The Monday Morning Quote #159

‘Those people who can stand at the intersection of the humanities and science, the liberal arts and technology, that intersection, are the people who can change the world’.”

Edwin Land to SteveJobs
As told to Walter Isaacson in his authorized Biography, Steve Jobs

One in four dentists suffer stress

From Dentistry online

How the silver haired, silver tongued Mr Lansley can effectively say “well that’s alright then” is beyond me. I have highlighted some of the figures that I find most disturbing. These findings are be unacceptable and the Secretary of State should say so.

Yet again is the use of “NHS” as a brand or badge.

Almost one in four NHS dentists has suffered from work-related stress in the last year, according to a new survey.
The annual NHS Staff Survey revealed 23% of respondents had endured the work-related illness.
In addition, 10% say they have been victims of discrimination and a further 13% endured harassment, bullying or abuse from patients in the past 12 months.
Five per cent of dentists had suffered physical violence from patients in the last year.
Working extra hours remains a problem with 87% working unpaid hours.
But it would appear most NHS dentists are happy in their jobs with 95% saying they believe they make a difference, and 89% valued by their colleagues.
However, they want to go further as just 73% are satisfied with the quality of work and patient care they deliver.
Work-related injuries were reported by 7% of the participants and 44% admitted to witnessing a potentially harmful error, near miss, or incident in the last month.
The staff poll questions workers in 38 key areas which also included work/life balance, work pressure felt, job satisfaction, support from management and training given.
Overall, the Department of Health said the results were the same or better in 25 out of 38 key measures compared with the previous year.
Health Secretary Andrew Lansley said: ‘This survey shows that NHS staff remain committed to providing the highest quality of care to their patients.
‘The number of staff happy with the standard of care remains stable, with some foundation trusts performing to a very high standard. Too many trusts continue to have less favourable levels of recommendation to family and friends. The NHS should use this as a basis for seeing improvement in the services we deliver for patients in the future.’
In total 250,000 NHS staff, including pharmacists, paramedics, and mental health workers, were sent a questionnaire and 134,967 responded.
The results are mainly used by NHS organisations to help them review and improve staff experience so that staff can provide better patient care.
Consultant doctors and dentists are grouped in the same category but does not include trainee dentists.
Anika Bourley

Fits well with this from Jo Taylor

NHS Pension Changes 2015 – Proposed Final Agreement

From Financial Tips! – Published every 4 weeks by Rutherford Wilkinson Ltd, written by Financial Planners Ray Prince and Graeme Urwin.

NHS Pension Changes 2015 – Proposed Final Agreement

On March 9th the Department of Health released a Proposed Final Agreement document for the NHS Pension Scheme following many months of debate.

Basically, it’s the governments final offer on what the NHS pension scheme will look like after 1 April 2015. The headline contents haven’t changed at all since the previous iteration of December 2011 (which the government referred to as the ‘Heads of Agreement’).

In a nutshell, we are still looking at a CARE (Career Average Revalued Earnings) scheme with an accrual rate of 1/54 of pensionable pay, the linking of the Normal Pension Age with the State Pension Age, and increases to employee contributions of 6% over the next three years.

Let’s take a look at the main proposals:

  • A pension scheme design based on career average (keep in mind that the General Pratitioners and General Dental Practitioners currently accrue NHS pension benefits on a CARE basis)
  • An accrual rate of 1/54th of pensionable earnings each year
  • Revaluation of active members’ benefits in line with CPI plus 1.5% per annum
  • A Normal Pension Age equal to the State Pension Age, which applies both to active members and deferred members (new scheme service only). If a member’s SPA rises, then NPA will do so too for all post 2015 service. Pre-2015 accrued rights will continue to be related to existing NPAs as will any  benefits accruing post 2015 to protected members
  • Pensions in payment to increase in line with inflation (currently CPI)
  • Benefits to increase in any period of deferment in line with inflation (currently CPI)
  • Average member contributions of 9.8%, with tiered contributions
  • Optional lump sum commutation at a rate of £12 of lump sum for every £1 per annum of pension foregone in accordance with HMRC limits and regulations
  • The current flexibilities in the 2008 section: early/late retirement on an actuarially neutral basis, draw down of pension  on partial retirement and ability to retire and return to the pension scheme will be included in the 2015 scheme
  • Ill-health retirement pensions to be based on the current ill-health retirement arrangements but with enhancement for higher tier awards to be at the rate of 50% of prospective service to normal pension age
  • Spouse and partner pensions to continue to be based on an accrual rate of 1/160th. For deaths in retirement, spouse and  partner pensions will remain based on pre-commuted pension
  • The current arrangements for abatement (for service accrued prior to and post 2015) will be retained
  • Lump-sum on death in service will remain at two times actual pensionable salary
  • For members wishing to retire before their state pension age there will be an opportunity to pay additional contributions to fund earlier retirement of up to 3 years early without an actuarial reduction
  • Added Years contracts in the 1995 section will continue on compulsory transfer to the 2015 scheme
  • Additional pension arrangements will continue
  • The operation of the Public Sector Transfer Club will be subject to further consideration and discussion between schemes

