I thought I would reprint one of my old newsletters for your entertainment. The newsletters are free and are delivered by email every two weeks. You can sign up for them by going to www.gdpresources.com and entering your information.

Hello again, and welcome to those who have recently joined us

Traditionally, people come to the dentist for one of 3 reasons.

i) a check up
ii) Pain / problems
iii) An appointment for treatment

They worry about coming to the appointment, which takes a lot of courage for some people. They often come to an uninviting, cold building where they are met, often, by a surely receptionist, who may even ignore the patient for several minutes. They then sit, often in a cold waiting room, with the latest in last decades magazines. They often have no idea when they will be seen. When they are called through to see the “dentist” with no real idea of what is to be “done” to them. And this is before the treatment starts. Horrible isn’t it? This might not be how YOUR practice is, but it still represents the reality of a large number of practices out there.

Even when the practice is properly run, it takes a while for the old experiences to be cancelled out, because we are dealing with frightened people. From mild unease to severe phobic reaction, the vast majority of people associate the dental surgery with fear. The main reason being that for the last 100 years, people have gone to the dentist about their teeth, and the pain associated with them. People didn’t know what caused dental disease. They just saw the dentist as someone who fixed things, who repaired teeth, often painfully. And of course there is that god awful scale and polish every six months.
People are also apprehensive about the cost. A lot of people still don’t understand that NHS dentistry is no longer free (for most), and that quality dentistry is now expensive. They still think that all dentists drive flash cars, and live in big houses. The newspapers and consumer programs are regularly sprouting the message that dentists rip you off. The same media then talks about all the lovely treatments available to your teeth, and the large sums involved. Some people get confused. They don’t realise that, yes, dentists often do have a higher standard of living than most people, but they don’t see the other side. What isn’t seen is the large number of dentists who are in financial, medical and psychological trouble. Is there a better way? Of course there is.

The traditional NHS practice worked under the following model: Drill, Fill & Bill. There was no money for prevention, so prevention was not done. Telling someone to brush and floss is not effective OHI. It can take several years, over a number of sessions, to teach the skills needed to look after their mouths. So what happened was that both the dentist and the patient stepped onto a treadmill of decay and repair. The mouth of the patient slowly deteriorated, and so did the health of the dentist. As a profession, we no longer have the highest suicide rate, but we are still pretty close to the top. I think we are now beaten by doctors and psychiatrists. This is not good. Things have to change, but we as professionals have to be the ones to change it.

We cannot rely on the government, because at the end of the day the government will do whatever it needs to get re-elected. We can only rely on ourselves as practice owners. Your practice is a business, and you need to treat it as such. The average practitioner works 5-6 days a week, and treats whatever is booked onto his or her day list. However, they don’t take the time needed to spend time ON their business, something that cannot be done when they are working IN their business. If you are working more than 4 days a week, you are (in my opinion) doing something wrong. You are living for dentistry, not using dentistry to make a living.
And people have many excuses as to why they work more than 4 days a week (I know I used to). But you know what? At one time I worked 5 and a half days a week. Now I work 4 days, and I am making more money than I ever did. And no, I didn’t go private; I am still an NHS practitioner. I just choose to work smarter, not harder. So what did I do?

• I got rid of my abusive, aggressive and unappreciative patients. And I am about to get rid of some more. 3 months notice, bye. This, to me is the big one. This alone can radically improve the profitability of ANY practice. Just think of the time freed up in your appointment book.
• I have excellent staff and pay them as well as I can
• I bought an intra-oral camera – it is a god send
• I offer every patient every option for their treatment
• I formulated an ethical effective sales system, which you can learn more about at http://www.gdpresources.com/products3.shtml
• I take the time to learn what patients want, not what they need.
• I ask my best patients to refer me their friends and family.
• I systemised my practice so that I wasn’t being constantly hassled by my staff over “little things”. We are not talking practice management here, nor are we talking clinical governance. We are talking the basic stuff. You can learn more about these systems at http://www.gdpresources.com/products1.shtml
• I took time out to work on my business so that I could plan for the future.
• When I bought the practice, I made sure I had an exit strategy.
• I joined a gym, and started eating right. You wouldn’t believe what a difference that has made.
• I keep a strict control of my finances, and save up for every major purchase. The only thing I ever bought on finance was an OPG machine, but that is only because it pays for itself.
• I wrote an Emergency management system which again is for sale on my website
  
  I am not trying to impress you. I am trying to impress upon you that there are ways to change the focus of your practice, but it takes a lot of hard work and it takes time. It also takes a complete change in the thinking of the dentist. You are not the only dentist on the planet. If you don’t like a patient, maybe they can be better served by a dentist more in tune with their personality. That old (and soon to be extinct) strategy of registering everything that could breath always confused me. Why treat people you don’t like. No matter how professional you are, the fact that you don’t like them (and that they often don’t like you) WILL affect the way you interact with them. And when something goes wrong, who do you think is going to be the first to sue you?
  
