Please relieve me

There’s enough stress in daily life without the added anxiety induced by the actions of our paymasters and regulators. A consistent approach with consideration for those doing a difficult job is not much to ask

03 October, 2018 / insider
 Arthur Dent  

The final part of my stress-related trilogy; or should it be the final nail in the coffin? Patients, money, staff, admin, Brexit, “Indy ref 2’, the weather, my kids: all create stress on a daily basis. What causes me more worry and ire than anything else? Our paymasters, police and regulators. In conversation with any of my colleagues, young and old, the causes of real stress are seen to be the PSD, DROs and GDC. Why? It feels like they don’t understand us, don’t seem to have consistency in their approach and at no point seem to help or benefit us.

Now, I know that’s probably not why they exist, however. PSD says it wishes to help and facilitate, and it monitors the satisfaction of their end users: dentists in the NHS. The GDC is supposed to be changing its Fitness to Practice process to speed it up and reduce costs resulting in a more streamlined service. The DRO service is overworked and understaffed and, therefore, not statistically relevant in terms of quality assurance.

I do have sympathy for the budgetary constraints these ‘services’ operate under. PSD has a standing 5 per cent funding cut year on year. If you asked us to work under that regime do you think we could? The GDC has maintained its fees for the last five years or so, so in real terms its funding is being cut by inflation. The DRO service, I believe, hasn’t had any realistic change in the couple of decades I’ve been working. Certainly not in staffing, which is its major cost, but also the only way it could improve its ability to assess and monitor our quality.

There’s a flip side to the funding issue. A representative and statistically relevant DRO service would require significant funding to ensure enough patients were seen to reflect the qualities of individual dentists. Very expensive. But it would be a great way to identify problems early and direct training to both individuals and groups of practitioners. In the longer term, this would result in higher quality, reduced misclaims and allow ‘outliers’ to be identified reliably and dealt with. All of this would ultimately help patients, dentists and PSD to achieve higher quality and better value for money.

PSD is moving to a more electronic-based system to reduce their staffing and allow them to reduce costs. That should, in theory, be good as a more straightforward system should be more consistent and reproducible. Very often individuals and their opinions create the inconsistency that we perceive. The Senior Dental Advisor said, in an interview in this magazine, that they wanted to create a service which educated their end users and interacted in a more positive way. However, they brought in the new system for EDI and ran roadshows to tell us about it after the fact. Surely, if you want to educate, avoid problems to users and facilitators alike, and reduce the chances of errors, you run the education first?

The biggest bugbear of the dentists I talk to is the apparent inconsistency with which we are dealt with. Prior approval of treatment plans which, in years gone by would have been approved without question, are being challenged or declined. There always seems to be some line that they trot out to justify it, like ‘treatment in excess of that required to secure and maintain oral health’. What does that mean? Surely it could be: ‘take all the teeth out and put in plastic dentures’? That would secure and maintain oral health, wouldn’t it? It would also result in a referral to the GDC.

Chewed PencilsSpeaking of the GDC; our esteemed regulator strikes fear into the heart of every dentist I know. Why should ordinary and reasonable dentists be worried by the regulator? Surely this kind of honourable dentist should have no concerns about referral? The GDC advertised for complaints. They created a complaints system where patients can refer directly to the regulator without any local resolution being explored. They have a Fitness to Practice system which is not fit for purpose. You can be caught in the system for two years waiting to have your case dealt with. I cannot imagine the kind of prolonged stress this would cause. Then to add insult to injury, they make us pay huge amounts for the privilege.

It seems nowadays that being judged by your peers is not applicable. If you don’t perform an endo like a specialist then you must be inept. (PSD is of the same mind – ‘suboptimal root treatment’!) Working in
the NHS and having financial and associated time constraints are no mitigation either. So we have to take the time and have the skill of a specialist who charges eight  times the cost and takes four times as long? It just doesn’t seem fair.

A level playing field with care and consideration for those doing a very difficult and stressful job would seem reasonable. It just doesn’t seem to be possible from where I’m sitting. I long for a framework in which everyone understands their role and achievable aims are constructively monitored and funded. Unfortunately, I work in NHS dentistry. Never gonna happen. Perhaps that realisation is the kind of mental Shangri La that could relieve me of my work-related stress?

Arthur Dent is a practising NHS dentist in Scotland. Got a comment or question for Arthur? Email arthurdent@sdmag.co.uk

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Tags: anxiety / Insider / October 2018 / regulations / Stress

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