Some of the transitional protection includes:

  • All accrued rights are protected and those past benefits will be linked to final salary when members leave the scheme. Existing arrangements with respect to the Uniform Accrual  Formula for Medical Health Officers (MHOs) will continue to apply for staff who move to the new arrangements
  • All active NHS Pension Scheme members in the 1995 arrangements with a pension age of 60 or 55 who, as of 1 April 2012, have 10 years or less to their current pension age, including MHOs and members of the special classes, will see no change in when they can retire, nor any decrease in the amount of pension they receive at their current Normal Pension Age. This will be achieved by allowing such members to remain in their current arrangements until they retire
  • The current rules requiring staff in the 1995 scheme to retire, take all benefits and be prohibited from further pension scheme membership will be retained but with the following changes. Staff on taking their 1995 benefits after the age of 55, will be able to defer their 2015 benefits but without the possibility of further accrual
    Indicative Contribution Rate Structure (before tax relief)

Earnings                        11/12     12/13   13/14   14/15

£48,983 to £69,931      6.5%      8.9       11.3     12.5
£69,932 to £110,273     7.5%      9.9       12.3    13.5
Over £110,273                8.5%    10.9       13.3    14.5

The Financial Tips Bottom Line

From April 2015 the NHS pension scheme will be changing for all members. We’re certain the government will stick to their guns with the Proposed Final Agreement, but it will also be interesting to see whether doctors do vote for industrial action.

Action Point

The BMA in particular have been quite vociferous about the proposed changes. Starting on Monday 19 March they are running a series of roadshows where doctors can find out more details about the proposed changes and how they will be affected.

You can also see how much you stand to lose by visiting the modeller on the BMA’s website. BDA members can read their views here.

You can download the full Proposed Final Agreement document here.

The Monday Morning Quote #158

“Fix the problem, not the blame.”

Japanese Proverb

(Thanks to Mark Foster)

Dentists immune from music royalties claims – EU court

From BBC news.

Dentists immune from music royalties claims – EU court

EU law does not require dentists to pay fees for the music they play

Dentists who have music playing in their surgeries should not pay royalties because they are not broadcasting to the public, the EU’s top court has ruled.

The Luxembourg judges considered a case brought against a Turin dentist by an Italian agency that collects royalties.

Dentists do not broadcast music for profit and the audience is limited, the European Court of Justice ruled.

But hotel operators ought to pay royalties, a separate ECJ ruling said.

The court struck down an exemption for hotel operators in the Republic of Ireland, granted by the Dublin government.

An Irish collecting agency representing record companies, Phonographic Performance (Ireland) Ltd (PPL), had complained to the ECJ about the exemption.

The ECJ said hotel guests could be defined as “the public” because “they constitute an indeterminate number of potential listeners”.

In addition, a hotel operator profits from broadcasting music in hotel rooms, so he or she should pay royalties in addition to those paid by the radio or TV broadcaster, the ruling said.

The court’s rulings are legally binding across the 27-nation EU.

Under international agreements those who broadcast copyright-protected works to the public are liable to pay royalties to the artists.

The case affecting dentists was raised by Turin’s Court of Appeal.

An Italian collecting agency, Societa Consortile Fonografici (SCF), challenged a Turin dentist, Marco Del Corso.

