Modern Dentist Magazine Issue 13 by Charlton Grant

NAVIGATING RISK

Issue

13 ISSN 2515-6128

Understanding the risks Raj Rattan MBE, Dental Protection

Getting it right Managing business risk in dentistry Glenys Bridges, Glenys Bridges Practice Pathways

Dentistry in 2020 -

Increased claim risks Callum Goulding, Insync Insurance

Advice from the expert

Sue Boynton, Dentolegal Consultant & Dental Complaints Expert Key contributors to this issue

Welcome Risk management in dentistry can be defined in a few ways, but essentially it is a program designed to identify, evaluate, contain, reduce or eliminate potential risk and/or harm to patients, employees, and visitors within any dental practice or hospital. While not every negative outcome can be eliminated, Modern Dentist’s experts suggest some resourceful tips and insights offering practical examples on how to reduce risk in your practice, handle malpractice claims and develop a solid approach to future risks. Starting with Raj Rattan MBE, Dental Director at Dental Protection; Raj explores some of the key aspects of risk management, including risk categories, risk intelligence and our evolving approach to risk management. Sue Boynton, a Dentolegal Consultant and Dental Complaints Expert, understands the challenges faced by dental professionals in today’s increasingly complex sector. Sue spoke to Modern Dentist about her own experiences in dentolegal and how she believes the landscape has and is changing in terms of risk and its management, while offering some practical tips for practices.

Price Bailey offer specialist support for the dental sector, and with the industry facing many new challenges, it is important to have an expert on hand. John Warren and Kirsty Beck explain what sets Price Bailey apart from others in the market, and how they can help you to develop your business while focusing on what you do best: dentistry! And finally; Modern Dentist spoke to Dr Nishma Sharma, Clinical Leadership Manager, about her involvement with the Chief Dental Officer’s Clinical Fellow Scheme, and why she would encourage all those interested to apply. Details about the application process can be found on page 57. Make sure you also check out our panel of experts on the editorial board, who give their thoughts, advice and guidance on all aspects of the business of dentistry. I hope you find this edition useful and please get in touch if you have any suggestions, comments or feedback for future issues!

Callum Goulding is a specialist insurance broker serving dental associates and practice owners; he outlines why it is important to transfer your risks to your insurer as dentistry is at an increased risk of claims in 2020. We would like to introduce Modern Dentist’s first Forum. From pages 41-45, you will have access to several different opinions, experiences and insights from some well-known specialists in the field. Our expert voices give their opinion to a number of questions focused on risk, clinical negligence and malpractice claims, in order to fall in line with this issue’s theme: Risk Management.

Poppy Green Editor, Modern Dentist Magazine 01765 600909 | @Modern_Poppy poppy@charltongrant.co.uk | www.moderndentist.co.uk

Editorial Board Contributors Bernadette Dainton-Cartwright

Dr Richard Brown

Rob Griffin

Bill Sharpling

Mark Barry

Sophie Gray

Sales Director Swift Dental Group

Associate Dean (CPD), Director LonDEC, Faculty of Dentistry, Oral & Craniofacial Sciences King’s College London

Parrys Lane Dental Practice and Bupa Dental Care On behalf of Geo Orthodontics and Nuvola

Director ESM Digital Solutions

Heidi Marshall

Mike Hughes Principal Dental Practice Consultancy Service

Kelly Saxby Managing Director Green Apple Dental Recruitment Limited

Nathalie Smets

Partner Dodd & Co

Director Aspired Finance Ltd Dental Compliance Manager Isopharm

Marketing Manager Ancar

Co-Editor - Poppy Green, poppy@charltongrant.co.uk Project Manager - Martin Smith, martin.smith@charltongrant.co.uk

All material is copyrighted both written and illustrated. Reproduction in part or whole is strictly forbidden without the written permission of the publisher. All images and information is collated from extensive research and along with advertisements is published in good faith. Although the author and publisher have made every effort to ensure that the information in this publication was correct at press time, the author and publisher do not assume and hereby disclaim any liability to any party for any loss, damage, or disruption caused by errors or omissions, whether such errors or omissions result from negligence, accident, or any other cause.

Modern Dentist Magazine

Contents 31

Fulfil your potential Dawood and Tanner Academy

Risk Management Leo Briggs, DDU

Yorkshire Dental Suite

Insight

Risk Management

Leo Briggs, Deputy Head of the Dental Defence Union (DDU), discusses how we can minimise risks to patients and prevent recurrences by creating an organisational culture, encouraging openness and learning.

Interviews

Understanding the risks

Running a modern dental practice involves navigating risk and tackling the difficulties of clinical decision making. Raj Rattan MBE, Dental Director at Dental Protection, explores some of the key aspects of risk management, including risk categories, risk intelligence and our evolving approach to risk management.

Advice from the expert

A Dentolegal Consultant, and Dental Complaints Expert, Sue Boynton understands the challenges faced by dental professionals in today’s increasingly complex sector. Here she spoke to Modern Dentist about her experiences as a Dentolegal Consultant and how she believes the landscape has changed in terms of risk and its management; offering some practical tips that you can use in your practice right away too.

Editorial Board

What to include in a CV: CV writing tips for success

Meet the Editorial Board

Meet our resident editorial board writers for Modern Dentist Magazine. Modern Dentist is a magazine written for the industry by the industry, bringing you the latest in healthcare business news from a range of specialist professionals and thought-leaders.

Kelly Saxby, Green Apple Dental Recruitment Limited

The way forward: digital dentistry

Bernadette Dainton-Cartwright, Swift Dental Group

4|Modern Dentist Magazine

Why improving your work posture equals extending your career

How can further study enhance your career and what type of study is right for you?

Bill Sharpling, King’s College London

27 27 28

This technology works

Mark Barry, ESM Digital Solutions

Why use a professional broker?

Rob Griffin, Aspired Finance Ltd

What should first time practice buyers consider when looking to own their own practice?

Mike Hughes, Dental Practice Consultancy Service

What opportunities do mergers and acquisitions offer an already established dental practice?

Heidi Marshall, Dodd & Co

is the relationship between dentists and dental 29 How labs evolving? And what does

this mean for patients moving forward?

Dr Richard Brown, Parrys Lane Dental Practice and Bupa Dental Care

How realistic or advisable is it for dental professionals to admit their own mistakes?

Sophie Gray, Isopharm

Features

Nathalie Smets, Ancar

Fulfil your potential

The Dawood and Tanner Academy is a training and education centre based in central London. Their aim is to create a community of dentists, dental care professionals and administrators who wish to fulfil their true potential through accredited training. Here they outline how a training course cannot only benefit the dental professional but also the dental practice.

Advances in Caries Detection

The iTero Element 5D Imaging System with Niri Technology is providing a timely aid to dental radiographs for caries detection. This advancement will help dentists avoid patient exposure to excessive and repetitive radiation, reducing the risk and improving patient safety.

Getting it right – Managing business risk in dentistry

Glenys Bridges, Managing Director of Glenys Bridges Practice Pathways, discusses how we can better manage business risk in dentistry when quality management within regulatory guidelines directs the practice management.

Yorkshire Dental Suite

In this edition of Modern Dentist, our Practice Focus features Dr Abdul Dalghous and his team at Yorkshire Dental Suite. A hub of creativity, the Yorkshire Dental Suite is a relatively new practice boasting some of Britain’s most qualified dentists, surgeons and aestheticians. The state-of-the-art practice, based in Leeds, revolves around its patients, creating a relaxed environment as the team aims to restore the public’s trust in dentistry.

Forum: Risk, Negligence & Malpractice Claims

Welcome to Modern Dentist’s first Forum - there’s nothing more stimulating than a discussion forum. Here you will have access to several different opinions, experiences and insights from some well-known specialists in the field. Our expert voices give their opinion to a number of questions focused on risk, clinical negligence and malpractice claims, in order to fall in line with this issue’s theme: Risk Management.

Risk Management in Dentistry

Life in general is a series of risks. We learn to manage these risks as best as possible. The same applies in dentistry and our aim in 2020 should be awareness and management of these risks. This brief article from Priya Sharma will highlight the various factors we should always be mindful of while risk managing our practise.

Issue 13 | ISSN 2515-6128

Chief Dental Officer’s Clinical Fellow Scheme

48 48

Dentistry in 2020 - Increased claim risks

Practice owners and principals are now often picking up their associates’ claims. Callum Goulding Cert CII, a Senior Healthcare Development Executive at Insync Insurance, outlines why it is important to transfer the risks to your insurer.

Missing a trick - How consumer oral care brands can work better with dental professionals

Hamish Khayat, CEO and Founder of BURST, talks us through the relationship between oral care brands and the consumer, and how it can be improved by brands and dental professionals working more closely together.

Spotlight

Moving upstream conference 2020

In Shifting the Balance, the GDC has committed to moving the system of regulation forward against a new Corporate Strategy 2020-2022: Right time, right place, right touch. It was at the GDC’s Moving Upstream Conference 2020 that we were introduced to this year’s Moving Upstream Report.

Founded by dentists, the Tooth Fairy App enables patients to access a dentist for braces at a more affordable cost, or to access a dentist for single use, for either advice or assistance. After recently winning App of the Year, we hear more about Tooth Fairy’s vision to offer direct professional advice to manage patients.

Specialist support for the dental sector

With the dental industry facing new challenges, it is important to offer sector-specific advice. Price Bailey’s expert team understands the unique concerns of the industry and is ready to support the dental sector. John Warren FCA, Partner, and Kirsty Beck, Outsourcing Supervisor, outline what sets Price Bailey apart from other specialist accountants in the market.

FREE at

www.moderndentist.co.uk Supported By

Chief Dental Officer’s Clinical Fellow Scheme

Modern Dentist spoke to Dr Nishma Sharma, Clinical Leadership Manager, about her involvement with the Chief Dental Officer’s Clinical Fellow Scheme, and why she would encourage all those interested to apply.

Tooth Fairy: Video Call a Dentist on Demand

Product Reviews

Subscribe for

Case Study

59 60 60 61 61

mikrozid® - effective against enveloped viruses

Dawood and Tanner 10th Study Day

‘Check before you tick’ campaign highlights online eligibility checker for dental treatment

Working with Nuvola

Smile Train Appoints New Members to Medical Advisory Board

10 Minutes With

swiftdental group

Heidi Marshall

Chartered Accountant and Business Adviser at Dodd & Co.

Our publications contain advertising material submitted by third parties. Each individual advertiser is solely responsible for the content of its advertising material. We accept no responsibility for the content of advertising material, including, without limitation, any error, omission or inaccuracy therein. We do not endorse, and are not responsible or liable for, any advertising or products in such advertising, nor for any any damage, loss or offence caused or alleged to be caused by, or in connection with, the use of or reliance on any such advertising or products in such advertising.

Modern Dentist Magazine

Go Beyond Scanning With 3Shape and ESM Digital Solutions

Patient Trust

Practice Development

Treatment Monitoring

Patient Engagement

Treatment Simulation

Contact ESM today to find out more. UK: (020) 8816 7840

info@esmdigitalsolutions.com

Ireland: (01) 808 4446

www.esmdigitalsolutions.com

Insight

Patient safety first Dental practice can never be entirely risk-free, but it’s important to understand why adverse incidents occur and take steps to avoid them, says Leo Briggs, deputy head of the Dental Defence Union (DDU).

The following fictional scenario is typical and based on similar cases from DDU files:

Patients rightly take for granted that their dental practice will be a safe and clean environment, so when something goes wrong during treatment, it can be hard to accept.

A dentist saw his first patient of the day for a routine examination and carried out a scale and polish using the ultrasonic scaler. After the procedure, the patient commented that she had noticed an unusual taste and a burning sensation.

And if the incident was felt to be avoidable or earlier warning signs were missed, there can be serious dento-legal consequences for the dental professionals concerned.

After the patient left, the dentist discovered that the ultrasonic scaler system had not been thoroughly flushed through with water after disinfection.

The dentist contacted the patient to explain what had happened and apologise. He advised her to attend the local hospital where she was found to have minor chemical burns and ulceration to her oral mucosa.

On investigation, it emerged that an agency dental nurse had been asked to shut down the surgery the previous evening, but she had not been trained to use the equipment. The patient later made a successful claim against the practice owner.

The cost of a preventable error In the Dental Defence Union’s (DDU) experience, adverse incidents generally fall into one of these categories: • Administrative lapses such as a failure to follow up referrals. • System failures, for example, problems with data security or failures to ensure all equipment is correctly maintained. • Clinical lapses, such as inadequate monitoring of patients for periodontal disease.

This kind of incident shows why it is in everyone’s best interest to have effective risk management procedures in place to identify and pre-empt threats to patient safety before it is too late.

Modern Dentist Magazine

Insight Dental practice can never be entirely risk-free, but it’s important to understand why adverse incidents occur and take steps to avoid them Organisational culture So how can dental professionals ensure they understand the risk factors within their practice and mitigate against them? The foundation of every safe practice is an organisational culture which encourages openness and learning. Of course, dental professionals already have an ethical duty to put patients’ interests first. However, it is in the interest of practice owners to encourage staff to speak out when they see something of concern. This can be achieved through training but also by ensuring that staff have the opportunity to contribute ideas for improvements, by demonstrating that concerns are taken seriously and thanking staff who highlight potential risks to patient safety. At the same time, patients should have the chance to provide feedback on their experience though anonymous patient surveys. Reviews and ratings on various websites are another way to learn what patients think of a practice, both good and bad. It’s also important to gather information about the safety and quality of your service, via regular clinical audits and serious event audits of incidents that have or might have harmed patients. Such investigations should not be about fixing the blame on individuals but focus on what went wrong, why, and learning lessons.

Embedding a safety culture The information gathered from all these sources should enable dental professionals to systematically identify areas of risk within their practice; assess these for severity and frequency and then implement risk management strategies to reduce or eliminate them. These measures should be set out in written policies, shared with the practice team and embedded in training and induction. Important areas to cover include: • Infection control • Safeguarding children and vulnerable adults • Dental radiography • Data protection • Employment, staff training and development • Complaints • Raising concerns • Clinical audit • Referrals to hospital or community services While most practices are likely to have policies in place, it is still important to review these regularly to ensure they are still relevant and that you are meeting your legal obligations. Regulators require practices to have an ongoing system of quality assurance that identifies areas for improvement across all areas, including patient safety. Your practice’s policies and procedures should also reflect authoritative national guidance from organisations such as the General Dental Council

(GDC), the Faculties of Dental Surgery and General Dental Practice, specialist societies and the UK Departments of Health. Store policy documents in a folder and make them available to all members of the dental team, to help achieve a common understanding and consistent working practices.

Resources The good news is that there is now a growing range of resources available to help practices implement effective patient safety measures One recent initiative is the National Advisory Board on Human Factors in Dentistry (NABHFD), which was established in July 2018 to raise awareness of the factors that can lead to patient safety incidents and promote a patient safety conscious culture. There are toolkits such as the one to help avoid the risk of wrong tooth extraction, which can be found on the Faculty of Dental Surgery’s website. Dental professionals can always turn to the DDU and other dental defence organisations to learn about the common causes of adverse incidents that lead to complaints and claims, as well as how to avoid them. The DDU’s website has a number of resources at: www.theddu.com

Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service including a brief period overseas. He has also worked in general dental practice. Leo gained a Masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. From 19952017 he provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005. Between 2007 and 2009 he worked part time at the DDU and part time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009, Leo went full time with the DDU. In January 2016 he became deputy head of the DDU.

The foundation of every safe practice is an organisational culture which encourages openness and learning 8|Modern Dentist Magazine

Interview

Understanding the risks

Q A

What led you to become involved with the dentolegal arm of dentistry?

