Modern Dentist Magazine Issue 1

Modern Dentist Magazine

A new magazine for the business minded dental professional

Because business is never just black and white!

Issue

01 ISSN 2515-6128

The Future Caring for Inspections Patients Explained of Regulation OlderProfessor Matthew Hill GDC

Michael Escudier,

John Milne, CQC

Faculty of Dental Surgery

Key contributors to this issue

Getting Dentistry

RIGHT! Mick Armstrong, BDA

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Welcome

that are willing to rise to the challenge to meet those expectations and provide the best patient care, this is a golden opportunity.

It’s a brand new year, and the timing’s right for the launch of this brand-new free publication, so hello and welcome to the first ever edition of Modern Dentist Magazine. This bi-monthly magazine is essential reading for all forward-thinking practice managers, business owners and dental professionals, as it will cover the business of dentistry and tackle the challenges and opportunities facing your practice.

Modern Dentist features interviews and insights from dentistry experts on an editorial board comprising thought leaders from all aspects of the profession, who will share their opinions and advice on how your practice can make the most of these opportunities that will come your way in 2018. We want to hear your thoughts on the business of dentistry too, so if there’s a burning issue or a golden opportunity you’d like to talk about, or if you’ve got any feedback on the magazine, please do get in touch via the details below.

We’ve published another title, Modern Law Magazine, for six years now, and as I’ve been speaking to dental professionals while researching and producing Modern Dentist some clear contrasts that can be drawn between the two professions have arisen. For instance, solicitors have spent years struggling to provide legal services to the people who need it most following heavy cuts to legal aid, and similarly, dental professionals have faced difficulties working under the current NHS contract, something Mick Armstrong of the British Dental Association (BDA) spoke about in this issue’s first interview.

We’ve had a great time putting this magazine together and discovering more about the dental profession, and we hope you enjoy reading this magazine just as much. If you’d like to continue to receive Modern Dentist, please visit www.moderndentist.co.uk to subscribe for free.

Likewise, the demands of compliance and regulation are only increasing in the legal sector, as they are in dentistry as well. In this first issue we hear from both Matthew Hill, General Dental Council (GDC) and John Milne, Care Quality Commission (CQC), who outline their plans for the year ahead and demystify some regulatory processes and systems.

Brendan

Brendan Gurrie, Editor, Modern Dentist Magazine.

01765 600909 | @ModernBrendan brendan@charltongrant.co.uk | www.moderndentist.co.uk

But we also discovered there were some huge opportunities in the evolving dental profession. In dentistry, as in the legal sector, and as in the majority of other professions as well, the consumer expects more than ever from their service providers. And for the practices

Editorial Contributors Andrew Legg

Issac Qureshi

Mike Hughes

Dr. Geoff Baggaley

Kirsty Wainwright-Noble

Shaz Memon

Dr. Richard Brown

Lorraine Nadel

BDS MFDS RCS Ed Director, Implant Dentist The Campbell Academy (B.Ch.D D.G.D.P.(U.K.)R.C.S. Dip.Con.Sed(Newc) The Raglan Suite

Director of Client Services Ogilvy & Haart Head of Sales and Marketing Towergate Insurance Brokers

Managing Director Tempdent Recruitment & Training

Heidi Marshall

Mark Barry

Stephen Green

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

Accountant PFM Townends LLP

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

Director ESM Digital Solutions

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

Creative Director Digimax

Sophie Kwiatkowski

Nuvola Speaker Parrys Lane Dental Practice and Bupa Dental Care Partner Dodd & Co

Principal Dental Practice Consultancy Service

Cover Shot

Courtesy of Shutterstock

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Modern Dentist Magazine

Modern Dentist Magazine

Content 07

1.8 million over-65s could have an urgent dental problem

10

22 Examing the

Interview with Mick Armstrong, BDA

dental practice News

07

1.8 million over-65s could have an urgent dental problem

Professor Michael Escudier, Dean of the Faculty of Dental Surgery, discusses the impact of poor oral dental health in older patients and how access to and quality of dental care for them needs to be improved.

18 22

Interviews

10 15

Mick Armstrong

As Modern Dentist looks ahead to the challenges and opportunities for dentistry in 2018, Mick Armstrong, British Dental Association (BDA), told us about the work of the BDA in 2017, and how it plans to campaign for its members and for patients in the year ahead.

Matthew Hill

We spoke to Matthew Hill, General Dental Council (GDC), about the how the regulator is working with the public, other organisations and dental professionals to help regulation evolve alongside innovation to ultimately improve the provision of dental services for patients.

26

Regional Focus - Northwest

In the first of Modern Dentist’s Regional Focus interviews, we spoke to Stuart Allan, Northwest Regional LDC Representative, about some of the shared and unique challenges dental professionals are addressing in the region and how better public education can improve oral health

Examining the Dental Practice Raj Rattan, Dental Director at Dental Protection, spoke to Modern Dentist about the value of communication and feedback between dental professionals, regulators and the patient, as well as whether patients’ expectations have changed and what the industry is doing in order to meet them.

A clinic on the coast?

Interview with Dr. Sabine Pahl

Editorial Board

28 28 29

Rethinking regulation

Dr. Geoff Baggaley, The Raglan Suite

Being a dentist in the 21st Century

Andrew Legg, The Campbell Academy

Dental marketing made easy Shaz Memon, Digimax

29 31 31 33

Striking the Balance Heidi Marshall, Dodd & Co

How can dentists benefit from developing a tax strategy?

