I beg to differ

The next three letters are in response to Mark Bishop's opinion piece - The patient-dentist relationship and the future of dentistry - published in the BDJ in December 2018.

Sir, I read Mark Bishop's paper1 with interest and a degree of dismay. He bravely tackled two big issues: the NHS dental contract(s) and the GDC. I share his concerns but I cannot agree with his conclusions. As a practitioner of more than 38 years and an expert witness, I feel I have something to add.

The NHS

The concept that dentists as a profession are being singled out and victimised is incorrect and unhelpful. The simple observed fact is that if you work in a job where the government holds the purse strings then you will be asked to do more for less each time there is a pay review.

Speak with any policewoman, fireman, teacher or hospital employee and you will know that dentists are not unique or alone in this. I don't believe that there has been a single year in my practising career (1980 to date) when the government has awarded dentists a pay rise above inflation, so that means that each year has seen a pay cut in real terms. The advent of dental corporates and the tendering of contracts have merely served to accelerate the race to the bottom in our profession.

Moreover, the costs of operating a practice are not related to the RPI (Retail Price Index). Changes in practice and new regulations have to be incorporated at extra cost but without extra funding.

Doctors (GPs in particular) have a huge hold on the government and an excellent (if unjustified) reputation with the public as selfless philanthropic professionals who always put their patients first, whereas dentists have never shaken off the old 1970s reputation of being under-challenged and overpaid.

The fact that our surgeries now conform to minor operating theatre standards is lost on our patients and they still presume that the NHS pays for our surgeries, materials and staff.

Governments work by section, where individual departments are charged with saving money. It's rarely achieved but what often happens is a budget is removed from one department and lands at another. I call it compartment syndrome.

It happened when I was in the Royal Air Force when families were no longer entitled to treatment. It saved the MoD millions and no doubt someone got a knighthood for it, but it merely passed the costs to the NHS dental contract. This is what is happening with child dental health now. Cuts to the NHS contract mean that the children end up in hospital having GA extractions (hardly good for their health or our overall NHS budget).

The GDC

There are many weaknesses within the current system and we have an extraordinarily high proportion of disciplinary proceedings in our profession, compared to any other similar profession. This, in itself, should indicate that something is clearly wrong.

My own feeling is that the GDC should concentrate much more at the 'front end' by showing dentists what is expected, rather than using the big stick of disciplinary proceedings once something has gone wrong and a patient has been harmed. Prevention rather than restorative treatment makes sense.

The one thing I am certain of is that if any dentist finds themselves in front of the FTP (Fitness to Practise) committee, they will receive the most scrupulous, unbiased and fair consideration from the process and from the committee members.

I agree that some complaints should not reach this stage and that the whole, prolonged procedure is stressful for registrants but I am quite sure that no registrant is punished unfairly as a result of being before a committee.

The most common form of sanction is to impose conditions of practice. This could amount to working under supervision, limitation of scope and/or re-training. This is a form of sanction that is entirely appropriate and proportionate. It protects patients but does not prevent the registrant from practising. Erasure may have been the main focus of the paper but it is rare, and in my experience, always justified.

A profession must be prepared to deal with those who undermine its values. We must accept that a small number of our profession do not uphold the values of the profession and these people must be removed.

Our licence to practise is just that; in the same way that our driving licence can have penalty points applied for minor infringements and can be removed in the case of major infringements. A driving licence will be removed from a driver who makes repeated minor offences or a single major offence. Few drivers would say that was victimisation.

Self-regulation is not trusted by the public anymore. Consider the examples of the police, banking, financial services and the press and you will understand why. It is ironic that our profession regulated itself much better when we did it ourselves but we have to accept that those days are in the past.

The GDC is not going to 'go' and allow dentists to set up a more preferred model. Our only hope is to lobby the powers with a cogent argument for improvement of the current system. Bear in mind that the GDC is not there to protect dentists, it is there to protect patients. So self-interest will not help to convince anyone of the need for change.

Polemic

I blame the BDA for our plight. It has missed a chance to improve the reputation of dentists with the public. It has missed a chance to explain to the public how dentistry is funded (and how different the funding is to all other 'NHS' services). The BDA is our representative pressure group and should be fighting our corner. It is up to the BDA to be improving the public image of dentists and dentistry.

The adult dental health surveys have confirmed that dental health has improved massively in my lifetime. We have a lot to be proud of. In contrast, child dental health has improved but is now on the decline again. We know this is due to the funding model. It's time to say so.

If the GDC truly wanted to protect patients then it should recognise that there comes a point when the fees are simply too low to meet the required quality of the paymaster. It's up to the BDA to say this.