I have always been interested in law and was keen to develop a portfolio career. I was given an opportunity to work as a part-time dento-legal adviser at Dental Protection in the early 90s. I have always felt it is a privilege to be in a position where one can help and assist

professional colleagues. I continued to work on a part-time basis, and for the rest of the week, I worked in general practice and was involved in dental foundation training as a course organiser, as we were known in those days. I was then appointed as a Senior Dento-legal Consultant a few years before I took on the role of Dental Director in 2016.

The risks associated with clinical practise arise from the very nature of the procedures that are undertaken

Q A

What challenges have you observed in the dentolegal landscape during your time at Dental Protection?

Many of the challenges remain the same when it comes to providing clinical care to patients. The intricate nature of clinical work and the associated risks have always existed. As clinical practice advances so do the risks associated with it. Nowadays, I think recent graduates are more fearful than in the past as they are more aware of the consequences of failure and high patient expectations. These challenges have always been there, however, they are just amplified in the echo chamber of social media. The impact of the environment and the

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Interview

If we can adopt a rational view on risk – seeing it from an analytical perspective rather than how we ‘feel’ about it – we are more likely to have a pragmatic approach to it

Another challenge we face is the impact of target-driven dentistry. Research has shown the risks associated with target driven dentistry, including behaviours described as tunnel vision, misrepresentation and gaming. Tunnel vision relates to focusing on those aspects of care which are monitored or appear on reports. Misrepresentation refers to the risk of data manipulation - where what is recorded may be influenced by what is measured; it may not reflect what is done. Gaming is a term which has become part of the dental lexicon; it refers to altering behaviours to maximise benefit and gain from a system. Implementing new systems has unintended consequences on the professional landscape which we should never underestimate.

Q A

What are the risk categories in the general dental practice?

There are many ways to arrive at a classification. I tend to group risks under the following categories: • Operational risk • Compliance risk • Reputation risk • Business risk • Financial risk • Accident risk Another approach looks at the categories from a different perspective: • Potential for litigation • Possibility of erosion of reputation and confidence • A breach/threat to security of premises, facilities, equipment or staff • Significant actual or potential injury to patients or team members • Minor incidents • Significant occupational health and safety hazards Most classifications cover similar ground; it depends on what labels we choose to apply to the grouping of the risks.

system(s) under which dentists work has also contributed to this. The business side of dentistry has changed the landscape, both from a small business perspective and the corporate sector. We are now more aware of the commercial challenges given the growth of the corporate sector. NHS contract values are fixed with little prospect of growth. Practice growth is likely to be achieved by offering patients private treatment where the treatment is not available under the NHS, or where it is offered as an alternative to NHS treatment without misleading the patient. This is important since we often see cases where statements made to patients cannot be defended because there are allegations about misleading patients.

Q A

What are the risks associated with the practice of dentistry the result of?

The risks associated with clinical practise arise from the very nature of the procedures that are undertaken. The work conditions, the environment, clinical competence, knowledge and experience all play a significant part. Communication failure is another factor. It threatens the dentist-patient relationship and ineffective communication can compromise the consent process and compromise patient understanding of risks and benefits. This is the reason for our focus on communication and consent when we offer risk management advice to members. Record keeping is another recurring theme. Inadequate and/or incomplete records can

make it difficult to defend cases because clinical records are frequently subject to scrutiny. We provide members with advice and guidance on the subject in our presentations, publications and webinars. Whilst it is important, we must not forget that this does not displace or detract from the importance of competence when it comes to carrying out clinical procedures.

Q A

How is communication important in a risk strategy?

Effective and meaningful communication underpins the principles of consent. It helps to establish rapport and strengthen the dentist-patient relationship. In contrast, where there are pre-existing relationship issues, these contribute to pre-disposing factors which may encourage patients to sue, according to research.

How might the profession’s approach to risk management change? Are there new emerging trends that we need to be on the lookout for?

The risk management cycle is established and embedded in healthcare. Typically, the steps are: Step 1: Identify the risks. This should be a team responsibility where risks are identified, described or uncovered and noted. Step 2: Analyse the risk. Once risks have been identified, it important to determine the likelihood and consequence of each risk. Step 3: Evaluate or rank the risk. This is done by determining the risk magnitude - the combination of likelihood and consequence. Step 4: Treat the risk. This is concerned with risk mitigation. It is about how to minimise the probability. We should also remember that there is an upside to risk related to enhancing opportunities. This would fall under the business risk grouping I mentioned earlier. Step 5: Monitor and review the risks from time to time. These five steps are the foundations of risk management. Whilst new technologies and techniques may create new risks, they should still be managed in this structured way.

What principles would you advise practitioners to apply in order to control risk and failure from a clinical and business perspective?

The ‘what if’ question is a powerful question when it comes to controlling risk and failure. The focus of the question should Modern Dentist Magazine

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Interview The ‘what if’ question is a powerful question when it comes to controlling risk and failure

be about what may not go according to plan. What might the outcome(s) be. It is a question that we should ask ourselves before every procedure and intervention. By asking the question, we focus our mind on the present and what could happen and why it might happen when treating a particular patient during a particular appointment. The risks that we can identify in this way should prompt us to consider what safeguards we can put in place before we start the procedure. By approaching risk in this way, it becomes part of the clinical thought process rather than remaining as an abstract notion at the back of our mind.

What do you think is the rationale behind some patient’s complaints, and what might be the precipitating and predisposing factors behind them? Are rising patient expectations a key factor?

Many patient complaints relate to the gap between the patient’s expectations and the actual delivery of the service or the outcome. It is very easy to over promise and under deliver and this can drive complaints. This does not necessarily mean that the dentist is at fault – the patient may have unrealistic expectations and that is not necessarily their fault either. Advertising and marketing can help to set unrealistic expectations; it is therefore important to agree with the patient in advance of any treatment what a reasonable expectation could be. Not only in relation to the outcome but also in terms of the process of the care and treatment they are going to receive.

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Advertising and marketing are an important part of running a clinical business, however we must be aware of the unintended consequences, such as raising patient expectations. It is commonly said that patient expectations are rising, and from my own clinical experience I think it is true, but we may be inadvertently contributing to that by overzealous advertising.

How has technological change influenced risk management and risk in itself?

Advances in technology are often accompanied by revisions to clinical procedures and this can reduce the risk of clinical error – modern imaging technology is a good example. However, the introduction of new technology also brings new risks. I can remember working with early CAD-CAM technology in the late 1980s when the technology was in its infancy and we were working with Siemens at the time with the first CEREC machine. The challenges of working with optical impressions and the challenges associated with working with the software inevitably brought new risks. The technology has advanced leaps and bounds since those early days and many of the limitations have now been overcome. I think that is the pattern of working with new technology, but the risks can be plugged into the traditional risk management cycle when it comes to managing them.

Q A

How can we take a pragmatic yet robust approach to risk management in the provision of dental care?

It comes down to risk intelligence. There is a difference between the reality and the perception of risk. This risk perception gap partly explains why more dentists than ever before are fearful about clinical practice. We are all, often unknowingly, influenced by many cognitive biases which affect our view of the world. An example is availability bias. We recall those events that readily come to mind and use those as a basis for our view of the world. Risk management publications cite examples of cases with sub-optimal outcomes or report cases where patients have complained. This then distorts our view of the risk landscape. We do not consider the thousands of patients who are treated daily in general practice without any adverse outcome or incidents. The norm is not newsworthy, and it does not often get reported. In my role at Dental Protection, I meet many dentists and do many presentations to professional groups and newly qualified dentists. I am focusing on risk intelligence to ensure that there is a balanced message. We should not be complacent about risk, however; we should be rational about it. Pragmatism is about knowledge, meaning and truth. If we can adopt a rational view on risk – seeing it from an analytical perspective rather than how we ‘feel’ about it – we are more likely to have a pragmatic approach to it.

Dr Raj Rattan MBE

is the Dental Director at Dental Protection.

Roy McGillivray, Managing Director, said: “What a fantastic achievement for the whole team to win Best Dental Lab – this iconic award reflects all of the teams‘ continued hard work, support and dedication, as well as our position in the marketplace. Also, a BIG thanks goes out to all our clinicians and businesses for their custom and support.”

Swift Dental Group awarded ‘Best Dental Laboratory’ of the year… On the night, Swift Dental Group were finalists for Best Digital Laboratory, Best Implant Laboratory as well as FMC Dentistry’s most prestigious award, Best Dental Laboratory. This recent win has added to Swift Dental Group’s growing Laboratory Awards collection, including: • • • •

Best Implant Laboratory Best Digital Laboratory Best Team Best Dental Laboratory

Interview

ADVICE FROM THE EXPERT A Dentolegal Consultant, and Dental Complaints Expert, Sue Boynton understands the challenges faced by dental professionals in todayâ&#x20AC;&#x2122;s increasingly complex sector. Here she spoke to Modern Dentist about her experiences as a Dentolegal Consultant and how she believes the landscape has changed in terms of risk and its management; offering some practical tips that you can use in your practice right away too.

Dentists need to be given the chance to resolve complaints

14|Modern Dentist Magazine

Interview

Anyone who provides NHS dental care will be familiar with the challenges associated with the underfunded system. Add to that the burden of regulation, and you wonâ&#x20AC;&#x2122;t be surprised to hear of the effect on morale in the profession, along with high levels of stress and burnout

Firstly, could you tell us a bit about yourself and how your career in dentolegal began?

Initially, I worked as a dentist in primary care within the community dental service and general practice, and it was during that time that I found myself helping my colleagues when they had run into occasional problems, whether that be with the NHS, or more often than not, dealing with a complaint. Of course, I also ran into occasional problems myself. I remember really enjoying the challenge of helping colleagues who were facing difficulties, and I believe that was when my interest in dentolegal issues really began! After several years, I obtained a position with a dental indemnity organisation as a local advisor. I became a sort of trouble-shooter, figuring out and solving problems while reducing the risk of it happening again. From then on, I continued to develop professionally and became a full-time dentolegal advisor. I obtained a Masters Degree in Medical Law, along with a Fellowship of the Faculty of General Dental Practice and a Fellowship of the Faculty of Forensic & Legal Medicine of the Royal College of Physicians. I now work as an independent dentolegal

consultant, sharing my knowledge and experience with others across the dental profession. Typically, I spend about half of my time providing presentations, workshops and inhouse training on dentolegal issues, and the other half assisting individual dental professionals who have run into difficulties.

What would you argue are some of the major challenges currently faced by dental professionals in this increasingly complex sector?

We are facing challenging times in dentistry. For me, one of the main issues is regulation. When I started in dentistry there was no practice regulator, and the GDC standards focussed on the size of a nameplate. How times have changed! Now we have a practice regulator in addition to the GDC. There is a lot more paperwork and administration than in the past. Dentists are trained to be clinicians, but they are increasingly finding themselves spending valuable time and resources focusing on regulation and administration, and this places a huge amount of pressure on dentists.

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Modern Dentist Magazine

Interview

There are a lot of different ways of describing human factors. It’s all about recognising and understanding factors that lead up to human errors which in turn can impact on patient safety Anyone who provides NHS dental care will be familiar with the challenges associated with the underfunded system. Add to that the burden of regulation, and you won’t be surprised to hear of the effect on morale in the profession, along with high levels of stress and burnout. I think this, together with the culture of fear is what leads to some clinicians actively considering giving up clinical dentistry. We can’t afford to lose dentists.

Effective complaint handling is a must for every dental professional, how would you advise practices to capture and resolve patient dissatisfaction in-house, appropriately and professionally?

I have so many dentists approach me in disbelief that they have received a solicitor’s letter, or complaint from the GDC, and the dentist was entirely unaware that the patient was unhappy - the patient had not told them. I can fully understand how frustrating that must be for them. Dentists need to be given the chance to resolve complaints. The way to do that is to let patients know that they can go directly to the practice if they have a complaint. In order to do that, each practice needs a professional complaint handling procedure and you need to tell patients about it.

Engaging with patient feedback, capturing complaints and dealing with them appropriately, in-house, gives the patient confidence that their complaint will be dealt with professionally and will not affect their level of care in the practice. The Professional-wide Complaint Handling Initiative working group has produced a great resource that promotes professional complaints handling. It sets out what patients can expect from their dental team should they decide to provide feedback or raise an issue. You can find the resource here: https://www. gdc-uk.org/docs/default-source/ complaint-handling/profession-widecomplaint-handling-initiative-leaflet. pdf?sfvrsn=5a8c2cc6_2 Dental practices can let patients know feedback is welcome and if they have an issue it will be dealt with professionally. At the same time, practices need to be confident that their complaints procedure is up to date, and that their team is equipped with the knowledge and skills to deal with a complaint. Online and face to face CPD courses are available from a number of providers. Some practices run their own training and have fun selecting a member of the team to role play a patient who wants to make a complaint!

Collect patient feedback, use it, and show patients that you are using it. ‘We’re listening’ is an incredibly powerful message. It gives patients confidence in the practice 16|Modern Dentist Magazine

You have previously mentioned that there needs to be further recognition of ‘human factors’ and their impact on the dental practice – could you tell us a bit more about what this means and how we should educate ourselves further on ‘human factors’?

There are a lot of different ways of describing human factors. It’s all about recognising and understanding factors that lead up to human errors which in turn can impact on patient safety. Did you know that tiredness can have a huge effect on how we work? If someone is going to work and they’re tired, that can slow down their reactions and their thinking. Similarly, stress, communication, and teamwork can have an effect. Even something simple like hydration needs to be considered – if someone is dehydrated, which may be for any number of reasons such as they haven’t had time for a break, that can affect how their brain works, and that could affect patient safety. The aviation industry are at the top of the game in terms of human factors and the effect on concentration and performance, and we are getting there in dentistry; but we need to continue spreading the message and working as a team to identify and address the issues. Some human factors have simple fixes, which can benefit individuals, the team and patients.

Interview

Being in a position to capture and resolve complaints in-house may mean fewer patients approaching solicitors or the GDC. That’s got to be good for everyone!

What changes and/or challenges have you seen as a dentolegal consultant? Are there more to come in 2020?

Over the past year I have been surprised by the number of dental professionals I have come across who are trying to deal with either the GDC or patient solicitors on their own. I recently spoke with a dentist who had received a letter from a solicitor stating that they were suing them on behalf of a patient. The dentist had

been dealing with it by themselves for several months, with correspondence going backwards and forwards between the dentist and solicitor. That can potentially make the dental professional’s situation worse, not better; and in some situations, it can run up costs as well. I strongly advise practitioners who have found themselves in this same predicament to speak to their indemnity provider as soon as possible. They are the people with the appropriate knowledge and expertise.

The same advice stands for dental professionals who receive correspondence from the GDC. Don’t try to deal with it yourself – speak to your indemnity provider, that’s what they are there for.

Do you have any practical tips to offer our readers that they could use in their practice right away?

Absolutely! Firstly, collect patient feedback, use it, and show patients that you are using it. ‘We’re listening’ is an incredibly powerful message. It gives patients confidence in the practice. Secondly, make sure you capture patient complaints in-house in order to give yourself a chance to resolve them. Thirdly, train all the team in complaints handling. Being in a position to capture and resolve complaints in-house may mean fewer patients approaching solicitors or the GDC. That’s got to be good for everyone!

Sue Boynton

is an independent Dentolegal Consultant, Speaker, and Dental Complaints Expert.

Get in touch with Sue at: sue@dentolegalconsultant.com or via her website: www.dentolegalconsultant.com

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Modern Dentist Magazine

meet the

Editorial

BOArd

vide a Isopharm pro teresting in l, a n professio ay of and easy w your learning completing ts whatever requiremeny in the role you pla . dental team is offered via our

ng tand Our dental traini rm as we unders . fo at pl g es E-Learnin liv l na sy professio that you have bu n access CPD and ca This means you u have time. learning when yo nced y with GDC Enha Isopharm compl reflective ing lud inc , ns CPD stipulatio levant all courses to re learning, linking ty ali qu tcomes, development ou d urse content an co on e nc ra su as al on rs pe e lin of on the introduction tools for annual an pl t developmen subscribers!