Issac Qureshi, Ogilvy & Haart

A 3D Future

Mark Barry, ESM Digital Solutions

Ionising Radiations Regulations

Stephen Green CRadP MSRP MIPEM, Stephen Green and Associates

33 34

Forecast for Cloud

34 35 35

Get ready for GDPR

Sophie Kwiatkowski, PFM Townends LLP

Apprenticeships: an attractive proposition

Lorraine Nadel, Managing Director Tempdent Recruitment & Training Kirsty Wainwright-Noble, Towergate Insurance Brokers

Exciting times

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

Buying a practice?

You may need more than just a valuation Mike Hughes, Dental Practice Consultancy Service

Issue 1 | ISSN 2515-6128

50

The global parallels and differences between the USA and UK

29

44

Striking the balance

CQC inspection methodology should not be seen as something to be feared

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FREE at

www.moderndentist.co.uk

Supported By

Features

37

First-class Patient Experience

40

2018 - The year to unlock your practices profits

42

Hygienists and Therapists: A bright and shiny future

44

Encouraging improvement in practice

46

Who are the Dental Schools Council?

49

Measuring and maximising success with KPIs

50

The global parallels

Ed Challinor, Smileworks

Andy McDougall, Spot On Business Planning

51

Does size matter?

52

Discover five secret strategies to make 2018 your best ever

54

Silver Jubilee for FGDP(UK): Helping shape the UK’s dental healthcare landscape for 25 years

Chris Deery, Dental Schools Council

Lisa Bainham, Association of Dental Administrators and Managers (ADAM)

Reported by the Dentacoin Foundation

Ashley Latter

Mick Horton, Faculty of General Dental Practice UK

Alif Moosajee, for Philips

John Milne, Care Quality Commission (CQC)

David Worskett, Association of Dental Groups

OGILVY&HAART

Case Studies

57 57

PROTECTING YOUR WEALTH

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10 Minutes with...

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Enrico Steger

Master dental technician, Inventor and CEO at Zirkonzahn

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NEWS

1.8

million

over-65s could have an urgent dental problem

Professor Michael Escudier,

Dean of the Faculty of Dental Surgery, discusses the impact of poor oral dental health in older patients and how access to and quality of dental care for them needs to be improved.

At least 1.8 million people aged 65 and over across England, Wales and Northern Ireland1 could have an urgent dental condition such as dental pain, oral sepsis or extensive, untreated dental decay. These are the findings of a new report from the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons, which warns poor oral health could be having a significant impact on older people’s general health and quality of life.

Over the last 40 years, standards of adult oral health have improved dramatically. While just 22% of people in England aged 65 and over retained some of their natural teeth in 1978, by 2009 this had increased to 85% of 65–74 year olds and 67% of those aged 75 and over2. This is undoubtedly good news, but it does mean we need to look again at how we provide oral healthcare for older people.

Previously, dental treatment for older people primarily involved providing or repairing dentures for those who had lost all, or at least many, of their teeth. Now many older people require ongoing regular maintenance of heavily restored teeth, which creates new challenges for dentists. There’s also the challenge of making sure older patients can see a dentist. Many will have reduced mobility, be living in residential care homes or in their own homes with carers, and so will find it difficult, if not impossible, to travel to the dentist.

As the case studies in the Faculty of Dental Surgery report demonstrate, dealing with severe tooth or gum pain can affect older people’s quality of life and overall health in many ways. It can put them off their food and make it difficult to undertake daily tasks.

It can also make them reluctant to socialise with friends and family and so increase their isolation. As well as causing pain and difficulty eating, dental problems can make it difficult to speak and take medication.

For those without any natural teeth, having a comfortable set of dentures is extremely important for general wellbeing and quality of life.

Poor oral health in older people has also been linked to more serious conditions such as malnutrition and aspiration pneumonia.

In addition, although not directly caused by poor oral health, regular dental check-ups are essential to enable early diagnosis and prompt management of oral cancer and other mucosal diseases.

FDS estimates that, given population increases, if nothing is done to help older people enhance their oral health, there could be more than 2.7 million over-65s with an urgent dental problem by 2040. There is therefore an urgent need to improve access to and the quality of oral healthcare for older people.

In order to prevent oral health problems from developing or getting worse, it is essential that appropriate advice on maintaining good oral health is easily available for older people themselves, as well as their families and carers.

Dental health also needs to be viewed as part of older people’s overall health, with health professionals and social care providers being trained to recognise and address problems before they advance.

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Modern Dentist Magazine

News Given population increases, if nothing is done to help older people enhance their oral health, there could be more than 2.7 million over-65s with an urgent dental problem by 2040 Older people can face particular challenges in accessing dental services, with Public Health England research3 indicating that care service managers find it difficult to access domiciliary and emergency dental services for their clients if they need them. Research by the British Dental Association has also suggested that over-65s are less likely to be frequent attenders at the dentist than other age groups4. Ideally, all older people receiving

Regulators can play a crucial role in making older people’s oral health a priority for health and social care staff, particularly now that the importance of oral health in care homes and hospitals has been established by NICE. The Care Quality Commission, and other health and social care regulators in Scotland, Wales and Northern Ireland, should ensure that standards of oral care are assessed during their inspections of care homes and hospitals.

That there could be least 1.8 million people aged over-65s with an urgent dental problem is terrible. We are letting these people down at a time when they need the most help. We absolutely must work together to ensure a joined up strategy for improving access to dental services for older people.

Professor Michael Escudier, Dean of the Faculty of Dental Surgery.

Figure 1: Percentage of over-65s retaining some natural teeth

Anonymous Case Study

90

Edward is a 74-year-old man with dementia who lives in a care home. He does not have an oral care plan. He starts to leave his food untouched and the care home asks his doctor to visit, but no cause can be found for his reduced appetite. After two weeks Edward is admitted to hospital after a fall, and his medical team have to consider placing a nasal tube for feeding. A nurse in the hospital carries out an oral assessment and notices his teeth are broken and his mouth looks dirty. He is referred to the onsite maxillofacial unit and is seen by a dentist, who identifies that Edward has a broken tooth that is cutting into his mouth and causing traumatic ulceration. The dentist is able to remove the tooth and Edward starts eating again. He is discharged from hospital the next day.

