Page 1

TOGETHER EVERYONE ACHIEVES MORE

Issue

02 ISSN 2515-6128

Addressing Mental Health Luke Moore Dental Elite

Shaping the Future Nikki Patel

Young Dentist Committee

Enabling Developing Innovation Dentistry Edmund Proffitt BDIA

Key contributors to this issue

Catherine Barton BUPA


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Welcome Issue 2 of Modern Dentist has landed, and I hope that lifts your mood because, as you’re going to read about in this issue, a happy team is the key to a healthy business. Mental wellbeing is receiving more attention in the UK today, and in line with this, the dental profession is looking more closely at its own stress levels. It’s no wonder that these are particularly high in dentistry, as Dental Elite’s Luke Moore explains in this issue’s News. With complex work, anxious patients and ever-present compliance requirements to keep in mind, in addition to constantly changing external economical and governmental influences, the sustainability of a dental practice can only be ensured if team members are taken care of. This doesn’t necessarily have to be via remuneration. As contributors to this issue point out, value means different things to different people in the modern workforce. For the FGDP’s Sophie Ainley, opportunities for continued education are highly important, and she discusses her experiences of this as part of the Sector Soapbox feature, in which we hear the viewpoints on hot topics from the leading bodies in the profession. Nikki Patel, newly elected Chair of the BDA’s Young Dentist Committee, also explained the importance of nurturing young talent when we spoke to her about the goals of the YDC over the next three years. It was good to hear from Nikki about how the YDC is welcoming young dentists into the profession, and how practices can

do the same, so that the next generation of dental professionals is a healthy and happy one. Because happiness is what it all comes down to at the end of the day, and despite the challenges and sources of stress currently in the profession, dentistry is also undergoing a lot of positive change. Constant product innovations, digitalisation and new business models are all reasons to smile for those practices that take advantage of them, especially with National Smile Month just around the corner. You can read all about these in this issue, but if you feel we’ve missed something and there’s a particular topic you want to be covered, please get in touch with us via the details below; we’ll be very happy to hear from you.

Brendan

Brendan Gurrie, Editor, Modern Dentist Magazine. 01765 600909 | @ModernBrendan brendan@charltongrant.co.uk | www.moderndentist.co.uk

Editorial Contributors Daniel Redland

Director Tempdent Recruitment & Training

Daniel Woricker

Dr Richard Brown

Parrys Lane Dental Practice and Bupa Dental Care Geo Orthodontics

Lecturer in ISD Wired Orthodontics

Heidi Marshall

Dr Geoff Baggaley

Mark Barry

(B.Ch.D D.G.D.P.(U.K.)R.C.S. Dip.Con.Sed(Newc) The Raglan Suite

Dr Harry Singh

BChD (Leeds), MFGDP (UK), GDC No: 72684 On behalf of Med-fx Limited

Shaz Memon Sophie Kwiatkowski Accountant PFM Townends LLP

Director ESM Digital Solutions

Stephen Green

Mike Hughes

Principal Dental Practice Consultancy Service

CRadP MSRP MIPEM Radiation Protection Adviser, Medical Physics Expert and Radioactive Waste Adviser Stephen Green and Associates

Modern Dentist Magazine is published by Charlton Grant Ltd ©2018

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.

3|Modern Dentist Magazine

Marketing Ancar

Creative Director Digimax

Partner Dodd & Co

Editor - Brendan Gurrie, brendan@charltongrant.co.uk Project Manager - Amanda King, amanda@charltongrant.co.uk Editorial Assistant - Poppy Green, poppy@charltongrant.co.uk

Nathalie Smets

Cover Shot

Courtesy of Shutterstock

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Modern Dentist Magazine


Modern Dentist Magazine

Contents 15

Enabling Innovation

10

Interview with Catherine Barton, Bupa Dental Care

News

07

Southwest, as we spoke to Andrew Taylor, Chair of the Cornwall and Isles of Scilly Local Dental Committee about how the region’s location creates challenges for practitioners and how the LDC is attempting to address these.

Staying mindful of mental health

Mental health issues are receiving increasing attention in the dental profession and in wider society too. Luke Moore, Dental Elite, examines some of the common causes for this in dentistry and explains what can be done to improve mental wellbeing on individual and national levels.

22

Interviews

10

Developing the dental profession: Interview with Catherine Barton

We spoke to Catherine Barton, the new General Manager of Bupa Dental Care, about her outlook on the profession and how she plans to help practices and professionals under the Bupa brand meet the changing needs of today’s patients.

15

Enabling innovation: Interview with Edmund Proffitt

Clinical need is becoming a key factor in motivating dentists to try new products and so innovation in technology is on the rise, says Edmund Proffitt, British Dental Industry Association (BDIA), who spoke with us about what the industry, government and regulators can do to encourage innovation.

18

Regional Focus: Southwest

This issue’s Regional Focus looks to the

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Shaping the future: Interview with Nikki Patel

We caught up with the newly elected Chair of the BDA Young Dentist Committee, Nikki Patel, who told us about the aims of the Committee over the next three years and how these will help address the challenges facing young dentists to shape the future of the profession.

Editorial Board

27 27

Appealing to your patients

29 29

Whose name is it anyway?

Shaz Memon, Digimax Dental

Increasing efficiency within your practice Heidi Marshall, Dodd & Co

Shaping the future

31 33 33 35 35 37

Sophie Kwiatkowski, PFM Townends LLP

Profitability – the two sides of the profit equation

Mike Hughes, Dental Practice Consultancy Service

Open all hours?

Dr Geoff Baggaley (B.Ch.D D.G.D.P.(U.K.) R.C.S. Dip.Con.Sed(Newc)

The importance of ergonomics: preventing future back and shoulder pain

Delivering best patient care Johnny Minford, Minford Chartered Accountants

How can practices stand out from the crowd in a competitive market?

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

37

Technical Specialist or allround Customer Service Guru?

Daniel Redland, Tempdent Recruitment and Training

How can processes in dental practices become more digital in order to improve efficiency and service?

39

IR(ME)R 2017

39

Stephen Green CRadP MSRP MIPEM, Stephen Green and Associates

Payroll: a key component

Nathalie Smets, Ancar

Louise Fegan, Morrisons Solicitors

Mark Barry, ESM Digital Solutions

31

22

How utilising facial aesthetics can help grow your dental practice as a business

Dr Harry Singh, BChD (Leeds), MFGDP (UK)

What price would you pay for peace of mind?

Darren Scott-Guinness, Dental & Medical Financial Services


Issue 2 | ISSN 2515-6128

44 The new

world of digital currencies

50

31

National Smile Month

Payroll: a key component

Subscribe for

FREE at

www.moderndentist.co.uk

41 41

Integrated Smile Design (ISD) Daniel Woricker, Wired Orthodontics

47 50

Importance of collaboration

54

Is your dental practice ready for GDPR?

56

Periodontal disease: the hidden epidemic

Standing out from the crowd Amanda Maskery, Sintons

Features

42 44

52

Sector Soapbox

Modern Dentist’s panel of resident associations outlines the burning issues.

Digital currency: the new trend

Dr George Carr, George Carr DDS & Associates PLLC, is an early adopter of cryptocurrencies in dentistry. Here, he explores this new world of digital currencies and advises how you can utilise it for the benefit of your practice.

Dental practice values: the last 10 years and the future

Alan Suggett, National Association of Specialist Dental Accountants & Lawyers (NASDAL), reviews the previous quarterly NASDAL goodwill surveys to identify the trends in practice values and provide some top tips on anyone thinking of buying or selling.

Inspiring patients and communities for National Smile Month

The Oral Health Foundation is calling for National Smile Month 2018 to be an opportunity for dentists to help inspire their patients and spread positive oral health messages nationwide, Dr Nigel Carter explains.

Barry Lanesman, Dentex Healthcare Group, discusses the benefits of co-ownership and a joint venture partnership as collaboration becomes the key to creating a sustainable business.

Supported By

As the 25th May GDPR implementation date rapidly approaches, Jamie Foster, Hempsons, dishes out his advice for how practices can prepare for the implementation of GDPR.

Jo Dickinson, Hygienist and Key Opinion Leader at Acteon, is helping to promote awareness of periodontal disease within the UK. She explains what dental teams can do within their practice to help develop patient care and disease prevention and how this can benefit the practice in turn.

Case Studies

57 57

Geo Orthodontics

Getting to know Nuvola – invisible, removable and practical

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10 Minutes with...

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Graham Byrne Your Smile Direct

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Modern Dentist Magazine


NEWS

Staying mindful of mental health Luke Moore

Mental health issues are receiving increasing attention in the dental profession and in wider society too. Luke Moore, Dental Elite, examines some of the common causes for this in dentistry and explains what can be done to improve mental wellbeing on individual and national levels. Today, mental health illness is considered to be a prevalent problem within the UK dental profession. While this isn’t a new development, it’s only in recent years that the enormity of the problem has come to light, due in part to the greater availability of data and understanding of the issue. A heightened awareness and decreased social stigma and embarrassment about mental health has no doubt helped with this too, resulting in more dentists opening up about their own experiences. As such, we now know that there is a high risk of mental health illness among dentists, which has led to growing concerns about suicide in dentistry. The exact numbers for 2018 are unknown, but in a previous study, the levels of minor psychiatric symptoms were found

to be 32% in general dental practitioners. In comparison, doctors had a prevalence of 27.8%, while the general population was much lower with 17.8%1. As for suicide, it is well documented that there is a link between suicide and mental disorders, though data released by the Office for National Statistics suggests that occurrence is much lower among male dentists compared to low-skilled workers. For female health professionals, on the other hand, the risk is shown to be much higher, so the profession should bear this in mind moving forward2. According to a report released by the British Dental Association in 2017, the main types of mental health issues in dentistry are stress, burnout, anxiety and depression. Less commonly reported were sleeplessness, breakdowns, withdrawal, drug use, panic attacks and alcohol use, amongst others. In the short-term, mental health can have a severe impact on well-being and day-today life, leading to loss of motivation, social disengagement and absence from work. Relationships with loved ones can often be affected too, which can lead to separate,

though no less upsetting issues. As for longterm, mental illness could lead to quitting the profession, early retirement, further health complications and, in severe cases, suicide. But what is it about dentistry that is having such a detrimental impact on dentists’ mental health and well-being? What are the causes? There are a number of factors that can impact mental health, from work conditions and isolation, to regulation and litigation, uncertainty of NHS dentistry, pressure of targets and tight schedules, finances, complaints and more.3 The dental practice can be an unforgiving environment, even for those who are not suffering with mental health issues. When you consider, then, that some or all of these conditions are present in a number of practices up and down the country (in varying degrees, of course), it’s a wonder that more dentists aren’t more severely affected. These difficulties simply cannot be faced day after day without serious consequences.

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News It’s only in recent years that the enormity of the problem has come to light, due in part to the greater availability of data and understanding of the issue Perhaps that’s why almost 58% of the UK’s NHS dentists are planning to leave NHS dentistry in the next five years4. It is no secret that NHS dentistry has become pressurised as a result of the contract system; it is quite possible that this could have an adverse effect on mental health. Either way, it is clear that more must be done to address this issue. On a national level, attention to remuneration, regulation and contract reform will be key moving forward, but action must also be taken within the dental practice to safeguard mental wellbeing. Some of the recommended preventive measures that could be taken to minimise mental health illness include:

that promote well-being, there are ways in which dentists can take mental health into their own hands. Help is at hand Of course for anyone suffering from mental health illness, it’s not always easy taking those first steps – but help is at hand. Leading UK charity Mind provides a range of training and well-being courses to help teach individuals and companies how to manage, develop and promote healthy mental health. There are also a number of guidelines and information leaflets available to aid recovery, as well as two confidential helplines and an online community called Elefriends where individuals can go to for support.

Mental health illness is likely to be an ongoing issue in dentistry, but with the right support from charities like Mind, dentists can take positive steps in overcoming difficulties. If you or someone you know is suffering from mental health issues, visit www.mind.org.uk.

Luke Moore

Founder and Director, Dental Elite. If you’d like to support Dental Elite in their endeavours for Mind, visit www.justgiving.com/fundraising/dentalelite – any donation, no matter how large or small, would be greatly appreciated.

Attention to remuneration, regulation and contract reform will be key moving forward, but action must also be taken within the dental practice to safeguard mental well-being

• Improving the working environment at the practice through effective communication and support • Regular staff meetings and team building to reduce isolation and encourage communication • Working sensible hours and taking a lunch break • Taking annual leave to diffuse tension and stress It’s also up to the dentist to take proactive steps to look after their mental health. From exercising more and living a healthier lifestyle to advocating positive changes in the practice

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To help the charity to continue improving and saving lives, Dental Elite has pledged to take on a ‘Wish List’ from the Coventry and Warwickshire branch of Mind. Through fundraising, we hope to enable Mind to improve the facilities at the branch and fund specific courses for people in need, whilst also raising awareness amongst the dental profession. A number of the team are taking part in various events and challenges throughout 2018, including the mighty Wolf Run 10K obstacle course in April, skydiving in May, and the notorious 24-hour Three Peaks Challenge on Thursday 5th July. The agency has also already completed a 10K run around Draycote Waters in Rugby, helping to raise crucial funds for the worthy cause.

1 Myers and Myers (2004). ‘It’s difficult being a dentist’: stress and health in the general dental practitioner. British Dental Journal, 197, pp. 89–93. Accessed online February 2018 at https://www. ncbi.nlm.nih.gov/pubmed/15272347 2 Office for National Statistics. Suicide by occupation, England: 2011-2015. Accessed online February 2018 at https://www.ons.gov.uk/peoplepopulationandcommunity/ birthsdeathsandmarriages/deaths/articles/suicidebyoccupation/ england2011to2015#suicide-by-occupation-among-females 3 British Dental Association Research Paper. The Mental Health and Well-being of UK Dentists: A Qualitative Study. Published August 2017. Accessed online February 2018 at https://bda.org/dentists/ policy-campaigns/research/workforce-finance/Dentists%20wellbeing%20and%20work-related%20stress/dmhb/Documents/ The%20Mental%20Health%20and%20Well-being%20of%20 UK%20Dentists%20A%20Qualitative%20Study%20Final.pdf 4 British Dental Association. ‘Half of NHS young dentists heading for the exit’. Published 1 October 2017. Accessed online February 2018 at https://bda.org/news-centre/press-releases/half-of-nhsyoung-dentists-heading-for-the-exit


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Interview

Developing the dental profession Catherine Barton

We spoke to Catherine Barton, the new General Manager of Bupa Dental Care, about her outlook on the profession and how she plans to help practices and professionals under the Bupa brand to meet the changing needs of today’s patients.

