20 March, 2014

Rocky road to recovery

Dear Pat Kilpatrick (director BDA Scotland) and Robert Donald (SDPC chair),

Thank you for sending out the letter of advice Re: recovery of the alleged overpaid monies, a situation made necessary by the flawed ‘lifelong
registration’ system introduced by the Scottish Government, despite its obvious problems being pointed out by dentists at the time of its introduction.

I am appalled that the PCFS is planning to bulldoze the recovery through, while ignoring the equally obvious flaws in the recovery process. I am equally
appalled that the BDA and the SDPC have rolled over and accepted this situation. What you are asking us to accept is that it’s okay for the board to take
away money from us in a single month, in the hope that we will be able to make up the amount through a 2.5 per cent ‘uplift’, which was woefully inadequate
in the first place.
This has been a tactic used for many years. Remember the previous clawback when figures were initially leaked which were very high? When the compromise
figure was negotiated, we all breathed a sigh of relief and accepted it. The caving in by our representatives to this new clawback only opens the door for
similar tactics to be used in the future.

I’d be interested to hear what your advice will be to myself and other associates in a similar position. This clawback covers a period dating back to 2006.
From 2006-2012, I was a practice owner. In July 2012, I sold my practice but continued to work for the new owners as an associate. When the board takes an
amount from my February schedule, the new owners and myself will have to enter into negotiation as to what percentage of the clawback is my responsibility
from the time I was owner, and how much is from the period since I became an associate.

In the seven years since this situation has arisen, there must be hundreds of associates who have moved on and changed list numbers. For the total amount
to be subtracted from their current list number is surely flawed. Are their current employers supposed to pursue money from the previous employers? What
about the practitioners who have moved away from Scotland or retired between 2006 and 2013? How is the clawback going to be applied to anyone who has no
current list number?

Your letter states that the timetable commences with a letter sent to each practitioner “sent out late December” with only a figure in it. This letter
should be accompanied by the data which has led the board to come up with the figure they claim is due from each practitioner. It is unacceptable that we
have to request the data and that there is a time limit on challenging the figure owed.
It is up to the board to prove that the figure has some basis in fact. Since the original system was flawed from the outset, why should we believe their
figures now? The BDA should be urging all practitioners to request the data. They should have to prove their figures are accurate from the outset. An
apology from the Scottish Government for the situation arising wouldn’t go amiss either.

At a time when the majority of Scottish dentists have remained loyal to the NHS, and figures suggest that their take home pay has reduced by 10 per cent
from the 2008 levels, this is an unwelcome kick in the teeth, not helped by the helpless wringing of hands by our representatives

and the acceptance that “nothing can be done”. At least, if nothing can be done, we should make a lot of noise, and maybe the Government will cease to
think of us as pushovers.

Thank you also, for the template letter to send to the Scottish Minister for Public Health. I would urge all dentists to either send the letter as it is,
or even add some choice words of their own.

Yours sincerely, David Garrick, GDP, Alva

BDA response:

Dr Garrick is absolutely right and echoes the feelings of GDPs across Scotland. Clearly we welcome his encouragement to the profession to make good use of
the template letter the BDA has drafted for the profession; only by speaking up in numbers can we convey to the Scottish Government just how strongly we
feel on this issue. The BDA is lobbying hard behind the scenes, of course – and that lobbying has already secured a delay to the process, but more remains
to be done and the public noise we can make by acting as one is invaluable.

This is a woeful tale. We have lifelong registration, let us not forget, against the advice of the profession. The BDA lobbied hard to explain the
potential problems with it. So there can be no doubt that the problems that are now arising are of Scottish Government’s making. And now we have shifting
parameters for the recovery exercise. There are clear problems with Scottish Government’s data and the fact that it cannot even guarantee not to pursue
deceased practitioners is nothing short of disgraceful. If even one widow or widower is troubled by a letter because the Scottish Government cannot take
the trouble to get its data right, there will be a massive outcry and the BDA will be leading it. That’s why we’re calling for the whole exercise to be
postponed; it is unacceptable that it should go ahead while concerns of this magnitude exist.

The uplift issue was not straightforward and was debated at length by the 16 members of SDPC. We did not “cave in”. We undertook a structured appraisal of
the options and made a considered judgement. Ultimately, we concluded that the clear threat that any uplift would be withdrawn meant that we had to secure
that funding for practices. Considered solely as a matter of principle, we might have told Scottish Government what it could do with its 2.5 per cent, but
we’re not dealing with principles, we’re dealing with underfunded practices across Scotland that are struggling to survive and desperately need that money
to continue caring for their patients. And the uplift is important not just in the short term of course, but the longer term too, because it contributes to
the baseline figure upon which future funding and pensions are calculated.