80 70 60 50 40 30 20 10 0

65+ 1978

65+ 1988

65-74

1998

75+

65-74

2009

75+

NOTE: In 1978 and 1988 the Adult Dental Health Survey reported the total number of people aged 65 and over retaining some natural teeth. In 1998 and 2009 separate figures were reported for those aged 65-74 and 75 and over, as reflected in the graph above.

social care support should have a named dentist.

In hospitals and other acute care settings, all junior doctors, nursing staff, allied health professionals and support staff should receive oral health training, while in the community it should be provided for pharmacists, community nurses, geriatricians and all other healthcare professionals who have regular contact with older people. The Mouth Care Matters programme, which is already being delivered in hospitals in South East England, provides an excellent example of good practice in this area.

Social care providers should also provide their staff with appropriate training about oral health and care, as well as ensuring that all services have an oral care policy and cover oral health as part of initial health assessments. In Wales, the Welsh government already funds a programme called Improving Oral Health for Older People Living in Care Homes5 that requires outcomes such as these to be met, and can prospectively serve as a model of good practice.

8|Modern Dentist Magazine

There is also a need for more information about older people’s oral health to better understand the full scale of this issue. NHS Digital should include figures within its quarterly dental statistics on the proportion of people aged 65–74, 75–84, and 85 and over who visited an NHS dentist in the preceding 24 months, so that this can be compared with the access rate for other adults. It is also essential that the Adult Dental Health Survey continues to monitor developments in older people’s oral health. The last one took place in 2009 and we have still not had assurance that the next, due in 2019, will go ahead.

As the population grows and ages, demands on dentistry will increase. It is essential that the oral health profession be fully prepared for these changes. In part, this is about ensuring that changes in demand for dental services are matched by appropriate resources over the coming years, and the government must regularly review whether dentistry has sufficient support to meet patient need. It is also vital that oral health professionals receive the training they need throughout their careers to deliver the sorts of complex dental treatments that older people will increasingly require.

Case study provided by Mouth Care Matters programme.

It is essential that appropriate advice on maintaining good oral health is easily available for older people themselves, as well as their families and carers 1 Scotland did not participate in the Adult Dental Health Survey 2009 from which this data is taken.

2 Based on data from Health and Social Care Information Centre (2011) 1: Oral health and function – a report from the Adult Dental Health Survey 2009, Table 1.5.1 Proportion of edentate adults: England 1978–2009.

3 Public Health England (2014) North West oral health survey of services for dependent older people, 2012 to 2013 – Summary of findings, p6–7.

4 British Dental Association (2012) Public perceptions of choice in UK dental care: findings from a national survey, p12.

5 Improving Oral Health for Older People Living in Care Homes in Wales. http://www.wales.nhs.uk/ improvingoralhealthforolderpeoplelivingincarehomesinwales [accessed on 05.06.2017]

Interview

MICK ARMSTRONG As Modern Dentist looks ahead to the challenges and opportunities for dentistry in 2018, Mick Armstrong, British Dental Association (BDA), told us about the work of the BDA in 2017, and how it plans to campaign for its members and for patients in the year ahead.

Q A

What have been some of the biggest challenges the dental industry has faced in 2017, and how has it responded to these?

Our responsibility is to ensure the voice of dentists is heard in the debate about general health, while fighting for our fair share of NHS resources. Brexit now seems to be taking a lot of the government’s time, and as a result our issues can seem even further down the agenda.

We have been proactive. In the last twelve months we have had dentists raising these issues on the floor of the House of Commons and debating properly. We have had the media pick up several themes that we have raised about the emergency crisis in access.

The message we’re repeating ‘til we’re blue in the face is that government has a responsibility to set an overall preventive strategy for dentistry. That’s the key to everything.

Q

Can you outline the core aims of the BDA’s 2017 manifesto? Where has there been success in achieving these aims, and where did you find challenges?

A 10|Modern Dentist Magazine

Our manifesto focused on prevention of oral disease, which really lacks a national programme.

So we pushed hard and thought we were getting somewhere with a sugar levy, and a lot of our problems are closely related to those that

Interview

health, technology and the way dentistry is delivered. It is a much more pleasant experience, and that is entirely down to dentists leveraging these improvements and investing in the new methods of treatment. This profession has transformed dentistry over these last 50 years.

come with obesity. If we could have seen a proper rollout of a genuinely ambitious obesity strategy supported by the government, it would have been great. Obviously that was diluted, but I still think we made significant progress with the levy.

We want a better NHS contract and we’ll continue to push as we inch towards that. We also wanted a fair funding settlement from the NHS; that has not occurred despite raising patient charges and despite the sugar levy. Funding for NHS apprenticeships continues to decrease, not increase. The number one

Q

In a snap election this manifesto served as a reminder to the parties of the issues we’ve been fighting for long-term.

We’ve outlined what we want from this government and will keep fighting for it.

We’ve got MPs and media talking about our issues, but we have to keep this going.

Q

Following the BDA’s celebration of 50 years at Wimpole Street, what do you identify as some of the biggest cultural and professional changes in the business of dentistry throughout those years?

A

The public’s oral health has dramatically improved, and the people who are now retaining teeth well into old age has significantly increased. The actual amount of decay in the population has significantly decreased, and that is not only a result of dentists’ efforts but also of fluoride toothpaste.