Q

How has your career history to date influenced your outlook on the dental profession, and has this perception changed since taking on your current role?

A

Before becoming General Manager of Bupa Dental Care, my personal and professional experience of dentistry meant I was already very impressed by dentists’ focus on quality of care for patients.

As a qualified actuary who had advised the medical industry in previous roles, I already knew that the profession was committed to high standards. This has only been confirmed by what I have since seen from our associates at Bupa Dental Care. Not only are dentists dedicated to delivering great care for each patient that visits their chair today, they are also

10|Modern Dentist Magazine

is well-resourced. At Bupa Dental Care, we’ve launched a new recruitment campaign called Love Your Everyday, which champions the flexibility of dentistry and the opportunities for career development and progression that we offer.

hungry to improve and develop their skills for the patients they’ll care for tomorrow and in the months and years ahead.

I have also been impressed by the diversity within our sector, with women in senior roles in practices across the UK, and all communities well-represented and looked after.

Q A

What are the key challenges in the profession that are currently affecting Bupa Dental Care practices? How is Bupa Dental Care addressing these, and do you feel they are affecting other practices in the same ways?

A key challenge facing the dentistry profession as a whole, not just here in the UK, is recruitment. We need a pipeline of enthusiastic new dentists coming into the sector, and we need to ensure that every corner of the country

Another challenge, which I see as much as an opportunity, is that patients are increasingly behaving as consumers. They are shopping around for the services and treatments that work best for them rather than just going to the nearest practice. Both NHS and private patients’ expectations are rightly higher than they have been in the past, and this is especially true at Bupa Dental Care, due to the halo effect of the wider Bupa brand. We welcome this, relishing the chance to provide anyone who sits in our dentists’ chairs with the best care possible. I actually use “patients” and “customers” interchangeably; that’s how


Interview

A

Patients now want more when it comes to service and appointment availability, so as a sector we need to meet those demands. At Bupa Dental Care, we’re doing this by creating a consistent look and feel in our practices, working to make sure that patients can experience the same care across the board.

Q A

The Bupa brand is synonymous with quality, and we’re proud to see that translate into our dental offer through the work of our associates across our practices. Due to Bupa’s established reputation within the private healthcare sector, some people are surprised that we offer check-ups and treatments on the NHS, which is a significant part of our business. We want to make sure Bupa Dental Care becomes a brand for everyone.

Ensuring our services are available for patients at suitable times in today’s busy modern world is key, and indeed a large number of our practices offer extended opening hours incorporating early, evening and weekend appointment slots.

Brands are important as they provide patients with the assurance that the service provided will be of a consistent and high standard, but a dentist’s individual reputation can be just as important. The relationship fostered between a dentist and their patient from appointment to appointment is invaluable, creating trust and loyalty over time. It’s vital that each individual, whether they practice independently or as part of a wider corporation, takes responsibility for their own reputation being synonymous with quality care.

Digital advancements are revolutionising workflow, creating a smoother, more seamless experience for both patients and practitioners

important it is for us that they choose to come back time and time again.

Q

How is the data obtained from Bupa Dental Care’s network of practices utilised to provide the business with a greater understanding of patient health, habits and expectations?

A

We use both quantitative and qualitative data to inform what we offer our patients. NHS data is helpful, alongside our own surveys into what patients expect from their dentist and Bupa Dental Care as a brand. We track their experience through our Net Promoter Score to ensure we’re listening and adjusting our approach as needed.

Q

How are patient expectations towards dentistry changing, and what steps is Bupa Dental Care taking to ensure its practices are able to meet these?

Rightly, our patients expect a standard of service that starts with a warm welcome and ensures they feel as comfortable as possible throughout their visit. Our people provide this in spades. Their expectations for how their teeth will look are also increasing. Going way beyond fixing a problem or addressing any pain they may be experiencing, patients want their teeth to look great. This means we’re seeing a rise in demand for aesthetic dentistry.

What value does brand provide to a practice for consumer engagement and patient trust, and are there steps that small or independent practices could take to build their own brand?

Q

How does Bupa Dental Care’s scale and reach allow it to drive innovation within its practices, and what forms does this innovation take?

A

Our scale allows us to innovate and offer our patients the latest treatments, but just as importantly, we’re able to trial and adopt different models of delivery. More and more, we’re drawing on the strengths of our wider team of specialists, including dental therapists, nurses and orthodontic experts.

Patients are increasingly behaving as consumers. They are shopping around for the services and treatments that work best for them rather than just going to the nearest practice

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Modern Dentist Magazine


Interview

We’re also pleased that some of our practices are currently involved in the NHS contract pilot, and we are proud of our legacy, through Oasis Dental Care, of trialling different models over the past ten years.

Q

How are Bupa Dental Care’s practices becoming more digital as available technology continues to advance, and what do you believe are the next steps on the road to digital dentistry?

A

I’m most excited about how digital developments can be harnessed for education and workflow.

When it comes to training, our associates can now access the very latest digital resources from across the world. As a new generation of dentists joins the profession, including millennials and Generation Z – digital natives who have grown up with apps and tablets – training will need to be increasingly interactive and engaging. Digital advancements are revolutionising workflow, creating a smoother, more seamless experience for both patients and practitioners. Documents can be centralised and accessed easily, helping consistency across appointments. We now have digital radiography across our practices, which saves time, and scanning rather than creating impressions and trays for braces also means we can move quicker.

When it comes to developments down the line, we see ourselves as fast followers. We don’t want to be the first to adopt technology that hasn’t been tested, but we want to embrace it and roll it out quickly once we know it will benefit our patients.

Q

How does Bupa Dental Care maintain consistency in standards and care across its varied network?

A

Consistency across our brand is key for us, and it starts at the point of recruitment. Selecting people with great skills and potential is essential.

We then deliver consistency in standards and care through ensuring our associates are fully supported. They have mentors and wider clinical involvement on compliance matters. I’m hugely passionate about prioritising our own people in order to best serve our patients. If our practitioners feel well supported and well rewarded, they will go the extra mile for our patients. We take pride in “growing our own,” with a well-established Dental Nurse apprenticeship programme and Practice Manager Academy enhancing our teams across the estate. We also ensure consistency through our strong Clinical Care team, led by our clinical director, Eddie Coyle. They

Catherine Barton Catherine Barton became General Manager of Bupa Dental Care in January 2018. Bupa acquired Oasis Dental Care’s practices in 2017 and now provides access to private and NHS dental care from more than 400 practices across the UK and Ireland. Catherine is a qualified actuary with considerable experience in the UK motor and household insurance markets. Catherine was formerly Commercial & Finance Director at Bupa UK with responsibility for the Finance, Legal, Risk, Actuarial and Tax functions. Prior to joining Bupa, Catherine was a Partner at both Ernst & Young LLP and Deloitte. Outside of work, Catherine enjoys a variety of interests including skiing, tennis, photography and learning German, as well as spending time with family and friends.

12|Modern Dentist Magazine

influence the decisions we make as a leadership team, and their guidance is invaluable.

Q

Has market uncertainty affected appetite for practice selling with the UK dental profession, and how do you predict this will change post-Brexit?

A

I would see the key factors affecting when and whether practitioners choose to sell their practices as being retirement, freeing up of capital and creating the space to focus on clinical delivery rather than the wider aspects of practice management. While Brexit has created uncertainty, the key drivers to sell will still be there, so I expect market consolidation will continue in spite of Brexit.

Q

What are Bupa Dental Care’s plans for continued growth over the next twelve months, and what are your aims for the business as you continue in your new role?

A

Since incorporating the Oasis Dental Care brand last year, we have proved that Bupa is a perfect home for dental care, and I’m excited about growing our business in the years ahead. My main focus will be on making sure that we provide a great place to work for our people, who are responsible for delivering excellent care and service to our patients.

The relationship fostered between a dentist and their patient from appointment to appointment is invaluable, creating trust and loyalty over time


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Interview

Enabling innovation Edmund Proffitt

Clinical need is becoming a key factor in motivating dentists to try new products and so innovation in technology is on the rise, says Edmund Proffitt, British Dental Industry Association (BDIA), who spoke with us about what the industry, government and regulators can do to encourage innovation.

Q A

Are there trends in innovation taking place in the dental industry that the BDIA has identified, for example in the types of products being developed?

This is something we survey regularly, and our 2017 Dental Technology and Trends survey highlights a few interesting trends. For instance, the top three products that dentists intend to purchase in the next twelve months are digital intra-oral scanners/impressioning systems, intra-oral cameras and soft-tissue lasers. Intra-oral cameras available in practice increased by 8% from 2015 to 2017 to 46% of practices, and there has been continuing growth

to develop, trial and ultimately retail innovative, new and improved dental products across all areas and disciplines. In short, this progress is a combination of industry led innovations, clinical need and the drive to provide excellent clinical outcomes and to meet changing patient needs and expectations.

in the adoption of practice management software. Again, interestingly, 64% of dentists cite clinical need as the key decision factor in motivating them to try a new technological product.

Q

What are the other main drivers for such innovation?

A

As cited above, according to BDIA research, nearly two thirds of dentists state clinical need as the key decision factor in motivating them to try a new technological product. This fosters innovation and stimulates the industry

Like all areas of technology, there are clear adoption phases, and dentistry generally seems to mirror this, so, hopefully, innovative products will filter through

Q

What issues do counterfeit devices create in the industry, and how is the BDIA’s CSIDI seeking to address these?

A

The main issue arising from counterfeit and non-compliant dental products is the risk they represent to patients, users and to a professional’s registration. To mitigate these dangers, the BDIA launched its Counterfeit and Substandard Instruments and Devices Initiative (CSIDI) four years ago. Our messaging for this dental press based advertising and awareness campaign is simple: non-compliant, substandard and counterfeit dental

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Modern Dentist Magazine


Interview

The ongoing implementation of the new EU Medical Device Regulations (MDR), coupled with the impact of Brexit, provide the industry with perhaps the biggest regulatory challenges of a generation instruments and devices are potentially dangerous to patients and users and the BDIA, BDA, GDC and MHRA recommend that all purchases, however small, are made from a reputable supplier and that all suspect instruments and devices are reported to the appropriate authorities at the earliest opportunity. We are very proud that the UK’s medical device regulator, the MHRA, joined us as an official partner in this campaign last year, and that our dental press advertisements have won four awards over the last two years.

Q

It’s also interesting to note that around 80% of dental products are imported, with a high proportion coming from the EU, so there should be a desire and motivation from both ‘sides’ to reach a workable solution. In fact, the BDIA has issued joint letters with our EU trade body urging just this to both UK and EU negotiators. We would also urge the government to ensure that the best trade ‘deals’ are obtained to minimise tariffs, non-tariff barriers and any other obstacles to the import and export of medical and devices.

What impact might Brexit have on the dental industry, and where should the government’s focus be to minimise any negative impact?

A

Brexit could have profound effects both on the dental profession and the dental industry, depending upon the eventual agreement that emerges. For manufacturers and suppliers of dental equipment, the key thing is maintaining the continuity of regulation across the EU and UK, including the recognition of CE marks and UK Notified Bodies and Authorised Representatives for medical devices. Without this continuity, the import and export of dental devices could become time consuming and expensive,

16|Modern Dentist Magazine

supports this work and our colleagues in the profession on this long journey. Perhaps as important is the requirement that change is backed up with government funding to ensure an appropriately funded, progressive prevention orientated ‘new’ dental contract is the end result. We also believe that the government should recognise the significant role and contribution that private dental treatment contributes to the nation’s oral health, whilst easing the burden on NHS funding requirements.

impacting on suppliers, dentists and patients. This is keenly recognised and acknowledged by the UK government, and post-Brexit continuity of medical device regulation is key to a harmonious and efficient supply chain going forwards.

Q A

What changes does the BDIA feel need to be made to the current NHS contract to create a better environment for dental professionals and suppliers?

I think that there is a widespread consensus that the UDA system needs overhauling, and, of course, pilots of iterations of a prototype of a ‘new’ contract are ongoing. The industry broadly

Q A

Where do you believe there is room for improvement in medical device regulation, and how can regulators achieve this?

The ongoing implementation of the new EU Medical Device Regulations (MDR), coupled with the impact of Brexit, provide the industry with perhaps the biggest regulatory challenges of a generation. Whilst, in principle, the MDR makes perfect sense and is evolutionary, rather than revolutionary, if I had a magic wand I would certainly change some of its requirements as they seem to particularly adversely affect dental devices in a number of areas. Particularly threatening is unnecessary up-classification of low risk devices for no


Interview

obvious scientific reason, casting doubt over stainless steel surgical devices and giving us some confusion over what dental devices may need to be accompanied by an ‘implant card’ in the future. It’s not just our GDC registrant colleagues that have suffered significant regulatory cost increases in recent years; BDIA members have faced very significant increases in regulatory compliance costs in the last few years, and this is a trend that is very unlikely to change in the near future.

Q

What are the current barriers to innovation in the dental profession and in the industry, and how could these be overcome?

A

Well, the current NHS Contract does not seem to encourage capital spending on cutting edge, innovative dental technologies. Whilst there are a host of technologies that can improve treatment processes and speed up treatment and outcomes, such as CAD/CAM equipment and chairside manufacturing, there is an understandable reluctance to invest based upon incomes and returns from providing NHS dentistry.

Q

What steps can be taken to ensure NHS practices are able to embrace innovation at a pace similar to their private counterparts?

A

That’s a tough one, with no simple answer, apart from more funding from the NHS. As new technologies begin to mature,

together to increase the numbers of those regularly attending the dentist. I believe that this is predominantly in the private sector, and it is in this area that there is potential for growth and development. Perhaps a public facing education and awareness campaign and further take up of dental plans could contribute to this vision of growing access in the future.

there is the opportunity for broader uptake, and we hope that some products are moving beyond the ‘early adopters’ and are becoming more widespread and established in time. Like all areas of technology, there are clear adoption phases, and dentistry generally seems to mirror this, so, hopefully, innovative products will filter through.

Q

How can increased public engagement improve the nation’s oral health, and does the dental industry have a role to play in this?

A

By increasing engagement with the public, there is a greater opportunity to encourage access and good oral health habits. By tapping into and accessing public interest and building confidence, along with improving the image and public perception of dentistry, there is a significant opportunity to improve access, engagement and new habit formation, particularly in the non-NHS sector, providing great opportunities to improve oral health. The dental industry is just one of the many partners who could form a coalition to achieve this going forward.