The ECJ ruled that “the public” refers to “an indeterminate number of potential listeners and a fairly large number of persons”.

Patients do not go to surgeries to listen to music but “with the sole objective of receiving treatment”, and the number of people in a typical dental surgery “is not large, indeed it is insignificant”, the judges explained.

Dental hygienists teaming up with other health care professionals

As a follow on from my post on direct access for dental hygienists comes this piece from Nufar Kiryati, I realise it’s from Canada but “The times they are a changin’“.

Dental hygienists teaming up with other health care professionals

Dr. Alfred Fones, a dentist from Bridgeport, Connecticut who founded the dental hygiene profession in 1913, envisioned dental hygienists working in collaboration with other health and social service workers to provide preventive health care to the public. Fones once said: “It is primarily to this important work of public education that the dental hygienist is called“. He considered dental hygienists as the channel through which preventive oral health care knowledge should be delivered to the public.

We are going in the direction that Dr. Fones already envisioned 100 years ago. I think Dr. Fones’ ideas are very much valid today as we witness a new path of collaboration work between dental health care professionals and other health care practitioners.

As part of my mission to equip dental hygienists who want to change their career paths or enhance their existing careers with the knowledge and information they need, I am constantly researching what are the new trends in the dental hygiene arena.

In my recent global scan of the dental hygiene profession I discovered some interesting and exciting information about some of the major changes we are expected to witness that will have an impact on the dental hygiene job market. These changes include the expansion of the scope of practice to become an independent profession and an increase in the length of training, having countries like Japan that offers dental hygiene studies combined with nursing schools or social worker license as well. In addition, there is a surge in demand for dental hygiene services as the public awareness to preventive care is gaining its spotlight and the baby boomers retire and create demand for more preventive dental care. In 2011, the oldest segment of the baby boom generation was 65 years of age, marking the beginning of an important demographic shift for dentistry. As seniors, boomers will continue to require dental care more than previous cohorts of seniors. The association between oral and systemic health is becoming clearer and dental practitioners will become more involved in promoting their patients’ overall health.

The real opportunity here is to understand how these trends can influence dental hygiene career opportunities. Treating seniors with complex systemic conditions and acknowledging the fact that the oral health condition is directly linked to systemic conditions should lead one of the major changes in the dental hygiene arena:  working with other health care professions in group type practices.

People understand today that in order to live a healthier life, the body needs to be treated as a whole, viewing oral health as an integral part of our well-being. Therefore it is only natural to receive preventive oral health care in adjunct to other health care services. For example, a group practice offering dental hygiene services, nutrition support from dietitians, a family physician and a smoking cessation specialist – all under one roof!

In Nova Scotia, Canada, dental hygienists are collaborating with a team of nutritionists, licensed practical nurses and health educators to work together with students, teachers, parents, and the community to promote, maintain and improve the health and well-being of the school community under the “Our Healthy School” campaign which is a Health Promoting School initiative to promote healthier living. I am wondering why we are not seeing more initiatives like this one. Why aren’t we hearing more about independent dental hygienists working with other health care partners to offer a “whole body preventive” approach?

Is it the fear from the unknown? Is it the lack of knowledge about what exactly this business venture involves? Teaming up with other health care professionals could be easier then we think. After all, you will not dive into it on your own but rather have partner/s to work together with. The possibilities are out there – whether joining an existing group practice or teaming up with another practitioner to open up a new health care facility, you just need to choose your career path direction. Seeking advice from an experienced mentor and networking to find the right people to connect with can certainly help you move in this direction. It is truly a win-win situation when we team up with other health care professionals – the public wins because they get to receive a “whole body” approach to their health needs – treating their whole body and not just from the neck down, and the dental hygiene profession wins because we get the recognition the profession deserves from both the public and our colleagues.

Nufar Kiryati RDH BHA

Owner and CEO, Knowledent

Make your dream a reality. Dental Hygiene Career Change Consulting


Can you surprise like KLM?

Thanks to Alan Stevens for bringing this to my attention. Great use of social media.

How can you use this for inspiration in the way you behave towards your patients, customers, clients?