  
  

The NHS defends itself

NHS hits back at dentist claims

Published on 18/01/2008

(my comments in GREEN)

THE NHS has refuted claims there are serious problems accessing national health dentists.
The North West has been hit the hardest by a shortage of NHS dentists. The introduction of the new dental contract in April 2006 led to thousands of dentists opting out of the NHS.
Since then more than a third of people in England and Wales have not visited a dentist, according to a Citizens Advice Bureau survey (that's about 7 million people according to some reports).

Lack of access to the NHS was the most commonly cited reason, mentioned by 31 per cent of those who have not been to an NHS dentist since that time. Citizens Advice chief executive David Harker said: "These figures show the scale of the lack of access to NHS dentistry, reflecting the evidence which bureaus across England and Wales have been reporting ever since the early 90s. People on low incomes are particularly affected as private treatment is just not an option." (I won't get into the debate that, whilst there are many genuine poor, many more people on so called "low incomes" still have a considerable amount of discretionary spending)
The charity said it welcomed the 11 per cent increase in government funding for NHS dentistry from this year.

Mr Harker said: "This has the potential to deliver real improvements in access to dentistry but it needs to be carefully targeted on those areas where patients are experiencing the most acute problems. Primary Care Trusts have a duty to ensure that dentistry services meet local requirements and it is vital that they start planning how to allocate their additional funds now." (these are the same PCT's that got shafted by the governments miscalculations of Patients Fees received. It wouldn't surprise me if much of this money gets swallowed up dealing with shortfalls and bureaucracy)
The Department of Health said it measures access by the number of people who have seen a dentist (I saw a dentist the other day, he was in tescos!!!) in the previous two years and the latest figures show that 60 per cent of the North West's population have visited their dentist in that time compared to 55 per cent for England as a whole.
"There is often a gap between perception and what is actually happening on the ground," said chief executive of NHS North West,Mike Farrar.
"Access to dental services in the region has been remarkably constant in recent years which is why we are puzzled by the CAB's claims. (perhaps access has been consistently bad?)
"We know there is scope for improvement in some areas and in March 2007 we asked all PCTs to produce local oral health strategies to set out how they will improve dental health and access to dental services." So not only were most PCT's being reorganised, chopped up and moved, you were also asking them to produce reports on a topic they had never really had to deal with before April 2006. And besides, there is no way nGDS can improve dental health because there is no provision for prevention in the contract. Without prevention, you cannot have health improvements. It's not frickin rocket science, and despite what the CDO says, until the system actually pays for and encourages for prevention, it isn't going to happen in a way that is going to have any effect. That's just the way it is.

It's the economy stupid

Because we are entering a recession, with the economy about as healthy as a asthmatic in a smoke house, I will be focusing my blog on the economic health of the country. I know you don't think that has anything to do with dentistry, but ask someone who was practising in the 70's and I am sure they will disagree. The economy has EVERYTHING to do with running a practice, especially with the safety net of the NHS collapsing around our ears.

Very shortly the bank of England will start cutting rates again, which will have the effect of driving up the price of everything imported into this country. As we are now a net importer of oil, and as oil is used for pretty much everything, I don't need to tell you what this means. Cutting rates damages the strength of Sterling, especially against the Euro. Yes, it might make credit cheaper, but we are entering a period of credit contraction. It will be a while before we see any easy credit, and the days when you could get a loan for your practice with no collateral are pretty much over...... at least for a while.

I remember when I tried to get my first practice purchase loan. The first tow banks wanted me to not only sign over my soul, but they also wanted written guarantees from the great maker that the soul was actually worth something. The of course came the Royal bank of Scotland, who gladly threw money my way, and off we went.