Q

Where are there opportunities for collaboration between dental stakeholders in order to improve market conditions for the industry as well as patient care?

A

I believe that there is a significant opportunity for stakeholders to work

Q

What are some of the BDIA’s other strategies to improve the dental industry in the next year and beyond?

A

In addition to the significant advocacy work we undertake, our BDIA Policy and Public Affairs Roadmap identifies around fifty specific activity areas, including, of course, the new MDR and regulation, as well as Brexit. We are also working on some other exciting industry projects for 2018. We are about to launch a completely new version of our website, we have totally revised and updated our very popular industry training course, ‘BDIA Certificate: Introduction to Dentistry’, and we have just launched a new CSIDI press advertisement. We are also working on a campaign to promote BDIA members as the ‘go to’ source for purchasing dental products and are offering our members our most extensive ever range of seminars and events to help them keep up with the ever growing challenges of compliance.

Edmund Proffitt Edmund brings over 30 years of experience in trade association management to the BDIA, where he held the position of Policy and Public Affairs Director before taking over as Chief Executive in April 2017. Having been responsible for establishing the dental industry’s CSIDI activity tackling counterfeit and noncompliant dental equipment, creating the Association’s Policy & Public Affairs Roadmaps and leading dental industry discussions on the Medical Device Regulations, Brexit and Virtual Manufacturing issues, Edmund is in an ideal position to ensure that the industry’s voice is heard in changing and challenging times. He also sits on a number of industry and medical devices committees and

is the current Chairman of the UK MedTech Forum. As the voice of its members - trusted manufacturers and suppliers of innovative products, services and technologies who are interested in shaping and improving the future of dentistry, sharing knowledge, building business, networking and engaging in initiatives to develop dentistry – the BDIA play a pivotal role in driving standards for the provision of quality oral healthcare. BDIA members range from leading international businesses within the sector through to small and medium sized companies, and every member adheres to a professional code of practice.

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Modern Dentist Magazine


Interview

Regional Focus:

SOUTH WEST Andrew Taylor

This issue’s Regional Focus looks to the Southwest, as we spoke to Andrew Taylor, Chair of the Cornwall and Isles of Scilly Local Dental Committee about how the region’s location creates challenges for practitioners and how the LDC is attempting to address these.

Q

What are the main challenges that dental professionals in the Southwest are facing at the moment, and how are they tackling these?

A

The main challenges they are facing are: Providing dentistry in a rural area: the physical geography of the southwest means many patients travel significant distances to access dentistry, whether that’s NHS or private.

For NHS dentists, providing a reasonable and acceptable level of care within a heavily restricted and underfunded service is becoming more and more difficult, with four practices handing back their NHS contracts and privatising in the last year. The government’s austerity has meant for many dentists that they are unable to provide NHS dentistry without the private income it brings to a practice from options not available on the NHS. Regulations and bureaucracy: there are now more than thirty organisations with an interest in dentists and more than ever, monitoring and influencing

18|Modern Dentist Magazine

and governing dentistry. Despite the government’s focus in reducing this, they have made no progress and have in fact more than doubled the admin side of dentistry in the last 3-5 years.

Recruitment: recruiting new dentists on the NHS is very difficult as many are opting not to provide NHS care in favour of private or hospital jobs. The southwest has always struggled to attract dentists due to rural location, its distance from a dental school and the poor opportunities for career development and diminishing NHS pay. There are also only a handful of specialist dentists in the southwest and a woefully unacceptable and poor secondary care service provision due to a real lack of recruitment to consultant and specialist posts and historical lack of service provision. Mental health, burn out and suicide: the pressures of dentistry have always been high combined with many of the above and dealing with 20-30 patients a day, with often complex and anxious patients with high needs and the pressures of life in general. There’s also added

scrutiny from the GDC and regulatory and governing bodies with no help or support from the regulatory bodies or human acceptance.

Decreasing the GA rate in children is a national problem, and improving the oral health of adults and children is another.

One main challenge for patients and dentists is the patient charges, which have been increasing at 5% whereas the payment to practices has been minimal. There will be a stage over the next five years where what patients pay and dentists receive is the same, effectively privatising NHS dentistry and fixing the cost at the same time; clever from certain view points.

Q

A

What has been the key positive or negative area of change in the Southwest region in the past decade, and how have professionals in the area responded to this?

Key negative changes include:


Interview • Loss of occupational health services for practitioners • Austerity from government • Amalgamation of the PCT to an area team for the southwest, understaffed and funded • Orthodontic recommissioning and procurement • Premature early retirement of experienced practitioners • The UDA dental contract • Low morale as a profession

Positive changes: • Formation of the LPN, although yet to show the significant fruits they were supposed to offer • The expanding private market and interest of patients from all ages. In addition the opportunities to improve and career progress in this environment • Significant steps in oral health awareness and prevention • Short term orthodontics

through these processes. We are also a source of information and resources for local practitioners through our website.

Q

How have the needs of dental professionals in the Southwest changed in the last five years?

A

I don’t think the needs of dentists have changed; we still need increased help and support both financially and palliatively from the area team and nationally through sensible policy and a new dental contract. The dental contract, despite heavy criticism by dentists, critical review and general consensus from all is still existing to be. This has been the case since 2006 and is causing great problems and poor care for patients and providers.

Q

Have patient expectations changed in the Southwest, and to what do you attribute any such changes?

A

Patients’ expectations have changed greatly over the last five years. The

The demand for cosmetic restorations, procedures and quality caring service have changed the face of practices

Q

What are your core aims as a regional representative of the Southwestern LDCs?

education and knowledge of patients through the web, social media and celebrity culture has changed the way we view and access information as well as our needs for our oral health. The demand for cosmetic restorations, procedures and quality caring service have changed the face of practices. We have seen a huge increase in patients turning their back on NHS care in favour of private care. We have had to adapt and change to the challenges this produces. Patient expectation is also at an all-time high in this disposable era. The interesting thing is that improving our practices to provide these additional requirements and features has added to running costs, which has made providing NHS and private dentistry in conjunction a challenge, with many making a loss or breaking even on NHS care, which is unsustainable.

A

With limited influence and input into local commissioning, provision of services and the area team under significant pressure to cut costs and feed money back centrally, it is difficult to envisage that we will be able to make an impact or make positive changes despite best efforts.

Currently our core aim is to help and support local orthodontists through the procurement and re-tendering process, offering advice, help, support and putting positive constructive pressure on the local area team, holding them to account for any changes.

This is in addition to our core aims of helping and supporting local dentists, either directly or through our PASS scheme, liaising with the area team and LPN and giving all dentists a say in changes and decisions made centrally and feeding back to the area team. We also represent on PAG and PLDP groups, giving clinical input, help and advice and giving context to practitioners going

Q

How do you and the LDCs in the region ensure LDCs maintain their relevance to the profession?

A

We engage with as many dentists as possible and attend as many events

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Modern Dentist Magazine


Interview

For NHS dentists, providing a reasonable and acceptable level of care within a heavily restricted and underfunded service is becoming more and more difficult

as possible, locally and nationally, to keep up to date and feed back, help and support where possible. Being a practicing NHS and private dentist with enhanced skills and being an NHS/private provider, performer and principle of a large eight surgery practice aids this. It keeps me engaged, current and on topic.

Q

the profession, as in all walks of life.

NHS dentistry has without doubt fuelled the stigma around dentists’ pay. The low cost has given patients the expectation it should be cheap. The media has not helped with rash and inaccurate statements around pay. The headline figures have been misguided with the naive misinterpretation of the difference between gross and net pay and the costs dentists face. Roughly half of over the counter pay goes straight out to costs before dentists’ pay. When in comparison to our peer groups, we are, for the majority, below that of solicitors, doctors, and healthcare professionals in the UK or other countries.

How do you feel the pace of innovation differs in the Southwest compared to other regions? Where is the region ahead of curve in this area, and where might it be behind?

A

Provision of services in the specialities is and has been archaic and limited in the region. Being a great distance out and on a limb of the country with no boundaries with other counties makes the southwest vulnerable from isolation and consideration nationally. I can’t think of any areas we are ahead, which is a demoralising thing to say for local practitioners, apart from small local initiatives with limited impact.

Q

How do you think the dental profession is perceived by the public? Do LDCs have a part to play in building relationships on this level?

A

LDC’s definitely have a role in presenting the profession in a positive light and, where possible, taking every opportunity to promote this. However, our primary role and responsibility is to practitioners and levy payers. I believe the perception from the public is better than ever, apart from a small minority having had bad experiences in one way or another, and a minority of practitioners have negative influence on

20|Modern Dentist Magazine

Q

Do you feel that the Southwest dental market has a voice in wider conversations outside of the region?

A

We definitely have a voice and it is listened to, talked about and debated locally and fed back nationally, but it has little or no influence. NHS England are disorganised and not open to taking on messages fed back.

Q

A

What does the future look like for the dental professionals in the Southwest region?

The future is bright with the expansion in private care and efforts being made locally. The NHS outlook is bleak and unpredictable. It is of great worry what is happening with the orthodontic process locally and nationally, and this seems to be a sign of things to come for the upcoming potential dental contract revision.

Andrew Taylor Andrew had aspirations of being a dentist from aged twelve and qualified in 2005 from Cardiff Dental school, achieving Merit for clinical and academic achievement. These aspirations gave him the drive and motivation to own and establish the caring family practice of which he is now Principal, Wadebridge Dental Care. In 2009, Andrew was elected as Local Dental Committee Chairman for Cornwall and Isles of Scilly, allowing him to influence dentistry and represent, guide and help local dentists in Cornwall. He also represents the southwest region nationally on the GDPC-LDC liaison group, which meets quarterly at the British Dental Association, and in his involvement with the Local Professional Network in Cornwall. Outside dentistry, Andrew moved to Cornwall in 2005 and set up home with his wife Melissa, who qualified as a dentist in the same year and now also works at the practice. In his spare time, he enjoys keeping fit, watching Rugby Union/Formula 1 and time spent with his wife and their cocker spaniel Henry on long walks, soaking up the Cornish sunshine.


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Interview

Shaping the future

Nikki Patel We caught up with the newly elected Chair of the BDA Young Dentist Committee, Nikki Patel, who told us about the aims of the Committee over the next three years and how these will help address the challenges facing young dentists to shape the future of the profession. 22|Modern Dentist Magazine


Interview

Q A

What will be your main areas of focus for the new three-year term of the YDC?

The YDC champions the views and interests of dentists within the first ten years of qualification, in terms of policy making, political lobbying and improving the quality of working life for younger dentists and their prospects for the future. The YDC represents members’ views across branches of dental practice, specialist groups and professional activities. The main areas of focus for the next three years will revolve around: • Dental Foundation Training, Dental Core Training and the continuing education of dentists • Career development in clinical practice and leadership • Dentist morale and support through the first stages of their careers • Increasing the representation of young dentists on the decisionmaking bodies within dentistry, e.g. LDCs • Developing and enhancing inclusionary and participatory channels for engagement with members and stakeholders • Building a community for younger dentists

Q A

We seek the solutions and demand the changes by engaging with other organisations and bodies so we can help reshape dentistry so that it works for dentists and our patients

Q A

Socially, national recruitment has made it more difficult to settle down in one area, younger dentists are buying houses later and having families later, and an increasing female workforce has also had an effect on working patterns. Many dentists chose to study dentistry thinking the career would be totally different to what it actually now entails. These shifts can influence expectations and outlooks in dentists’ lives and careers.

However, not all change is doom and gloom. With change also comes opportunity. It could be argued that many career options are still yet to be developed. With advances in digital technology and artificial intelligence, who knows what the future of the profession may look like in the next decade and what opportunities that may bring to the way we work? It is an exciting time and the innovators amongst us may see this as a prospect to drive the profession in a direction that was previously unimaginable.

Q A

What are your aims and goals during your tenure as Chair of the YDC?

I really want to get out there, to engage the profession and stimulate discussion to encourage dentists to start lobbying for positive change. I am accessible and will remain a visible point of contact not just for young dentists, but for any organisation or group who want support to engage younger dentists. By providing guidance, support and leadership, I will ensure members are encouraged to participate and that all views are heard whilst prompting discussion and highlighting areas of controversy that have gone unaddressed. I want to see a more joined-up approach with collaborative working across other organisations and bodies to deliver our objectives.

This reduction in spending power can make dentists more discriminating on what they spend their money on.

It can be argued there has not been a more important and pressing time for the YDC. Young dentists are the future of the profession and so the views of the Committee are integral in shaping it. The YDC comment on consultations from other organisations on dental issues, such as the GDC, NHS or Government. Alongside this, the Committee act in an advisory role to the PEC, the Association’s highest decision-making body, on policy affecting young dentists. Where the PEC is asked to approve a major decision or adopt a policy position regarding an issue affecting young dentists, the PEC will be guided by the YDC. Additionally, YDC members are elected as cross-representatives to other BDA committees to ensure their voices are heard with regards to issues affecting other Committees.

The YDC are working closely with LDCs, HEE and other organisations to improve young dentist representation in driving forward the wider dental agenda. The YDC also speak at various national and regional conferences and events to communicate their work and gather the views of the younger profession.

How do you feel the dental profession has changed in recent years, and what does this mean for young dentists?

The dental landscape has changed dramatically in recent years and is continually changing with increasing student debt upon graduation, increasing costs including practice overheads, indemnity and regulatory fees, skill mix and practice ownership to name but a few of the changes. Alongside this, we have also seen significant year on year real terms erosion of dentists’ disposable incomes but with increasing costs of upskilling.

What influence does the YDC have on the wider dental profession and among other associations and organisations?

Q A

Are young dentists today under more pressure? What are the biggest drivers of the pressure being put on them, and how will the YDC seek to address this?

Dentists face so many pressures in the modern dentistry world. The burden of over regulation with the GDC, CQC and NHS England can put considerable

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Modern Dentist Magazine


Interview Learning needs to be creative, interactive and fun to stimulate discussion and debate. This allows sharing of experiences, which advocates an environment for learning pressure on all dentists, not just younger dentists. Low morale, complaints, compensation culture, poor practice infrastructure and workload issues make for a tough environment for dentists to work within. Ongoing delays and uncertainty in relation to contract reform put the profession at risk and under undue stress.

A

There have been several studies performed looking at the stress levels and psychological stress symptoms that dentists present with, which makes for a sobering read.

Patient expectations and demands have never been higher, and this, coupled with the difficulty of meeting UDA targets, and dwindling salaries, means it’s no wonder morale is rock bottom.