Name/Job Title: Nathalie Smets – Marketing Manager Company: Ancar Services: Manufacturer of Ancar dental units Describe Ancar in three words: Family business, customer-minded, strong What makes you unique? I easily adapt to every circumstance and situation.

Name/Job Title: Mike Hughes, Owner Company: Dental Practice Consultancy Service Services: Business consultancy, practice valuation, practice financing Describe DPCS in three words: Caring, knowledgeable, available What makes you unique? Direct personal service.

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p Swift Dental was established in Roy McGilliv ray and Mark St 1984 by has since evol ved into the UKevenson and dental laborato ’s larges over 300 dedicary group, employing t te d team members nationwide. We are a full-se built on passio rvice dental laboratory – pioneers of di n and innovation and are tru gi to have celebra tal dentistry. We are proud e industry, and arted our 35th year within th training and re e continuously innovating, e the forefront ofsearching in order to stay at the dental indu stry. Our technicians possible level are trained to the highes GDC and DAMand comply with MHRA, t technicians ha AS standards. Many of our than 20 years ve been with us for more and some have into senior man agement roles progressed . We pride ours elves on the hi the products w gh quality of the personable e offer to our customers, and our collaboservice they receive integrity, innovarative approach. Our a business has tion and transparency as making Swift supported our growth, De choice for clini ntal Group the preferred cians.

Green Apple Dental Recruitment is the UK’s Leading Dentist Recruitment Agency specialising in the placement of GDC Dentists into Permanent Associate and Locum Dentist roles in NHS, Mixed, Private and Specialist practices in the UK. Name/Job Title: Kelly Saxby, Managing Director Company: Green Apple Dental Recruitment

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Describe Green Apple Dental Recruitment in three words: Professional, personal, efficient

What makes you unique? We have the most experienced dental recruitment team in the UK with nearly 45 years combined!

After 30 years of looking after dental practices, principals and associates, you can rely on us to know the drill when it comes to your financial affairs. Our unparalleled knowledge and understanding of the dynamic world of dentistry has helped hundreds of our dental clients stay one step ahead of the rest. Our specialist knowledge, which comes from acting for a large number of dental practices, enables us to provide an exceptionally high quality of specialist service. Work with us and we will assign a healthcare team to you who you can contact for advice at any time. Our experts will produce accounts as quickly as possible after the year end and provide tax estimates as soon as the draft figures are available. We can advise you on areas in which dental practice performance could be improved and compare results with our own averages and national average figures for dentists’ profits. If you are looking for advice on pension schemes, locum cover, income protection and permanent health insurance, our own Independent Financial Advisers, Dodd Wealthcare Limited, who specialist in healthcare can help. Ask us for details. Our specialist dental accounting team is headed up by Heidi Marshall. We have clients all over the country and are members of NASDAL (the National Association of Specialist Dental Accountants and Lawyers) and ASPD (Association of Specialist Providers to Dentists). For more information, please contact Heidi Marshall.

Name/Job Title: Bill Sharpling. Associate Dean (CPD) and Director LonDEC Company: Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London Services: LonDEC is a provider of post qualification education and training for the who dental team. Describe the Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London in three words: World ranked No2. What makes you unique? LonDEC is a world leading post qualification dental education and training centre offering CPD for the whole dental team. About Us LonDEC (London Dental Education Centre) is a state-of-the-art education and training centre designed to enhance and further the skills and knowledge of the entire dental team. Opened in late 2009, by King’s College London in partnership with the NHS London Deanery, the £2.4 m highspecification centre is dedicated to the task of training healthcare professionals, driving clinical standards and improving clinical leadership via unrivalled opportunities for continuous personal and professional development. Post qualification education LonDEC provides an unrivalled range of dental courses and is home to a vast selection of post qualification education and continuing professional development opportunities for every member of the dental team at all levels. Perfectly located Just a short walk from Waterloo mainline station, the London Dental Education Centre is based in the Franklin-Wilkins building of King’s Waterloo Campus and is the perfect location for the training that supports the development of new and advanced skills in modern dentistry. Want to find out more about training at LonDEC’s world class facilities? Simply contact us today to discuss your dental courses/dental CPD requirements by emailing info@ londec.co.uk. Alternatively, you can discover more about our courses at https://www.londec.co.uk/ londec-courses and our facilities at https://www. londec.co.uk/our-facilities. You can also follow us on Facebook at https://www.facebook.com/LonDEC , Twitter https://twitter.com/LonDEC and Linked In https://www.linkedin.com/company/londec/.

Name /Job Title: Rob G Comp any: A riffin, Direc spired tor Servic Finan e ce Ltd Equip s: Finan c m e Purch ent, Dig for Den tist ita ases & Tax L l Equipme s (Dental Descr nt, Pr oans) actice word ibe Aspir ed Fin s: Wh y pay ance more in thr What ? ee broke makes yo r u s u within and fina nique? be ch the mark nce comp With vario value allenging. et, being u anies ava us il aim tos remain thHowever, nique can able financ be the p e same. Wour core whilst e rates witrovide the e always throu providing hin the delowest ghou t the personal 1 ntal marke custo mer jo-2-1 servicet, urney .

Name /Job Title: Dr Richard Brown, Associate Dentist in three practices in the Bristol area providing general and cosmetic dentistry, with an interest in orthodontics and endodontics Describe Geo Orthodontics/Nuvola in three words: Contemporary, innovative and reliable

ESM Digital Solutions is an independent provider of 3Shape, scanning and software solutions to the orthodontic and dental profession. We deliver systems, training and on-going support so you can embrace the many benefits 3Shape’s market leading technologies can offer your business. Whether you are a clinician searching for the perfect digital impression system or a laboratory that needs an open, flexible and powerful productivity tool to help you take your business to the next level, you can be confident that ESM will have the right solution for you. If you can’t find what you are looking for or would like more information about how our business can help yours and why ESM is becoming one of the most preferred 3Shape partners, contact us today and our friendly customer service staff will be happy to help you with your enquiry.

If you are interested in joining our editorial board of experts and becoming a thoughtleader for the industry, then please get in touch with the MDM Team at: martin.smith@charltongrant.co.uk or give us a call on 01765 600 909 We look forward to hearing from you!

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Modern Dentist Magazine

Sell your dental practice for free Demand for practices with a turnover of more than £700,000 is at an all-time high, with practice owners often able to achieve above asking price offers and complete in less than six months

Practices recently sold with no fee to the vendor Free on-site valuations CQC assistance & advice

Glasgow

Lancashire

 9 Surgeries  Good retention of staff  Vendor willing to stay on  Good location

 7 Surgeries  Good UDA value  Modern practice  Share sale

Turnover: £4,815,745 Asking price: £8,403,155

Turnover: £1,675,935 Asking price: £3,100,000

Achieved price: £10,000,000

Achieved price: £3,700,000

Accurate valuations Extensive buyer database

If you’re considering your exit, looking to retire or would just like an up-to-date valuation of your business, contact the trusted, reliable team at MediEstates on 01332 609318

*No fee applies when selling your dental practice to a MediEstates Premier Tier Buyer.

contact@mediestates.co.uk

01332 609318

www.mediestates.co.uk

Editorial Board

What to include in a CV:

CV writing tips for success

Are you looking for a new job in 2020? Not sure what to include on your CV? Look no further as Kelly Saxby of Green Apple Dental Recruitment, offers her top tips for making sure your CV gets you noticed. Your CV is the chance for you to sell yourself to prospective employers. It should tell them about you, your professional history and your skills, abilities and achievements. Ultimately, it should highlight why you’re the best person for the job. Below you will find some factors to consider when deciding what to include on your CV.

Format Your CV should be simple yet punchy. With the ability to work from so many different devices, we recommend keeping the style and layout uncomplicated, so your CV is easy to read in all formats.

Contact details Always include your full name – we recommend using the format as it will appear on your GDC certificate. We also suggest that you include a mobile number and an email address as a minimum. Including your postcode is also helpful for practices who are advertising a permanent role and want to check your proximity to their location.

Objectives It is always best to clarify what you are looking for, i.e. days, remuneration, expectations, etc., by including a cover note alongside your CV. You can amend this to fit to your current requirements and each individual role rather than altering your CV, this is especially helpful if you are a Locum.

Registrations If you are, for example, an NHS dentist, including your GDC registration and National Performer number details will help a prospective employer identify you and confirm your suitability for their role much quicker.

Education and qualifications Including relevant education and qualifications is an absolute must! You can also include general education and any specific courses that may be of interest and/or suitable. Ensure you include the dates of your qualifications as this will help determine how much experience you have.

Experience and employment history Practices, recruitment managers and recruitment agencies all want to know how long you have been working in your field, where your employment took place, and the type of work you have been undertaking. Include an outline of your work history, noting your start and end dates, the name of the practice/hospital/company you worked for, your job title, and a brief description of your duties. This will all help to paint a clear picture for a potential employer, and it adds credibility to your application. If there are gaps on your CV, be prepared to explain them if they aren’t clearly outlined.

References Plan to have referees in place when looking for a new role. Including their details on your CV is helpful, but it is not a must. If you prefer not to include their details when initially sending CVs out, we suggest simply noting ‘references available on request’ to acknowledge that you are aware you will need to provide one should your application progress.

Additional information Feel free to include additional information on your CV, such as CPD, driving abilities, etc. You can include personal interests and activities, but we recommend that you keep this brief. If you are struggling with your CV, many recruitment agencies will be able to provide you with a template to get you started - give one a call!

Kelly Saxby

Managing Director, Green Apple Dental Recruitment Limited.

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Moden Dentist Mag 2020_Layout 1 22/01/2020 14:38 Page 1

Specialist Dental Accountants www.doddaccountants.co.uk

Kno wle dge ab a

dvic with e o all t ut cha he tter For a confidential, no obligation discussion about how we can help your dental business, accounting and advisory needs contact Heidi Marshall on 01768 864466 or email heidi@doddaccountants.co.uk.

Editorial Board

The way forward:

digital dentistry How can the introduction of scanning and software solutions act as a flexible and powerful tool to help take a business forward? Swift Dental Group began their digital journey in 2015; fast forward to today, where Swift Dental Group are true pioneers of digital dentistry with multiple awards to show for their digital journey to date.

CAD element (Computer-Aided Design). The file is then sent to the milling machine or Renishaw machine to be milled or laser-sintered – this is the CAM element (Computer-Aided Manufacturing).

Swift’s fully equipped digital laboratory; incorporating a 3,000sq. ft. state of the art digital suite, is industry leading in the UK. We continually strive to improve the quality and consistency of our products and services through innovation and customer feedback, making Swift Dental Group ‘the perfect fit’ to support clinicians and their teams with their digital workflows.

Swift Dental Group mill in the following materials: PMMA, which provides high-quality temporary restorations; wax, creating beautiful diagnostic wax ups; soft metal, the perfect alternative to full shells - milling in soft metal provides a smoother finishing surface with greater anatomical features; composite, and the fastest growing dental material, Zirconia, in the industry currently. Zirconia has exceptional strength and beautiful aesthetics which makes it the perfect choice of restoration, whether it is a Full-Form NHS restoration or a layered private Zirconia, you and your patients can discover all the benefits of this CADCAM restoration, including minimal chairside adjustments, shorter turnaround times, accuracy, consistency and at a great price.

As a clinician you may only consider your digital journey beginning when you purchase a scanner, however, at Swift, our restorations are still produced digitally, using the latest innovative materials, regardless of how your impression is received; either conventionally or digitally. In fact, 96% of all our Crown and Bridge restorations go through some form of digital process. For the perfect digital workflow and to utilise the digital journey, taking a scan provides you and your patient with the following benefits; a greater patient experience and journey, reduction in turnaround times, reduction in material costs, fewer impression faults such as drags and blows, and fewer remakes. Plus, logistically, there is no risk of the file being received late or damaged. Swift currently scan all Crown and Bridge models that are cast from the original impressions; however, we’re currently looking to invest in a CT scanner which can scan all conventional impressions received into STL files. STL files will then be uploaded and designed into the requested restoration, taking into consideration the occlusion, margins, anatomical features and morphology of the tooth; this is the

Embracing the digital journey has never been as easy

The cost of Palladium has risen more than 25% since the new year and is likely to increase even further. Palladium is a common component of dental casting alloys, meaning bonded crowns on all service levels will increase in price by 25% or more. Is there a better time to swiftly switch to Zirconia, and offer your patients metal-free restorations that have great aesthetics and strength? Embracing the digital journey has never been as easy; the whole team at Swift Dental Group have significantly invested in both time and resources, thus improving their digital workflow. Whether it’s researching and developing new products and materials, or further developing their bespoke laboratory system, Swift continually strive to improve the quality and consistency of their products and services through passion and innovation.

Bernadette Dainton-Cartwright

Sales Director, Swift Dental Group.

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Editorial Board

Why improving your work posture equals extending your career

How can further study enhance your career and what type of study is right for you?

Nathalie Smets

Marketing Manager, Ancar. Imagine sitting on your operator stool after performing your final dental procedure of the day, you rise and pause before walking out, letting the discomfort in your back settle. Your neck aches and your shoulders hurt, and you realise it’s only Wednesday. It’s time to ask yourself how to improve your posture in the dental clinic.

Further study can help enhance a career in several ways. The level of career enhancement can be determined, to a certain degree, by the amount and depth of further study undertaken.

Practicing the art of dentistry requires a high degree of concentration and precision. But awkward postures, repetitious hand movements, and persistent vibration to the hand and wrist from a high-speed hand piece can make practitioners vulnerable to musculoskeletal disorders. Consider that many dentists work in a static, uncomfortable position when treating patients. This sustained position can lead to pain, injury, or, in severe cases of musculoskeletal disorders, disability or early retirement.

Many educationalists will advise that one of the best and most convenient ways to study is via the blended learning route.

According to a study published by the British Dental Journal Team, musculoskeletal disorders are the leading cause of illnessrelated early retirement for dental professionals. Common problem areas include the lower back, shoulders and hands. Early stages of musculoskeletal disorders can go unnoticed by a dental practitioner. It’s important to be aware of your working habits and posture, and to consider any risk factors for these disorders, like working without an assistant, a hunched posture, not taking breaks or not doing any stretching exercises. Here are some tips to avoid such injuries. First, you need to select a stool for lumbar support, adjusted so that you sit with your feet flat on the floor and your thighs sloped downward. Position the patient in a manner that helps you stay in ideal ergonomic form to avoid straining your neck and back. Make sure your dental unit has a thin backrest and no obstacles underneath the chair so you can get as close to the patient as possible without bending over. The instrument delivery tray you are using should be light and easy to move with one finger. Use appropriate lighting and loups to minimise strain to your eyes and to help prevent your neck from craning forward. And finally, design your operating area so that you can easily reach and grip your instruments. Whether you are still at the beginning of your career or mid-way through, it’s important that you develop good habits. In order to do so, ask a physiotherapist or expert to show you how it should be done.

There are a variety of post qualification training courses available to all dental professionals - these will range from courses of a few hours’ duration to Masters degrees and specialist training that are many years of further study.

Blended learning is an approach that combines accessing online educational materials and online interaction with tutors and other learners. This is coupled with opportunities for interaction via traditional “classroom” methods. As an example, at the Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, students studying for a post qualification award in certain dental disciplines, via the blended learning route, will attend a residential element at the faculties post qualification and training centre – LonDEC (www.londec.co.uk) - for the very important practical skills learning. The rest of the academic year is spent learning predetermined subject matter online at a time of their own convenience that suits them best. Many dental professionals find blended learning a good way to enhance their skills as it allows them to continue working whilst also studying – learn whilst you earn, is often used to describe how this method of skill enhancement suits some people’s needs. Many blended learning programmes also allow learners to stop at a certain point within a programme if they feel they have attained the level of enhancement that fulfils their needs. This need can of course be learning skills or gaining a qualification, and for most, it’s a mixture of both. Most education providers offer open days or open events and signing up to these can help those wishing to enhance their careers determine which way is best for them. Attending a short CPD course organised by a provider that also offers further and enhanced study, will also give learners an excellent feel for how further study could be with that institution. Many dentists attend the short courses at LonDEC for this reason and then go on to sign up for a blended learning Masters programme. For further info on any of the above feel free to contact info@londec.co.uk or https://www.kcl. ac.uk/study/faculties/dental-institute/distance-learning.