The thing that happens in credit contractions is that people stop spending money. With their credit cards maxed out, and the equity in their house disappearing as the housing market slumps, people close their wallets and stop buying luxuries. Luxuries like tooth whitening and cosmetic dentistry. Having your toothache sorted is a necessity, but having Invisalign on your wonky teeth isn't. When money is scarce, necessities come first. Food on the table, and heat in the radiator. Gym memberships, Pizzas and second cars suddenly become an unexpected strain. A million people in the USA are close to having their homes repossessed, a million people in the worlds largest economy. The stock market looks ready to give back all the gains from the last few years, and Christmas for shop owners was a complete nightmare. You can hide you head in the sands, or you can PLAN for what might be several years of severe economic pain.

Recessions are healthy. They are necessary. Unfortunately, do to manipulation by governments and central banks, this recession will be worse than is should have been. With our housing market now starting to decline, the British consumer has reached the end of his economic rope. We are all spent out. Anyone thinking of undertaking major practice alterations/relocation's/readjustments may want to think twice. 2009/2010 may well see several thousand dentists enter the private sector, just as people start to feel their Bank accounts heavy with debt and light of savings. People will become angry, and if we are not careful their anger will be aimed towards us. If the economy goes into a major recession (and Gordon, you will have a lot to be held accountable for if it does) then the profession will be seen to be abandoning the public in its hour of need. Imagine the newspaper headlines on that one.

"AS PEOPLE LOSE THEIR JOBS, DENTISTS THINK ONLY OF THE MONEY"

The BDA's feeble mumblings that "dentists have a bad deal from the new contract" will be meaningless. You have to take this into account. if you choose to leave the NHS for the private sector (and it is still my opinion that you should) you have to take this all into account. We have to do it the right way, even if it means treating some of the most deserving in our communities for nothing.

And I want to repeat something. It is my opinion that you should leave the NHS. The PCT's themselves will be facing pricing pressures as government revenues sink. Your income will not be guaranteed, so you might as well work with the local population in a way that is affordable and ethical than risk it all on a paycheck that might not be there in 3 months. Businesses can still thrive in a recession. they just have to be prepared, frugal and sensible.

Recession?

It occurs to me that there are business cycles, created partially by the availability of credit. When credit is readily available, businesses are able to expand using borrowed money from banks and investment agencies that offer easy terms at low interest rates. As the economy heats up, more money is borrowed by more and more people. The banks, not wanting to miss out on good thing, start to be less vigilant in their lending policies. More and more people and businesses that cannot really afford the money they are borrowing are sucked into the credit frenzy, usually by short term preferential introductory rates.

This is what happened in America when the Federal Reserve lowered interest rates to 1%. The so called Subprime market that developed sucked in people of low income and poor credit history, fooling them to fool themselves that they could afford a $500,000 home even though they were only earning $10 at Walmart.

Unfortunately, credit booms are always followed by credit contractions, where the easily available credit gets withdrawn from the market. It becomes harder to get credit, and the banks get more stringent on repayments. This period usually occurs when people start to default on their payments on mass, resulting in losses. In the old days the bank would take the loss, repossess the home or the asset, and after a period of months all the dead wood would be flushed from the system allowing the credit cycle to reset.

It's a little bit different this time. The American banks, in their wisdom, sold on the mortgages so that they were no longer liable. Wall street firms wrapped this Subprime debt up with other debt in various instruments, and then insured these instruments int he event of default. Nobody seems to know where all this dodgy debt is, and as such none of the banks are willing to lend to each other. They also want to keep as much cash as possible for fear of their own investments being hit by this subprime timebomb. The credit gets withdrawn from the market, businesses no longer have access to easy money and start to fail, people get made unemployed........ and the favourable introductory interest rates on millions of American and Uk mortgages reset at much height levels. Repossessions and loan defaults skyrocket and the whole economy sinks into a recession as the consumer shuts his wallet and refuses to buy.

Americas top investment bank now says that the US is in a Recession. Roughly 15% of our exports go to the US, and the Christmas retail period was an absolute disaster. This will hit the UK hard, just at the time when PCT's are getting ready to deal with the new paradigm of 2009. Hundreds, if not thousands of dentists may leave the NHS to enter the private sector JUST AS the UK economy enters a recession. Massive increase in the overall cost of dentistry with a decrease in its availability and a decrease in the consumers ability to pay.

