“We are providing oral care, not just dentistry, for individuals…”

Stephen Hancocks’ Editorial British Dental Journal 22nd November 2019

“We are providing oral care, not just dentistry, for individuals not just a homogenous bunch plucked from the general public…”

“….One is left in little doubt that the current UDA system of remuneration in England, for example, fails utterly to address such important shifts in emphasis. While it is difficult to foresee a model other than that offered by a private route which would provide an obvious solution it cannot be outwith the wit of clever people to devise systems to allow quality over quantity whilst also enabling livings to be made….”



Come and work for Smile Direct!

The advertisement on indeed.co.uk looking for staff, or should that be “new team members?”, has some interesting comments from the people who have experienced the fun of being part of The Smile Direct community. Take a look and make your own mind up but it smacks to me of a sales driven, under trained, workforce with a high turnover, who have been over promised rewards which are difficult to achieve. Did I expect anything else in 2019?

What amused me most was one of the images on the site, not this typed one:

Rather the one that reminded me of an examination I was taught about but, thankfully, never had cause to use during my long and varied clinical career. I’ll let you imagine why they chose it.

The Monday Morning Quote #581

“There is no reality except in action.

Man is nothing else than his plan; he exists only to the extent that he fulfills himself; he is therefore nothing else than the ensemble of his acts, nothing else than his life.”

Jean-Paul Sartre

Do dental patients know what they want?

Do (Dental) patients know what they want?

A recent article in the British Medical Journal discussed the instruction from Health Education England that patients and public should be consulted on ‘What they need from 21st century medical graduates’.

I’m reminded of Henry Ford: ‘If I’d asked customers what they wanted, they would have told me – “A faster horse!”’.

Steve Jobs, added: ‘People don’t know what they want until you show it to them.

‘That’s why I never rely on market research.

‘Our task is to read things that are not yet on the page.’


If we’d asked people 50 years ago they wouldn’t have mentioned prevention and treatment of dementia in a reply.

Indeed, it is likely they would not have considered prevention at all.

Would they have suggested smoke-free workplaces, public houses and restaurants?

If the same question is asked of dental patients, ‘painless’, ‘free’ and ‘always available’ might be high on the list.

Two decades ago, a desire for straight white teeth without much ‘drilling’ would probably have been included as desirable.

But not considered possible by most dental patients.

The revolution in general (dental) practice driven by a desire to deliver an alternative to disease-driven repair care with minimally invasive, patient centred, cosmetic care was not anticipated.

Similarly, putting dentistry at the heart of general medical care would scarcely be an expectation or demand from most of the population – were they even to be asked.

Yet we know that the future must embrace the concept of ‘putting the mouth back in the body’.

Dentistry’s task is to take Job’s words and not only read but also write things not yet on the page.

Who knows where that might take the next generation of dentists?

First published in Dentistry.co.uk

The Monday Morning Quote #580

“It is a good thing to follow the First Law of Holes:

if you are in one, stop digging.”

Denis Healey


Thought of the day 191114 – “Out of time”

From reestheskin’s blog, under the categories “Bullshit, NHS” Link HERE

At one time the words ‘manager’, ‘management’, or worst of all, ‘line-manager’ were alien to much of medicine or academia. Things still got done, in many ways more efficiently than now. It is just that our theories of action and praxis have been ransacked by Excel spreadsheet models of human motivation and culture.

It is the final line from the quote that those controllers of ‘managers’ should be scared of:

“The next recession will retard this trend but it is unlikely to kill it.”

Oh the places I will go – Part 3 – Bounceback

Part 1 – The World at my feet

Part 2 – The World at my feet – in pieces

18th March 1993

My 40th birthday and a very significant date in the life of my practice. In the wake of the 1990 NHS contract and subsequent clawback of fees a group of dentists in Gloucestershire “held hands and jumped” to remove our dependence on the NHS. Several of us had things in common, we were of similar age, had big loans and couldn’t see how we could square the circle of carrying on providing our best for patients and continue to make a living.

With the assistance of the fledgling group, Gloucestershire Independent Dentists (GID) and supported by each other, in the words of Judith Cameron, we leapt and the net appeared. Some practices changed overnight, I was more cautious and transitioned over a 12 month period, giving all my adult, non-exempt, patients one last NHS course of treatment. This enabled me to have a conversation about the why, how, when and who of the changes. In those days Denplan was just about the only game in town and Gloucestershire became “Denplan county”.

I dreaded making the change, I anticipated wholesale rejection, arguments, insults and my hard work unravelling in minutes. I couldn’t have been more wrong. Because I changed gradually, and every patient received a letter ahead of their next visit plus good PR from GID, the word had got round. I allowed time to talk to explain my motives and to offer alternatives. The overwhelming feeling was one of acceptance, some begrudging, some cancelled their appointments “on principle”, some disappeared and then reappeared. More patients that I expected just said, “I’m surprised it has taken you this long, you have been giving private service since you opened.”

Instead of it being a catastrophe it was a tiny bump in the road. At the same time I started studying with the Open University on their MBA course which was really useful but due to circumstances beyond my control I was never able to complete. I also enrolled with Dr Mike Wise’s year long restorative course which also made me raise my game.

So I found myself with a largely private practice. There was still a significant NHS commitment because of the number of children we had attracted, which took a lot of management but worked extremely well and became a model for others to follow.

Things were looking up, I had managed to get a mortgage after a couple of years of banks not wanting to touch me with a bargepole, had remarried and our son was born in early April.

Life was good and the challenges were under control. The work was no less hard but the road was looking smoother.

The Monday Morning Quote #579

“Listen up – there’s no war that will end all wars.”

Haruki Murakami

Kafka on the Shore

Mouth Cancer Action Month

The report can be accessed here

Oh the places I will go – Part 2 – The world at my feet – in pieces.

1st January 1991.

The world at my feet – in bits. 

A lot can happen in 28 months. After the rapid success of the first practice. Hubris set in and in October 1989, flush with arrogance, I opened on a second site. This time I spent (borrowed) big time. Growth was slower, I was spread thinner and interest rates went through the roof. 

My first wife had fled and started divorce proceedings. What property we owned was in negative equity. The bank, for some reason of their own which I have never understood, forced me to close the first (profitable) practice, leaving me with a long lease to maintain. I spent two consecutive Christmas and New Year holidays and every weekend doing on call sessions to generate income of any sort. Plus there was a new NHS contract to grapple with.

I couldn’t understand how I was working so hard yet seemingly getting nowhere. Dentists were successful weren’t they? I was certainly making money but not keeping any. It all seemed to disappear before I could get it. The bank were constantly snapping at my heels telling me what I already knew – that I was in debt. Bank managers came and went, each one less approachable and sympathetic than the last. 

A recession was apparent and interest rates had recently come DOWN to 14% after 12 months at 15%. With no money, no house and a huge pile of debt I had no choice but to succeed. 

My pride dented, but determined to succeed, I set about taking my business as seriously as I took my clinical practice.


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