another note we've just found out that one of our early work experience lads is about to qualify hinself as a dentist, so we can't have put him off too much!

Holier than thou...

noreply@blogger.com (Adam Randall) — Fri, 20 Jun 2008 09:04:00 +0000

Chloe has a cavity... I was mortified to find a luckily very small hole in one of her deciduous teeth. I guess that she's always been a bit rebellious and to this end enjoys getting one over on her parents, pretending she's brushed her teeth when she hasn't and stashing sweets in her bedroom and the like. Still I'd always assumed that my children wouldn't ever need their teeth repaired. Still she's in on Tuesday to have it repaired, she's binned her stash of sweets and she's been brushing like mad ever since. Perhaps she's learnt a valuable lesson..

The New NHS

noreply@blogger.com (Adam Randall) — Mon, 26 May 2008 17:24:00 +0000

Well I've got the details of my final appeal back and I'm sorry to say that its been rejected... It seems that the Primary Care Trust are able to ask us to complete double the amount of dental work for the same income. I suppose that there was a moment of epiphany now that I realise that rather than being about caring for the patient the health service (at least in dentistry) is about re-electing a Labour government. As I see it, it's a win win contract for them. If we are able to meet our increased targets then they can say 'look how much more dentistry is being done on the NHS' and if we refuse and abandon the NHS then the plan is to have larger centers staffed with lower paid foreign dentists and they can say 'look at the new Practices we've opened'.

No word though for the patient that has to travel farther to see a dentist. No word for the patient that sees a different dentist each time they go to one of these larger poly clinics. No incentive for their dentist to properly sort out the dental problems that they have - just quick and cheap treatment to get them out of the surgery. It seems to me that NHS dentistry will become a patients quickest route to ill fitting dentures. Still the politicians and bureaucrats aren't bothered. They can afford to go Private....

Smile...

noreply@blogger.com (Adam Randall) — Sat, 17 May 2008 10:24:00 +0000

So Smile week has come and gone again. This year David bravely donned a toothbrush outfit and visited local schools with Katrina and Kelly dressed as tooth fairies. The staff were particularly impressed by the enthusiasm of the teachers at the schools and the involvement and participation of the children. This year the message was good foods/bad foods and the importance of brushing for young children. Generally in the last 15 years or so there has been a big improvement in the condition of children’s teeth, but sadly there were still children in the schools with poor teeth and no dentist. Considering that the important lessons are learnt at an early age, this doesn’t bode well for the dental health of a small but persistent minority…

Complaints, complaints, complaints..

noreply@blogger.com (Adam Randall) — Fri, 16 May 2008 13:12:00 +0000

Interesting times. We’ve just submitted our final appeal about our new contract to the NHS Litigation Authority. Cornwall Primary Care Trust submitted pages of information about how much money they need to collect off patients to try to justify their position. My response was two lines. Firstly I didn’t think that a reasonable person would find that more than doubling our targets overnight for the same income was fair and secondly the PCT are charged with discussing and agreeing the new contract. Neither of which they have done. Hopefully the complaint will go my way.. Watch this space.

We had a lady in at the desk this week complaining very loudly about her estimate for £2,000 worth of dental treatment. She was 98 and was clearly distressed at the amount of work suggested. When the girls eventually calmed her down and got a chance to look at the estimate it transpired that her estimate was from a different local Practice. This is so sad on all sorts of levels…

And the next question is..

noreply@blogger.com (Adam Randall) — Tue, 11 Mar 2008 14:15:00 +0000

Another interesting week. I’ve been bemoaning some of the information we need to supply to the Primary Care Trust. We’ve just had a long questionnaire to complete, asking us ‘whether the rooms are kept at a comfortable temperature’, whether all the staff are ‘aware of the occupational health contact details’ and about our equal opportunity policies among other items (about 200 in all). However speaking to my friends in the construction industry I realise we’re not alone. Apparently part of their Health and Safety Assessment is making sure they provide the right factor suncream when their workers are in the open.
I realise that when politicians appoint committee’s to look into this or that inevitably they will come up with a prescriptive list of what should or shouldn’t be done, but I’m not altogether sure that I want a society where every aspect is dictated to me by somebody else ‘for my own good’. Surely it is better to establish principles towards each other that act to our mutual benefit? Maybe that’s one reason why emigration is reaching such high levels? On a happier note, the tiling in reception is finished and I want to recommend Sean and his team for looking after us. Try for yourself with Sjm tiling on 07855796170

Say no to Tesco's!

noreply@blogger.com (Adam Randall) — Fri, 01 Feb 2008 19:46:00 +0000

What a lovely place Honiton is! Where else would you find such an interesting selection of shops from antique toys to Honiton pottery and milkshake bar! I got the impression though that there is a bit of a cloud hanging over the town with 'say no to Tescos'' signs littering the high street. I guess along with change its probably inevitable that Tescos will come, but I think it will be very sad if this affects this charming little town. Even in dentistry, big companies are coming. Every few months we are approached by a larger company wnting to buy the Practice. Typically these dental corporates such as Oasis and IDH have dentists that only stay a year on average, but more and more they look set to dominate dentistry in the UK. My worry would be how well would the patients be looked after? What would I do?