The YDC is there to be the voice of young dentists across the UK and in all fields of practice. We seek the solutions and demand the changes by engaging with other organisations and bodies so we can help reshape dentistry so that it works for dentists and our patients.

Q A

Q

Historically, dentists reached a stage in their career following graduation where they were more readily able to progress from associate to practice owner. Becoming a principal allows a different set of skills to be developed and utilised including business, strategy, finance and marketing, to name but a few. This will have allowed dentists to sustain a varied career with development opportunities. With the majority of associates now remaining in the same role for their whole careers, dentists are now losing their autonomy. We need to create a dental environment where dentists have opportunities to utilise their skills to their best abilities whilst keeping the work varied and interesting.

Dentistry can be very stressful, and stress can affect clinical decision making. Therefore, having established pathways to reach out for support to others, resilience training and mentorship can be valuable. This can also help to retain dentists at a practice to provide longstanding continuing care for patients.

What can practices do to make dentistry more welcoming for new and young dental professionals?

Having looked at studies researching what younger people want from their careers in general, it has been established that a good work-life balance is preferred along with a workplace that offers mentorship, ongoing education and work that provides variety. Some dentists may want more than just a surgery and equipment to complete their allocated UDAs; they may also want training, comfort, feedback and support. Practices that offer ongoing education to allow dentists to develop their clinical and communication skills will be highly valued.

What skills do you think newly qualified dentists need to acquire to have a happy, successful and life-long career in dentistry? What value do these skills bring to a practice and patient care?

Q A

How is dental education content and delivery evolving to meet the needs of a modern workforce?

We have seen a shift from reading and listening to lectures to more online training, in the forms of e-learning, webinars and social media live channels. The BDA now hold live feed roundtable discussions, which can be accessed live worldwide. Learning needs to be creative, interactive and fun to stimulate

Nikki Patel

Nikki is the newly elected Chair of the BDA Young Dentist Committee and will serve for a three-year term from 20182020. She works part time in dental practice alongside her role as Head of Evaluation of Digital Programmes at NHS England. She has a wide range of experience working in various dental fields including in general dental practice, secondary care and in the community dental services. Nikki has completed a Fellowship in Clinical Leadership to learn how the wider health system operates so she

24|Modern Dentist Magazine

discussion and debate. This allows sharing of experiences, which advocates an environment for learning.

Q A

What’s the best piece of advice you’ve had that you would pass on to young dentists entering the profession?

Gain a wide array of experience in different sectors of dentistry early on in your career, think beyond the usual, and branch out, explore. Doing this will not only highlight your strengths and weaknesses and enable you to determine what you really enjoy, but will also give you a broad range of skills that will be attractive to future employers.

Join networks and groups to interact with colleagues regularly, e.g. regional Young Dentist Groups. Not only does this enhance learning potential so we can provide our patients with the best care we can, but it also provides an invaluable pillar of peer support – we all need a helping hand every now and again.

Not all change is doom and gloom. With change also comes opportunity. It could be argued that many career options are still yet to be developed

can help influence change at a national level. She is proactive in pushing and striving for positive change, especially for younger dentists. She has served on several committees and has spoken at many conferences, nationally and regionally. Nikki is an avid writer for the dental press and is Secretary of the British Dental Editors Forum. Nikki is currently working towards a Masters in Healthcare Leadership, Commissioning and Transforming Services.


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Editorial Board

Appealing to your patients How can practices stand out from the crowd in a competitive market? Dentists are investing in branding and marketing more than they ever have in the history of dentistry. The reason for that, I believe, is that patients are now much more aware of the cosmetic enhancements dentists can offer their smile through awareness created by marketing. Dentists are using train stations, buses, billboards, social media, websites, Google and much more to target potential patients. This means that when a new patient is out looking for a new dentist, they will often have a huge choice on who they want to see. Studies indicate that in many cases, patients are willing to travel outside of their local area to seek cosmetic dentistry. So what are patients looking for and what do you need to do to stand out? This topic could be written as a book, however, for the purpose of my column, I have listed the key things I feel you can look at to improve your ‘appeal’.

1. Aim to collect as many Google and Facebook reviews as you can. Reviews make you stand out on Google searches as you can see above: 2. Have a strong policy on patient satisfaction – invest in front of house training. It’s the small interactions that make a huge difference. Ensure every patient has the opportunity to fill in a questionnaire about the service they received at your practice. The better service your patients receive, the more your practice will stand out due to glowing referrals in a competitive marketplace. 3. Invest in a bespoke dental website. As a dental website designer and marketer, I cannot more strongly recommend reviewing your website. Your website is the centre of all of your marketing and is often the

first place new patients will go to research you. The positioning of elements and design psychology applied to the interface can drastically increase how well your site converts. 4. Google Search Engine Optimisation – the more times you appear for important searches, the higher the chance of you attracting more patients to your website, resulting in more consultations and new patients to the practice. Visit the Dental Marketing Tips section on our website at https://digimax.dental for further ways to improve your visibility and to stand out.

Shaz Memon

Creative Director Digimax Dental

Increasing efficiency within your practice What common areas of excessive costs can dental professionals address in order to reduce their spending and free up more of their budgets? About 80% of my job involves working with dental clients, and the other 20% is taken up being a partner at Dodd & Co. I therefore not only have a good insight into the dental industry but also the day to day challenges a business owner faces in trying to juggle a hundred different jobs! I try to encourage my clients not to get too bogged down in the minutiae of everything, as spending hours shopping around to save a couple of pounds is not a cost effective way of running a business. However, ensuring you have good robust systems in place and a team of staff with various responsibilities to lighten the load is vital. It is fair to say that tax is one of the biggest out-goings for dentists. Appointing an advisor that helps you with your tax planning well in advance of the payment deadlines is important so that you can save and plan your cashflow. As a member of the National Association of Specialist Dental Accountants and Lawyers (NASDAL), I have access to detailed national statistics. This gives me the opportunity to benchmark my clients’ results against similar types of practices and highlight any areas where they may be overspending or underperforming. Common areas of over spending are materials, lab fees, wages and advertising. Materials and lab costs are increasing, and unfortunately

smaller practices will always suffer more as the larger ones benefit from economies of scale. Shopping around is good, but making sure you are minimising waste is even better. Regarding the wages bill, I am not saying you should give your staff a pay cut, rather ensure they are working effectively and where there have been increased wages costs for hygienists, due to pay rises and auto-enrolment responsibilities, make sure you are passing them onto your associates via the referral fee. Advertising is important but so is monitoring the results. Ask new patients how they heard about you and then analyse results to see what works and what doesn’t. Often cheap forms of advertising, like social media and word of mouth, can be the most effective. Unfortunately NHS practices don’t have the luxury of increasing their prices, but generating more income is always more profitable than reducing costs. Dentists are better off spending time looking at how they can increase efficiency by maximising surgery hours and ensuring that their hygienists/therapists are kept busy on the routine work, so they can concentrate on higher end treatments.

Heidi Marshall Partner Dodd & Co

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Modern Dentist Magazine


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Editorial Board

Whose name is it anyway?

Digital workflows

Louise Fegan

Partner Morrisons Solicitors In recent times, many principals and associates have sought to incorporate in the pursuit of a reduced tax burden. Incorporation is the process by which a new or existing business registers as a limited company. This is not a process to be taken lightly; legal and accounting advice is needed at an early stage. Just one consideration for dentists will be giving the company a suitable name. Whilst this may sound trivial, establishing the name is not as straightforward as it may seem! For example… Dr. Tooth decides to set up a company to run his dental practice through. He would like to name the company “Smiley Face Dental Holdings Limited” – seems like an appropriate name, right? Potentially yes, but there are various hoops to jump through before it will be accepted: • The use of the word “Dental” or “Dentistry” in a company or business name requires the approval of the General Dental Council, which is then submitted to Companies House for final Secretary of State approval prior to incorporation. In addition, the titles “Dentist”, “Dental Surgeon” and “Dental Practitioner” are also restricted and only those who are registered dentists or a visiting EEA practitioner are authorised to use them. • Coincidentally, there is already a registered company called “Smiley Face Co Limited” (not owned or anything to do with Dr. Tooth). A company may only register a name which is the same as (or very similar to) another company name where the two companies form part of the same group or consent is given by the other company. Some words, including “Co” are disregarded when looking at whether names are the same. • It is also good practice before selecting any company or other business name to ensure that no one has already registered a trademark for businesses in the same ‘class’ as the intended use. For dentists, this is most likely to mean checking the trademark register for similar names within class 44, which includes medical services, by a search of the UK government trade mark register. Anyone with a registered trademark in that class using the “Smiley Face” name has a strong starting point to make Dr. Tooth change his trading name. As such, unless he can comply with the requirements set out above, Dr. Tooth will need to think of an alternative name for his company!

How can processes in dental practices become more digital in order to improve efficiency and service? “When I was considering moving to digital radiography at my practice, I spent a lot of time evaluating the current spend on consumables, time spent processing images etc. and it was touch and go whether or not the investment in digital would save me any money, but I decided to go ahead anyway. On the day of installation and training for my new digital x-ray equipment, I realised that all the deliberating and number crunching I had done did not consider the other benefits the technology would offer. When I took my first OPG and had the information available to me there and then, in front of the patient and I could discuss their treatment need instantly, I realised that spending time focusing on the numbers was only served to delay implementing this incredible tool at my practice.” This is a conversation I had with an Orthodontist when he was considering investing in an intra-oral scanner. His point was very clear in that yes, the numbers are important, but an investment in digital can benefit the practice and treatment in terms of efficiency and service. This is easy to underestimate and can often be overlooked as business owners get bogged down in the numbers. Digital processes have been implemented in all aspects of dental practices, from appointments and financial records to patient notes and imaging. These processes have been implemented to improve efficiency, which inevitably results in cost benefits. Areas of dentistry currently experiencing a large growth in the implementation of digital processes is where 3D scanning and printing technology is replacing conventional impressions and lab techniques. New digital technologies such as intra-oral scanning, in house printing and milling all offer patient benefits such as a more comfortable and engaging experience and shorter treatment times, all leading to improved practice efficiency and a better all-round service for the patient. When you are considering replacing existing processes with digital workflows, never underestimate the benefits it can offer you, your practice and your patients in terms of the overall experience and efficiency.

Mark Barry

Director ESM Digital Solutions

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Modern Dentist Magazine


Fall in love with dentistry again Private dentistry is booming, but an increasing regulatory environment makes growth complex and time consuming

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Editorial Board

IR(ME)R 2017 Following on from the institution of the latest Ionising Radiations Regulations (IRR17) at the beginning of January, the new Ionising Radiation (Medical Exposure) Regulations came into force on the 6th February - IR(ME)R 2017. There are certainly some subtle changes in the legislation, more overt extensions of an employer’s duties and a greater emphasis on quality assurance programmes for example, however, the formalising of the Medical Physics Expert (MPE) role is perhaps one of the more significant aspects. When IR(ME)R 2000 came into force, the regulations defined the Medical Physics Expert (MPE) as: ‘a person who holds a science degree or its equivalent and who is experienced in the application of physics to the diagnostic and therapeutic uses of ionising radiation’. However, there was no formal certification or qualification for the MPE role with, in practice (and certainly in the independent sector), a Radiation Protection Adviser (RPA) most likely to act as the MPE as well.

IR(ME)R 2017 now defines an MPE as: ‘an individual or a group of individuals, having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to exposure, whose competence in this respect is recognised by the Secretary of State’. So now the competence of the MPE will need to be recognised through a formal training and/or certification route. In consequence, RPA2000 (the assessors of the competence of RPAs) have compiled ‘a list of individuals who have been authorised to act as an MPE’, and they will also help develop the criteria for the assessment and certification of MPEs. It appears that there will now be a ‘grandfather rights’ period, during which those on the list will be tasked to provide a portfolio of evidence to confirm their competence in their specific area/s of MPE expertise. Applications for this list closed on the 31st December 2017 and will be displayed on the RPA2000 website.

In dentistry there will be a requirement for the MPE to be consulted on keeping doses as low as reasonably practicable to patients, e.g. radiation protection concerning exposures, dosimetry and quality assurance, so make sure that anyone giving you advice in this area (your current RPA for example) is on the list and is therefore entitled under the law to do this.

Stephen Green CRadP MSRP MIPEM

Radiation Protection Adviser, Medical Physics Expert and Radioactive Waste Adviser Stephen Green and Associates

Payroll: a key component Auto-enrolment is a phrase that you may have heard circulating a lot in recent months. By law, every employer with at least one member of staff has a duty to enrol those who are eligible into a workplace pension scheme and then contribute towards it. If you were an employer prior to 1st April 2017, you will have a staging date, by which you will need to have a qualifying scheme in place. Within six weeks from your staging date, you have a legal requirement to tell your employees how auto-enrolment affects them and their rights. From 6th April 2018, the minimum contributions that both you and your employees pay into the workplace pension scheme are set to increase. It is of paramount importance that whichever method you use to process your payroll is prepared to deal with the increase in contribution levels. Currently, both employers and staff have to contribute 1% each into the scheme. The changes from 6th April are summarised below, with the government also announcing a further rise in contributions from 6th April 2019. Date changes effective from

Employer minimum contributions

For small business owners, this additional admin to deal with may seem daunting. Pension intermediaries, such as NEST, are working with small business owners to make the process naturally integrate with their existing structures, so that the pension contributions can be made directly from payroll softwares. Payroll isn’t the most exciting task you undertake while running a business, but it is a key component. Real Time Information (RTI) submissions make the process more manageable. The end of the tax year is approaching, and with that comes the payroll year end. As well as the usual submissions, every employee must receive a P60 summarising their earnings for the year by 31st May. It is also worth remembering that if you pay any of your employees on the 5th April, that you will have an extra pay run, which you will need to process before you can run the year end.