We’ve seen huge improvements in oral

Well it certainly isn’t all about NHS dentistry; the total national spend on dentistry is 50/50, and that is approximately £3.5bn each in NHS and private. And certainly, patient expectations are driving a lot of that private growth. People don’t want to only just retain their teeth, they want their teeth to look and function well and last a long time, and research coming out at the moment would indicate that a very important part of their perception of social mobility is to have attractive as well as pain-free teeth.

What impact is the current NHS dental contract having on dentistry, and how does the BDA suggest it can be reformed for the betterment of professionals and patients?

Q

We have a cash-limited, target-driven system that doesn’t deliver proper preventive care to the people it is supposed to; those who need it the most

item on all of our members’ agendas is stress, and that is fundamentally caused by over-regulation.

A

A

We are hands on and in negotiations with government to make it better.

We have a cash-limited, target-driven system that doesn’t deliver proper preventive care to the people it is supposed to; those who need it the most. We need to see that refocused.

Rather than tick boxes and targets, dentists need to be able to direct that resource where we can secure the best improvements in health outcomes.

We want to see a capitation based system, and we are hopeful that the Department of Health will agree and we will head towards that goal.

Q

How have changing patient expectations of the services they receive influenced the dental industry in the 21st century?

Where are there opportunities for improved relationships between dental regulators and practitioners, and what role does the BDA play in this?

A

It is no great secret that we have been at odds with our main regulator, the GDC, for the last few years because of their overbearing and hugely expensive machine that they impose on the profession. We are beginning to see a better relationship; the BDA is working with them to improve the processes that are involved in protecting the public.

Only a very small percentage of the profession are involved in the more serious cases, and we would like to see that reflected in a reduced fee for regulation. We do think things are improving, but it is not being reflected in the amount we are being charged.

Q

In which areas has the BDA Good Practice programme identified room for improvement in the services provided by dental professionals, and in which areas is the industry excelling at good practice?

A

The BDA Good Practice scheme launched in 2001, and more and more practices are signing up.

I can’t overstate the importance of the contract reform. Most of our young dentists work in the NHS, and to be honest it is not a very welcoming world when they leave university and get into this current contract

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Modern Dentist Magazine

Interview

We wanted to help members show patients that they can expect a certain standard of care. At the outset it was a way of demonstrating that you were compliant, and it has fed into the work overseen by bodies like the CQC.

The CQC has been really good for dentists because we are shown to be the most compliant of the service sectors, on fundamental tests for being caring, responsive, effective, safe and well led.

We believe that Good Practice initiated that, and we will keep developing the scheme to make sure it is a quality mark for every dentist who wants to go over and above.

Q

What were the outcomes of the BDA’s “We are dentistry” campaign, and what kinds of work has the BDA been celebrating as part of this?

A

This campaign is part of our commitment to putting the work of our members centre stage.

We are a unique profession, and we are a small profession, working in communities, hospitals and universities and out in general practice. It is a way of bringing the profession together; all of those different branches have similar problems and face similar challenges

and indeed very similar patients, and it was a way of showing that we are united in providing good quality health care wherever we can. We thought bringing all of those different strands together would be a very useful exercise.

It got a very positive response. There were obviously some concerns about how things are policed and paid, but we found that people were remarkably enthusiastic about dentistry. We are still a very positive and committed profession despite all of the negativity surrounding our contracts and regulation.

Q

In your opinion, what should be the 2018 New Year’s resolution for the UK dental industry?

them. And where a patient has not been under significant harm, then we believe the fear of losing one’s career and registration should not be there. Those are my two main goals for 2018.

Q A

Given the rise in oral cancer, we believe that it is morally indefensible that the HPV vaccine isn’t offered to boys. We have made our case many times. It seems mainly to be done on costs, and I think that is just appalling, so we will continue to press for that.

We are officially neutral on Brexit - but as a trade union we are working to ensure any outcomes do not hit on our members or compromise the care they provide to their patients.

We operate in all four countries of the UK, and we know that their contract requirements are very different. But we do have serious input from our colleagues in Northern Ireland, Scotland and Wales; the problems that they face are very similar and we have to work hard to represent those colleagues to the best of our ability.

A

I can’t overstate the importance of the contract reform. Most of our young dentists work in the NHS, and to be honest it is not a very welcoming world when they leave university and get into this current contract. We are looking for a contract that can help them to develop their skills and empathy, without meeting these crushing targets.

We hope the fear of regulation will be reviewed, so that people can make honest mistakes and can apologise for

What are some of the other key campaigns and projects you and the BDA will be promoting in 2018 to help improve the industry for professionals and patients?

Mick Armstrong Mick Armstrong was elected as the BDA’s Chair in 2014. He has served as a member of its Principal Executive Committee since 2012.

He qualified in 1985 from Newcastle and has spent all of his practising life in General Practice.

For the last 20 years he has been a partner in Armstrong & Haire Ltd, a six surgery, mostly NHS practice in Castleford, West Yorkshire.

He has served on BDA’s Representative Body and was Chair of LDC Conference in 2010. He has been involved with FD training for over a decade.

Outside dentistry he is married with 3 children. His interests are rugby, cricket, collecting and restoring historic trucks and associated paraphernalia, film noir, Pinot noir and/or black pudding.

12|Modern Dentist Magazine

We are still a very positive and committed profession despite all of the negativity surrounding our contracts and regulation

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Interview

Matthew Hill

We spoke to Matthew Hill, General Dental Council (GDC), about the how the regulator is working with the public, other organisations and dental professionals to help regulation evolve alongside innovation to ultimately improve the provision of dental services for patients.

Q

A

What does the GDC recognise as some of the biggest influences on the UK dental industry and the work of practitioners in the 21st century, and how has the profession responded to these?

One could argue that many of the factors affecting the dental sector are shared by the wider health environment and indeed society more widely.

The whole nature of the relationship between the public (whether in general terms or as individual patients) and healthcare professionals has changed.