More bad news from the toothface

noreply@blogger.com (Adam Randall) — Fri, 01 Feb 2008 19:36:00 +0000

Another of my friends has given up and left the NHS. This comes at a time when we've just had our budget cut by £20,000. I guess that we will have to cut the NHS sessions on Saturdays, which will make things difficult for those people that work during the week. Very much I want to keep a service going for patients on the NHS as there are some patients that will really suffer without it.. However as long as the local Primary Care Trust have a low priority for dentistry I guess that the future looks grim. Hopefully I can get some help through my MP Dan Rogerson. We shall see.

Sod's law

noreply@blogger.com (Adam Randall) — Fri, 25 Jan 2008 16:51:00 +0000

Helen has this conviction that if I'm ever away from the Practice then calamities tend to happen.. This weekend I've been in Krakow and while solemnly looking around the horrors of Auschwitz I received a couple of panicky messages asking me to get in touch ASAP. It turns out that while we were having the new flooring installed in reception the builders have hit a water pipe... Considering Micheal was working it must have been entertaining to say the least for any poor patients while the builders frantically run around trying to find the stopcock. Hopefully I will return and it will all be fixed and dried out as though nothing has ever happened.

Onwards and upwards..

noreply@blogger.com (Adam Randall) — Fri, 25 Jan 2008 16:44:00 +0000

Its been a lovely Christmas really. I'm very lucky to live in a small hamlet called Talskiddy (of the treacle mine fame). Anyway shortly before Christmas we had the annual carol singing which was polished off by mulled wine in one of the houses. I don't imagine that there are too many places now where there is a real sense of community.

Jinny's leaving at the end of December. She's off to start a therapist course in London in January and truth be told we'll be sorry to see her go. Popular and hard working were sure Jinny will do well and are very proud of her for getting into Kings college to study this course which will enable her to perform simple fillings on patients. I must admit though I'm slightly dreading the leaving party as where Jinny's involved these things have a reputation as being raucous affairs.

Reception is getting a face lift in January. Hopefully there won't be too much inconvenience for patients.. At least that's what I've been promised. I've always thought that in an ever changing world you have to try to continually improve both the Practice and you clinical skills if you're not to be left behind. Hopefully it'll look nice anyway.

A busman's holiday

noreply@blogger.com (Adam Randall) — Fri, 25 Jan 2008 16:39:00 +0000

A funny weekend. Went to the dentist! I was up in Birmingham at an exhibition and met up with an old University friend. Back at his Practice we gave each other check ups... He had a filling done and I had my teeth cleaned. Bearing in mind that I consider this a routine thing that I do many times a day I'd forgotten how painful it can be! I was lying in the chair pushing myself into the headrest as hard as possible to try to get away from the sensation. Afterwards I convinced myself that it was a good thing to remind myself what its like to be on the other end of the mirror, and also not to leave it so long next time..

The lunatics are running the asylum

noreply@blogger.com (Adam Randall) — Wed, 19 Dec 2007 18:51:00 +0000

Had a bit of a situation this week. Got a phone call midday on Thursday from Cornwall Primary Care Trust asking us to send in invoices for some washer disinfectors that we were invited to express an interest in 3 months previously. All the paperwork was completed and sent off in good time and we heard nothing until the phone call when we were asked for invoices by Friday at the latest. This gave us less than 48 hours to order the equipment, have it delivered and submit the invoice to the PCT. All this for a possible funding of 30 percent of the cost. Obviously this is impossible to do, but this is the reality of government announcements about 'increased funding for dental practices'. If this didn't happen time and time again it would be almost funny.

When all the lights go out..

noreply@blogger.com (Adam Randall) — Wed, 19 Dec 2007 18:44:00 +0000

Challenging day Thursday. Power cut right in the middle of the afternoon. As I desperately tried to find out if there was a problem inside the building, more and more patients were arriving. One poor woman had had her injection for a wisdom tooth extraction, but it became increasingly clear that we would have to abandon any treatments as it wasn't safe to continue with no power. Generally patients were very good, although one woman was complaining about her taxi fare in and I ended up offering to pay her fare for her! About 5 hours later Western Power got the electricity back on. Still the emergency lighting works..

A load of old cobblers..

noreply@blogger.com (Adam Randall) — Wed, 19 Dec 2007 17:41:00 +0000

Spent the weekend looking for a granite cobble. Generally I suppose that we suffer a very small amount of theft and vandalism compared to other businesses and certainly in other parts of the country. Our front car park however seems to be a destination for skateboarders and invariably our tree feature keeps getting damaged (we've had to replace the tree once). This time the cobbles around the base of the tree have been dislodged and thrown into the bushes. We couldn't find all of them and that's why I've wasted 4 to 5 hours of my weekend to date trying to find a replacement. This low level thoughtlessness and pettiness is probably endemic in our society, but I just find it all a little depressing. I've resisted it but I am finally considering CCTV to start catching these vandals in the act .