Sophie Kwiatkowski Accountant PFM Townends LLP

Employee minimum contributions

06/04/18 to 05/04/19

2% 3%

06/04/19 onwards

3% 5%

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Editorial Board

Profitability – the two sides of the profit equation

Mike Hughes

Principal Dental Practice Consultancy Service There are two sides to the profit equation, with the first being income generated and the second being expenditure incurred. Poor profitability impacts both on the lifestyle of the business owner and also in the potential business value, as businesses with higher profit levels tend to be more attractive purchase targets. Clearly if your income is broadly fixed, as it is within an NHS practice, the other side of the equation that can be targeted is expenditure, and when taken all round, changing your electricity supplier is not going to do it! The big-ticket items are of course payroll, other practitioner costs (associates/hygienists/therapists as appropriate) and laboratory and material spend. There are not many practices that are significantly over-staffed when taking into account the need for holiday cover etc., however I have come across cases where this is the case and there comes a time when, in the interest of the business, difficult decisions need to be made and conversations had. Addressing the mix of practitioners in the practice is perhaps a little easier, but have you sat down and thought about whether your practice has the most effective mix? Also, there has generally been downward pressure on remuneration packages for associates, and if you have not moved with the times you could be paying more than you really need to, clearly to the benefit of the associate involved but at a personal financial cost to you. In my experience, it is easy to get in a rut over purchasing. This is a task that is often delegated to a manager or senior receptionist with little control over what is being bought, the supplier chosen or any negotiation for best price. This is particularly the case when associates have free rein to request an order; I believe that, periodically, the process needs to be reviewed to ensure greatest efficiency. Beyond these costs there may well be other expenditure that can be controlled. Many practice owners are inevitably too preoccupied with the day-to-day business of dentistry to concentrate on some of the finer details of running a business. An independent review of practice performance can prove invaluable in both the short and long-term, and an outside view in the form of a practice efficiency analysis can be a great way forward.

N E P ? O S R U O H L L A Do higher consumer expectations warrant a need for a 24 hour service? “The transformation from patients to consumers has moved at a glacial pace” – a quote from an article written in the 1980s. It is fair to accept that the demands and expectations of today’s patients have increased over the years. They are encouraged to be more questioning and more challenging in regard of our professional opinions and our suggested options for their treatment. Whilst I believe the dental profession is “stepping up to the plate”, would it be a further improvement to increase the opening hours of practices, simply to be more convenient and attractive to our “consumers”? Consumers now expect to be able to access almost anything 24 hours a day - food, banking, fuel, even alcohol. How would a 24 hour service impact the dental industry? Patients could no longer claim they cannot attend as it clashes with work, but would it simply dilute the appointment book or actually attract any of the 50% of the public who currently avoid the dentist? My view is that it would not improve numbers, as restricted access hours are not the prime reason patients do not attend. Opening hours would not impact on patients who fail to attend due to dental anxiety, fear of cost, or simply being unaware of the risks they face by not attending. Further to this, practices would probably become fewer, larger and multi-discipline, and this indirectly would not help access. In pure business terms, who would pay for a 24-hour service? Where practices are able provide more specialist services, patients would be expected to fund it. Personally, I can’t ever see a situation where the NHS would be interested in funding 24 hour general practice. GPs probably work fewer “out of hours” than they did several years ago and I’m sure benefit from an improved work life balance. Personally, I feel dentists in general would also have no desire to offer a 24 hour service for this reason. In conclusion, whilst patients would no doubt wish to receive a 24 hour service, I believe it is not warranted and many factors would need careful analysis and progress before it ever could be.

Dr. Geoff Baggaley

(B.Ch.D D.G.D.P.(U.K.)R.C.S. Dip.Con.Sed(Newc)

GDC No. 55152. at The Raglan Suite www.raglansuite.co.uk

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Editorial Board

The importance of ergonomics: preventing future back and shoulder pain

When one thinks of ergonomics, one thinks about keeping the correct posture, but we often forget that the equipment we use to work with affects that. Studies have shown that over 60% of dentists suffer from neck and back pain. Incorrect use of equipment can cause a forward leaning posture and excessive reaching with the arms, which results in shoulder, joint or lowerback problems. When you spend over 2000 hours a year looking at oral cavities, it is important to consider some tips to avoid this.

Rear-delivery systems accommodate all clinical instruments behind the patient. It is the least expensive option and keeps the equipment out of view of the patient, which decreases anxiety. It works well when true four-handed dentistry is practiced but is not recommended for two-handed operations as it provokes extensive reaching, leaning or twisting of the torso, which can contribute to lower-back pain. Side-delivery systems require less trunk-twisting for the dentist to retrieve instruments. But you must remember to squarely face the system when changing burs, rather than sustaining a twisted posture. One problem I see with some dentists who use side delivery is the tendency to “lock” themselves into one working position. This tends to stress certain areas of the body and leads to pain. Also, correct height of the sidedelivery system is paramount to preventing shoulder pain. The instruments and hand pieces should be no higher than elbow level. In case of over-the-patient delivery systems, the arm extends over the chest of the patient, so hand pieces and other instruments are within

easy reach for both dentist and assistant, minimising excessive reaching or shift of vision. Although when not adjusted correctly, it requires upward reaching at the shoulder when seated, a risk factor for shoulder pain. But don’t forget, the best practice with any delivery system is to change positions as frequently as possible, depending on the tooth surface being treated, in order not to lock yourself in one position. Some other things you can do to correct your posture while working are using good loupes and adequate lightening to decrease the extent to which your neck is held forward and flexed down, positioning the patient’s head at a level that gives you good access to the oral cavity and always try to hold your elbows at a 90 degree or less flexion. And of course, take a break in between difficult cases.

Nathalie Smets

Marketing Ancar

Delivering the best patient care Are you giving patients the best care? Of course! Is everyone else in your practice? How can you tell? There are performance indicators for business factors...see future pieces. But there are a couple of aspects that might alert a practice owner that an environment conducive to best clinical practice is not being created. Simple patient complaints is an obvious flag, but do the patients always know? Similarly, the incidence of remedial work, but every practice, patient list and level of the clinician’s technical interests are different. It is about comparison to expectation, not the indicators themselves. The number one enemy of patient care is working under stress for extended periods. Distraction, or a lack of time can lead to problems being missed or misdiagnosed, or wrong decisions being made. And of course, if there is no time to smile at the person in the chair, the patient experience is downgraded. So what are the alerting indicators? A clinic squeezing more and more patients into a day is the main red flag, shown by diary patterns and by average patient chair times. The treatment types can also be an indicator of strain; it is known that stress pushes people towards

routine, where the challenge to comfort levels is lower. An absence of longer ‘jobs’ might indicate the dentist feels they have no ‘slack’ in their schedule; treatment is postponed. The balance between routine and non-routine work rolls off most software and can be monitored. Each clinician works in their own way, some actively managing particular times of the day or week, others more content to have a randomly booked diary. Neither is right, or wrong. But trend variations highlight changes in working practices, which may be indicative of an underlying issue. The key is to have an awareness of the ‘norm’, so you can react to changes in it for whatever reason. What de-stresses the practice? Be sensitised to the effect of strain on your work capabilities. Arrange your diary and workload accordingly to organise in a way that gives the best chance of excellent patient care being delivered each hour, every hour.

Johnny Minford

Principal, Minford Chartered Accountants Member of NASDAL and ASPD

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Modern Dentist Magazine


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Editorial Board

How can practices stand out from the crowd in a competitive market? Dr Richard Brown

Parrys Lane Dental Practice and Bupa Dental Care, Nuvola Speaker for Nuvola courses

In dentistry there is potentially as much benefit from investing in marketing your business as there is from actually performing good work. Today’s market place is extremely competitive, you can compete on price, quality and branding. In a perfect world, each and every patient should feel like they are the only patient you are seeing that session; afford them time, courtesy and your expert opinion, no matter how small the enquiry. The patient journey starts at the reception. To truly stand out, ensure the reception team are natural ‘people’ people, it doesn’t matter how good the clinician’s treatment planning and communication are, if the message is not echoed throughout the patient journey, they are unlikely to take up your treatment, nor sing the praises of the practice to others. Word of mouth recommendations are the best new clients you can get as they will arrive thinking you are fantastic, all you need to do is continue that thought process! Take advantage of the fantastic technology available to dentists today, something as simple as showing patients their radiographs on a high quality monitor and involving them in decisions can turn routine consultations into further recommendations and more satisfying treatment. Chairside scanners can allow you to further stand out by showing patients how their crown is made, or straightening their teeth in front of their eyes from a five minute scan! Social media is useful if used well; regularly updated, well presented Instagram/Facebook pages or practice websites with real patient success stories will provide a powerful message directly to a wide audience, often at no cost. My feeling is that I would always focus on quality of work rather than competing on price. The number one way to stand out from the crowd, in my opinion, is to provide beautiful work that leaves patients comfortable and feeling valued. The more they love the work you do for them, the more likely they are to recommend you to people they meet. If your prices are higher than competitors, be sure to be able to justify why. I suggest that the level of experience, quality of materials used, time allocated for appointments and the environment in your practice are all determining factors in fee setting.

Technical Specialist or all-round Customer Service Guru? What are you doing to engage your team and increase patient loyalty?

Daniel Redland

Director Tempdent Recruitment and Training Having spent the last 22 years working as a Consultant Business Psychologist, I would regularly work with telecoms, financial services and manufacturing, but very rarely was there any interest from the healthcare sector. I often wondered why this was the case; the argument always put forward was, ‘it’s a very technical role, we don’t focus on the softer skills’. But surely this misses a big trick. Not just from a patient care perspective but in terms of business impact too. Bad news travels; it tends to reach more than twice as many ears as praise for a good service experience, and social media now makes this even more dangerous. Worryingly, research shows that only about 4% of dissatisfied customers will voice their concerns to you, 96% won’t voice their concerns at all, and 91% of them won’t ever come back to you! So, the question to you is what are you doing to ensure your team are supported to be the best ‘all-rounder’ and not just ‘technical’ practitioner? Here are some tips from one professional to another: 1. When recruiting, focus on behavioural skills and not just technical skills, and use a competency-based recruitment approach focusing on behavioural skills such as team working, communication and empathy. This is easily achieved using competency-based interview questions and even psychometrics. 2. Develop a robust performance management process for team members. Set SMART goals and Key Performance Indicators you can measure and monitor and tackle issues as they arise through regular catch ups. 3. Understand your team’s aspirations. Think about career paths for each team member and have career discussions with them. What are their aspirations? How can you support them? Helping your team work towards their career goals will lead to an engaged and happy team. 4. Build team spirit! Events don’t have to be intricate team building events where you have to trek the Himalayas. It might just be something as simple as team CPD or even a beer at the local pub! So, what can you do now to tackle some of these challenges? You might consider enrolling your Practice Managers on a course. The Dental Trailblazer group set up an apprenticeship programme specifically to target good leadership in practice just last year. You might also consider upskilling your team through post registration training and CPD sessions, which are a great opportunity to get the team together and develop them as a whole. Good luck and give us a call if you want to discuss further.

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Modern Dentist Magazine


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Editorial Board

How utilising facial aesthetics can help grow your dental practice as a business The commonality between cosmetic dentistry and facial aesthetics is that the patient is the driving force behind treatment. Both modalities are ‘want’ driven rather than ‘need’ driven. Given this ‘want’, dentists are ideally placed to deliver facial aesthetics. Our patients trust us; we have empathy and have built rapport with them. Therefore, we have the jump on offering facial aesthetics in a secure and controlled environment. On the clinical side of things, we regularly perform injections several times a day. We are familiar with this procedure and have mastered how to give injections with minimal discomfort. Dentists are also experts in the facial anatomy and structures; we spend hours every day performing in this region.

In my experience, patients that have undertaken facial aesthetics are more inclined to explore cosmetic dental procedures and vice versa. My cosmetic dental patients were eager to explore the benefits of facial aesthetic treatments. Now, how do we build up our facial aesthetics business? I will be launching a book ‘Let Go Of The Handbrake’1, which covers this in greater detail. However, the emphasis is on three major components: 1. Attract… new patients More importantly, attract more new patients for free. Use your existing patient database; they will already be having these treatments and know others that also undertake these procedures. Organise an open evening and send regular newsletters showcasing any new services you will be offering. 2. Convert… more patients How to convert patients without selling. You don’t want to be a line chaser and not just treat the ‘consequence’ of ageing but rather the ‘cause’ of ageing. And on the

same thread, you don’t want to scare the patient with a big treatment plan when their only concern was their frown line! 3. Retain… existing patients Retain patients without being pushy. Control the appointment book. Once a course of treatment has been completed successfully, pre-book their next appointment. Don’t leave it for them to contact you, they may forget about you!

Conclusion

We can conclude that cosmetic dentistry and facial aesthetics go hand-in-hand to offer your patients the best results from their cosmic dental work. And who is better positioned to offer these facial aesthetic services than the dentist?

Dr Harry Singh

BChD (Leeds), MFGDP (UK), GDC No: 72684, writing on behalf of Med-fx Limited 1 www.letgoofthehandbrake.com

What price would you pay for peace of mind? Over the last year we are aware of a small yet noticeable decline in the number of enquiries from dentists relating to financial protection. This includes products such as Life Cover, Income Protection and Critical Illness Cover. Are we doing enough to explain the risks and benefits of protecting your wealth and income? Are you placing enough value on the peace of mind that financial protection brings to you and your family?

However, it is also vital to protect what you hold dear, so you don’t stand to lose everything.

£

The same applies to protecting your income, particularly if you have a family that relies on your salary. Some people consider insurances such as these just an unnecessary cost. When you consider the peace of mind it brings to you and your family though, can you really attribute such a low value?

Protecting your financial position is what we do Generally, a decline of interest and commitment from our dental customers to protect their financial interests could mean that we need to raise the awareness. Particularly when it comes to protection products, it is essential you are receiving the right information to make educated financial decisions.

Ensure at least your liabilities are covered in the event of sickness, accident or death.

Protection products include: • Income protection – to protect your income in the event you are unable to work • Critical illness – pays a lump sum if you are diagnosed with a critical illness and are unable to work • Life cover – pays a lump sum to a beneficiary in the event of your death, typically used to eliminate debt commitments, such as a mortgage

As is the nature of sickness, accident and death, we don’t plan for it. So it becomes essential that we at least build in a contingency should we need a fall back.

Not protecting your wealth because it’s an “extra cost” Creating an investment portfolio or climbing your way up the property ladder is the exciting part.

Are you vulnerable to financial risk? Clearly, a general decline in the number of people taking-up protection could mean more are left in a vulnerable financial position.

Ensure your finances are sufficiently protected.

Darren Scott-Guinness

Independent Financial Adviser Dental & Medical Financial Services This article does not constitute advice. Professional advice should be taken prior to acting on any part of it.