While the Scottish Government remains committed to the recovery exercise going ahead, we urge practitioners to take the steps not to get caught out by it;
request your data and check it carefully and, if you are a BDA member, avail yourself of our expertise. We have written to practitioners explaining what
they should do in more detail.

But we certainly haven’t given up on the exercise

going ahead yet; so please join us in making the point to your own MSP and the Minister. The more of us that write, the better the chance that we will be
listened to.

Robert Donald, Chair, Scottish Dental Practice Committee, British Dental Association

Trainers raise meeting concerns

Dear Dr David Felix,

The West of Scotland trainers met on Thursday 9 January as we had discussed at the first of the Task & Finish meetings.

The format of the day, however, was very different to previous gatherings in that we all met in small groups in different locations, principally to discuss
the GDC Standards document and how it relates to VDP’s and VT training in Scotland. In my particular group, we were actively dissuaded from discussing both
the superannuation issue or anything else pertaining to remuneration for trainers. Despite this, at least two of the groups discussed the pension
deductions made and the recent letter from the CDO. A number of points were discussed during afternoon session among the groups.

There appeared to be no clarification about the superannuation deductions. Trainers are unable, for instance, to access the information from SPPA regarding
updated pension statements. They do not know what was deducted and when and how much has been refunded. It was made quite clear to us last year that the
payment to trainers of superannuation on the trainees gross NHS income was illegal. It would appear that payments were not in breach of pension regulations
after all and that it was only the way that these regulations had been interpreted. Trainers would like to know if any deductions made prior to the April 1
2013 are also to be reimbursed and, if not, why?

When the groups eventually came together at the Royal College, it was apparent that similar conversations had taken place across the schemes. It was made
quite clear that despite all the trainers being present, there was no time allocated for general discussion. There was, however, a brief discussion
following the speaker for this evening session. Some of the issues were discussed and a straw poll of the trainers present found no one happy with the
present arrangements.

On Thursday, there was no rallying call to training that usually takes place. There was no chat about how great it is to be a trainer and how much kudos
this brings to a practice. There was no information as to whether there would be any incentives to training. Instead, we were informed that only 31
applications by trainers had been received by NES. It was also indicated that this year trainers would be appointed without even the need for an interview.
This is potentially undermining further the position of trainers and suggests that trainers are no longer held in high regard.

Many of the trainers expressed the view that they would not sign up to training without knowing the details of any trainer contract. One trainer said that
last year he had signed up to training, only to then find that, rather than receiving superannuation on his VT’s earnings, deductions would be made. He
would not have trained under these circumstances.

Rather than reassuring trainers on Thursday, a great many were left reluctant to sign up to an unknown quantity. These include experienced trainers who
have been devoted to training and are proud of the role they have had in mentoring new graduates over many years, but now feel so undervalued that they are
considering their positions. Loss of superannuable VT’s earnings, lack of remuneration due to low patient numbers, and a marketplace flooded with
associates, leave a significant number of dentists considering the need to train. This is on the back of a reduction in the GDPA to £80,000, changes
to Determination X, and a training grant that has not been increased for at least seven years.

This feedback should reinforce the pressing need for an immediate increase in practice allowance and training grant. Any increase in trainer income could
be cost neutral with an appropriate decrease in VT salary. The CDO’s letter discussed VT’s gross earnings of £40,000, which would indicate that
current VT salaries are unrealistic in the present climate.

If an effort is not made to show that the trainers’ efforts are valued, then the number of applications for this year is likely to remain low and fall way
short of the number of positions required.

John Denham, James Barrett, Ainsley Ness, Elaine Humphreys, Alec Dunlop,

Stephen Reid, Robert

Thomson, Jacqueline Frederick, Jackie Nicol.

NHS Scotland response:

Thank you for the opportunity to comment on the letter from Mr Denham and a number of his colleagues.

NHS Education for Scotland (NES) values the commitment of trainers in delivering high-quality education and training to recent graduates.

We are aware of current issues which may impact on trainer recruitment and are working closely with colleagues in Scottish Government to identify possible
solutions. I anticipate that we will be in a position to make a formal announcement on incentives in the near future.

NES is a special health board responsible for supporting NHS services in Scotland by developing and delivering education and training for those who work in
NHS Scotland. For the sake of clarity, NES has no locus in terms of interpretation and implementation of superannuation regulations.

Dr David Felix, postgraduate dental dean, NHS Education for Scotland

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