Bill Sharpling

Associate Dean (CPD), Director LonDEC, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London.

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Editorial Board

This technology works

Why use a professional broker?

How can the introduction of scanning and software solutions act as a flexible and powerful tool to help take a business forward?

You require the very best funding options available to you, but have you got the time to source the best products within the marketplace?

Dental shows and publications are inundated with companies promoting their digital dentistry solutions, most notably; intra oral scanners, software, 3D printers and milling machines. Alongside these marketing efforts are lectures and articles presented by a whole range of professionals including the key opinion leaders, but also, more and more unlikely faces are appearing sharing their digital experiences. The reason is simple: this technology works, it works well and is now becoming more and more mainstream.

Running your business is time consuming enough, but a professional broker will know exactly how to package a proposal to ensure they secure the best finance package in the quickest time. They will provide an initial quote so you will know full costings at the beginning, and they complete the whole process by dealing with your supplier, invoices and ensuring payments are made on time to enable a smooth process.

Amongst the obvious reasons why a clinician may employ this type of technology (i.e. accuracy, patient comfort etc), one of the key reasons is that is often considered as a great practice builder.

Using the services of a professional broker can add inherent value at a fraction of the cost. A broker who understands which funders would better support your application based on your own background and experience is invaluable and can provide you with the best rates to suit your circumstances.

Patient engagement and trust: For the most part, patients love to see their scans, there are also those who hate looking at their teeth! To have a full, real-colour, 3D representation of a patientâ&#x20AC;&#x2122;s teeth in front of them is a powerful communication tool. It helps the clinician clearly explain what is being discussed and it aids the patient in fully understanding the need for treatment. Self-prescribing: Patients will often spot something that concerns them, for example, a chipped molar or excessive amalgam and open the discussion about potential next steps, your role is to simply facilitate and guide. Increased efficiency: With the correct system and correct training, scanning is faster, it is more accurate than conventional impressions meaning your impression appointments will be shorter and the need for adjustments and remakes will be reduced. Delegation: In non-invasive cases, nurses often scan patients, freeing clinicians up to do more dentistry. Peer communication: Products such a 3Shape communicate include the ability to seamlessly communicate with labs and peers to share and discuss cases. Indication of commitment to patients: Intra-oral scanning and the associated software and tools does require a reasonably significant investment but you are not investing in a toy or a gadget, you are investing in your practice and your patients and this can offer a strong message. Scanners and the associated software are no longer the future, it is the now! Feel free to contact us at ESM to discuss how it can work for your practice. Phone 020 8816 7840.

Mark Barry

Director, ESM Digital Solutions.

Most professional brokers know which funding options will be more likely to support your application, and at the most competitive rates, saving you a great deal of time, hassle and money! Many of the best options are not available directly to you so it pays to use a specialist independent finance broker. Understanding which finance house has an appetite for your requirements can be crucial, because although most funders want the straightforward proposal, we all know that your requirements are sometimes not straightforward. Believe it or not, many funders donâ&#x20AC;&#x2122;t just want to lend money to anyone, they all have different criteria for different projects, and this can be reflected in the rates they will charge you. Some of the additional services you can secure with a specialist broker is to provide stage payments to enable suppliers to have funds during various stages of the project. You can also secure deferred payment options to help with other costs during your project, especially at the beginning, so deferring payments during the first few months can help with cash flow. We believe it is all about trust, if you can trust your broker to provide you the correct options at the best rates and secure approval, then you do not have to worry about your application.

Rob Griffin

Director, Aspired Finance.

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Editorial Board

What should first time practice buyers consider when looking to own their own practice?

What opportunities do mergers and acquisitions offer an already established dental practice?

Mike Hughes

Owner, Dental Practice Consultancy Service. Of late, the demand for practice purchase is tending to outstrip supply, and the danger is that this can lead to ill-advised purchases where the practice purchased does not meet the needs and expectations of the buyer. These are some steps you should take before even looking at prospectuses for practices that are for sale so that you can weed out those that are not going to work for you. Ask yourself where you want to be in 10 years’ time. Do you want to be a dentist or a business entrepreneur? If it is the latter and you have the resources to fund it, then you are probably going to need a larger multi-surgery practice that will stand up as a business entity, independent of your direct involvement as a practicing dentist so that you can work on your business development. If, however, it is the former, then a smaller practice with a good profit potential that is easier to run maybe more suitable for you.

There is a rise of “mini-corporates” in the dental industry. I act for a lot of entrepreneurial dentists who are keen to own several practices rather than just one traditional lifestyle practice. When this is the case, I always ask them to think of the big picture and have a long-term plan in place. Owning more than one practice does not always mean earning more money (when you factor in bank loans for purchasing), and I can guarantee you it will mean twice the headaches. It is really important to have a long-term strategy so that you can check your acquisitions compliment the vision and, ultimately, help you achieve the end goal. Buying up any practice because it is going cheap is not a good strategy! Both mergers and acquisitions offer economies of scale. This is because there are often cost savings relating to larger businesses.

Do you envisage working primarily within the NHS or privately? If you feel that your ambitions lie as a private dentist, why purchase an expensive NHS business and go through the pain and uncertainty of converting it when there may be a good private practice available that you can purchase more cost effectively?

For mergers where the practices move into the same premises, there are significant cost savings to be had in terms of the premises costs – rent, rates, heat and light. Reduced accountancy fees (as only one business, not two), less staff costs, only one reception rather than two and only one practice manager for example. The administration costs of patient plans reduce as the patient numbers increase and the ability to negotiate with your suppliers increases as well.

Do you have plans to pursue specialisms such as facial aesthetics, implantology or orthodontics? If so, does the practice lend itself to pursing these options? Do your plans entail attracting patients directly in which case you need a practice with high visibility? Or are your expectations more aligned to obtaining referred patients, in which case a practice that is easy to find and where parking is easy is likely to work best.

Acquisitions of additional separate practices offer less costs savings but increased opportunities in terms of referrals. If you are a specialist practice purchasing a well-established local practice that currently refers all their specialist work elsewhere means that you can start to refer the work to your specialist practice and increase your turnover and profits at the current practice.

Finally, and perhaps most importantly, you need to consider what the practice might return to you financially. There are many practices that are making a reasonable living for their current owner who is debt free, but which might produce a significantly lower net return after considering acquisition costs, debt servicing and of course any potential refurbishment that may be required.

When looking at an additional practice you need to ensure that it can stand on its own two feet and make money being associate led, or at the very least, be able to service the business loan. If you are the only business owner, then a good practice manager(s) is key. Remember that there is only one of you and you can’t be in two or three places at once!

We have a long experience of working with practice purchasers in order to ensure a good fit for a target practice and provide a bespoke consultancy service aimed at this important phase in a dentist’s career.

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Heidi Marshall

Partner, Dodd & Co Limited, Chartered Accountants & Business Advisers.

Editorial Board

How is the relationship between dentists and dental labs evolving?

How realistic or advisable is it for dental professionals to admit their own mistakes?

Sophie Gray

Dental Compliance Manager, Isopharm.

And what does this mean for patients moving forward? This is an interesting conundrum and one that has two very distinct answers. In the simplest terms, it’s a matter of scale. Do you, as a dentist, want a huge lab making 100,000s of appliances a day in a fully automated process? Or do you value a more bespoke, lower volume but much more personal service? Companies, like GEO Nuvola aligner, make fantastic products and have the benefit of being able to pick up the phone and discuss things with a human being who understands you and your patients’ wishes rather than joining a queue for an adviser which could take days. In prosthetics, when you look at costings for a crown lab fee ranging from £24.95 to £280+, you could expect to see quite a range in quality and finish of the products. Personally, I have always worked to have a lab with whom I can pick up the phone and discuss a case, I value the relationship with the laboratory far more than the lowest cost restoration. With this in mind, we move to sending photos to the laboratory (easier than sending the patient themselves, however, that is another valid alternative). The high-resolution digital images which our cameras can produce give the technical team a world of information. Combine this with systems like elab, grey card and polarisation, and suddenly, 99% of the guess work is removed. The results can be stunning. On a level above, some practices have their ceramicists working directly on site. Of course, these practices have a high enough volume to support the technical team and are often doing multi-unit cases daily. As my career has progressed, my knowledge of what is possible has driven my desire to achieve it or surpass it for each new case. A lab with an accessible and clear input system allows me to upload 3D scans, photos and prescriptions from anywhere and at any time! So, in terms of what the relationship between dentists and their labs means for patients moving forward, I guess it depends on which type of dentist/laboratory relationship your practice has. If it’s the right one, the future is very bright!

Dr Richard Brown

Parrys Lane Dental Practice and Bupa Dental Care, is a Nuvola Speaker for Nuvola Courses.

Dental professionals must observe the highest ethical standards, place patients’ interests first and act to protect them. The General Dental Council’s (GDC) Standards for the Dental Team (2013) form the ethical guidance that dental professionals must apply in their everyday work. The below extracts from this guidance should be kept in mind. • Put patients’ interests first (principle one); • Be honest and act with integrity (standard 1.3); and • Offer an apology and a practical solution if a patient makes a complaint (standard 5.3.8). In addition to this, the GDC’s professional duty of candour guidance details being open and honest with patients when something goes wrong whether they have made a complaint or not. This means that healthcare professionals must: • tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong; • apologise to the patient (or, where appropriate, the patient’s advocate, carer or family); • offer an appropriate remedy or support to put matters right (if possible); and • explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened. It is important to note that apologising to a patient is not the same as admitting legal liability and registrants should not withhold an apology in fear; this could cause issues later down the line. In addition to a professional duty of candour, organisations which provide healthcare services carry a statutory duty of candour. Meaning practices have a duty to support their staff to be open and honest when something goes wrong. The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England who ensure health and social care services provide people with safe, effective, compassionate, high-quality care and encourage care services to improve. They introduced Regulation 20: Duty of candour which sets out specific requirements that providers must follow when things go wrong and are underpinned by the Health and Social Care Act (Regulated Activities). This includes illustrative examples of incidents that trigger the thresholds for the duty of candour and links them to specific extracts of the regulation. To conclude, it is both realistic and advisable for dental professionals to admit their own mistakes and the guidance noted above provides templates and advice on the best approach for such situations.

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Modern Dentist Magazine

Features

Fulfil your potential The Dawood and Tanner Academy is a training and education centre based in central London. Their aim is to create a community of dentists, dental care professionals and administrators who wish to fulfil their true potential through accredited training. Here they outline how a training course cannot only benefit the dental professional but also the dental practice. Besides the fact that Andrew Dawood and Susan Tanner are recognised experts in the field of implant dentistry, they are extremely approachable and so willing to share their very considerable clinical experience - Dr Serge Kotok Satisfied patients who have had implant treatments that are minimally invasive, frictionless in execution, long lasting and trustworthy are the best advertisement for a dental practice, helping it to grow in stature and reputation. A well-trained team allows clinicians to focus on their work, something that patients always recognise. A philosophy of continual growth and improvement not only benefits clinicians but will lead to improved business success and increased team morale – ultimately all to the benefit of patients. The desire to make sure that our own team and our referrers were well trained led, to the inception of the Dawood and Tanner Academy. Modern dentists are trained to learn processes and procedures, of which there are many in implant dentistry. They are also educated to be wiser and more reflective on their treatments; to be able to step back and see the bigger picture, consider alternative options and long-term perspectives. Continuous training not only helps clinicians to keep up to date with the latest techniques, materials and available equipment to improve quality of their treatments, but also improves patient’s confidence as they are being treated by a clinician committed to continuous professional development.

Training gives us an excellent opportunity for meeting our peers. As dentistry can sometimes feel solitary, we can benefit from knowledge transfer through the sharing of ideas and experiences. It is important to continue attending training courses of topics that could be slightly outside of your scope of practice, so that you can broaden your knowledge and understand how other clinicians can contribute to a multidisciplinary approach. A short course can be the driving force to make that move to specialty training, changing the way you treat patients or even increasing the skills of your dental nurse. It is very important who you choose to learn from. Lecturers can have a great positive impact towards your perception of dentistry and motivate and inspire

you to continue aiming for excellency. Personal and professional skills have a direct impact on the development and improvement of the practice’s business. The Dawood and Tanner Academy is a dental training centre with a difference. The Academy developed from the culture of the Dawood and Tanner Specialist practice, where advancement in skills and training, together with a multidisciplinary approach, has been an inherent part of treating patients successfully. The Academy has a team of educators who are leading dental professionals in their field, respected tutors covering all aspects of post graduate dental training; they will share their knowledge through current dental techniques and inspire you to grow within your profession. For more information about the Dawood and Tanner Academy, please visit: www.dawoodandtanneracademy.co.uk, or contact the team about courses on 0203 219 5975.

The course consisted of one day a month over a few months - I felt that it was structured well and wasn’t overwhelming. Attending a course with the Dawood & Tanner Academy gave me the knowledge and confidence to restore implants and I have since begun restoring implants on my own patients - Dr Shan Lam

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Modern Dentist Magazine

Features

Advances in Caries Detection The iTero Element 5D Imaging System with Niri Technology is providing a timely aid to dental radiographs for caries detection. This advancement will help dentists avoid patient exposure to excessive and repetitive radiation, reducing the risk and improving patient safety. Align Technology, Inc. (NASDAQ: ALGN) announced that its near infrared imaging (NIRI) technology was developed to aid dental professionals in detection of interproximal caries. Align’s award-winning iTero Element 5D imaging system does not emit harmful radiation to capture images, making it possible to scan the internal structure* of patients’ teeth in real time. As well as presenting 3D colour dental imaging features and outcome simulation, the scanner comes fully integrated with technology to aid in the detection and monitoring of interproximal caries lesions above the gingiva.

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This is a timely advance that may help dentists with regular monitoring of their patients’ teeth, without the need for repeated exposure to harmful radiation. In the study, published in the October 2019 issue of Thyroid magazine1, researchers have concluded that dental radiographs should be prescribed only when the patient has a specific clinical need and not as a standard part of routine dental evaluation, and that dental professionals should avoid unnecessary screenings. iTero Element 5D scanner may become a standard of routine monitoring that can help catch lesions earlier and at the same time, help dentists avoid patient exposure to excessive and repetitive radiation.

The iTero Element 5D is the first intraoral scanner that uses near-infrared imaging (NIRI) to scan the internal structure of the teeth – thereby acting as a digital aid for detection of interproximal caries. While dentists may still need to take traditional x-rays, they now have an option to use the iTero Element 5D scanner to scan patients at every visit for preventive oral health. This allows for more frequent monitoring of interproximal caries during every routine appointment, thereby helping to ensure that a patient’s lesion progression can be tracked and receive timely care, whether that’s preventative or interceptive treatment.

Features

Diagnosing carious lesions or cavities, especially those that are interproximal, can be hampered by numerous factors, including variations in tooth shape and alignment. Traditional x-ray film limitations include variability in exposure levels, poor angulations in image capture or overlapping contacts in the image

Image of Dr Marcos White, The Courtyard Clinic Academy

Dr Mitra Derakhshan, Align Technology vice president, global clinical, advised: “Diagnosing carious lesions or cavities, especially those that are interproximal, can be hampered by numerous factors, including variations in tooth shape and alignment. Traditional x-ray film limitations include variability in exposure levels, poor angulations in image capture or overlapping contacts in the image, and more. The iTero Element 5D Imaging System aids in detecting and monitoring the progression of interproximal cavities above the gingiva without harmful radiation, helping ensure that patients receive even better care.”