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Modern Dentist Magazine


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Editorial Board

Integrated Smile Standing out from Design (ISD) How can digital dentistry help patient communication and manage expectations? Daniel Woricker Lecturer in ISD for Wired Orthodontics

Digital dentistry does not always require a huge investment of money into software or equipment. Using just a digital camera and a laptop, we can greatly improve patient communication. I do this by taking a full set of clinical pictures of each patient and creating an Integrated Smile Design (ISD) for them. An ISD is simple to create once you understand treatment planning, which I learnt through Wired Orthodontics, and a bit of playing around on your laptop to get used to PowerPoint or Keynote. It allows you to present a large amount of information to the patient, including every important detail and involving all disciplines of dentistry without overwhelming them. Sitting with the patient and going through the ISD together, you quickly realise the power of communicating with this visual aid and you start to learn a lot more about the patient’s expectations. You can at the same time educate the patient on what you see and your concerns. The ability for the patient to take the ISD away with them gives them time to process all the information and ask more questions. As the patient is much more educated and informed on the procedure, this is also very beneficial in improving consent, and the process builds great trust. However, it may still be unclear as to what the final result may look like. This is where digital dentistry can again be of great help. The plan generated by the ISD can be used to create a smile simulation. This may be showing the patient the stages of orthodontic treatment with the braces on their teeth, showing what their smile will look like after veneers or how much tooth will be visible at rest after restoring a wear case. In orthodontic cases, I often use Wired Orthodontics’ lab to create digital Kesling set-ups as placing the STL files into the PowerPoint creates 3D models for the patient to see as part of their ISD. Using digital dentistry, such as an ISD, is a very effective way of communicating complex treatment. It is a great way to educate the patient, enough to gain informed consent and helps you to understand and manage their expectations.

the crowd Amanda Maskery

Partner and Head of Dental Sintons

Owning a dental practice or group has always presented challenges, but the marketplace has never been more crowded than it is now, meaning it is more important than ever to ensure that your business stands out from the crowd. While the value of providing a first-rate customer service is well known, the importance of creating and building a brand for dentists is still underestimated. Generally, in dentistry, branding has not been regarded in the same way as it is in the corporate world, where multi-national businesses expand on the strength of their brands. But now, with the growth of dental corporates and multi-practice groups, branding is becoming an increasingly important factor. Creating a brand which is unique and people can identify, talk about, recommend to others and remember is as important for single practices and corporates alike, especially where there are other local competitors for existing and potential clients to choose from. Effective branding is also important when looking to expand, franchise or sell your business. When you are adding another site to your existing portfolio, doing so under a brand will enable people to know who is moving into their area, and can help give confidence that this is an established dental business taking over their local site. Equally in franchising, the importance of a strong brand is crucial – to enable your business to thrive in other areas relies on an existing strength of reputation, and through being part of that recognisable brand, patients will know that each site under that umbrella will offer the same levels of service and quality. The creation of a brand identity, which can help support the expansion of your business, can also be of great importance when it comes to selling. It is much easier to market a business which is well known and has invested time and effort in standing out from the crowd – to a potential buyer, they are important factors in instilling the confidence to take on a site in a new territory. In this day and age of dentistry, being an increasingly competitive business and distinguishing yourself from the many other players has never been more important and is something that must be given due consideration.

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Features

Sector Soapbox Modern Dentist’s panel of resident associations outline the burning issues

Improving performance in Fitness to Practice (FtP) In recent years, society’s understanding and acceptance of mental health issues has greatly improved, but there is still a long way to go before that journey is complete. I’m still quite new to the General Dental Council (GDC), but I think it’s fair to say that this comment could equally apply to the GDC. The substantive part of my role is to improve how we perform in Fitness to Practise (FtP) across the board, and, in the context of mental health and wellbeing, it’s on my agenda to enhance how we support those going through the process.

The ‘enforcement’ element of our role is a vital part of the GDC’s work, but we understand the experience of going through FtP can be a stressful one. This is why we must do all we can to minimise that stress wherever possible and offer support to people who may need it. We are keen to improve how we communicate with people going through FtP because we know that what we say and how we say it has the potential to have a big effect. Work is underway to better understand this and to revise how we communicate - I look forward to this being implemented in the near future. One area in which I think improvements have already been made is the support we provide when concerns are identified. For example, we have spent quite a bit of time talking to third party organisations about what they can offer, and there’s now a really good page detailing this on our website – https://www.gdc-uk.org/ professionals/ftp-prof/support.

We have also worked with charities Samaritans and Mind to deliver training to our teams working on the front line. The training has helped them to better understand mental health issues and to identify possible signs of distress when interacting with people. Where possible, issues have been identified and the training helps them to understand the best ways to communicate in order to provide more effective support. These are just a few areas where I feel our work to improve FtP is taking shape, and I look forward to talking about further developments soon.

Tom Scott

Executive Director, Fitness to Practise Transition General Dental Council (GDC)

Advancing dental education Although originally from Manchester, I graduated from Liverpool University in 2014 and completed my foundation training in Liverpool. I undertook and passed the MJDF examination in June 2016 and was appointed as the Early Careers Board observer for the FGDP in September 2017. I have worked in general practice in Liverpool since graduating, and currently live in South Liverpool with my partner Chris, who is also a dentist. As a new graduate, it is easy to feel that you ‘know it all’ having just passed your finals and likely having excellent theoretical knowledge. However, after a short time in general practice it becomes clear that this is not the case! Successful completion of your foundation year shows that your skills have developed

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somewhat and you are deemed safe enough to branch out on your own; this is when your dental career truly begins. Dentistry is an ever-changing and rapidly progressing field. In my opinion, if you do not keep up with changes and progression, you will be left behind. It is extremely important both for yourself and for your patients to keep up-to-date with advances and changes; this in itself allows me personally to feel confident that I am providing my patients with the best quality care. Dentistry is such a competitive field, and anything you can do to make yourself stand out can only be a good thing. The best thing about the MJDF examination is that it is a nationally recognised qualification – to pass you have to demonstrate a certain level of knowledge. Having completed the examination does not necessarily make you a ‘better’ dentist but shows future employees that you have a good-quality skill-set and are willing to learn and progress in your career. Completing a recognised qualification can open up many

career opportunities, whether that is working in general practice or progressing onto specialist care. Many principals in general practice will use this as a marker for candidate quality. With so many people applying for the same jobs – any extra qualifications you have can help to show that you are the best candidate for the job! The FGDP(UK) motto is ‘advancing dental care’. This is the reason that I became a dentist. Continued education and development allows me to provide the bestquality care to my patients on a day-to-day basis, as well as allowing me to progress through my career and open up many different opportunities.

Sophie Ainley,

Associate Dentist, Garston Dental Practice and Early Careers Board observer Faculty of General Dental Practice (FGDP)


Features

Practice Managers: an evolution Looking back on almost 20 years’ experience as a practice manager, never before has there been as much responsibility on the shoulders of practice managers, and now more than ever, they are finally getting the acknowledgment they deserve. When I began as a PM back in 1998 at the age of nineteen, the role could be quite basic and there was not the level of compliance or responsibility that comes with it now. In those days, I learnt as I went along and quite frankly from the many mistakes that I made. There can’t be too many careers in which one is expected to be an HR manager, marketing manager, compliance manager and business manager, to name just a few, whilst also being an approachable, occasional shoulder to cry on – and not forgetting referee! The role needs to be carried out to the highest of standards, often without any formalised, additional training, other than Core CPD. However, it would be fair to say that the role has evolved at different rates in different practices. ADAM’s 2017 Salary Survey demonstrated that there was a huge range of pay disparity that was often (although not always) dependent or linked to the scale of responsibility the PM was working at. So, is this the fault of practice owners not understanding, or PMs not asserting themselves and demanding the credit and pay that is due to them? Part of the problem for PMs is not being aware of what they don’t know, and then finding out where they can gain the training and skills to equip them in their roles. There are often no allowances for error, and certainly not in areas such as HR and compliance, where there are legal implications.

In my experience, the majority of PMs are happy to take on a huge workload, but too often are also expected to be a receptionist one day and maybe a dental nurse the next in addition to their PM roles, often without the reflection in remuneration. Many dentists are so busy treating patients (which is as it should be) that they sometimes don’t realise the extent of the workload or the systems that are in place and being used by the whole team to ensure the smooth running and success of their practice. I would like to say that I don’t believe there is a vast swathe of PMs that are being undervalued, but for those grafting away and feeling overworked, underappreciated and underpaid, the quote, “You get what you pay for” springs to mind. Many of you may not know that Chris Barrow was involved with the BDPMA in the 1990s. I caught up with him and asked for his take on the massive changes in the role of a dental practice manager over the last 20 years. “Back in 1997, when the BDPMA was representing the profession, I wonder what the reaction would have been if I had predicted that 20 years later: • Qualification courses all the way up to MBA standard would be offered by academic institutions • The fully-functioning Practice Manager would have to demonstrate leadership and management skills in key business functions: • Financial monitoring and analysis • Branding • Direct marketing • Digital marketing • Patient relationship management • Treatment co-ordination • Post-treatment follow-up • The patient experience

• The practices in which they work would include: • Vast nationwide corporates with over 500 locations owned by healthcare insurers and financial institutions • A rapidly growing sector of privately owned multiple location microcorporates • In-store dental chains owned by (or renting from) major high street retailers • Economy, business and first-class environments • The world in which they work would be dominated by the Internet of Things, bringing a digital perspective to every aspect of their work • That private dentistry in the UK would have grown from £1 billion to £5 billion a year of sales (and that the £2 billion pound NHS dental budget in 1997 would be £2 billion in 2017).” A good practice manager is integral to the running of a successful practice. Indeed, John Milne, CQC’s Senior National Dental Adviser, recently said at a CQC Reference Group Meeting: “The CQC inspection programme, to date, has found that a delegated and empowered practice manager is a key component of a well led practice.” Considering that the majority of failed CQC inspections are in the area of the “well led” outcome, surely there is no better reason to not only look after your practice manager but delegate, empower and reflect this in their salaries based on responsibilities. Anyone like to predict where we will be in 2038?!

Lisa Bainham

President Association of Dental Administrators and Managers (ADAM)

• Clinical governance • Compliance • The complete HR function

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Features

Digital currency: the new trend Dr George Carr,

is an early adopter of cryptocurrencies in dentistry. Here, he explores this new world of digital currencies and advises how you can utilise it for the benefit of your practice.

Credit cards are a tried-andtrue method for digitally transferring money. However, a new and sometimes more efficient way to transfer money is becoming increasingly popular worldwide. It’s called digital currency, and it’s turning into an undeniable part of our future. So, dental professionals would be wise to learn about it. Simplified, cryptocurrency (crypto) is a form of digital currency. There are many different types of it, including the most well-known: Bitcoin. Both cryptocurrencies and credit cards may transfer money from the patient to the business owner. However, while credit

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cards utilise banks and leverage the user’s borrowing power, cryptocurrencies bypass the banks to digitally transfer money. There’s the “fun factor” of using crypto. Users get to try a new form of payment, use a new form of technology, and feel a sense of autonomy as they control the way their money is handled. The volatility of cryptocurrency also makes it a standout. These “fun factors” are a major reason why the profiles of cryptocurrencies continue to rise. It’s worth noting that government regulation could create major challenges for crypto. However, history proves that governments are not always successful at regulating desirable commodities. A good example is alcohol. Almost a century ago, the United States Congress ratified the 18th Amendment to the Constitution and ushered in a period known as Prohibition. We all know how that turned out. Eventually the Feds changed course and found a way to tax alcohol.

When it comes to dental offices, cryptocurrency offers a variety of perks. One of the most impressive is that it decreases merchant fees, with no optional chargebacks. Over time, 3% credit card fees get expensive and irritating. In comparison, many of the fees associated with cryptocurrency are either almost non-existent or very small. In fact, sometimes consumers are given a 1% discount just for using cryptocurrency, which would still save you about 2%, compared to traditional merchant fees. Additionally, unlike credit cards, cryptocurrency money transfers are irreversible. Once you have the money, no one can take it back. As dentistry becomes more technologyoriented, associating yourself with new technology like cryptocurrency can help your practice stand out. In fact, some dentists use crypto as a free form of advertising, which helps attract patients who value tech-savvy businesses.


Features

As dentistry becomes more technology-oriented, associating yourself with new technology like cryptocurrency can help your practice stand out

crypto, you have the potential to lose most, if not all, of your money quickly. Then again, some people have made millions using crypto. If you don’t describe yourself as a risk-taker, think twice before you hold cryptocurrency.

Adopting cryptocurrency in the dental office is easy; all you need to do is accept it. There is no special machine or permission needed. Dentists simply need a wallet, but not the kind you keep in your back pocket. A crypto “wallet” is a digital wallet, which you may store privately on a hard drive. Or, you can keep the crypto wallet on an exchange like Coinbase.com. It’s extremely simple to obtain and use a wallet address. Some currency exchanges like Coinbase.com may even let you use your email address to direct your cryptocurrency into the proper wallet. Bottom line: you don’t have to be smart, tech savvy or even rich to use cryptocurrencies. It’s really that simple. It’s important to keep in mind that crypto is not considered a safe investment. By accepting

At the same time, risk-averse dentists can still accept crypto and not be subjected to the high value volatility and questionable future of crypto. This is done easily by selling the cryptocurrency on an exchange for fiat money as soon as you receive the crypto payment. Alternatively, you can use the crypto to purchase something from another business or individual accepting crypto. Again, crypto acts like “real money”. It’s just in a digital format. For the pessimists who don’t believe they can quickly exchange their digital money into traditional fiat money, review the market caps of the most popular and recognised cryptocurrencies on Coinmarketcap.com. There are millions of people in the world who have already electively chosen to give these cryptocurrencies a value. Since there are so many millions of global users, believers and supporters, these currencies may be liquified into fiat currencies 24/7, every day of the year, and even on a leap year.

Users get to try a new form of payment, use a new form of technology, and feel a sense of autonomy as they control the way their money is handled

Realistically, even if you accept crypto, you won’t get many patients clamoring to use crypto at your office anytime soon. Surprisingly, it’s not because your patients don’t own cryptocurrencies but, instead, they’re unwilling to part with it. Their fear of missing out (FoMO) on the potential increased valuation of cryptocurrencies has proven to be very powerful. Regardless, there’s a good chance your patients who own cryptocurrencies will be eager to chat about it. In that sense, you can think of crypto as another form of bonding with your patients; some people discuss sports, while others discuss crypto. It’s true that many people are highly skeptical of cryptocurrency. In fact, they believe crypto is a complete fraud and “full of darkness”. So they question why I choose to enable it. My response is simple; I am a fan of accommodating people. If my patients are happier because I accept their Bitcoin cryptocurrency as payment, then that’s what I’ll do. Regardless of what happens with the current cryptocurrency phenomenon, I believe it’s important to always consider where we are in this world and adapt to it daily. My question for you: which risks will you take? For me, accepting cryptocurrency from a patient is low-risk and good business. In fact, my personal risk management is telling me I should hold some crypto as a form of investment. What is your risk management telling you?