The Internet, and the democratisation of previously expert information it has brought about, coupled with the positioning of the patient at the centre

NHS services at least, how services are commissioned is a major influence on the sector, which is why contract reform and equivalent processes across the UK are so important. And it is difficult to think about this issue without recognising the increasing presence of corporate dental businesses in the sector and the risks and opportunities that might represent.

of services, which has been a goal of public policy for the best part of two decades, may force a rethink of the role of healthcare professionals more widely.

Equally significant, at least in terms of day-to-day practise, is the UK’s aging population; many are living longer – and more dentate – lives, and many in the profession are recognising the implications in terms of patterns of treatment and how services are delivered. It’s really important that regulation facilitates and does not hamper innovation to react to these challenges in service delivery.

Of course one of the biggest unknowns is the impact of the UK’s withdrawal from the EU. In dentistry people have tended to focus on workforce, and that’s important, but there is a range of other potential regulatory impacts, including in relation to mutual recognition of qualifications and medicines control, for example.

Thinking about dentistry specifically, it goes almost without saying that for

The data we have access to is limited so the picture we can build is often incomplete. To tackle this, we’re seeking to work with partner organisations who own different parts of the puzzle

Q A

Has the GDC identified any areas in particular where dental professionals regularly fail to meet standards, and where are the areas in which they are succeeding?

At the GDC we are starting to get a debate going on the nature of

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Modern Dentist Magazine

Interview standards and whether it remains helpful to see them as a set of absolute tests that are capable of being passed or failed, as opposed to a set of principles to guide professional life.

In Shifting the balance we talk about the need to be more intelligencebased and data-driven in our approach to regulation. For fitness to practise (FtP), for example, this includes analysing the data available to us to help understand if there are themes emerging from the cases we see. This would enable us to think more about possible solutions, upstream of formal regulatory action, such as changes to education programmes or suggested CPD, with the aim of delivering public protection without relying so heavily on enforcement.

November 2017 saw us publish our first ever analysis of FtP cases with some really interesting results. From our very early explorations into this way of working, we found that complaints arising broadly fit into three themes: 1. treatment issues, 2. convictions and cautions and 3. communication. If there’s one takehome message from this piece of work, I’d say it’s that a significant proportion of cases we are seeing are in this final category. This suggests that more attention to softer skills is needed in education and ongoing training to ensure registrants understand

Whilst, yes, an important part of what we do is enforcement, there is much more that we can and should be doing to make a positive impact before issues gets to a serious stage what their patients will fairly expect, as well as the risks associated with underperforming in this area.

Q

A

As a starting point, I think it’s useful to say that the GDC has a specific remit and set of tools at its disposal, as set out by Westminster. While these are significant, they are designed to deal with comparatively serious matters and many of the levers for a complete and effective system of dental regulation are held by other organisations. To be effective therefore, we must work closely with a wide range of bodies for the benefit of patients and the sector itself. In Shifting the balance we set out our vision for dental regulation, which very much relies on further developing these working relationships and practices to implement an effective model of upstream regulation.

We will continue to seek out ways to become more sophisticated in how we use data to influence our activity. For instance, the data we have access to is limited so the picture we can build is often incomplete. To tackle this, we’re seeking to work with partner organisations who own different parts of the puzzle. This raises challenges in terms of protecting confidential information, but the potential shared benefits for the sector justify at least trying to overcome the challenges.

How does the GDC collaborate with other industry bodies, regulators and associations to improve dentistry for professionals and patients?

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We’re also aware that for patients, the landscape of dental regulation can be a confusing one to navigate, with apparent blurred lines between what the GDC and other organisations can do for them. With the aim of clarifying this for patients, and to reduce over-regulation and duplication, the Regulation of Dental Services Programme Board (RDSPB) was formed. This collaboration, between us, the Care Quality Commission and NHS England, has worked on a number of initiatives to this end, including the development of a joint statement on complaints and a shared working protocol on how to manage enforcement action. The remit of this group is focused on England, but we hope to roll out the principles through collaborations in other parts of the UK. Alongside this activity, we worked with patients, dental professionals and stakeholders in the development of a new ‘self-filtering mechanism’ for patients who are seeking to raise a complaint through our website, and this went live in September 2017. By asking a series of questions before an FtP complaint can be raised, it builds understanding about the GDC’s role and whether we are the best placed to resolve the issue in question. Where we are not, it helps complainants to understand the best way forward, which could well be to raise the issue directly with the practice in the first instance.

Alternatively, it signposts them to organisations that are better-placed to help with their issue, with the aim of avoiding costly and stressful FtP cases where appropriate.

Interview

Q

A

How did the GDC identify the need for Enhanced CPD, and how will it support dental professionals in meeting the new requirements?

Many dental professionals have expressed to us quite strongly that they see a focus on their own development as part and parcel of being a professional.

We have listened carefully to this view and are seeking approaches to CPD that offer the profession the opportunity to take responsibility for development, and to do it in ways that “work with the grain” of what they are already doing.

This might mean, for example, much greater importance placed on peer to peer development like mentoring and peer review. This will only work if the profession shows that it is willing to seize the opportunity on offer.

Enhanced CPD (ECPD), with its central focus on the personal development plan, is the first step along this road.

ECPD came into force on 1 January 2018 for dentists and arrives for dental care professionals on 1 August, and there are a number of significant changes that everyone needs to be aware of. To support professionals and CPD providers through the transition we have produced a series of resources including written guidance, templates and films, which we think are clear and easy to use - these are all available on our website at gdc-uk. org/ecpd.

