Clinical freedom in a time of austerity.

First published online in Dentistry Blog on 8th April 2019. Full article.

Clinical freedom is becoming an aspiration rather than reality.

I regularly have to straddle a line between what principals need and what associates want, whilst attempting to keep both sides happy.

Often this involves money and the phrase ‘clinical freedom’.

Amongst the things they never teach you at dental school is that you must cover your costs before you can take anything out for yourself.

Increasing overheads makes this hard.

For instance, a 13% increase in CQC fees to ‘better align the cost of regulation’ must be borne by business owners.

As far as NHS practices are concerned, the minimal rise in fees during a decade of austerity have been swamped by rising costs.

Where contracts are fixed and consume a week’s full-time work to achieve them, there is little or no room for increasing productivity.

Associates, who have the dubiously privileged position of being self-employed, must take their share of the repeated squeezes on practice owners.

Either earn more (difficult with a fixed contract) or cost less.

Because previous generations earned a bigger slice than you, unfortunately does not mean that there is any divine right.

In any profession it is time and expertise for which people pay.

The third party fee setter (the NHS) took a set of fees from a decade and a half ago and continues to run with them.

This ignores the flexibility and evolution that existed in the dental contracts for nearly six decades, which helped practices stay agile in order to remain profitable.

Sometimes these money pressures are manifested in a reduction in quality of working conditions; for instance equipment might not be maintained, materials and laboratories are chosen on cost and choice is limited and staff might be ‘bargain basement’.

As the first casualty of war is truth, so clinical freedom can become an aspiration rather than a reality.

“One third gone and what have you done?”

The Incisal Edge Newsletter for May 1st.

“Strike another match, start anew.” (Bob Dylan)

April 30th was our financial year end for nearly two decades and I still have a feeling that I must end something and, more important, start something around that date. Whilst tidying, reading and binning yesterday I came across these lines. I don’t know who wrote them originally but I like the simple message.

  • We are where we are.

  • It matters not how we got here.

  • What matters is; what happens next.

We’re a third of the way through 2019, blink and the summer will have gone, have you made the changes that you dreamed of, taken the steps you hoped  for or chosen the new path? If not now when?

I am a great fan of goals & plans and objectives & tactics sometimes what matters most is what you do in the next 10 minutes.

Many people (especially in dentistry it seems) have a tendency towards  “perfection paralysis” they want everything to be “right” before they make changes, before they start something new and, because it never will be, because perfection never quite happens, sadly they don’t start, they don’t make the move, and they are left with their dreams, hopes and aspirations unfulfilled.
If you are one of those perfectionists
this article might help.

To read online CLICK HERE

A Builder’s Lesson

How shall I a habit break?
As you did that habit make.
As you gathered, you must lose;
As you yielded, now refuse.
Thread by thread the strands we twist
Till they bind us, neck and wrist.
Thread by thread the patient hand
Must untwine, ere free we stand.
As we builded, stone by stone,
We must toil, unhelped, alone,
Till the wall is overthrown.

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