Dr George Carr

George Carr DDS & Associates PLLC.

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Features

Dental practice values – the last 10 years and the future

Alan Suggett, National Association of Specialist Dental Accountants & Lawyers (NASDAL), reviews the previous quarterly NASDAL goodwill surveys to identify the trends in practice values and provide some top tips for anyone thinking of buying or selling.

I have been preparing quarterly goodwill surveys for NASDAL for more than ten years, and as the proportion of UK dentists looked after by NASDAL members has increased (currently around 28%), the surveys have become more and more accurate. The surveys have two bases, firstly analysing actual practice sales, and secondly, analysing valuations prepared by professional valuers. The statistic captured is goodwill as a percentage of practice gross fee income. When the surveys first started being prepared, there was no differentiation between NHS and Private goodwill; since 2009 this split has been captured. In fact, we have three data pools: NHS, Private and Mixed. For simplicity’s sake, this article concentrates on actual deals only (as that eliminates subjective opinions and analyses only facts) and only considers the main two categories of NHS and Private.

The headlines from the results of surveys over the last ten years are: 1) NHS practice values have risen from less than 100% to 170% 2) Private practice values have risen from just over 80% to 100% A much greater increase in NHS values when compared to Private. Why is this? The main reasons seem to be the following: 1) Running an NHS practice requires far fewer entrepreneurial skills and “customer care” than a Private practice: Cynically, in many areas, NHS patients are rather like sheep, creatures of habit who require considerable discouragement before they will change dental practice, whereas Private patients are spending their own money and taking an active choice to use one practice as opposed to another. 2) Patient losses under new ownership: This factor is an extension to the above point. The percentage of Private patients who leave the practice after a change of owner is higher than with an NHS practice, hence business risk is higher. 3) Cashflow: NHS contracts bring with them a certainty of cash flow. Rather than the usual

general business model of providing goods and services and then waiting to be paid, NHS practices are paid 1/12 of the contract value each month, irrespective of the amount of work actually carried out. Of course, the day of reckoning arrives if insufficient work is carried out, but that isn’t until six months after the end of the contract year. 4) Lender enthusiasm: Perhaps because of point 1, lenders are much more enthusiastic about lending for NHS practice acquisition. Lloyds Bank, the major lender in the sector, in some circumstances is still prepared to make loans at 100% of valuation (i.e. no deposit paid by the borrower) for NHS practice purchases, as opposed to 5% or 10% deposit requirements in relation to Private practice loans.

Currently the popular opinion is that values must have peaked – but have they? |47

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Features impacting on practice goodwill, there are factors which fuel increases. The number of buyers comfortably exceeds sellers, and bank of Mum and Dad regularly provides practice funding, which creates deals that don’t make economic sense. So, what does all of the above mean to potential buyers and sellers of dental practices?

Tips for buyers Consider moving to Cumbria, or other geographically remote areas. Values are lower, but be careful that profits aren’t also low! Make sure that you have a good accountant and ask him or her to prepare a proper “Viability Forecast” – not some back of a fag packet jottings, but a simple financial review that estimates what your cash based profit will be, calculates an accurate tax charge, and takes loan repayments into account (N.B. you don’t get tax relief on loan capital repayments).

Consider moving to Cumbria, or other geographically remote areas.Values are lower, but be careful that profits aren’t also low! 5) Large corporate and Private Equity investment: For the last few years, major dental corporates such as IDH/MyDentist and Oasis (now part of BUPA) have been investing heavily in NHS practices. More recently, the appetite for Private Equity investors has risen, once again almost exclusively in relation to NHS practices. This has caused upward pressure on NHS goodwill values.

2) MyDentist (the dental corporate): In late 2016, MyDentist, the largest corporate dental group in the UK, stopped buying new practices, and shortly after this, started actively selling less well performing sites. This caused shockwaves throughout the market as some practices were sold at huge discounts to the market rate (I even heard of one practice being sold for £1!).

Ever since I started acting for dentists (in 1981!), the dental community has been considering increasing goodwill values with great trepidation. Back in the 1980s, average goodwill values were about 30%. When the psychological threshold of 100% was being approached, many dentists talked in terms of the dental equivalent of the Dutch tulip bubble in the 17th century – to no avail as values kept rising. Currently the popular opinion is that values must have peaked – but have they?

3) Brexit: Dental practices, particularly those who carry out NHS work, are highly reliant on the services of dental associates. Many dental associates are foreign. The impact of Brexit has caused many foreign associates to move back home, presumably as they are concerned about their longer-term prospects if they remain in the UK, and perhaps because of their pay rate declining in relation to the Euro.

My view is not so much a peak, more a fragmentation of the market, and fragmentation in several different ways: 1) Geography: A few years ago, practice values inside of the M25 started to rise at a higher rate than other areas – “London area lunacy”!” This rippled out and jumped to other major conurbations such as Manchester, Birmingham and Nottingham. This contrasts with areas such as Cumbria and other more remote areas where values are considerably less.

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4) NHS contract performance and profit difficulties: Partially because of the above, the ability for many NHS practices to perform their full contract value has become more difficult. The word on the street is that many practices do not expect to fulfill their full UDA target in the year ending 31/3/2018. More generally, NHS profits have been declining since 2009, even where targets are achieved. The NHS “pay cap” has restricted contract increases to less than 1% p.a., despite inflationary cost rises exceeding this. 5) Associate desperation and bank of Mum and Dad: Despite a whole range of negative issues

Tips for sellers If your practice is profitable then an “EBITDA” valuation basis is probably the most appropriate. If it is small and/or with low profits, then the traditional value based on a percentage of fee income is probably appropriate. Begin exploratory discussions with your trusted dental advisors in good time. In the case of a private practice this might be four years before intended date of retirement, as you might have to work for three years (maybe even four) after the practice sale. Also, have early discussions with at least one dental practice sales agent – they are the people who really understand the market. They all have different styles, so it’s important that you find which one you have the best chemistry with. Don’t wind your practice down in the lead up to putting it on the market – one way or the other, your sale proceeds will be based on a combination of fees and profits, so don’t let them decline before you sell.

Alan Suggett

is a Chartered Accountant and Partner at UNW LLP Chartered Accountants and Member of the National Association of Specialist Dental Accountants & Lawyers (NASDAL).


Helping dentists expand, manage and sell their business. Morrisons is a recognised national leader in dental legal services, we are regularly recommended by healthcare agents, banks, accountants and corporates as expert legal advisers and are members of the National Association of Specialist Dental Accountants and Lawyers (NASDAL). Our team have over 20 years experience acting for dentists, on the buying and selling of practices. We provide practical, commercially focused solutions that will help you to realise your goals and protect your assets.

www.morrlaw.com

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Features

Inspiring patients and communities for National Smile Month

Dr Nigel Carter

The Oral Health Foundation is calling for National Smile Month 2018 to be an opportunity for dentists to help inspire their patients and spread positive oral health messages nationwide, Dr Nigel Carter explains. The charity is encouraging everybody to get involved in the campaign between 14th May and 14th June by organising activities and events that will promote oral health far and wide. What is National Smile Month? National Smile Month is the UK’s largest and longest-running campaign to promote good oral health. Together, with thousands of individuals and organisations, it highlights three key messages, all of which go a long way in helping us develop and maintain a healthy mouth: • Brush your teeth last thing at night and on at least one other occasion with a fluoride toothpaste. • Cut down the amount of sugary foods and drinks and how often you have them. • Visit your dentist regularly, as often as they recommend. Ultimately, the aim is to help us achieve good physical and mental wellbeing by improving our oral health.

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The campaign encourages dental and health professionals, schools, pharmacies, community groups, colleges and workplaces – in fact anyone with an interest in good oral healthcare – to join in and help educate, motivate and communicate positive oral health messages and improve the quality of smiles all around the world. With the help and enthusiasm of those who are passionate about promoting healthy lifestyles and improving the quality of life for others, National Smile Month sees thousands of events and activities, educating and engaging local communities about the importance of a healthy mouth. National Smile Month isn’t just about education and stressing the importance of a healthy mouth. The key to the success of the campaign is that we have lots of fun doing it! By taking part in National Smile Month, you are helping to create a healthier and happier world. The campaign channels positivity and promotes the true value of a smile, not only for its benefits towards physical health, but mental wellbeing too.

Getting involved Taking part in National Smile Month is so easy. It doesn’t necessarily involve lots of time or money, just the passion to make a difference and help promote oral health. Whether it’s in your dental practice or in a local school, pharmacy, retail outlet, workplace or even out on the streets themselves, use the campaign to educate as many people as possible about the importance of good oral health. We are looking for people who can take our values and desire for oral health education and come up with fun and engaging ways to spread the word among their community. To inspire you in organising terrific National Smile Month events, here are a few of the favourites from the Oral Health Foundation that are guaranteed to put smiles on everyone’s faces: • Smileathon - Grab some of our Smileys and take as many pictures as you can of people using them. Whether it’s a selfie, or a photo with family, friends or colleagues, show us as many smileys as you can muster. Post them on Facebook and Twitter with hashtag


Features

We are looking for people who can take our values and desire for oral health education and come up with fun and engaging ways to spread the word among their community

National Smile Month is our (and your) chance to promote positive oral health messages throughout your local community and help put a smile back on so many faces

around the world. National Smile Month is our (and your) chance to promote positive oral health messages throughout your local community and help put a smile back on so many faces. With your support, National Smile Month reaches more than 50 million people each year and is the biggest and most effective annual reminder of the importance of good oral health. But there is still more work to be done: • A quarter of all children starting school have tooth decay.

#MySmileySelfie and you can also be in with a chance of winning some great prizes. • Two Minute Challenge - This is great fun and perfect for schools, colleges, workplaces and community groups. In fact, anywhere there are working groups of people. Take two minutes out of the day to collectively brush your teeth. It’s so simple to organise and is a great reminder about the importance of brushing for a full two minutes – it’s also great fun! • School Visit - Schools working alongside parents and health professionals have an important role to play in educating young children about healthy lifestyles. For National Smile Month, we’re encouraging dental professionals to make contact with nearby schools to deliver oral health education in the classroom. • Brushathon - Brushing our teeth is not usually considered a communal event. It’s done in the privacy of our bathrooms, in the morning and last thing at night. But during National Smile Month, dental practices, hospitals and oral health educators partner up with local groups to encourage them to brush their teeth simultaneously for two minutes. What makes

the Brushathon such a great event is the factor of mass participation. The activity creates a brilliant buzz, especially among children, which will mean they’re more likely to engage with the subject. • Fundraising - Organising events as a means of fundraising can be a great way to involve an array of different people, from family to friends, patients to pupils and from colleagues to the community as a whole. It can raise awareness for oral health in a fun way, reaching new audiences and a wider potential new supporter base. Whether it’s a sponsored dance, duck race or even face painting, there are many easy and effective ways to take part. And by donating the proceeds of your event to the charity, all the hard-earned money raised can go towards their valuable work in bringing better oral health for all. For more inspiration on how you can get involved in National Smile Month 2018, visit www. smilemonth.org.

The Impact of National Smile Month At the Oral Health Foundation, we are determined to improve oral health, not only in the UK but

• Around a quarter of all adults say they have not visited a dentist in the past two years. • Three in every ten adults suffer from regular dental pain. • A quarter of adults don’t brush their teeth twice a day and over four-fifths of the population have at least one filling. This is where you come in. With your help, National Smile Month can have long-lasting benefits on the quality of thousands of lives. A smile is not only hugely important for our health but has an effect on our personalities, self-confidence, relationships and success. With a good oral health routine, and with your support during National Smile Month, we can help reduce the number of people suffering from poor oral health and wellbeing. Make sure you tell the Oral Health Foundation about your event and activities through social media via @SmileMonth and #SmileMonth.

Dr Nigel Carter OBE

is Chief Executive of the Oral Health Foundation.

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Features

Importance of collaboration

Barry Lanesman,

Dentex Healthcare Group, discusses the benefits of co-ownership and a joint venture partnership as collaboration becomes the key to creating a sustainable business.

Co-ownership versus traditional models Traditionally, dental business models have been focused on acquiring dental practices and managing their expenses. Dentex is very different; our focus is creating a partnership of dentists who can work, talk and learn from each other, whilst also being free to manage, control and develop the clinical aspects of

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their practices. It is much more about personal development and the benefits this brings to each practice and subsequently the whole group; rather than just driving financial profits. So, we are much more focused on how we grow a practice clinically, not just manage and increase their financial profit. The other substantial difference is that the dentists retain ownership in the group, so

have an interest to see Dentex grow and thrive – they haven’t sold out, they’ve bought in. We’re not looking for people who want to get out of dentistry, we want people who see their future in dentistry, are engaged and want to evolve their role in dentistry as part of a broader partnership. By Dentex taking away the administrative burden, they can continue to involve themselves in the parts of the practice that they enjoy.


Features

Future proof your dental practice Dentex is about creating a long-term partnership of dentists, not grouping and selling practices. If you take accounting and legal firms as examples, they have been able to grow nationally but also internationally, and this is because they’ve taken a group of people with different skills and worked in partnership to grow a better business with better information. That has never been done in dentistry. Creating a true partnership means everyone focuses on what they do best, which means creating a sustainable business. The concept of working together in partnership and not as individual practices is a new idea, which, for us, is where the future of dentistry lies. Dentists are often forced to work in isolation over many years but when working collaboratively as part of a wider group they can truly thrive.

Collaboration and inspiration With collaboration, there is much more support and transfer of knowledge and a lot of inspiration and motivation from other dentists. Once you have that connectivity, you can get a more sustainable business. Couple that with the support services that we put in place and the sharing of common knowledge that we’re learning from the practices, and vice versa, we can create a connected and sustainable longterm practice. As long as you can keep growing

Alan Suggett comments In my opinion, the Dentex offering to practice owners wishing to sell their practices is different to the other large corporates. Rather than just being paid in cash, possibly subject to a retention or “earn out”, the Dentex offering is typically 80% of the practice sale proceeds to be paid in cash, with the remaining 20% being held in Dentex shares. In this way the principals who join as partners have a vested interest in helping Dentex grow and prosper. Assuming that the value of Dentex rises as it grows, this could be an excellent way for principals to realise cash, minimise their risk and stress of running all aspects of their practice (CQC, staff matters etc.), and have some funds invested in an investment which they could benefit from by contributing rather than being merely an investor.

Alan Suggett

is a Chartered Accountant and Partner at UNW LLP Chartered Accountants and Member of the National Association of Specialist Dental Accountants & Lawyers (NASDAL). He is independent of Dentex and not associated.