Q A

I also talked earlier about our new selffiltering process for patients seeking to raise FtP complaints, and the aim of this work is to reduce the number of inappropriate cases arising, with more issues being resolved more quickly and

In addition, as foreshadowed in Shifting the balance, 2017 saw us start a major review on the entire FtP process to help us understand the changes that are needed and we’re already seeing some of the benefits of this work. We’ve been involving a very wide range of people in that review, including the public, individual registrants, professional bodies and defence organisations. The emerging conclusions look promising, particularly against the background of potential changes in regulatory policy signified by the Department of Health’s current consultation in this area.

Q A

What were the key findings from responses to the Shifting the balance programme, and how does the GDC plan to act on these to develop regulation in the industry?

In December of 2017 we published Shifting the balance: GDC’s response and next steps, which summarised the responses we received over the consultation period as well as the next steps we’d be taking to implement the proposals.

How will the fitness to practise process change in 2018 as a result of responses to the GDC’s recent consultation?

We introduced case examiners just over a year ago now, and that has already started to deliver a more proportionate range of outcomes while maintaining the right level of public protection.

efficiently. Whilst it’s too early to take meaningful results from this, I look forward to sharing its impact once it’s had time to bed in.

The proposals touch on so many aspects of dental regulation and, if any of your readers have not yet looked at our plans, I’d really encourage them to visit gdc-uk.org/shiftingthebalance to find out more. Although the initial consultation is complete, we are committed to ongoing engagement with the professions and other stakeholders to make sure we introduce changes in the best possible way.

A major theme in Shifting the balance is ‘moving up stream’. This is the idea that whilst, yes, an important part of what we do is enforcement, there is much more that we can and should be doing to make a positive impact before issues gets to a serious stage.

One example of this, as I touched on earlier, is through more sophisticated use of data to move toward a more intelligence-led approach to regulation.

2018 will see the GDC begin publication of an annual State of the Nation report for dentistry, which will include greater use of this data as well as workforce issues, a summary of complaints and related trends, updates and analysis of activity within professional and system regulation and developments in dental services and service delivery, all against the backdrop of wider developments in healthcare regulation and changes to NHS arrangements.

Q A

Can you outline what the GDC’s Patients, Professionals, Partners, Performance strategy will involve, and what are the core aims and key projects the GDC will be undertaking in 2018 and beyond as part of this?

2018 sees our three-year corporate strategy, colloquially referred to as The 4 Ps, entering its final year and our 2018 business plan, which will be out in January, will heavily draw on the priorities as set out in Shifting the balance.

One of the most significant pieces of work is likely to be a major consultation on our approach to setting fees. This, we hope, will open the door to beginning a constructive conversation, later in 2018, on our strategy for the next three years and the activities we propose to conduct to achieve the regulatory outcomes we seek.

This will provide an opportunity, for example, to show how we are striving for best value in our pursuit of patient safety and public confidence in dental services. As an example of this focus, last year we took the decision to relocate around 90 posts to Birmingham with the aim of reducing costs associated with multiple London bases of operation.

This will be implemented in 2018 and is projected to contribute significantly towards our drive for improved cost effectiveness.

Matthew Hill Matthew Hill is the Executive Director, Strategy, at the General Dental Council (GDC), and his role focuses on the development and implementation of strategy, policy and communications. The GDC is the UK’s statutory regulator of just over 100,000 members of the dental team, including approximately 40,000 dentists and

60,000 dental care professionals. Its primary purpose is to protect patient safety and maintain public confidence in dental services. To achieve this it registers qualified dental professionals, sets standards of dental practice, investigates complaints about dental professionals’ fitness to practise and works to ensure the quality of dental education.

It’s really important that regulation facilitates and does not hamper innovation |17

Modern Dentist Magazine

Interview

Regional Focus:

NORTH WEST Stuart Allan

In the first of Modern Dentist’s Regional Focus interviews, we spoke to Stuart Allan, Northwest Regional LDC Representative, about some of the shared and unique challenges dental professionals are addressing in the region and how better public education can improve oral health

Q

A

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

We work to a national contract, so a lot of the challenges we face are also national ones. One of these is the fact there’s a limited amount of funding available. If you want to do more work you can’t get more UDA’s, you can only work to the maximum your practice has been allocated. If you don’t, they take the money back from you and it tends to disappear from dentistry altogether, going back to plugging the big black hole that is the National Health Service. What that effectively means is the dental budget is shrinking, but we know the department of health will say it’s because the money wasn’t needed and so is being used for something else. It assumes all dentists see the same number of patients for the same number of similar treatments every year.

I’ve been registered since 1978, and in that time the degree of regulation has

18|Modern Dentist Magazine

increased exponentially, and the number of cases taken before the GDC for seemingly trivial matters has increased hugely. I do recognise the current regime at the GDC have made strident efforts to reduce this and to put things into context, trying to deal with things on a local basis. The CQC is still new, and it’s an extra realm of expense we’re exposed to. The vast majority of dental practices pass their CQC inspection on the first opportunity. They’ve only ever had to close very few practices, so I do wonder whether spending all that money has actually achieved anything.

It’s like having a speed trap set up; if everyone’s driving below the speed limit then the police officer is just sat in his car twiddling his thumbs, and you’ve got to ask whether it was worth buying that expensive radar trap in the first place.

Q A

What are the core aims of the Northwest Federation of LDCs?

We support our LDCs and there are lots of common problems we need to help them with when they flag them up. They

let us know about the issues in their area, and we share these when we go to London, and you won’t be surprised to learn a lot of the challenges we face are similar to what everybody else is facing. Differences come from things like devolution in Greater Manchester, which is still an unknown; we don’t know where exactly it will go with dentistry.

Q A

How have the needs of LDC members in the Northwest changed over the last ten years?

Ten years ago we didn’t have the CQC, so having to adapt to that degree of compliance has been a big change.

Compliance generally has changed too.

