Am I beating a DEAD horse???

I know, I know I sound all misery and gloom. My friends used to call me Perma bear because I refused to buy a house and wouldn't invest in stocks. But the last year or so, they have begun to understand my reasoning. Ok, this was mainly because I wanted to concentrate on my business and had limited capital, but there was always a deep nagging doubt in the back of my head.

The problem with a bubble, of any kind, is that it is almost impossible to tell the top. So I was quite happy to step aside for the last several years because I didn't want to be caught at the top. Was I right to do this, hell I don't know. But I spent the time concentrating on my business, and not dabbling in other things and that seems to have worked quite well. The one thing I was certain I would never do is to get overextended in debt.

Now the media is awash with doom and gloom stories. you cannot miss them, even if you tried. Even when bullish sentiment gets into the media it is castrated by howling voices of derision. Here's an example:

http://www.telegraph.co.uk/money/main.jhtml?xml=/money/2008/03/23/ccliam123.xml

The responses to his post are not very favourable.

Does this mean we will enter into a recession? Again, I don't know. It certainly looks like we will. And I know what you're asking, what the frickin heck has this got to do with a blog on NHS dentistry? Well, like it or not, your practice is a business, and businesses have to survive recessions. For those of us in the NHS, it would seem there is a beacon of hope to ride through the choppy seas. it looks like ring fencing will be extended to 2011. if the recession hits hard (and we should know by the beginning of next year if this will be the case) then 15000 practices all going private in a sea of unemployment, bankruptcies and house repossession may not make the best business sense. How likely is a housing downturn......... well, here is another link.

http://www.housepricecrash.co.uk/pdf/abn-amro-home-truths-04042007.pdf


I still feel that our future lies outside the NHS, but (to steal a famous Scotsman's saying) one has to be prudent about this. Whatever plans you make for the next five years MUST take into account economic realities of our present time.

Just a thought

Health Select Committee

Yesterday's final evidence session for the Health Select Committee

http://www.parliamentlive.tv/Main/VideoPlayer.aspx?meetingId=1269

BDA press release

*Half a million in England lose access to NHS dentistry*


Statistics published today by The Information Centre offer further evidence that the Government's 2006 reforms are failing to achieve their aim of improving access to NHS dentistry.

The figures show that more than half a million people across England have lost access to NHS dentistry since the implementation of reforms in April 2006.The statistics show that 27,602,000 patients were seen by an NHS dentist in England in the 24 months up to 30 September 2007, compared to 28,145,000 in the 24 months up to 31 March 2006, a reduction of 543,000 patients.

This figure is in addition to the approximately two million people that the Department of Health acknowledges wanted access but were unable to get it before March 2006.Susie Sanderson, Chair of the BDA's Executive Board, said:"Today's statistics offer fresh evidence that the Government's reforms to NHS dentistry have failed to achieve the stated aim of improving access to care for patients. The reforms have also failed to allow dentists to deliver the kind of modern, preventive care they believe their patients deserve."The loss of access to NHS dental care for half a million patients is a milestone in the failure of these reforms. It's time for the Government to start listening to patients and dentists and work with the profession to find constructive solutions to address the problems with these reforms."

Unfortunately the government won't listen because we don'y shout loud enough!!

Its that time of year again

Dentists will fall into one of two camps at this moment in time. there will those who will have pretty much done their UDA's (pronounced UDERS) and will be putting their feet up a bit, maybe going on holiday or just taking it easy. The other camp won't even be close to doing their UDA's and will be cramming whatever treatment they can through the door to make up the numbers.

For many patients, their experience of being treated in March will fall into, again, one of two camps. They either won't be able to get an appointment because their dentist is either full up or at UDA maximum, or they will be able to get an appointment, but it will entail sitting in a packed waiting room whilst the dentist runs late on his New Contract Treadmill.

Remember what I have always said on my website:

• If you are working more than 4 days a week chairside, you are doing something wrong
• If you are having less than 6 weeks `holiday, you are doing something wrong
• If you are routinely working into your lunch hour, you are doing something wrong
• If you are more than 2 weeks booked up, you are going to compromise your cash flow.... and guess what, that probably means you are doing something wrong :)

Nuff said

The LDC delegation meets the CDO

Some interesting little nuggets of information have surfaced from this meeting:

• There is a problem with LDC's funding
• Local Commissioning is here to stay with dentistry leading and the others in the NHS will follow.
• With regards to additional 11% uplift, this money is recurring and no defined timescale would be imposed by the DoH on PCTs in planning its use.
• Concern was raised that previous guidance on year end issues was largely ignored. Guidance is apparently a method where PCTs can act differently but have a coherent reason why, whereas direction is a "must do". In other words they have no set blueprint to follow. Interesting that RIngfencing is a Guidance and not a direction.
• "Access" has been defined as a service within reasonable distance from home of reasonable "quality". What the frak does that mean??????
• "Quality" was defined as appropriate treatment from an appropriate clinician in appropriate setting. Ok, that makes everything so much clearer. Phew, I was worried there. Damn it, they didn't define appropriate......... we could have gone on like that for hours!!!!!!!
• There was further denial of miscalculation of contract targets - so John Renshaw must be wrong then, although somehow I don't think he is.
• Apparently when in discussions with practitioners, PCT' s should take into account the practitioners experience and dedication to the NHS, and treat them as a valued resource. You know, I feel almost floaty having read that. I think I will find myself a field and dance among the flowers. PCT's may well treat GDP's as valued resources, but that isn't going to stop Clawback

Blah blah blah blah :)

As I said, you can stay in the NHS and deal with the regulations, the bloated buerocracy and the threat of Clawback and a PCT suddenlt strapped for cash........... or you can make your way to the Exit door. It's the one over there with the word PRIVATE written on it in large glowing Gold letters. Your choice..... BUT, also take account of the economic factors affecting this country. Going private at the hieghts of a recession, for example, may not be the wisest move.

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.