“This information was written by Alan Stevens, and originally appeared in “The MediaCoach”, his free weekly ezine, available at”


The Monday Morning Quote #157

“Laugh and grow strong”

St. Ignatius of Loyola

Speak up on DFT application process, BDA urges dental students

09 March 2012

Speak up on DFT application process, BDA urges dental students

The British Dental Association (BDA) has launched a survey of dental students involved in this year’s round of applications for Dental Foundation Training (DFT) places. The research will put together a full picture of the experiences of final-year student BDA members that the BDA will feed back to the organisers of the DFT application process.

The research asks participants about issues including the quality and timeliness of information provided prior to the process beginning, the user-friendliness and appropriateness of the process, the way interviews were conducted, and the way places were allocated in December 2011.

Dr Judith Husband, Chair of the BDA’s Education Committee, said:

“The BDA has received informal commentary from members and non-members alike about aspects of the way the Dental Foundation Training application process has been managed this year. It’s important that feedback is provided through formal research so that a fuller picture of applicants’ experiences can be put together and fed back to those responsible for the process.

“It was clear that the previous system needed to be replaced to deliver a better experience for dental students. It’s important that this year’s applicants share their experiences to help hone the new system. I urge all those invited to participate in the survey to do so and make their voices heard so that the BDA can help to make sure that positive changes can be made next year.”

The survey is open from 6–19 March. All BDA student members who took part in the process have been invited to take part. Final year students who are not currently members but took part in the process can participate in a parallel piece of research here:


Notes to editors

1.       The BDA called for action to resolve some of the issues identified with the process in January. For details visit:

2.      The British Dental Association (BDA) is the professional association for dentists in the UK. It represents more than 23,000 dentists working in general practice, in community and hospital settings, in academia and research, and in the armed forces, and includes dental students.

3.      For further information, please contact the BDA’s media team on 0207 563 4145/46 or visit You can also follow news from the BDA on Twitter:!/TheBDA.


Dental Hygienists call for Direct Access.

An open letter to the profession from a group of dental hygienists makes a well argued case for direct access and is worth a read and some thought.

 Dear Sir,

RE: Direct Line Lack of Assurance1

As active members of a group of like-minded dental care professionals campaigning for the establishment of Direct Access (DA) for dental hygienists (DHs) we read the editorial referenced above with interest. However, our interest soon waned and turned to disappointment as it became clear this was to be no balanced debate of the issue.

It is, at best disappointing to have the anecdotal stories, of what some might perceive as the BDA’s protectionist stance, confirmed in print. Even more so when part of this argument seems to be based on apparently erroneous and disingenuous information.

The first point we would take issue with is the assumption that our case for DA is based on the premise that DA equates to Independent Practice (IP). DCPs have had the right to own and operate their own independent practices since April 2006. Some have already done so, even employing dentists. It is apposite to make it absolutely clear that DA is NOT about IP.

The first point we would agree on is that regarding the non-desirability of setting up in IP. We see DA as being very much a part of life in general practice. True, there are some who would like to set up independently but these are few and, as mentioned earlier, we feel most of those that want to have already done so. For many hygienists, DA would merely legitimise the status quo. The main point of DA is to increase access to a “Circle of Care” – another entry point into professional dental and, indeed, holistic general healthcare.

The second point we would contest is the supposed lack of precedent. The piece reports there is none, save for the anomaly of CDT’s – a group of DCPs who do have DA. This IS precedence. It is also deemed that this registrant group have sufficient skills to identify abnormalities and refer onwards to an appropriate healthcare professional. We contend that all the arguments relating to hygienists’ apparent lack of training, their apparent lack of diagnosis skills and the possible risk of missed oral cancer all fall at this point. Yet DA antagonists continue to argue that a hygienist, who has been at full time dental school for at least 24 months, treating many patients under supervision, does not have the necessary skills to recognise pathology.

The precedence angle taken in the editorial also seeks to neatly sidestep the precedence that is optometrists, nurse practitioners, midwives, podiatrists and physiotherapists, all of whom have DA to patients without first recourse to a doctor. They all work professionally within their scope and refer as necessary.