We’re not looking for people who want to get out of dentistry, we want people who see their future in dentistry and adapting to change, you’ll be ahead of the curve. One of the main things we are developing is a specific training program that supports the sharing of clinical expertise across the Dentex group and enables our dentists to continue to develop themselves and their practices.

Barry Lanesman

is CEO of Dentex Healthcare Group.

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Features

Is your dental practice ready for GDPR? As the 25th May GDPR implementation date rapidly approaches, Jamie Foster, Hempsons, dishes out his advice for how practices can prepare for the implementation of GDPR.

Keeping confidential information about staff and patients secure is a responsibility dental practices have taken seriously for a long time. But the requirements are about to increase under the General Data Protection Regulation (GDPR), which will apply from 25th May 2018. GDPR is an EU regulation but, irrespective of Brexit, the government has made it clear that UK law will align with European law on this issue and a new Data Protection Bill is currently before Parliament. GDPR has similarities with the existing UK Data Protection Act 1998 (DPA), but does extend requirements in some areas. In particular: • The obligation to provide information to data subjects has been enhanced • The need for data controllers to include mandatory terms in their contracts with processors • There is a need to ensure that data privacy is built into all activities requiring the use of personal data • Mandatory reporting of information

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breaches is now a requirement for all data controllers, with a maximum 72 hour time limit • There will be changes to subject access rights and powers to charge fees • The maximum fines for data breaches will be increased significantly - the current limit is extended from £500,000 to €20,000,000 or 4% of global turnover The new law means that owners and managers of practices will need to make changes in processes and procedures, appoint people to new roles, and weigh up the impact on some of the practice’s activities.

Owners and managers of practices will need to make changes in processes and procedures, appoint people to new roles, and weigh up the impact on some of the practice’s activities


Features What level of security do you need in place to protect privacy? Any dental practice will be aware that ensuring confidentiality and the security of data is an essential requirement to operate in the field of dentistry. Given the nature of dental practices and the potential harm that could result from misuse of health records, data controllers will need to demonstrate a high level of security, and dental practices will need to keep themselves up to date with industry standard guidance for security levels appropriate to healthcare data as well as address the specific factors GDPR anticipates.

Do you need patient consent for use of their data? Both the DPA and GDPR require certain conditions to be met before personal data can be used, and in the case of sensitive personal data (described as ‘special category data’ under GDPR) such as health data, there are further conditions that need to be satisfied. Consent is one of the potential justifications for the use of personal data. However, it must be borne in mind that consent once given can be revoked, and if consent is used as the justification for processing, the business model must be able to cope with the immediate cessation of data processing in the event consent is withdrawn. The requirements for demonstrating consent are also much more stringent under GDPR. In practice, while consent will be an important part of ensuring that the usage of data is fair and transparent, it is unlikely to be as useful as a justification for the processing undertaken. Fortunately, other conditions, including

legitimate interests or performance of a public task and health and social care purposes are still recognised as the lawful justification for processing data.

Do you need a privacy notice? Yes. Aside from the need to satisfy the conditions for processing, data controllers are under an obligation to ensure that processing is fair and lawful and appropriate information is given to data subjects as to how their data is to be used. This is commonly in the form of a subject information notice, sometimes called a privacy notice. Such notices should demonstrate transparency as to how the data is to be used and shared. Data controllers will be expected to explain, in straightforward language, what data relating to the data subject will be collected, how it will be used, the purposes for which it will be used and how their data may be shared. It is necessary to prepare subject information notices appropriate for children, if their data is collected and used. Under the GDPR there is an emphasis on providing information to data subjects proactively, rather than simply having the data available on request.

Do you need a Data Protection Officer? It depends. GDPR obliges data controllers to appoint a Data Protection Officer (DPO) to be the lead for GDPR compliance in an organisation if they are a public authority or a ‘large scale’ processor of special category personal data.

The current guidance as to what large scale processing entails is not very helpful. In practice, we expect that a small dental practice may reasonably consider that it does not need a DPO but a corporate dental practice is likely to need one.

What practical steps should you take to prepare for GDPR? We recommend all dental practices undertake the following steps: • Map your data flows to identify what information you will need to collect and process and where it is intended that data will flow to and for what purposes and under what safeguards • A privacy impact assessment should be undertaken, assessing whether it is necessary for the data to be used in that way, what the risks to the data are and how those risks will be controlled • Identify whether you need to have a DPO, and if so, who will be fulfilling that role • If you use data processors, review whether your existing contracts will meet the GDPR requirements • Make sure you have processes in place to identify and report data breaches promptly It is worth noting that practices that can demonstrate they have done appropriate work in preparation for GDPR are less likely to receive a fine than those who have done little or no preparation for it.

Jamie Foster

is a Partner at Hempsons.

Consent is one of the potential justifications for the use of personal data. However, it must be borne in mind that consent once given can be revoked |55

Modern Dentist Magazine


Features

Periodontal disease:

the hidden epidemic Jo Dickinson,

Hygienist and Key Opinion Leader at Acteon, is helping to promote awareness of periodontal disease within the UK. She explains what dental teams can do within their practice to help develop patient care and disease prevention and how this can benefit the practice in turn. Periodontal disease affects nearly half of the adult population in the UK. However, periodontitis is both preventable and treatable. The cost of both is relatively low in view of the impact it could have on the healthcare budgets of many countries, including the UK. With a growing momentum in awareness of the importance of periodontal health, there is likely to be an increase in demand for treatment and information regarding prevention. Periodontitis is classed as a chronic noncommunicable disease and is sixth on the table of the most prevalent diseases worldwide. Chronic non-communicable diseases such as cardiovascular disease (CVD) and diabetes are putting a huge burden on healthcare services and their associated costs. As more research emerges supporting the fact that periodontal disease may well be a contributor to other chronic noncommunicable diseases, it would now be prudent to see public health promotion programmes and integrated medico/dental strategies carried out at a national and local level. There are many confounding factors that influence periodontal disease and these other chronic diseases; therefore a cause and effect relationship cannot be truly established. For example, obesity, smoking, and age all influence both periodontitis and diabetes. How each plays a part is still being studied closely. What is becoming clear, however, is that periodontal disease increases systemic inflammation and creates oxidative stress that could well be

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contributing to many of these inflammatory diseases. The treatment of periodontal disease is known to reduce the microbial burden of the oral cavity and reducing systemic cytokine levels. The evidence for periodontitis being associated with systemic disease is stronger for some conditions than others. For example, the evidence for links between diabetes and periodontal disease is more robust than that of preterm and low birthweight babies. There is now reliable and consistent epidemiological data that severe periodontitis affects glycaemic control in diabetes. In addition, other studies have demonstrated that treatment of periodontal disease can produce a 0.4% reduction in the HBA1C count after three months. This may appear insignificant but in fact produces the equivalent benefit of taking an additional diabetic drug. In the case of cardiovascular disease, there is some epidemiological data that periodontitis does increase the risk of CVD, even after removing the influence of confounding factors.

So what can the dental team do within their practice? As a nation we are living longer and keeping our teeth for longer, and 60% of over 65 year olds are now present with severe periodontitis. Many of these inflammatory conditions are expected to become more prevalent as the population ages. Helping patients grasp their role in disease prevention and taking responsibility for their oral health is a difficult and sensitive subject. Planning for this shift in dental care will be advantageous to a dental team. Appearing to be ahead of the game to your patients will always be a practice builder and having a knowledgeable team that can communicate effectively is a successful formula.

Implementing well thought-out practice protocols and making use of good referral pathways to other healthcare providers is a strong starting point. The use of highly developed technology can not only assist in diagnosis and education of patients but allow the dental team to communicate more resourcefully by sharing data and clinical reports. Acteon believe in collaborating/supporting the dental team in developing their patient care. As our understanding of dental science evolves, the technology to treat and prevent is also developed. In the spirit of the EFP Manifesto, Acteon are pleased to launch their new periodontal campaign and would like to know if you would be willing to make the pledge?

Jo Dickinson RDH FAETC

Hygienist and Key Opinion Leader at Acteon.

Appearing to be ahead of the game to your patients will always be a practice builder, and having a knowledgeable team that can communicate effectively is a successful formula


Case Studies

Getting to know Nuvola – invisible, removable and practical I’ve always had a little obsession with my teeth looking healthy, white and wanting that perfect smile. I have chips and crosses just like everyone else, so they are far from “perfect”. I’ve wanted braces for years now, but because of me being an actor it’s never been ideal to have metal on my teeth. I needed something clear and something I could take out of my mouth whenever I needed to. I thought this was very unrealistic and that I wouldn’t find something so practical, but then I found out about Nuvola. Ones I can take out when I need to and that you can’t even see. I started my journey with Nuvola in November 2017, and I genuinely couldn’t be happier. At first you think to yourself “how will I eat or drink hot tea or coffee?” or “is it going to become a thing which makes me dislike the process of having straight teeth?”, but it couldn’t be easier taking

Mitch Hewer (Actor).

them out and putting them back in. They are really easy to clean, so it isn’t a challenge making sure they still appear unnoticeable. That’s one thing I have acknowledged the most; no one even knows I have them in.

To get in touch with Geo Orthodontics please contact them via 01825 714601 or info@geoorthodontic.com, or visit their website www.geoorthodontic.com

I always mention to people that I have braces now and people are honestly in disbelief when I take them out and show them. I’m on my 6th brace now and I have noticed a lot of movement with my teeth already, which makes me very excited about the end result. The first time I put the braces in I could really feel the tightness and was slightly worried that I would have really achy and sensitive teeth throughout the entire process. I very quickly found out that it wasn’t going to be

the case just as Dr. Richard Brown reassured me at his Bristol practice. I actually found that I started to look forward to the new brace each fortnight because I kind of enjoy the tightness that they give, as I feel that I am getting closer to the perfect smile that I’ve always wanted.

DMG UK New Ecosite Bulk Fill

I really couldn’t be more satisfied with my experience so far with Nuvola. Practical braces that no one even knows I have in, pretty much invisible braces! What more could I ask for?!

Quick and reliable restorations with a modern bulk-fill material

As a modern permanent filling material, a packable bulk-fill composite is

a viable alternative to classic materials such as glass ionomer cements or amalgam. What advantages are offered by this latest bulk-fill generation and what should manufacturers and users bear in mind? DMG, the dental materials manufacturer from Hamburg, has just unveiled its much talked-about, newly-developed posterior composite Ecosite Bulk Fill. Dr. Susanne Effenberger, the Dentist who is Head of Clinical Research at DMG, was asked what makes it special. Reliable – even without layering? Quick and easy to apply in just one step, with no need for labour-intensive layering – that is the calling card of new Ecosite Bulk Fill. But has the need for layering really been completely eliminated? What are the implications of this for the reliability and stability of the filling? Dr. Effenberger’s response: “Ecosite Bulk Fill guarantees complete curing, which is a limiting factor in some materials, of up to 5 millimeters. And this is with a light-curing time of just 20 seconds. Additional surface coating is not required. The extremely low shrinkage stress values ensure a durable and reliable marginal fit. The packable nanohybrid composite also has excellent thixotropic properties, which allow for a controlled adaptation to the cavity walls.“ Crucial point: Contact point “An aesthetically and functionally effective contact point formation is a challenge which is often underestimated“, allows Dr. Effenberger. “The firmer material consistency of Ecosite Bulk Fill ensures particularly convenient and precise handling. In practice this means a simplified formation process and

truly reliable and effective contact point formation – as well as the time saved in the finishing process. Another plus point is the excellent mechanical properties of the material, which allows for functional anatomical occlusal surface formation and, with a little finishing and polishing work, a high surface quality.“ Retains optimum flexibility when it comes to bonding The Ecosite Bulk Fill Starter Kit also includes a matching 1-bottle universal bond. Dr. Susanne Effenberger: “It was important to us to equip dentists with a complete package. Ecosite-Bond allows clinicians freedom of choice when it comes to conditioning and is absolutely ideal for use with a modern bulk-fill composite. Ecosite Bulk Fill can of course be used in combination with other light-curing bonds.“

For further information contact your local dental dealer or DMG Dental Products (UK) Ltd on

01656 789401, email info@dmg-dental.co.uk or visit www.dmg-dental.com |57

Modern Dentist Magazine


10 Minutes with... Graham Byrne yet more hassle out of the equation for customers. The network of our partner dentists has also expanded as the process becomes more popular within the industry, bringing our service to even more potential customers in our key markets of the UK, Ireland, France, Italy, Australia and New Zealand.

Q

What has been the key positive or negative change in your area of the market?

A Graham Byrne,

Founder, Your Smile Direct.

Q A

Has the profession changed drastically since you started working in it?

Yes, customers are embracing technology and seeking greater convenience and value, which in turn continues to drive innovation. The technology is advancing, the expertise of the professionals involved is progressing and the processes are being streamlined to offer the customers the best service possible. When YourSmileDirect began, there was nothing like it on this side of the Atlantic. We also used Home Impression Kits exclusively to create customers’ treatment plans. Now, we have the option of using the latest technology to take 3D scans in our Smile Clinics, taking

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The key positive change in our area of the market is that people are becoming more open to remote treatment; both consumers and other dental professionals. Teledentistry is becoming recognised more and more as a way to work alongside traditional dentistry to bring affordable dental care to everyone, not just to the wealthy. We primarily treat minor cosmetic dental concerns, which traditionally would not be covered by the state or medical insurance. Many of our customers come to us delighted to finally be able to afford to correct minor to moderate concerns that have bothered them since a young age, and this is what we aim to provide to people.

Q A

Who inspires you and why?

I draw inspiration from many industry leaders in my field and in the wider technology world. I founded YourSmileDirect after I went searching for cosmetic dental work as a consumer and found the process to be both time consuming and expensive, so I fully subscribe to the Steve Jobs line of thinking that ‘consumers don’t know

what they want until they see it’. People who innovate, who push boundaries and who bring something new and exciting to the consumer are inspiring to me.

Q

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

A

I am extremely fortunate to have received advice and support from a number of people over the years. This ranges from my peers, to industry leaders within the dental sphere, to personal relationships such as my parents, colleagues and friends. Their advice, guidance and encouragement have been instrumental to my development and it would be impossible to single out one piece of advice from an individual person.

Q A

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

I always thought I would enjoy teaching, so I would likely be a school teacher.

People who innovate, who push boundaries and who bring something new and exciting to the consumer are inspiring to me


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Modern Dentist Magazine


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Modern Dentist Magazine Issue 2  
Modern Dentist Magazine Issue 2  
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