A plea for clarity when it comes to pay

17 February, 2020 / editorial
 Will Peakin  

In his annual report published last November, Hew Mathewson, the outgoing chair of the Scottish Dental Practice Board (SDPB) expressed concern over plans to replace the organisation. “We must accept that SDPB is an anachronism dating back to the beginnings of the NHS and that its equivalents in the rest of healthcare are long gone,” he wrote. “However, reflecting on the work of SDPB, and that of my predecessors, I can’t help but be impressed with how the members unfailingly put Primary Care Dentistry and our patients at the heart of all its work. Currently, while Practitioner Services is not directly accountable to SDPB, it does actively engage with it and formal SDPB approval is required for changes of policy etc. A Board which properly understands, and is empathetic to, what is happening in practice is unlikely in my view to be matched in this respect at least by its successor which will inevitably have its roots in, and first loyalty to, ‘the administration’.”

As we detail in our feature on National Dental Governance, the process of replacing the SDPB – an intention signalled by the Scottish Government in its Oral Health Improvement Plan published in January 2018 – is now in its advanced stages. Putting aside debate over the merits or otherwise of such a change, the process is in itself a challenge; the SDPB is a statutory body and any formal adoption of its functions is contingent on legislative change. However, the chair of the putative governing body, Paul Cushley, has emphasised its intention to be open and engaged with the profession. “Reinvigoration of the governance arrangements gives NSS an opportunity to address many of the criticisms outlined in the Oral Health Improvement Plan,” he told Scottish Dental. “Previous structures have served us well in the past, but the review and changes are required to ensure that structures and processes are fit for the 21st century and are able to adapt to the new model of care and the new SDR going forward.

Transparency, collaboration and consultation are intrinsic to the development of these structures.” While governance may strike many practitioners as a rather dry subject, divorced from the realities of everyday practice, its impact on their work, their livelihoods, and their wellbeing can be significant. Take the case of Hugh Taggart, for example. He has been embroiled in nearly-decade long dispute with Practitioner Services over their belief that he was an “outlier” in the use of a particular procedure. We detail the case, and the issues stemming from it, in our news story here and a background feature here. It is a byzantine story which would have played out in a public forum had it not been for the decision by Practitioner Services to ‘walk away’ from a court case it had brought against Taggart.

“The system of remunerating practitioners strikes this observer as being unwieldy”

Will Peakin

For his part, Taggart was frustrated by their climbdown; there were policies, procedures, and decisions that he would have welcomed being subject to scrutiny. The Glasgow-based dentist, who was compelled to sell his two practices, had to cash in pensions, and feared he would have to sell his home during his ordeal, may still get his wish; he has made a referral to the General Dental Council.

The reason for linking these apparently very different stories – one bureaucratic, the other bruising – is that the system of remunerating practitioners strikes this observer as being spectacularly unwieldy and prone to heap yet more worries on an already pressured profession. As the SDPB recedes from view and the National Dental Governance Committee, as it is called, comes to prominence the issue of payments to dentists, and how they are verified, will no doubt be on the agenda again. Perhaps more significantly, this year will see a wider discussion of the proposed New Model of Care which, if implemented, will have profound implications for how dentists treat patients on the NHS, how they are paid, and how those payments are verified. As Hew Mathewson also noted in his report: “The concern that practitioners can be under scrutiny or in some cases formal investigation for several years, to the detriment of their own health, remains an issue.” Particularly when an investigation is abandoned before it can be tested in court.

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