Caries progression assessment

This is a timely advance that may help dentists with regular monitoring of their patients’ teeth, without the need for repeated exposure to harmful radiation

Additionally, through iTero Element 5D scanner’s visualisation tools, patients can see what the dental professional sees – empowering practitioners to make even more informed decisions for the care of their patients if and when their carious lesions progress. This may also help patients to gain a clearer understanding of their oral health – according to the recent Align survey, users agree the

imaging and visualization capabilities of iTero Element 5D are designed to enable better patient education and improved understanding of their oral health.** Prior to the iTero Element 5D scanner launch, only separate caries detection devices existed as a complement to x-rays; however, this required practitioners to make additional investments on top of the existing x-ray technology, and also created inefficient chairside workflows. By seamlessly combining three key scanning technologies (3D data, intra-oral colour photos and NIR images) into one, single integrated scan, the efficiency and inter-connectedness of the dentists’ workflow may also increase dramatically. It was this cutting-edge innovation that led to the iTero Element 5D scanner being awarded 2019 High Technology Launch of the Year at the UK’s Dental Industry Awards.

*Enamel and dentine. **Based on a survey in May of 2019 of n = 15 practitioners who experienced working with iTero element 5D for an average period of 6 months, representing both GPs and Orthodontists in CAN, EMEA and APAC, who were presented with a level of agreement scale from strongly agree to strongly disagree with the following statement: “The Imaging and visualization capabilities of iTero Element 5D scanner are designed to enable better patient education that lead to better patient understanding of their oral health”. Data on file at Align Technology, as of November 15, 2019. 1 Dental X-rays and the risk of thyroid cancer and meningioma: A systematic review and meta-analysis of current epidemiological evidence”, published online on 14 October 2019 in Thyroid, ahead of inclusion in an issue.

For more information on the iTero Element 5D scanner, please visit www.itero.com, or contact your local iTero representative.

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Modern Dentist Magazine

Features

Getting it right Managing business risk in dentistry Dental businesses need to equip themselves to manage continual challenges, all of which call for an extensive range of knowledge and skills to prevent management inadequacies from undermining clinical excellence. Every practice must be equipped to manage business risks such as, patient dissatisfaction, shortages of essential materials, technical problems, the shortage of high-quality staff, or even environmental disasters that potentially pose challenges for dental businesses. Dentistry is heavily regulated. Quality management standards are enforced by regulatory bodies with authority to implement sanctions if standards of patient care fall below the nine principles of the General Dental Council’s (GDC) Standards for the Dental Team: and for practices in England, the Fundamental Quality Standards, derived from the Health and Social Care Act 2008 and regulated by the Care Quality Commission. When it comes to meeting the regulatory standards, formal management education is vital to know and keep up to date with the required standards. With the right training, the team can make the regulations tools for success, rather than a burden for business. Teamwork is essential to reduce the burden of compliance. The CQC set out the required

Business risk is manageable when quality management within regulatory guidelines directs the practice management

management structure with the Registered Provider, ultimately accountable for the quality of the services provided, as set out in the Statement of Purpose developed as part of the initial registration process; and the Registered Manager, with responsibility for meeting the Fundamental Standards of care provided and monitored by the CQC and detailed in the Key Lines of Enquiry (KLOE)

• The skills mix in every practice must include extensive ranges of skills and knowledge to initially meet these KLOE requirements and also keep these measures up to date and fit for purpose

In terms of business risk management, the Wellled KLOE provides both standards and guidance for meeting them. In particular, W5 requires that there are clear and effective processes for managing risks, issues and performance. It species the need for the service to include: • Comprehensive assurance systems, performance issues escalated appropriately through clear structures and processes which are regularly reviewed and improved (W5.1) • Processes to manage current and future performance which is regularly reviewed and improved (W5.2) • A systematic programme of clinical and internal audit to monitor quality, operational and financial processes, and systems to identify where action should be taken (W5.3) • Robust arrangements for identifying, recording and managing risks, issues and mitigating actions? Is there alignment between the recorded risks and what staff say is ‘on their worry list’? (W5.4) • Risks Assessment when planning services, for example, seasonal or other expected or unexpected fluctuations in demand, or disruption to staffing or facilities (W5.5) • Assessment of the potential impact on quality and sustainability when considering developments to services or efficiency changes (W5.6)

Over more than 30 years working with dental practice managers Glenys Bridges and PartnersAcademic has created a series of accredited courses, (see www.glenys.bridges.co.uk) ranging from supervisory management training for Lead dental nurses and receptionists, progressing on to operational management programmes at level 4 for practice managers, and on to our Level 5 Management Skills for CQC Registered Managers.

The guidance for providers falls short of a clear statement of the level of management qualification required to meet the standards.

We offer a pathway for management excellence, supported with free access for our students on practice management courses to our growing range of management skills eCPD programmes focusing on eCPD Category C (Maintenance and development of knowledge and skills within your field of practice). In addition, we provide a free monthly newsletter to update, inform and entertain our subscribers; you can subscribe at http://eepurl. com/gf3n91. Working hard is not enough; working SMART is more likely to result in the implementation of the required quality management standards, client satisfaction and a motivated team. Business risk is manageable when quality management within regulatory guidelines directs the practice management.

Glenys Bridges CMIPD

is the Managing Director of Glenys Bridges Practice Pathways.

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Modern Dentist Magazine

Practice Focus

Everything you need in a patient plan, without paying for anything you don’t. Admin fees from just £1 per patient per month Your own dedicated and experienced business development manager The freedom and ﬂexibility to build the right plan for you and your patients

Yorkshire Dental Suite

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Practice Focus

Dr Abdul Dalghous is the Owner of Yorkshire Dental Suite, and in partnership with his wife and two sons, has spent almost two years turning what was a well-known Doctor’s surgery into the outstanding premises that now houses Yorkshire Dental Suite. Originally from Libya, Abdul came to the UK in 1994 following the offer of a scholarship to complete a Masters Degree in Head and Neck Surgery at the University of Leeds. Since then, he has become a highly experienced specialist Oral Surgeon, spending the last few years working in numerous Yorkshire hospitals’ Maxillofacial Departments. Alongside his hospital work, he spends his time providing Oral Surgery Clinics throughout the Yorkshire area for Leeds NHS England and the Leeds Dental Institute; while providing tuition and touring various dental schools in Libya as a visiting Professor. As the educational supervisor for the Maxillofacial surgery department in Leeds, Abdul is heavily involved in the teaching and training of many clinicians, not only in oral surgery but also implant placement techniques, and he continues to share his expertise through the courses he runs in the purpose-built lecture facility at the Yorkshire Dental Suite Training Academy. “I enjoy teaching,” said Abdul, “and it is a pleasure to spend time with dental professionals and either help them learn something new or help them enhance their abilities - I believe interactive and practical teaching is the best method for dentistry.”

The practice offers a unique dental experience and every member of the team is prepared to go the extra mile for every one of their patients in order to maintain and improve their oral health

Abdul also has plans to give back to the wider community, especially in Leeds. “My next project is to build a charity in the local area,” he explains, “there are a lot of people in this part of the country that can’t afford to pick up the phone and ask for help – I want to change that.” Abdul’s plan is to host an open-house session for people who need dental treatment but can’t afford it; and during that session he will invite young dentists to conduct the treatments for free under his supervision; “the dentists will benefit from the opportunity to learn and build on their skills, while the wider community will have the opportunity to access free oral health care.”

Teamwork A practice built from scratch, the Yorkshire Dental Suite is a bubble of relaxation which provides a range of procedures, including wisdom tooth removal, complex surgical extractions, bone grafts, implants, and facial aesthetics. Abdul also accepts referrals for all aspects of Oral Surgery and implants from General dental Practices in and around

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Practice Focus

Our mission is to change the perception of dentistry

Yorkshire. But as Abdul explains, it is his team that helps shape the practice. The team at the Yorkshire Dental Suite are some of the most experienced and talented groups of dental professionals in their field. With five different clinicians working at the practice, every day is different, with the chance to be involved in a wide range of treatments such as implants, orthodontics, and cosmetic bonding/veneers. While most of his team are just starting out in their careers, every team member is given the chance to grow and develop by attending a range of courses, enabling them to become more confident in their role and widen their skill set, while working on their personal development. “I want them to aim for the top,” said Abdul.

Aiming for the top Yorkshire Dental Suite’s reputation in the market precedes them. “We have worked extremely hard to ensure we offer a first-class service,” said Abdul, “and we are very proud to have earned over 550 excellent five-star ratings on Google Reviews.” Yorkshire Dental Suite’s Facebook and Instagram brag huge followings, with their YDS Smile Journey videos generating hundreds of views, comments and likes, earning them a significant and positive standing in the eyes of the online community. It was only after the introduction of Abdul’s sons to the practice did the clinic’s presence on social media really start to rocket. With influencers from all over the country now walking through their door, the Yorkshire Dental Suite is becoming the centre for dentistry in the North. “Overall though,” said Abdul, “our mission is to change the perception of dentistry. We see

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a lot of patients who have a real phobia of the dentist, and we want to change that,” said Abdul, “it is all about making it an enjoyable experience for our patients and alleviating any fears they may have. Communication is the key – if we have a nervous patient walk through the door, we sit them down and gradually introduce them to the practice, we never go straight to the surgery.” Abdul understands only too well that patients can be worried about seeing their dentist; “A bad experience can stay with you for the rest of your life,” explains Abdul, which is why Yorkshire Dental Suite aims to create a “spa-like” experience for its patients, coupled with Abdul and his team’s in-depth knowledge and experience of sedation, the atmosphere is a comfortable one. Yorkshire Dental Suite strives to create a tailored approach for its patients, while guaranteeing long-term results. The practice offers a unique dental experience and every member of the team is prepared to go the extra mile for every one of their patients in order to maintain and improve their oral health. Yorkshire Dental Suite’s aim is simple: to enable their patients to show off their smiles with confidence and pride while offering a reliable and five-star service.

Mr A Dalghous Ph.D

(Oral Medicine); FDS RCS (Eng.); M.Dent.Sci (OMFS); FFD RCSI (OSOM); FDS RCS (Ed); FDS RCPS (Glasgow); BDS (Hon), Specialist Oral Surgeon and Implant Surgeon, Owner of the Yorkshire Dental Suite. For more information, contact Yorkshire Dental Suite at 0113 887 9594, or email them at hello@yorkshiredentalsuite.co.uk.

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Forum

Welcome to Modern Dentist’s first Forum - there’s nothing more stimulating than a discussion forum. Over the page you will have access to several different opinions, experiences and insights from some well-known specialists in the field. Our expert voices give their opinion to a number of questions focused on risk, clinical negligence and malpractice claims, in order to fall in line with this issue’s theme: Risk Management. While we may not always agree with what we read, if it enables a platform to discuss, explore and engage with not only colleagues but our fellow peers, then mission accomplished.

So, meet our Forum experts and join the discussion over the following pages.

Stephen Hooper is an Associate at Hempsons

Stephen joined Hempsons in January 2020 as part of the firm’s merger with Eastwoods. Stephen joined Eastwoods as their first paralegal in 2004 and became their first trainee in 2006. He qualified in 2008 and was made Associate in 2015. Stephen’s practice covers a range of disciplines, with a particular focus on defending professionals involved in regulatory and disciplinary proceedings such as GDC, GMC, HCPC, NMC and NHS Trust/NHS England Investigations. He is ranked in both the Legal 500 and Chambers & Partners for Professional Discipline. Stephen also defends clients facing criminal allegations including sexual assault, gross negligence manslaughter and fraud, and is recommended in the Legal 500 for General Crime. In addition, Stephen maintains a broad practice defending clinical negligence and personal injury claims, judicial reviews and statutory appeals, and has represented numerous clients at inquests.

Neel Jaiswal BDS (1996) MDGDP (2003) is a Director at Professional Dental Indemnity Ltd.

As a Partner in Professional Dental Indemnity Ltd I introduce dentists to a comprehensive dental malpractice insurance cover policy with a Lloyd’s of London approved underwriter who have years of dental experience and a global presence. As a fellow Dentist, it’s my role in the company to make sure we are being looked after. After graduating from Birmingham University Dental Hospital in 1996, I went on to attain a Vocational Training Certificate in Norfolk. Wanting to broaden my skills, I worked as a Junior Doctor in Oral and Maxillo-Facial Surgery at Lincoln Hospital. I then worked in Sydney, Australia gaining a wide variety of experience. Upon my return, I practiced in London and Middlesex and further trained completing my Membership exams at the Royal College of Surgeons. Neel Dentistry and Professional Dental Indemnity (PDI) gives me the perfect opportunity to demonstrate my professionalism and determination to provide the best possible care and results.

Expert bios continued over the page.

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Forum

WHAT IS CONSIDERED TO BE NEGLIGENT FOR A DENTIST? ISOBEL MICHIE Dental cases are often settled out of court without establishing case law. However, there are a vast number of clinical negligence cases that go through courts and produce the case law which is then applied to dental negligence cases. Bolam v Friern Hospital Management committee and Bolitho V City and Hackney Health Authority. Breach of duty: Bolam sets out that a doctor is not negligent if they have acted in accordance with a responsible body of opinion. Bolitho narrowed the scope of the test, stating that the court must be satisfied that the body of opinion relied upon has a logical basis. In other words, the independent expert evidence must stand up to scrutiny. The practice adopted must be in accordance with the standards of the time. Causation: In relation to all dental and clinical negligence claims for damages, the claimant must establish the breach of duty, but also that any such breach, on the balance of probabilities, caused the alleged damage. There is also a significant body of causation case law that Weightmans would be pleased to advise further on, particularly in relation to informed consent. Post Montgomery v Lanarkshire Health Board, in relation to informed consent, a leaflet outlining any procedure/treatment and its risks will not suffice. It is important that dentists discuss all material risks (i.e. risks that a similar person in that particular patient’s position would attach significance to). The different options for treatment, as well as any costs involved must be carefully explained and the discussion must be documented. The patient must have understood and be in a position, so that they can choose between options and decide what is best for them. They should be referred to a specialist service, if this is required. When this happens, the practice must pass on all relevant medical information. Darnley v Croydon Health Services NHS Trust establishes that if an NHS Trust chooses to delegate tasks to receptionists (non-medically-trained personnel), it will be liable for damage caused through the negligence of those staff where it results in foreseeable damage to patients even prior to admission to hospital; and this duty extends to patients who have not been treated because they have chosen to leave the hospital, where that decision results at least in part from misinformation provided by hospital staff. In Sanderson v Guy’s and St Thomas’ NHS Foundation Trust the court held that NICE guidelines are a practical tool to be used in conjunction with clinical judgement. They do not provide a substitute for logical clinical judgement which can be supported by responsible and reasonable body of dentists. We do continue to advise that any departure from evidence-based guidelines must stand up to considerable scrutiny and record keeping regarding the decision making.

Look for transparency; clear and fair terms with no hidden costs Len D’Cruz

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THERE CAN BE A FINE LINE BETWEEN MAINTENANCE AND NEGLIGENCE; WHAT CAN DENTAL CARE PROFESSIONALS DO TO ENHANCE THEIR TREATMENT PLANNING CAPABILITIES TO AVOID RISKS TAKING PLACE? NEEL JAISWAL It’s important that during recall examinations on patients we know that we are treating the patient with fresh eyes and reiterate the diagnosis and possible treatment solutions, plus the risks of not having treatment. Make sure this is recorded. Clear and accurate record keeping cannot be stressed enough.

HOW CAN A PRACTICE MANAGER ENSURE THE ENTIRE DENTAL TEAM IS REMAINING COMPLIANT? NEEL JAISWAL Be proactive. One of the ways to ensure that your dental team is remaining compliant is to ensure that audits are being done of record keeping and clinical success outcomes. Also, ensuring that the team has done a personal development plan and are maintaining their required CPD requirements, including complaints handling ethics, medical emergencies and cross infection, among other requirements.