It's a possible scenario, so it's worth planning for. This isn't financial advice by the way, just thoughts that are probably wrong. After all Gordon's in charge!

Remember, the new contract is GOOD for patients!!!

It must be true because the CDO said so. Not only is it good for patients, but its good for dentists as well apparently. Now excuse me Dr Cockcroft but I was under the impression that nGDS had cost the tax paying public an extra £60 million in NHS dental charges. And then of course you have the 500 or so dentists that have left in disgust over the last 18 months, joining the private sector because most of them felt they had no choice.

And what is the end result of all this. There are fewer NHS dentists, with 250000 fewer patients seeing an NHS dentist. So tell me, is it good for patients that it is costing them more? Is it good for patients that fewer of them can actually find an NHS dentist? I was under the impression that the new contract was supposed to resolve the access issue. Did anyone actually believe that.

And even now many people don't understand the new system. Now I would gladly give my patients the nifty little information leaflet that the government created to explain it all......... but we were only sent 200 originally, and these were then recalled about 2 weeks later because of the bit where it said you could have dentures made for about £50. Have we had any fresh information leaflets since?

No - we have a poster, which is very nice I suppose.

Have we had a written manual on where and when to claim what fee band?

No - you can phone up the BSA (the government agency that deals with the collection and collation of payment data) three times with the same question and sometimes get three different answers. Oh and there are those stange Q&A lists on the BSA website, but they don't really help.

We have a situation now where most NHS practice owners now have no confidence in the new contract. We now have a situation where less people can access an NHS dentist, and when they do it invariably costs more. We also now have a situation where dentists are having to put their entire focus on the generation of targets........ because it's financial suicide for their business if they don't (you cannot deliver healthcare to your patients if your business is bancrupt). So, as I ask Dr Cockcroft, how is this better for patients? I need it explaining to me because I'm really thick and I don't understand.

The True Treadmill

I hear it said time and again that nGDS was introduced to removed dentists from the dreaded treadmill. Well, if you believe that, then I have some American Subprime debt I would really like to sell you.

Let's get this straight. Under the old contract, the treadmill was NOT a creation of the system, it was a result of how the dentist worked in the system. By cramming your appointment book with everything that decided to walk through your door you:

• Ruined your cashflow (because nothing ever got finished)
• Ruined your health (because you never got a break and were working too hard)
• Ruined your ethical standing (because you missed things, rushed things and patched things)
• Ruined your skills (because you never spent the time to go on those courses and do the job properly)

So you worked harder when the government cut the fees, proving that you could earn the same by doing more work. NEVER do that to a bureaucrat, because he will just carry on doing that until steam comes out of your arse. Instead, we should have slowed down, spent time with our patients to find out what they actually wanted. To do this, you had to purge your appointment book of those individuals that didn't appreciate your time.

• The late arrivers
• The late payers
• The obnoxious
• The lecherous
• The non attenders

Why did we as a profession continue to treat these people? The vast majority of the people who sue you are those people that fall into these categories. And yet we, as a profession put up with them.

But I'm getting distracted. OGDS was a treadmill by choice, nGDS/PDS is a treadmill by design. To stay in this system, you have to work towards targets that were invariably calculated unfairly. Many dentists were asked to do too many UDA's, resulting in a shortfall and clawback. How can a dentist tell how many UDA's he can ethically do in a year when the system is untried and untested. Targets in Healthcare is a disgraceful concept. Whoever thought this up should be ashamed. You have a fixed monthly payment, based on a level of activity that was greater than most dentists actually did (whilst removing actual items of treatment that the dentists can do to meet the targets - e.g. Ortho), in a system where the costs of running the practice are rising year on year. The only way to offset the rising expenses is to do more private work. But this risks not leaving enough time to meet your targets, which risks clawback and a reduction in contract value. It's a vicious circle, with no way back if you should choose to step off the treadmill and risk going fully private.

And the fact that we have targets PROVES that the new contract is not about preventing disease. The whole point of prevention is to stop people having work done. Thus if you successfully run a preventive practice........ how the hell can you meet targets when targets are based on the surgical intervention of the disease process. So by being an ethical dentist, and by actually improving the health of your patient base........... you get penalised. It's absolute fricking insanity, and ANYONE who promoted this as being good for dentist and good for patients needs to be strongly informed that they are wrong.

Just a thought