A huge number of LDC members are now getting their first dental degree outside of the United Kingdom; in fact, in 2015 more people registered with the GDC with an overseas degree than with a UK degree. It means we’ve got a profession with lots of different backgrounds and lots of different languages.

Interview

The number of dentists training in the United Kingdom has reduced, partly due to expectations that not as many dentists would be needed today, so a lot of our colleagues from Europe have filled these gaps. A few have gone back since Brexit, as the pound has plummeted and they’re not sure how welcome they’ll be.

Things like television makeover programmes have raised patient expectations, often to unreasonable levels. You sometimes have people attend with basic dental needs that have to be addressed in order for them to have a healthy mouth, but they’re not interested in that and would rather have wall-to-wall crowns to get a “Hollywood smile”. It becomes a matter of sitting down with the patient and explaining to them what’s important and what the consequences of not having basic dental needs met are. They can be given the impression they can get all sorts of cosmetic things done under the NHS, and the administration will quite reasonably say the money is intended to achieve and maintain health rather than items which are cosmetic. With television makeover programmes, you

In Greater Manchester there’s a huge shortage of (medical) GPs, and we’ve realised dentistry is starting to see the same kind of challenges as it’s getting much harder to recruit. The problem is that a dentist has to be GDC registered, so they have to have appropriate qualifications to achieve this. Practices can’t do a lot about that, as you can’t train a dentist as an apprentice in the practice. It’s a concern, but there are

The health service is creaking at the seams never see them going back after ten years to see how restorations and treatments have aged; it’s always just an instantaneous thing; meanwhile the profession is trying to provide treatments which ensure long lasting health improvements.

movements to have other professionals work with us, and there’s a greater dependence on hygienists and therapists now.

Expanding their grades further would be one way to address staffing issues, but with this comes the problem of patients preferring to have everything done in one sitting. Some patients don’t like the idea of therapists and want to be treated by a dentist. It’s similar to some A&Es that have highly qualified and perfectly competent nurses who can provide some required treatments, but their patients demand to be seen by a doctor and not a nurse.

And as well as all this, the health service is creaking at the seams. We have a system that promises you can get almost anything on the NHS, but we’ve got limited means to provide this.

Regularly we only get 50% to 60% of the population attending the dentist under the NHS. You don’t have to be a master mathematician to work out that if everyone who was entitled to treatment decided to seek it at once, we’d have to either increase the budget drastically or have some seriously long waiting lists.

Q

A

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?

When talking to patients I sometimes find there’s a peculiar dissonance where they tell me the profession as a whole is made up of money-grabbing individuals who don’t care about people’s health, but their dentist happens to be the exception and is a complete saint, which is bizarre, but it probably represents personal experience and commonly held views possibly garnered from media coverage.

It’s important that the profession does communicate with the public, though I’m not sure an LDC is the right way to do that. However, it’s important the public does have people there who

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Modern Dentist Magazine

Interview

In Greater Manchester there’s a huge shortage of (medical) GPs, and we’ve realised dentistry is starting to see the same kind of challenges as it’s getting much harder to recruit

can give them authoritative answers.

LDCs do have a role in corresponding with Health and Wellbeing Panels on local councils to make sure dentistry is factored into their local health plans and to explain what we can and can’t do.

Q A

How important is the role of the Northwestern LDCs in representing, supporting and promoting the needs of practitioners on a national level? Do you feel that the Northwest profession has a voice in wider conversations outside of the region?

As mentioned, in Greater Manchester we have complete devolution of the health and social care budget. In fact, the area team in Manchester is now styled the “Greater Manchester Health & Social Care Partnership” rather than “Area Team”. The name change emphasises a different way of thinking.

Dentistry has been put to the side for the time being as there are some big issues in medicine to sort out, but I do understand that dentistry is a small element of the overall budget.

Therefore it might always be the case that we’re considered after medical care has been arranged - we’ll have to see how this changes in the next year.

Manchester was devolved a budget of £6.1 billion, which sounds like a huge amount of money, but running hospitals etc. is very expensive and that doesn’t go very far! It makes me wonder if we really have devolution; if we’re given the money while still having to conform to the national contract and regulation,

20|Modern Dentist Magazine

isn’t that delegation and not devolution?

I don’t really know what the drive behind devolution is, but we will do our level best to make it work and improve the NHS dental offer and the working lives of the professionals delivering it.

One of the basic truisms that’s difficult to communicate to the general public is that for the most part dentists deal with two diseases that are optional; tooth decay and gum disease; a good diet and proper hygiene means you don’t suffer from either. When patients and their representatives ask me about dental health I do enquire about diet, particularly the consumption of junk food, fizzy pop and sweets, and also their hygiene habits. Commonly they say they don’t want to talk about that, they just want to discuss clinical dentistry.

Naturally if we didn’t have decay or gum disease we wouldn’t need as much clinical dentistry.

Regrettably the prevention message is unpopular, though people need to understand it. This is not a unique dental problem; I was speaking to specialist nurses about their type 2 diabetic patients, most of whom are overweight and most of who have a poor diet and do little exercise. These patients are interested in recently developed modern drugs that can lower blood sugar because they want to carry on eating poorly and not exercising. The simple message that you can be healthier by eating better and exercising more is very unpopular, and it brings us back to the desire for instant results again.

Q A

What does the future look like for the dental practitioners in the Northwest region?

Because we’re not getting sensible diets and good oral hygiene, there’s plenty of work to be done – there’s no prospect of unemployment in the short term!

All we need is somebody to pay for it properly.

Stuart Allan Stuart Allan BDS MGGDP (UK) qualified at Sheffield University in 1978, joining a practice in Greater Manchester as an associate, later becoming a partner, and he still works there part time.