Len D’Cruz is a Senior Dento-legal Advisor at the British Dental Association (BDA)

Len is a general dental practitioner, foundation trainer, practice owner testing the NHS prototypes, and senior dento-legal advisor at the BDA. He has 21 years’ experience supporting dentists with complaints, clinical and regulatory issues, and clinical negligence claims. He is lead lecturer at the University of Bedfordshire teaching on the MA in Dental Law and Ethics. He has authored and coauthored two books: “Understanding NHS dentistry” and “Legal aspects of general dental practice” (Churchill Livingstone), and has contributed legal and ethical content to a number of textbooks, journals and websites. He regularly shares his wisdom on NHS regulations and contract reform. He has both dental and legal qualifications.

Forum

BREAKDOWN IN COMMUNICATION IS A COMMON CAUSE FOR MANY CLAIMS FILED;WHAT ADVICE WOULD YOU GIVE TO DENTAL PROFESSIONALS TO ENSURE THEY ARE ALWAYS ON THE SAME PAGE AS THE PATIENT? STEPHEN HOOPER Many dentists are given this advice and simply hear the sound of an old, tired record being played to death, but it is an inescapable truth that communication is fundamentally important to safe (and hopefully complaint-free) practice. I have represented countless dentists who are clinically excellent, who have sound treatment plans in mind, but whose ultimate downfall is that they fail to explain themselves to their patients and then fall victim to complaints. Dare I say it, I used to be treated by a dentist who was guilty of that; lovely though she was, at times she failed to communicate her thought processes to me, and it was only because I probed (excuse the pun) and asked questions that I knew not only what she was proposing by way of treatment, but why that was the best treatment for me at that time (which it invariably was). Bear in mind that I have the advantage of knowing a little about dentistry because of my job – the average patient will not be as wellinformed as I am, so they are more likely to simply be led by you. In the post-Montgomery era, there is a greater emphasis on consent-taking being patient-focused. That means listening to the patient in front of you and catering your discussions and what information you share so it is relevant to that person – no two patients are the same, and you need to be sensitive to what is important to the person in the chair. Information leaflets are helpful, but it is far more important that you listen, and that you explain your findings and thought process to the patient, so they understand your proposals and are fully-aware of all the options available to them – even if some of those options (including having no treatment at all) are not what you would recommend. Ultimately, that means needing to offer your patient a commodity which is unfortunately rare for a busy dentist: time.

NEEL JAISWAL Always try and build a good and friendly yet professional rapport with your patients. Asking the patient to present their case back to you with the pros and cons ensures they have had time to consider and reflect upon their options. Following up the patient with a member of staff and asking for feedback also may stop potential claims happening if caught early enough and managed.

ISOBEL MICHIE The essential checklist to avoid claims: Good communication of all options and consider the individual patient’s needs. Ensure records of discussion and treatment are accurate, complete and up to date for on-going patient care and handover purposes. Monitor dental health, as it could be getting worse and take steps to improve it. Give medicines safely and store them correctly. Ensure there are always enough staff on duty with the right knowledge, skills and experience to make sure the patients are safe. Ensure the premises and equipment are kept clean and hygienic to prevent any risk of infection to patients. If staff or patients have any concerns about safety, then they should be able to raise them.

WHAT IS CONSIDERED MALPRACTICE FOR A DENTIST? NEEL JAISWAL The long answer is, in sums, that a dentist becomes legally obliged to pay as a result of a claim made against them arising from an injury, following from a negligent act, error or omission in the conduct of your professional business. In short, this means claims or allegations made against you from patients for their injury or your alleged wrongdoing. Policies do, however, widen out to cover regulatory investigations, review boards, expert witness work, and even matters like defamation. More recently, cyber cover is included along with data breaches and privacy matters.

Isobel Michie is the Principal Associate at Weightmans LLP

Isobel studied medicine before converting to law. Since qualifying as a solicitor in 1994, she has specialised in both clinical and dental defendant negligence acting on behalf of defence organisations, private insurers, NHS Trusts and NHS Resolution. Isobel has extensive experience across all dental and healthcare disciplines, including cases involving the utmost severity birth and adult brain injuries. She has a particular interest in cases that relate to informed consent. She has both extensive trial and mediation experience. Her advice is pragmatic, robust and cost-effective ensuring earliest possible resolution of claims and complaints, with a focus on patient safety and lessons learnt. Legal 500 2020: Rising Star & Key Lawyer

Record any incidents that happen and, if you receive a complaint, ensure that the practice deals with it in the right way and in accordance with the professional duty of candour (be open and honest). Apologise and identify the learning and identify how to stop the incident happening again to other patients.

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Forum

WHY ARE DENTAL CLAIMS FOR COMPENSATION INCREASING?

WHAT ARE THE COMMON PITFALLS THAT CAN LEAD TO CLAIMS AND REGULATORY INVESTIGATIONS? STEPHEN HOOPER

ISOBEL MICHIE Dental private treatment costs are increasing and less treatments are offered on the NHS. Patients often remain unsatisfied by a complaint response letter or how the complaint is handled, and this leads them to bring a claim for compensation. Patients continue to be better informed. Negligence continues to be increasingly in the news with public enquiries and the increasing involvement of the CQC. In addition, there has been a significant increase in cases involving the allegation of the failure to provide informed consent, as this issue has been coming before the courts more frequently in clinical negligence cases. In addition, the increasing number of cases where we see the practice rather than the individual dentist being found to be liable as a result of vicarious liability, is also likely to be a significant factor going forwards, as patients may decide to litigate against the practice, rather than the individual dentist. Never has it been more important to check your indemnity liability insurance cover and ascertain if it is discretional or contractual and exactly what it covers.

Never has it been more important to check your indemnity liability insurance cover and ascertain if it is discretional or contractual and exactly what it covers Isobel Michie

Communication: My first answer has touched on this. Communication and lack of informed consent crop up as issues time and time again in claims and regulatory investigations, with patients complaining that they were not listened to, that had they known more they would not have agreed to the treatment undertaken or that the dentist was unsympathetic or rude. Record keeping: I can probably count on one hand the number of GDC cases I have worked on where record keeping was not an issue. It is hammered home to dentists constantly these days, but it really is important - your records are your first line of defence, so make sure they contain enough detail to demonstrate that you did right by the patient. Remembering the basics: I have worked on countless cases where dentists have been pulled up for skipping the basics, getting into bad habits and then when a complaint comes in, records are audited and all of a sudden they are accused of being systemically deficient. Carry out and record your BPEs regularly; take appropriate radiographs at appropriate intervals, grade, justify and report on them; take regular medical and dental histories and ensure the records are kept up to date. Often, these mundane details are crucially important, and it can come back to haunt you if you sidestep them.

NEEL JAISWAL Taking different branches of dentistry, there are different risks that are prevalent to each. For endodontics, for example, it’s important to do a risk assessment and ensure that the treatment is within a generalist capability and record that a referral is always available and can be offered. For Dental implants; showing thorough planning and ensuring full and valid consent is important. For periodontal disease, it’s important to ensure you’ve talked about treatment option referrals; smoking/vaping cessation and have regular periodontal charting where appropriate. Ensure the risk of losing teeth has been explained fully, including drifting, over eruption and loss of bone for future implants or denture retention. In orthodontics and cosmetic dentistry, again, managing patient expectations and what outcomes are achievable and are being achieved; use photographs to help patients understand what their commitment is to the treatment, including information regarding cost, night guards or retention.

ISOBEL MICHIE The commonest claims for damages that arise in dentistry are as follows: 1. Failure to provide informed consent and fully discuss the benefits, options and alternatives, particularly in relation to root canal treatment or extraction. 2. Delay in treating decay, infection and periodontal gum disease. 3. Negligent/inadequate treatment (root canal, extraction and poorly placed implants). 4. Unnecessarily prolonged treatment. 5. Failure to assess bone levels and closeness of upper teeth to sinuses causing oral antral communication. 6. Failure to assess position of nerves before extraction of wisdom teeth causing nerve damage. 7. Delay in diagnosis of mouth cancer. We do see the same issues arising in dental claims and Weightmans would be pleased to advise further on identifying these.

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Forum

I have represented countless dentists who are clinically excellent, who have sound treatment plans in mind, but whose ultimate downfall is that they fail to explain themselves to their patients and then fall victim to complaints Stephen Hooper

WHAT IS APPROPRIATE INDEMNITY COVER? NEEL JAISWAL The market gold standard here is £5m, but some practices opt for anything up to £10M. We always recommend cover in the commercial indemnity market as this cover is contract certain and regulated by the FCA thus there is no ability for insurers to exercise discretion.

LEN D’CRUZ Occurrence-based The type of cover most dentists are familiar with is occurrence-based indemnity. With this, if you are paying a subscription that is appropriate to the nature and full extent of your involvement in dentistry, at the time that the incident occurs you are entitled to request assistance from your indemnity provider. This can include the granting of indemnity against some or all of any associated costs, such as any damages paid to a successful claimant together with their legal costs and any legal costs involved in representing/defending you. Crucially, your entitlement to claim continues even when your relationship with the provider ceases or is temporarily suspended/deferred (e.g. maternity absence, career breaks): it continues in perpetuity for any clinical challenge arising from dental treatment provided during the period of cover – effectively, for ever.

DO YOU THINK THE PATIENT WILL BE MORE “COMPENSATION AWARE” GOING FORWARD? NEEL JAISWAL I think this has already happened with numerous legal law firms targeting dental patients through radio and print media. Where there’s a blame, there’s a claim culture, which is detrimental to patients in the long term as dentist can’t help but act defensively.

Claims-made The most common alternative to an occurrence-based indemnity arrangement is called ‘claims-made’. This kind of indemnity is generally the preferred offer by insurance companies. In its simplest form you can buy claims-made indemnity for a single given year, covering only treatment provided or events taking place in that year and reported to the insurer before the end of that year. Other possible variations might allow this very limited cover to be extended forwards or backwards (or both), e.g.: • Retroactive cover (allowing the policy to cover treatment provided during a specified period prior to the start date of the policy). • Run-off cover (allowing the policy to cover incidents that took place when the policy was in force, but which were not reported until after the end date of the policy. This is also called an ‘extended reporting period’ and is usually subject to a time limit). As if all this were not complicated enough, retroactivity and run off may attract additional premiums, or may not be offered at all. In addition, special conditions may well apply to the policy in some commonly encountered situations, creating unexpected gaps in cover. Protection Whether or not the cover you have is sufficient for your needs, depends on what the provider says is included and sometimes that’s not clear until something has gone awry and you need support. Look for transparency; clear and fair terms with no hidden costs. If you’re diversifying and providing facial aesthetics, you’ll want to know that’s included. If you’re responsible for staff as well as patients, check that your policy includes vicarious liability. Clinical negligence claims are expected to be covered but maybe GDC hearings aren’t. Support Check who’ll be at the end of the phone to help when you need it. Ideally, it’s someone who does or has done dentistry. Knowing that person speaks your language and can empathise adds an additional intangible moment of ‘phew’ in a moment of high stress.

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How do you avoid common pitfalls in the era of increasing dental negligence claims? Are you working in collaboration with experts who can help you understand the law and demystify the nuances to help you ensure safe practice? Get in touch to find out how we can help you to ensure safest possible working practices and how to resolve complaints and to prevent and defend any claims that may arise.

For further information please contact: Isobel Michie on 020 7822 1930 or isobel.michie@weightmans.com

www.weightmans.com

Isobel Michie, Principal Associate

Features

Risk Management in Dentistry Life in general is a series of risks.We learn to manage these risks as best as possible.The same applies in dentistry and our aim in 2020 should be awareness and management of these risks.This brief article will highlight the various factors we should always be mindful of while risk managing our practise. General Dental Council (GDC)

Informed Consent

It is imperative to always practise in accordance with the GDC’s Standards for the Dental Team. There are nine equally important principles you must always abide by. Always put your patient’s interests first. Ensure the public will always have confidence in you and the profession whilst maintaining the public interest.

You must always ensure to receive the patient’s fully informed valid consent at all stages in their oral health treatment and management. You must disclose all treatment options, risks and benefits, costs, etc., so they will be able to make an informed decision. Remember that consent may be withdrawn at any time and patients should not be coerced into having treatment.

Care Quality Commission (CQC) Your dental practice must comply with CQC’s five key lines of enquiry, that is, is your dental practice safe, effective, caring, responsive and well-led? You will need to have knowledge and demonstrate compliance at your inspection. You must incorporate all relevant regulations and legislation into your practice.

Record Keeping All patient records should be clear, accurate, contemporaneous and complete. This can not be stressed enough. According to the CQC, “One of the fundamental criteria used to manage risk in a dental practice is keeping good quality clinical records”. This should include a patient’s current medical history. Patient records should be audited systematically leading to insight into areas of improvement. The FGDP’s guidance on Clinical Examination and Record-Keeping is a useful tool to use.

Indemnity Registered dental professionals must hold appropriate indemnity for your scope of practice so that patients may claim any compensation to which they may be entitled. Ensure you have the right coverage to cover all your clinical responsibilities. This is without doubt of critical importance in a culture where there is a growing fear of litigation.

Complaints Handling It is crucial that a practice implements a proactive transparent approach to complaints handling so that patients feel confident to express their views, concerns and dissatisfaction. It is imperative that each practice has its own personalised complaints policies and procedures. All staff should be trained in how to competently manage a complaint.

Communication

Work Environment

Both verbal and non-verbal communication should be consistent, transparent and patient’s must easily understand what is being discussed. Open two-way communication must occur during all stages of patient care especially the treatment planning stages.

It perhaps would be an understatement to say that without a doubt dentistry involves high stress levels due to various factors including but not limited to the nature and actual working conditions in the dental practice; time pressure, challenging patient and personal interactions

The explosion of social media has brought a new wave of patients seeking to create the ‘perfect smile’. Be mindful to align patient’s expectation to clinical outcome.

and specific practice issues. Be aware of all your triggers and attempt to manage these in bite size chunks. Reflect on these and create an action plan on how to successfully control these. Maintain a supportive network both personally and professionally; this is of great importance if you are practising in isolation.

Skills and Knowledge The dental profession is continuously evolving, and it is critical to keep up to date of all the dynamics involved. Create your personal development plan and ensure you are competent in your field of practice.

Conduct You must act professionally and with integrity in both your personal life and whilst you practise dentistry. Your behaviour and attitude must always be what would be expected of you as a professional. This is very important to remember in today’s day and age where anything may be shared on the internet and on social media with a click of a button.

Conclusion As the new decade dawns upon us, it is imperative to seek aspirations, create goals and look to create a better version of ourselves while fully appreciating and being vigilant of all the risks we are vulnerable to. Robust risk management is integral to your success in dentistry.

Priya Sharma

BA (Dist.) BSc (Pharm.), RDN, FRSA, FRSPH has a wide range of experience in practice management, professional regulation and compliance.

Robust risk management is integral to your success in dentistry

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Features

Dentistry in 2020 Increased claim risks Practice owners and principals are now often picking up their associatesâ&#x20AC;&#x2122; claims. Callum Goulding Cert CII, a Senior Healthcare Development Executive at Insync Insurance, outlines why it is important to transfer the risks to your insurer.

Case Study

Mr X owns 10 Dental Practices within his family run business. Across these locations are hundreds of nurses, therapists and dentists all holding varying indemnity subscriptions and policies. On reading an article and speaking to a close friend that I previously insured, Mr X decided to insure the business for medical malpractice for a contingency policy in the event of a claim. A long-term practice associate decided to leave the UK and the patient list was shared between remaining dentists in the practice. Within a year, a single claim arose, then another, then another. A no win no fee law firm were raising complaints and initially the dentists that picked up the waiting lists, who had never had a claim, were being targeted. After a thorough investigation, all claims were sourced and thought to be the responsibility of the dentist that had left, but they were untraceable, and the defence union had in fact backdated a subscription cancellation due to unknown GDC action as a result of previous complaints. Therefore, no primary indemnity existed. Based on purchasing a contingent policy; Mr X was able to deflect all proceedings to his insurer who offered a ÂŁ10,000,000 limit covering all defence costs and subsequent pay-outs. The count to-date for costs stands at over ÂŁ150,000 and counting, while more claims arise. Without taking this cover on, Mr X would have faced these claims alone and would have incurred these costs himself.

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Features

No matter what you are doing; the moment you hire or appoint another practitioner you are exposed to any risks highlighted in this article

What can cause claim failure? • If an associate doesn’t notify their claim or is untraceable • If the defence union exercises discretion and fails to represent, e.g. post GDC action • If the associate fails to maintain ‘run-off’ cover and their past work is not indemnified • If the defence union backdates member subscription termination for a period that includes clinical work undertaken while working with you

In an industry where litigation is on the rise and protection is failing; do not take the risk. Transfer the risks to an insurer and focus on running the best practice and business that you can

Firstly, a bit of background… Increased work opportunities for associates in the UK and overseas, public health matters provoking time off and young dentists leaving or reducing hours to start families, are all factors boosting the locum and agency markets, meaning associates come and go as does their indemnity. The main point to highlight is that the dental defence organisations offer discretionary cover and the insurance-based provisions are ‘claims made’ and need to be maintained for them to work. Insurance or union indemnity can fail and can result in claim repudiation.

If any of these situations occur; you can hold the full claim liability as the practice owner and provider!

What can happen next? It is understood that as practice owner you will likely have a premises cover including the buildings, contents, and liabilities cover (Surgery/Clinic policy), while maintaining a separate professional indemnity subscription or policy to meet GDC requirements and cover you for your clinical work. Beyond this, you will ensure all dentists are independently indemnified. If any of the claim failures listed above occur; the lawyer or well-informed complainant will often change direction and be too invested to drop the claim so will then turn on you; the practice owner and service provider. The most frequent outcome here is that you are not protected in the event of this happening and can end up dipping into your business bank accounts or own assets to engage legal services and defend claims. If the dentist failed to maintain accurate and well-kept dental records, or if they have genuinely been negligent and have caused severe damage or injury to a patient; your damages costs can run well into six figures.

a knock-on effect on your practice and future successes.

What is the solution? For many years I have offered practice policies that cover the whole spectrum, including small practices with one site through to large companies with dozens of locations and hundreds of staff members. These can include NHS lists exclusively through to full private practice, advanced aesthetics and surgical clinics, implants and orthodontics. No matter what you are doing; the moment you hire or appoint another practitioner you are exposed to any risks highlighted in this article. A practice policy for contingent medical malpractice cover transfers all these risks to your insurer.

Conclusion… We know that individual claims can occur against you without fault. The more associates that work for you, the greater the risk. In an industry where litigation is on the rise and protection is failing; do not take the risk. Transfer the risks to an insurer and focus on running the best practice and business that you can.

Callum Goulding Cert CII

is a Senior Healthcare Development Executive at Insync Insurance. You can contact Callum at callum.goulding@insyncinsurance.co.uk for more information and advice.

With the increase of social media engagement this can also impact your reputation and have

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Features

Missing a trick

As we herald in a new decade, the oral care industry is at risk of sleepwalking into some pretty hefty challenges on the horizon. The opportunities for players in the market are staggering - in 2020, the global oral care market is estimated to be worth about $39.47 billion (approx. £30.33 billion). However, this means the amount of choice available to consumers today is burgeoning, and if this rate of growth continues, will quickly spiral out of control. While choice may sound like a good thing for buyers, it’s overwhelming. A jungle of brands screaming that they’re the only way to avoid diseases X, Y and Z. How are consumers supposed to make a proper, informed

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choice? And how are brands supposed to avoid getting lost in the noise? You must find an authentic way to be the brand that everyone talks about the most. And consumers don’t necessarily have the time or money to put in the legwork on researching all the brands in the space, especially considering the rising pressure to put more hours in at work and increasing

economic constraints. They can’t always afford to take time to look after themselves or spend as much money investing in their health. And this is one of the reasons why the oral care market has moved out of stores and into the online space. There’s a great solution to this - brands and dental professionals working closely together to bridge the gap. The best way to

How are consumers supposed to make a proper, informed choice? And how are brands supposed to avoid getting lost in the noise?

Features

How consumer oral care brands can work better with dental professionals

combat this, we set up the auto-shipment of affordable heads, helping patients with their oral care, and helping professionals from having to have the exact same conversation again with them. Freeing up a bit more of their precious time to focus on less-obvious healthcare advice. Another example of how dental professionals helped us deliver innovation is in the floss market. Previously, there had only been just two kinds - thin, string floss, which was easier for patients to get in between their teeth but didn’t grab enough plaque, and thick, woven floss that was more difficult for patients to get in between their teeth. Through the expertise of the dental professionals, we learnt that there are three main reasons patients give for why they don’t floss - ‘it’s gross’, ‘it’s hard’ and ‘I forget’. So, we set out to work with them to design the perfect floss from the ground up - naturally tackling those three excuses. As a result, worked with our community’s tracking their advice and then having over 1000 test physical samples before providing detailed feedback. A couple of iterations later we have a proprietary floss that over 96% of RDH’s recommend over the big-name brands. It simplifies flossing by expanding on contact with saliva, therefore sliding in between teeth easily and growing to fit the space therefore getting a deeper clean. The mint eucalyptus flavour smells fresh and tastes amazing, making interdental cleaning much more pleasant. And finally, the convenience factor of a subscription service, means patients have help in not forgetting.

The best way to see what people actually want and need is to learn from the people that are directly treating them

see what people actually want and need is to learn from the people that are directly treating them. Dental professionals know what their patients want and need - so why wouldn’t we listen to them from the ground up, before even developing the products? Oral care brands should be doing everything in their power to bring products their dental team believe in and recommend, right to their home or workplace. Consumers are exceedingly smart with a lot of resources at their fingertips, so doing this will give consumers options that both work better and feel better, as they indirectly demanded the changes through conversations with their hygienist.

This approach is surprisingly still a novel one in the industry. But it’s what we credit BURST’s success to. Working hand-in-hand with a network of dental hygienists and dental professionals, totalling more than 32,000 people, to develop our products from the ground up means that their patients are getting exactly what they require at a price that is affordable. For example, we learned from hygienists that one of the key challenges they faced with patients’ oral care routines was that it was extremely commonplace for patients to not replace electric toothbrush heads in time, because they either forget, or found the new heads to be too expensive. To

Overall, we’re really passionate about improving the game, and there are a myriad of ways in which this can be done. One additional practice could be borrowing established innovations from other industries. One of my favourite recent innovations from AT&T, who now have a home delivery set-up service when you purchase a new phone. They recognised that customers weren’t always getting a great experience whilst waiting in retail stores, which we all know can be frustrating, and set up a delivery installation system, where new phones are delivered ready to go in line with your predetermined specific preferences. I used this myself and I was exceptionally pleased by the convenience and affordability. It goes to show, you create loyal customers by treating them well and listening to them. And this is why we work so closely with professionals.

Hamish Khayat

is the CEO and Founder of BURST. https://www.burstoralcare.com/uk

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Features

Tooth Fairy: Video Call a Dentist on Demand

Tooth Fairy was founded by dentists with firsthand experience of the postcode lottery that exists within the UK. Both Dr Deepak Aulak and Dr Kian Dhinsa have treated patients across numerous cities, from London, to Cardiff, Birmingham and Portsmouth and have seen the difficult challenges patients face. Research such as that from Nottingham A&E, has shown that 1 in 3 paracetamol overdoses are due to dental pain, which reflects the lengths patients are having to go to escape the dental issues. Furthermore, reports by Bupa showcase how over 4 million patients, annually, don’t have enough time to access a dentist. Tooth Fairy exists to connect the millions of patients unable to access a dentist and overcome those access barriers. The synthesis of the app was founded with patients in mind, from the health regulatory approval to operate from the CQC (the UK’s first for any dental app), to the stringent indemnity covering any dentist working on the platform under the Tooth Fairy umbrella indemnity. Our platform is sophisticated enough to allow dentists to set up their diaries and allow

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patients to add autonomy to their care. The platform doesn’t just solve dental problems, it allows patients to discover different dentists, explore treatment options and discuss risks and benefits of treatments. Patients without a dentist can find a local dentist, and those with a regular dentist can connect with their own dentist. Patients with mobility issues can use the app, as well as patients with dental phobias and anxiety. Other use cases can also involve patients with autism, allowing them to become familiar with the dentist and the setting prior to a physical arrival. Recently, Tooth Fairy was voted “App of the Year” by the Dental Industry Awards and awarded the “Highly Commended Award” for High Technology Launch of the year. Such awards help recognise the work and hurdles that Tooth Fairy is overcoming for patients. There is a drive for dentists to adopt technology to better treat patients, and Tooth Fairy is leading this charge. As a company founded and run by dentists, we understand the importance of positive change coming from within the profession itself, to better both patients and dentists. If done correctly, patients can have better autonomy in dental care, whilst dentists

can maximise their use of dental knowledge through different mediums, and increase revenue and treatment uptake by connecting with patients outside of traditional working hours. To date, the app has been offered to dentists for free to join. The aim is not to replace the great work done in clinic, but to supplement it, and where dental services are already stretched, bridge that gap to allow patients to receive the high-quality care that dentists are trained to offer.

Dr Deepak Aulak BDS BSc (Hons) is a Dentist and CEO and Co-Founder of the Tooth Fairy App.

For more Modern Dentist Magazine insights, news, trends, blogs, events, news and stories FOLLOW US ON @ModDentistMag Modern Dentist Magazine

Send us over your news for our website www.moderndentist.co.uk To get in touch and find out how you can be featured in the magazine call Martin on 01765 600909

GROW WITH PRICE BAILEY Small enough to really listen, big enough to make a difference.

Get in touch: Howard Sears +44 (0) 2073 827407

Sharon Fox +44 (0) 1353 613155

#PBGrow

#PBGrow pricebailey.co.uk/grow pricebailey.co.uk/grow

Price Bailey LLP is a limited liability partnership registered in England and Wales, number OC307551. The registered oďŹ&#x192;ce is Causeway House, 1 Dane Street, Bishopâ&#x20AC;&#x2122;s Stortford, Herts, CM23 3BT, where a list of members is kept. Price Bailey LLP is registered to carry out audit work in the UK and Ireland by the Institute of Chartered Accountants in England and Wales.

Product Review

Specialist support for the dental sector With the dental industry facing new challenges, it is important to offer sector-specific advice. Price Bailey’s expert team understands the unique concerns of the industry and is ready to support the dental sector. John Warren FCA, Partner, and Kirsty Beck, Outsourcing Supervisor, outline what sets Price Bailey apart from other specialist accountants in the market. MDM: What services does Price Bailey offer to the dental market? John Warren: We offer a complete range of scalable services to fit the individual client. We can provide several back-office functions such as processing payments, payment of suppliers, monthly and quarterly accounts, tax returns, and a comprehensive review of the structure of a business. And, if our client ever comes to sell their practice, we have a strategic corporate finance team who can step in at a moment’s notice. Kirsty Beck: We have clients ranging from brand-new, start-up practices to well established businesses. We have a hands-on approach and ensure our clients receive a bespoke service that fits all their needs, right from conception to implementation and beyond. We work closely with the practice owner and manager to help them develop their business while allowing them to concentrate on what they do best: dentistry! MDM: Price Bailey’s team is made up of specifically chosen professionals with backgrounds in dentistry – what benefit does this add when forming a partnership with a client?

KB: I think it gives the dentists, the GDCs, more confidence because they know that we really do understand what they are talking about. Whilst we are accountants working in the healthcare sector, I previously worked in dentistry for ten years as a dental nurse and practice manager, which I feel gives me an edge when working with dental professionals because I understand their language. I believe it adds an element of comfort for our clients.

KB: The big challenge for dentists is growing their business, and therefore, advertising becomes an important obstacle to manage. How we help facilitate that is how we develop the business and set them apart from everybody else. We can’t help them necessarily with their industry specific challenges but if we are helping them to take away any unnecessary pressures, then this can only help them to succeed within the market.

MDM: What effect is rising technology having on practices?

JW: One of our main priorities is the figures and helping interpret them If the figures aren’t what the practice are expecting, we can talk them through the numbers and offer them crucial information to turn things around.

KB: There are hundreds of dental practices in the UK so there is a definite need to stand out from the crowd, and in order to do that, practices need to be forward-driven and modern in all aspects of their business. Technology will only enable practices to be more effective, efficient and up to date. Like every other industry you encounter, things are developing and adapting constantly, so it is all about being ahead of the game. Price Bailey pride themselves on being technically sound and would only help to increase a practice’s reputation and recognition. MDM: What other challenges are you seeing in the industry?

We work closely with the practice owner and manager to help them develop their business while allowing them to concentrate on what they do best: dentistry!

MDM: What sets Price Bailey apart from other specialist accountants in the sector? JW: I like to see us as a sounding board for our clients – we operate on non-office hours to suit our healthcare clients, working in partnership with them to resolve their issues and improve their business. KB: I like to refer to Price Bailey as life services. Accountants have that old stigmatism that no one likes the accountant and they only turn up at the end of the year, but that is not how we want to be seen. We want to be a part of the business and team as much as we can.

John Warren FCA

is a Partner, and;

Kirsty Beck

is the Outsourcing Supervisor at Price Bailey.

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Spotlight

Moving Upstream

Conference 2020 In 2016, the General Dental Council (GDC) started an open and serious debate about the future of dental regulation. This discussion was based around the hypothesis that the system did not deliver clear benefits for patients, nor gave them the confidence that their concerns were being addressed within the appropriate timescales; the system had encountered some difficulty in maintaining the support of those regulated; and was insufficiently flexible enough to enable a proportionate and graduated approach. It was clear that change was needed, and so, through the GDC’s Shifting the Balance report, proposals for action were published. Much progress has been made against those proposals, but there is still more to do. In Shifting the Balance, the GDC has committed to moving the system of regulation forward against a new Corporate Strategy 2020-2022: Right time, right place, right touch. It was at the GDC’s Moving Upstream Conference 2020 that we were introduced to this year’s Moving Upstream Report. The morning session began with an introduction from the Chair of Council, Dr William Moyes, who commented on the new strategy and the GDC’s eagerness to continue working and engaging with the GDC’s stakeholders in order to further develop dental regulation and utilise the opportunities ahead as they look to apply right-touch principles to the regulatory framework. He highlighted that there had been positive changes regarding the Shifting the Balance programme, and it had made a significant impact, with the GDC receiving wide-spread support for several elements that have been introduced. A panel session on Public and Patient Expectations of Professionalism followed, facilitated by Professor Jonathan Cowpe, Association for Dental Education in Europe. It became clear after hearing the panellists discuss the issue of professionalism, that there needs to be clearer lines drawn between registrants professional and private lives as the boundaries are becoming blurred by an influx of social media platforms and the expectation to build a brand and reputation online. The GDC had received a lot of feedback suggesting that there was an overlap; for example, “As a healthcare professional you are never really “off duty”’. It was concluded that ‘professionalism’ needed to be better defined and that the GDC could be the key to outlining the principles of professionalism – work which the GDC has work underway to address. The second panel session was facilitated by Dr Toby Ganley, Head of Right Touch Regulation at the GDC, and focused on Demonstrating Commitment to Right-touch Regulation. The panellists outlined the challenges all the healthcare regulators could face with outdated legislation. Better signposting is needed, but delegates did highlight that events such as this conference were an example of attempts the GDC were making to achieve right-touch regulation within dentistry. The third and final panel session focused on the Future Challenges of Dentistry and was facilitated by Margie Taylor, Former Chief Dental Officer for Scotland. Panellists touched on the constantly changing environment within the dental profession and the effect this was having on young dental professionals as a culture of fear, influenced by litigation and regulation, weighs down on them and defensive dentistry becomes the norm. The conclusion of the panel was to continue working together as a profession to move forward and achieve right-touch regulation. The conference then broke out into four workshops to cover a series of questions sprouted from ‘How well does the system in which dental services are provided protect the public?’ The Chairs fed back numerous insights suggesting that there needs to be a better bridging of knowledge between the dental profession and the public. Ian Brack, Chief Executive and Registrar, closed the conference, bringing an effective end point to the Shifting the Balance programme and supporting the change of brand and narrative to the new strategy from 2020-2022. For more information about the GDC’s Corporate Strategy 2020-2022: Right time, right place, right touch, please visit their website: https://www.gdc-uk.org/aboutus/our-organisation/our-corporate-strategy-and-business-plans.