The question of competency has been raised many times. It must be remembered that a DH currently spends a minimum of 24 months, including at least 1200 clinical hours, predominately concentrating on a single subject.  It must also be remembered that most students now dual-qualify as hygienists and therapists (DHTs) with a BSc primary degree after three or four years of study.  This aside, we accept that DA for newly qualified Hygienists is probably not appropriate. Many nuances are gained with experience and therefore, as part of our suggested model, we would propose that a Hygienist should have 5 years equivalent post qualification experience on the register before receiving entitlement to Direct Access (DA). DHs are registered, indemnified and subject to the same regulatory structure as General Dental Practitioners (GDPs); whilst there is some discussion around the ability to diagnose appropriately, it must be borne in mind that the GDPs themselves often do not diagnose many (any) neoplastic lesions in the dental surgery. They refer the patient onwards to those that have suitable expertise and facilities to hand. Current GDC curricula and guidance determine that DHTs must also be able to recognise oral pathology and refer appropriately. This we do daily already.

We understand that BDS undergraduates complete a longer training course. In actuality, however, there are so many disciplines to cover in that time that periodontal diagnosis and training seems to take a low priority. We have heard from BDS undergraduates who make this very point. We all in our working lives may have come into contact with young, newly qualified BDS graduates who cannot carry out accurate indices and therefore cannot collect and synthesise the information needed to make an accurate diagnosis. Periodontal therapy and diagnosis takes time to perfect and feel comfortable with, and we, as hygienists, carry out these tasks all day everyday – we get a lot of practice.

It is simplistic and wrong to suggest that an experienced DH cannot diagnose periodontal disease or recognise abnormalities. Many a DH in general dental practice has to carry out initial periodontal assessments including editing Basic Periodontal Examinations (BPE) passed to them, (if they get them), appropriately in line with the current British Periodontal Society’s (BSP) guidelines. They are also deciding on the appropriate treatment plan for their patients. Indeed, one only has to look at various online forums to see the day-to-day difficulties that DHs face in practice in this respect. Perhaps the GDC should carry out some simple research to assess the extent of this problem; a few simple questions would show that in general practice very few DHs receive any kind of definitive descriptive prescription and usually work in the absence of a diagnosis. We take the recognition of the BSP to allow DHs full membership to be a true and honest recognition of the work done by DHs to recognise, diagnose and successfully treat periodontal disease within scope.

It is a truism that 50% of the population do not attend a dentist. There are many reasons for this. However, there does seem to be a demand for the periodontal services of hygienists, a demand that has been the basis of a successful business model, namely that of SmilePod. This business initially offered predominantly hygiene services ostensibly by hygienists. Their clinicians are, in fact, mainly dentists and they have now made this clearer.

We have many anecdotal accounts of patients who wish to see a hygienist but not a dentist at a particular time. We know that patients frequently ring practices asking to see a hygienist. They may not have access to one at the practice they attend. Why should a patient have to pay for another examination? It makes no sense, and is unfair. Getting a referral letter can be difficult with some GDPs seemingly reluctant to put pen to paper and seeing such an act as tantamount to signing away money. We know of persistent patients who have fought to get a referral. This would seem to run counter to the argument that DA hygienists would confuse the public.

We see DA as a means of drawing more patients into professional preventive care at a time that prevention has never been more important with the increasing awareness of oral/systemic interractions. DA would allow us to work more effectively within a practice setting as a standalone registered health professional that can assess and treat within their own competency referring when and where appropriate.

DA would also make business models including partnership a more realistic proposition for DHs. To use one of business consultant Chris Barrow’s lines, it’s not about dividing the cake into smaller and smaller pieces. It’s a whole new cake! DA is all about increasing access to professional healthcare in a safe, regulated environment.

What practice principal would turn down the prospect of a new source of patients? Particularly during these tough economic times.

Yours faithfully,

David Bridges RDH, Amanda Gallie RDH, Shaun Howe RDH,
Elaine Tilling MSc RDH DMS MIHPE


Christina Chatfield RDH, Sarah Murray RDH, Margaret Ross RDH, Dee Benton RDH,
Lesley Card RDH, Tim Ives MSc RDH, Lisa Gibbs RDH, Kate Govier RDH,
John Stanfield MSc RDH

1. Hancocks, S. Direct line lack of assurance. Br Dent J 2012; 212: No2: p53

%d bloggers like this: