The Monday Morning Quote #139

“People love to buy things, but almost no one wants to be sold.”

Thomas Leonard

The Monday Morning Quote #138

“Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do.

So throw off the bowlines. Sail away from the safe harbour. Catch the trade winds in your sails.

Explore. Dream. Discover.”

Mark Twain

CQC A letter to The Times

Published in The Times today. Well done Andrew.

Dear Sir,

For the Care Quality Commission to blame chasing of paperwork targets for the sad state of affairs in hospitals is brazen indeed, as it is the CQC, along with Primary Care Trusts and other “governance” and “compliance” organisations which have enforced the burdensome paperwork load in the first place. For my own profession of dentistry this has resulted in a virtual tsunami of un-necessary policy writing and compliance with innumerable pieces of micro-managing and verification of processes.

Despite what some might say, whose jobs depend upon it, not one jot of this massive effort has resulted in the health or welfare of my patients, my staff, or myself improving. It has however added to the already high costs of running a healthcare business or service. I would not be suprised in the least to learn that nurses have been taken off caring for people and put in front of computer screens and manilla folders. It seems that the more organisations are involved in so-called “regulation” or a service the worse the service becomes.

This government said it would slash red tape.

They lied.

Yours faithfully,

Andrew Adey BDS
Dental Surgeon,

The Monday Morning Quote #137 – from Sam for Sam

The Sams in question being Beckett & Warburton.

“Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.”

Worstward Ho 1983

Cymru

40% of GPs looking to leave NHS by 2021

From Pulse Online

40% of GPs looking to leave NHS by 2021

Four out of 10 GPs do not expect to be working to an NHS contract in 10 years’ time strengthening fears of a ‘recruitment and retention crisis’.

The Healthcare Index published by Lloyds TSB Commercial, which talked to 208 GPs as well as dentists and pharmacists, found confidence in the future of the healthcare sector is very low with only 59% of GPs expect to still be working to an NHS contract in ten years time.

A spokeswoman for the researchers said that overall confidence in the future of the GP sector reflects widespread concern around finances and growing competition with 94% of GPs are expecting further financial pressures over the next five years and 92% anticipate increased competition in the market place over the same period.

Consolidation is expected in the GP profession, with 82% expecting a rise in the number of larger practices, potentially as a response to the formation of commissioning groups.
GPC deputy chair and Leeds GP Dr Richard Vautrey told Pulse: ‘These figures suggest a series level of anxiety within the profession about the future of NHS general practice which is being created by the Government in England’s Health and Social Care Bill.’

‘This anxiety is also reflected in the drop in the number of young doctors who are considering general practice as a career and the increased number of older GPs who are looking to retire early.’

‘There is a real risk that we are going to return to the recruitment and retention crisis that we saw prior to the introduction of the new GMS contract.’

 

The Monday Morning Quote #136

“When I was 17, I read a quote that went something like: “If you live each day as if it was your last, someday you’ll most certainly be right.” It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: “If today were the last day of my life, would I want to do what I am about to do today?” And whenever the answer has been “No” for too many days in a row, I know I need to change something.

Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure – these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart….

…..No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma — which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

From the text of the Commencement address by Steve Jobs, CEO of Apple Computer and of Pixar Animation Studios, delivered on June 12, 2005.

The full address is here and to watch him deliver it go here.

 

Fair Comment – Stephen Hancocks on the OFT investigation into UK dentistry

I always look forward to reading Stephen Hancock’s editorials in the British Dental Journal – I think his comments on the OFT investigation in the current journal bear repeating.

BDA members can read his thoughts here.

Editorial
British Dental Journal 211, 303 (2011)
Published online: 7 October 2011 | doi:10.1038/sj.bdj.2011.824

Fair comment
Stephen Hancocks, OBE

Send your comments to the Editor-in-Chief, British Dental Journal, 64 Wimpole Street, London W1G 8YS e-mail: bdj@bda.org

The trouble with ‘fair’ is that it is subjective. A fair day’s weather for a sailor might be a lousy day if you are on the beach. What might seem like a fair deal to you may be a poor outcome to me and what could be deemed as fair trading to one customer and merchant could quite easily be judged an outrage by others. We are all vaguely familiar with the Office of Fair Trading (OFT) and their various reports on such subjects as mobile ‘phone tariffs and the vagaries of energy supply companies and may even have a haunting memory of its report on private dentistry, published in 2003. It might therefore come as something of a surprise to learn that the OFT has just launched a new investigation into dentistry in the UK, this time including NHS dentistry.

On one hand, as a profession we might collectively raise our eyebrows and give a deep sigh at the prospect of yet more interference, more regulation and the potential placement of greater barriers to our actually being able to provide oral healthcare. However, it might be that in the interests of fairness the investigation could also help to clear the air, ostensibly for the consumer, since the OFT’s mission is stated as ‘to make markets work well for consumers. We achieve this by promoting and protecting consumer interests throughout the UK, while ensuring that businesses are fair and competitive’ (www.oft.gov.uk), but in doing so, also for dentistry.

The impact of regulatory change

Two of the eight aspects that the OFT indicated they would be focusing on, when they visited the BDA at the end of last month coinciding with the sudden announcement of this review, were ‘the impact of regulatory change: how it is or is not helping’ and ‘the availability of choice and impact of regulation on choice.’ We, the profession, the BDA and the BDJ have been constructively and vigorously lobbying in recent years to explain the real and potentially negative effects on patient care occasioned by the cumulative enforcement of regulations from the Department of Health (DH) (notably the ‘UDA’ system in the current NHS contract in England and HTM 01-05) and the Care Quality Commission (CQC) as well as the various edicts, rumours and disquieting developments from the General Dental Council (GDC).

The previous OFT inquiry was sparked by a ‘super complaint’ by the Consumers’ Association and a Which? report. However, it is, perhaps, curious that this new OFT initiative comes immediately on the tail of significant announcements last month on the competence of two of the above cited bodies. The Council for Healthcare Regulatory Excellence (CHRE) is to investigate whether the GDC is fulfilling its statutory functions (‘protecting patients’ – GDC vs ‘protecting consumer interests’ – OFT) as has been requested by the DH. Meanwhile what the BDA described as a ‘damning’ review of the work of the CQC by no less than the House of Commons Health Select Committee criticises the distortion of the CQC’s priorities by a statutory deadline to register dentists, and the Committee brands as ‘astonishing’ the fact that the CQC could ever have considered it sensible for small dental practices to be subjected to the same processes as large hospitals.

It is unthinkable that such evidence could be overlooked by the OFT in their exploration of the current marketplace. This does lead one to have some cautious optimism that any recommendations regarding competition that they make after March 2012, when their report is due (a tight timetable) may pave the way to some rational thinking as well as rationalisation of all these organisations apparently competing among themselves. Indeed, in the course of writing this editorial it has surprised me how many sets of acronyms I have had to list of bodies which should be synchronistic but in fact seem at worst to be preventing not oral disease itself but a route to effective prevention of oral disease; and this in the curtilage of a coalition government expressly campaigning to reduce quangos.

The OFT welcomes submissions from any interested parties (e-mail: dentistry@oft.gsi.gov.uk) and as has been shown in other recent campaigns (the BDA’s red tape campaign to name but one example), the greater the response the more notice is taken; so readers are encouraged to share their evidence of the real world of clinical dentistry and make their feelings known. Next Spring seems a long way off as we slide now into shorter days, longer nights and turning leaves but the deliberations of the OFT will make fascinating reading especially against the background of the new NHS pilots. There will doubtless be the long-standing, and palpably correct, repeated complaint that we as a profession do not communicate well enough with the public and with our patients. This will be fair and needs attention. The hope though has to be that overall some further good could come of such a comprehensive review. Yet after all these noble sentiments, laudable efforts at public and consumer protection and thousands of fine words it strikes me as horribly instructive that a ‘search’ for the words ‘improving oral health’ returns with the message ‘not found’. How fair is that?

Associates, Incorporation and the NHS Pension Scheme

This important update is from Thomas Dickson of Essential Money

Dear Alun

We know that many associates have been encouraged to incorporate over the last couple of years. However one of the main disadvantages was that we were pretty sure this was going to affect eligibility for the NHS pension. The Department of Health have now made it clear that from 7th November associates that are operating through a Limited Company will no longer be eligible for the NHS Pension Scheme.

Providers
A GDS or PDS Practice may be owned by a single-hander or by a partnership. It may also be a company limited by shares (or DBC). Where a shareholder is a qualified (and listed) dentist they are afforded type 1 dental Practitioner/Provider status under the NHSPS Regulations. As you would suspect if the shareholder is not a qualified dentist they do not have access to the NHSPS.
A shareholder must ‘pension’ all the GDS/PDS income that they take (i.e. draw down) from the business in the form of salary and dividends. Any GDS/PDS income that is not taken but left in the business cannot be pensioned now or in future years.
If a Provider opts out of the NHSPS or is ineligible to join their colleagues cannot ‘pension’ their GDS/PDS income.

Performers
If a Performer (i.e. Associate) works for a GDS/PDS Contractor as an individual they are also afforded type 1 dental Practitioner NHSPS status. However if a Performer creates a limited company and works at the Practice through that limited company they (or anyone else who works for the Performer’s limited company) cannot pension their GDS/PDS income with effect from 7th November 2011. This is because this sub-contractor limited company is not recognized under the statutory NHSPS Regulations.
So a Performer must work as an individual (not through a unique limited company) to be able to pension their GDS/PDS income with effect from the 7th of November 2011.
For more information on whether the tax benefits of incorporation outweigh the advantages of your NHSPS eligibility please reply to this email or call me on 0121 685 5060.

Employers Responsibilities
Another issue is that the pensionable income for some associates may have been understated on the ARR completed by the GDS/PDS practices at year-end. Basically an associate’s NHS pensionable pay must be no less than their net GDS/PDS income. So if their contract value was £150,000, their net income at 43.9% would have been £65,850. NHS Dental Services will soon be writing to those associates whose NHS pensionable pay may have been understated outlining the method to correct any error. The relevant providers (i.e. contractors) will also be written to.

NHS Pension Scheme Changes As a result of Lord Huttons report into public sector pensions, the Government has made it clear they will introduce changes to the NHS pension scheme in 2015. The good news is that they have also made a commitment that all pension benefits earned up to that point will be protected.
The main reason for this is that people are living longer and pensions are costing more. This cost has fallen on the tax payer. In the meantime therefore there is also a proposal to increase member contributions from April 2012 for anyone earning over £15,000 year which to be fair is most of our clients.
For those earning over £21,000 a year, the increase could be an additional 2.4% in 2012/2013 rising to an extra 6% in 2014/2015. This is in addition to the 6.5% or more that members are currently paying.

For more information or for some Q&As on this please – click here

Any questions please call me.

Best Regards
Thomas Dickson
Essential Money Limited
www.essentialmoney.co.uk
w: 0121 685 5060
m: 07973 136 365
f: 0121 685 5065

Steve Jobs

There is nothing that I can say that will not feel trite and overblown. Thanks to a great man.

Take some time & enjoy this speech; it inspires me regularly.

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