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Spotlight

Chief Dental Officer’s

Clinical Fellow Scheme Modern Dentist spoke to Dr Nishma Sharma, Clinical Leadership Manager, about her involvement with the Chief Dental Officer’s Clinical Fellow Scheme, and why she would encourage all those interested to apply. MDM: What is the Chief Dental Officer’s Clinical Fellow Scheme?

MDM: What skills and experiences does it offer?

Nishma Sharma: The Chief Dental Officer’s Clinical Fellow Scheme is a structured, leadership-focused initiative whereby dentists are employed by various prestigious dental organisations to work for them for a year. There are full and part-time roles available and the locations are varied around the country.

NS: Fellows will be asked to carry out challenging and meaningful work for the senior teams within the organisation. This is not a mentoring or training post, but an opportunity that involves a steep learning curve! However, project management, decisionmaking, chairing, writing briefs, stakeholder engagement will all become second nature soon enough. The beauty is, we all have transferrable skills as dentists, we just aren’t aware of them, so utilising them and pushing ourselves as more than just drillers/fillers is very exciting and incredibly rewarding.

The scheme is quality assured by the Faculty of Medical Leadership and Management. The fellows will be affiliated with medical and pharmaceutical fellows too. MDM: What were the reasons behind its development? NS: For too long there has been what I call a leadership deficit at a primary care level. I feel as a dentist on the ground, we have very little accurate and up-to-date information coming our way about the state of dentistry and the direction of travel for the profession. Sara Hurley, Chief Dental Officer for England, understands that leaders do not create followers; leaders create leaders. She could see the number of highly skilled dentists with natural leadership capabilities. She could also see the lack of emphasis and resource placed on the importance of leadership in dentistry. We wanted to formalise a way of recognising and harnessing those with the right skill sets to utilise and develop as the leaders of the future. The medics have long understood the importance of strong clinical leadership when it comes to commissioning services, implementing policy and influencing regulations. I feel our profession is years behind when it comes to understanding that it is not all about top-down policy imposition, but more clinically led bottom-up collaboration.

The scheme will have fellows sitting alongside senior decision makers and they will be encouraged to put their points forward. I visited Portcullis House, the Houses of Parliament and even Number 10 during my year as a fellow. The fellows will also experience a day at each other’s organisations to learn what the various bodies are about, which helps expand the learning curve even more. MDM: How did you get involved with the scheme and what have you gained from the experience? NS: A few years back, I felt I had had enough of not understanding why we were having to do what we do. The absurdity of working under the unfit-for-purpose NHS contract and the constant stream of scaremongering rhetoric I was reading online was too much. I felt that there was a general ignorance by the profession of all things dental-policy-politics related on the ‘front-line’, and I felt this suited decision makers just fine; the less we knew, the worse the negotiating position. Even now, the area teams seem only interested in mailing and communicating with providers or contract holders, meaning associates are completely left out of the loop on changes to regulation, policy

It’s time to get involved, think outside of the box and arm ourselves with an education on reality, to ensure the general dentists’ voice is heard

or contracts. As the number of independent principals decrease, the flow of information from the owner of the practice to those working the contract also seems to diminish, and therefore dentists are left in a vacuum of information, isolation and ultimately, apathy. This has given to the rise of ‘experts’ on social media who all come with individual biases and opinions, so it is hard to separate myths from fact, leading to a greater sense of fear of the unknown and stress. The longer we resign ourselves to being ‘just dentists’ and continue to keep our heads stuck firmly in the sand, the more say the powers that be will have. It’s time to get involved, think outside of the box and arm ourselves with an education on reality, to ensure the General Dentists’ voice is heard. I joined the OCDO three years ago and it has been one of the most influential career moves I have ever made. I have since been clinical lead for the scheme since our first set of fellows in 2018. I am incredibly proud of putting this initiative together as I strongly believe it is what we need if we want to champion clinically-led decision making, challenge new policies, and future-proof our profession by integrating oral health into the wider healthcare system.

Dr Nishma Sharma

is the Clinical Leadership Manager, leading the change and dental contract reform at the Office of the Chief Dental Officer. She is also a Clinical Reviewer and Discipline Specific Practitioner PAG/PLDP for NHS England Central & South Mids. You can contact Nishma on Twitter @drnish Applications for the Chief Dental Officer’s Clinical Fellow Scheme 2020/21 will open on the 2nd March 2020 and close on the 13th April 2020. For any queries, please email clinicalfellowscheme@fmlm.ac.uk, or visit https://www.fmlm.ac.uk/programmesservices/individual-support/clinical-fellowschemes/chief-dental-officers-clinicalfellow-scheme.

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Case Study

mikrozid® - effective against enveloped viruses The new coronavirus COVID-19 is an enveloped virus, belonging to the same family as the causative agents of MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome). Effective cleaning of surfaces is essential to protect both staff and patients from the risk of cross infection. The mikrozid® range offers products for all areas of the dental practice and all mikrozid products are virucidal against enveloped viruses in one minute.

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Modern Dentist Magazine

Case Study

Dawood and Tanner 10th Study Day The 10th Dawood and Tanner Study Day Programme took place 7th Feb 2020 at the Wellcome Collection in Euston. The theme of the day was ‘Planning for Success’, focusing on all aspects of restorative dentistry. Dr Andrew Dawood and Dr Susan Tanner are a husband and wife team who for over 25 years have run the highly successful Dawood and Tanner Specialist referral practice in London, renowned for their dental implant and restorative treatments, they are passionate about education and providing in-house courses, lectures and seminars. The 10th Study Day’s first lecture was from Dr Kevin Lewis on Managing Difficult Patients. Kevin described the different ways in which patients can present challenges and seem ‘difficult’ in their relationship with dentists and other team members. After a mid-morning break, Dr Andrew Dawood welcomed delegates back with Managing Expectations in Implant Dentistry. Andrew provided a detailed examination, and a comprehensive explanation, of what is planned and anticipated before treatment, and how this can make all the difference to the perception of a successful outcome. Dr Susan Tanner’s talk, Exceeding Expectations in Implant Dentistry, followed. Susan explained that an exceptional result depends upon meticulous planning and the careful application of fundamental prosthodontic principles. The afternoon began with Dr Zoe Laughlin. Zoe provided a demo-led exploration of materials the micro will become macro, the inanimate will animate, and the performance of matter revealed. The closing lecture was given by Dr Shanon Patel from Dawood & Tanner Specialist Dental Practice. The aim of this presentation was to give delegates an overview on how to improve the success of treatment by considering planning for success by systemically assessing the patient and the dentition, not just the tooth in question. All in all, it was a thoroughly informative day with plenty of sound advice and specialist knowledge from the speakers. The next Dawood and Tanner Study day will be held on 5th February 2021, details coming soon! In the meantime, there are plenty more courses available through the Dawood and Tanner Academy. See www.dawoodandtanneracademy.co.uk tel: 0203 219 5975 or email: office@dawoodandtanneracademy.co.uk

‘Check before you tick’ campaign highlights online eligibility checker for dental treatment

From 20 January 2020, new activity from NHS England and NHS Improvement, and NHS Business Services Authority (NHSBSA), encourages dental teams across England to support the NHS ‘Check before you tick’ campaign to help patients understand their eligibility for free or reduced cost NHS dental treatment. The campaign is an extension of ongoing ‘Check before you tick’ prescriptions activity which launched for the first time in September 2018, helping patients to understand if they are entitled to receive free prescriptions and how to claim correctly to avoid unnecessary penalty charges. The NHS makes checks on free and reduced cost dental claims each month; therefore, the campaign is important in helping to support dental teams to raise awareness of the need for people to check their entitlement using the NHS online eligibility checker. The eligibility checker can also let patients know about other means of

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support available to help them reduce the costs of dental treatment, such as the NHS Low Income Scheme. A briefing, along with a toolkit of posters, counter cards and information booklets have been produced and sent to dental practices for use all year round to help remind patients to always ‘check before you tick’, using the NHS online eligibility checker. The materials and further digital resources are also available to download via the Campaign Resource Centre. The campaign focuses primarily on patients making benefit-related claims who, according to audience research, can mistakenly assume they’re automatically entitled to free dental treatment and may therefore need more help understanding their eligibility. There is also low awareness that the NHS makes checks on claims for free dental treatment and can issue a penalty charge of £100 in addition to the cost of treatment to those who have claimed incorrectly. Dental teams are being encouraged to display the materials prominently, ensure staff are familiar with the eligibility criteria, and highlight to patients to check their entitlement before completing the patient declaration form. Information about eligibility is also available to download from nhs. uk/checkbeforeyoutick in a number of alternative formats, including large print, easy read and BSL. The online eligibility checker can be accessed here:

nhs.uk/checkbeforeyoutick

Case Study

Working with Nuvola I have been using the Nuvola system for the past two years. I believe I was one of the first delegates to attend the course when it was initially launched in London and immediately two weeks after attending the course, I had started three cases. Since then, I have completed several cases including on myself and I have to say that the results have been fantastic. I have found that the customer support from Nuvola is excellent, the team is always on hand to offer any assistance with marketing/open days and always goes the extra mile to provide support.

attachments is more reliable to bond on compared to other systems which may be fiddlier.

I find using the website to plan cases and speak directly with the lab is unique to any other system as it is possible to plan cases intricately and refine the Nuvola 3D visualisation depending on the patient’s desired outcomes and any limitations that may need to be considered.

More recently, I have started a more complex case with Nuvola using the OP system, this is for a class 3 case with lower spacing, the patient is doing well so far and is happy he could avoid fixed braces which he was not keen on.

In addition, the quality of aligners is excellent, the ease of placing attachments with the high-quality template stent is second to none and the fact that two sets of high strength retainers are included with each case means finishing treatments are straightforward and stress free. I find that the shape of the

Finally, the lab fee is very competitive, I like the fact that Nuvola offer a banding system depending on the complexity of the case, hence a short case will have a lab fee that better reflects the time spent, therefore allowing me to provide some level of discount to my patients, which is appealing as with other systems the lab fee is uniform no matter how short/long the case.

Dr Janine Sohota BDS

is an Associate Dentist at Bilton Dental Clinic.

NEXT NUVOLA TRAINING COURSE - 21st MARCH, LONDON registration on www.geoorthodontic.com - info@geoorthodontic.com

Smile Train Appoints New Members to Medical Advisory Board Global children’s charity Smile Train has appointed leading dental academic, Dr Peter Mossey, as one of four new Medical Advisory Board members. In the UK, babies born with a cleft lip and/or palate are typically treated immediately and for free on the NHS. However, in many other parts of the world children are a lot less fortunate and do not have access to the same level of medical care. If left untreated, clefts can lead to a range of serious medical problems - including difficulties with eating, breathing and speaking. Smile Train is tackling this worldwide issue, by empowering local medical professionals with the training, funding, and resources needed to provide 100% free cleft surgery and comprehensive cleft care to children globally giving them the power of a brand new, forever smile and the opportunity to live healthy and productive lives.

Speaking of his new appointment, Dr Mossey says: “During my Orthodontic specialty training, I was given the responsibility of being on call for children born with cleft lip and palate (CLP). For three decades since, I have dedicated my life to academia and my research to cleft lip and palate (causes and treatment). I admire Smile Train for its ethos, caring philosophy and strategic approach to the care of infants born with CLP around the world, and their actions have been transformative at individual, societal and global levels. Working with Smile Train will help me achieve some personal ambitions in this field but most importantly, I trust that it will lead to reduced mortality and better care for infants born with clefts and lead to new innovations in treatment and prevention in due course”. To learn more about Smile Train’s global efforts, please visit smiletrain.org

The charity’s Medical Advisory Board is comprised of experts from all over the world, across disciplines such as surgery, anesthesia, genetics, orthodontics, and speech therapy. The board has a vital role in helping the charity ensure that its cleft care programmes are safe, high-quality and comprehensive. Dr Peter Mossey – currently Associate Dean at the Dundee Dental School and Director of the WHO Collaborating Centre for Craniofacial Anomalies – has been especially selected to join the charity’s Medical Advisory Board due to his broad portfolio in clinical treatment, teaching, research and mentorship.

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Modern Dentist Magazine

10 mins with...

Heidi Marshall

Chartered Accountant & Business Adviser

Q A

Has the dental profession changed since you started work in it?

Dramatically. I started out in the industry in 2006 so I’ve seen the introduction of the “new!” NHS contract; the lift of restrictions on having a limited company, the significant increase in goodwill values, the corporates coming into the market, recruitment issues, significant pension changes and the rise of cosmetic treatments.

are having to spend more and more time behind their desks. All the changes in legislation make it very tough for single handed practitioners to survive. The second thing would be the pension changes. Annual allowance charges have hit some NHS dentists very hard. The rules are very complicated, with little flexibility/opportunities to plan. Again, I have seen good dentists leave the NHS earlier than they would purely because of their pension tax charges. This is being looked at and we are expecting

great ideas man and could generally put an accountancy spin on anything. The major quotes/advice that stick in my mind just before I joined the Dodd and Co partnership in 2012, was being told: “there’s no such thing as a work life balance, it is all just life now”, and don’t forget: “your earnings can go down now as well as up”. I don’t think there is anything that can truly prepare you for the work involved in running your own business and I’ve learnt so much over the years that very

I don’t think there is anything that can truly prepare you for the work involved in running your own business and I’ve learnt so much over the years that very little surprises me anymore!

Q A

What have been the key positive or negative changes in your area of the profession?

Positive Change - I think people care about their teeth a lot more than they used to and are much more health conscious, which can only be a good thing for the industry. There is still a long way to go, but, in my opinion, there has been a definite shift in attitudes towards the importance of seeing the dentist.

Negative Change – Not really in my area of the profession but without a doubt the increased red tape and paperwork. I completely understand that patient safety is important, but I think we have gone over the top. Unfortunately, I have seen a lot of really good dentists retiring early because they want to do dentistry but

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changes to the legislation, I just hope the government do more than tinker round the edges.

Q A

Who inspires you and why?

Mo Farah. Along with plenty of other sportsmen/women. I admire anyone with huge amounts of drive and ambition. It is what inspires me to work hard and always give 100% (I’m an accountant and so I hate it when people say 110% - it is not statistically possible!).

Q A

little surprises me anymore! I also have a lot of knowledge and experience that helps me understand what my practice owners are going through and enables me to advise them on all aspects of their business.

Have you got a mentor? If so, what was the most valuable piece of advice they gave you?

I’ve had several of them over the years. I learnt a lot of from my predecessor Paul Kendal. Paul was a

Q A

If you were not in your current position, what would you be doing?

I always said if I could earn what I earn as an accountant being a waitress then I never would have left that job. I’ve always loved people and food, so waitressing combined the two perfectly for me.

If I was to have a career change now, it would be more likely to involve property and/or dogs.

Heidi Marshall

is a Director at Dodd & Co Limited, Chartered Accountants & Business Advisers.

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