A member of his local LDC since the early 90s, elected secretary in 2007, when the LDCs in Greater Manchester decided to cooperate as PCTs merged, he was appointed chair of The Greater Manchester Federation of LDCs and also appointed the representative for the North West Regional LDC Federation.

He lectures for Health Education England on Law and Ethics, Complaint handling, Record Keeping and associated topics.

Interview

Examining the dental practice

Raj Rattan,

Dental Director at Dental Protection, spoke to Modern Dentist about the value of communication and feedback between dental professionals, regulators and the patient, as well as whether patients’ expectations have changed and what the industry is doing in order to meet them.

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Interview

Q A

What are the key areas where dental professionals fail to meet patients’ expectations? Have these areas changed over time or remained constant?

The process of managing patients’ expectations begins and ends with good communication. Dentists can reduce the risk of complaints by managing patient expectations and improving their communication skills.

When expectations are not met, the patient can feel dissatisfied, which can lead to complaints and claims.

One of the most important communication skills is the ability to understand what the patient wants.

Patient expectations of modern dentistry have increased significantly over recent years.

It is sobering to consider that despite the advances in dental care, Dental Protection’s experience shows that there has also been an increase in the number of patients lodging complaints expressing dissatisfaction with the treating dentist. Therefore, it has never been more important for members of the dental team to understand their patients’ expectations, in order to avoid a complaint.

It has been shown that explaining consultations in non-dental terms and listening actively to patients to gain a comprehensive understanding of their expectations are two important communication strategies. In Dental Protection’s experience, it is the failure to grasp patient expectations at the outset that often leads to problems, particularity when there is an unexpected treatment outcome.

Q A Recognising patients as customers is fundamental to the dental team providing patientcentered care

Have patient expectations of dentistry evolved alongside their expectations of other services, and what challenges does this create for the industry?

Society is increasingly consumeroriented, and patient expectations have risen commensurately in respect of all the services they consume, including healthcare. Dentistry is frequently paid for at the time of treatment, and this can prompt the patient to make a value judgement about the professional service that they have just experienced.

Recognising patients as customers is fundamental to the dental team providing patient-centered care, where a treatment plan is developed in conjunction with the patient to restore their oral health in a manner that they would prefer. The challenge for the clinician is to avoid projecting their own preferred solution and to refer the

patient elsewhere if those preferences exceed your own particular skill set.

Q A

Where do practices excel in providing patient care, and has this always been the case in those areas?

Dentistry is ultimately a people business.

It is a complex interaction between a highly trained professional team and a group of individuals whose motivation for seeking dental treatment is more often one of necessity rather than of choice. The interaction frequently presents a communications challenge, let alone a technical one.

Dental practices that want to excel in the provision of patient care must ensure their dental team have developed a working knowledge of how and why people react. Fortunately, the training needed is more widely recognised by more dental practices than ever before.

Q A

What steps do you suggest dental professionals can take in order to ensure they remain compliant?

The Care Quality Commission (CQC) and the equivalent UK variations are the arbiters of the standard of patient care in the UK, and their website provides plenty of detail on what steps should be taken to comply with their standards (www.cqc.org.uk). Dental Protection is not the arbiter when it comes to setting standards, but colleagues can approach one of a number of external independent agencies, which work with practice owners to optimise their level of compliance.

Q A

How has compliance in the sector developed over time, and have dentists been quick to respond to any changes?

It is interesting to remember that the expansion of the role of CQC to inspect premises used in general practice was introduced for dental practices before medical practices were included in the process. The dental profession adjusted their documentation procedures and adopted the use of audit to demonstrate existing standards and to highlight areas for improvement.

Q A

How does Dental Protection work with dental members to provide them and their patients with confidence in the standard of treatment?

We believe that prevention is better than cure, so we offer much more than defence. We can also provide expert advice, support and education to help protect members from risk. With years of experience supporting and defending dental practitioners, we have a unique insight into why things go wrong and

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Modern Dentist Magazine

Interview

how complaints and litigation can occur. This is why we have developed a range of courses to support members throughout their career.

One of the most popular courses we’ve created has been our Effective Complaints Handling Workshop, which we developed in conjunction with NHS England. The workshops had a lot of support, including from the GDC, and the feedback from delegates was also positive. The workshop was designed for those that work in a dental practice, and allowed participants to understand why patients complain as well as the most effective way to handle them.

Q

Are dental practices doing enough to signpost complaints procedures to their patients, and what is the course of action for professionals when complaints are made?

A

It’s fair to say that nobody likes to receive complaints, but our ability to respond to them constructively, and to learn any lessons that they provide for us, goes to the very heart of professionalism, especially working in dental practice. However good you and your team are, you will occasionally receive complaints. Research shows that where a complaint is handled well, then the loyalty of that patient is often strengthened.

A significant majority of the complaints and episodes of litigation experienced

by Dental Protection members display some evidence of a breakdown in the interpersonal relationship between the patient and the dental professional.

Complaints tend to arise in one of three ways; in person, in writing or by telephone. Whilst a complaint made in writing or on the telephone can be addressed discreetly without other patients necessarily becoming aware, complaints brought in person should, wherever possible, be contained by taking the patient somewhere quiet and private at the earliest opportunity.

Dentists and their staff have a duty to remain aware of the GDC Standards: “You should make sure that everyone (dental professionals, other staff and patients) knows about the complaints procedure and understands how it works. If you are an employer, or you manage a team, you must ensure that all staff are trained in handling complaints.” Standard (5.1.2)

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Q

Do dental practices do enough to celebrate and utilise the good feedback they receive?

or likelihood of a finding of current impairment. However, Dental Protection believes they could still further reduce the number of unnecessary fitness to practise hearings, and it is indeed something we have called for.

A

It is well-recognised that one of the most valuable assets for any business is word of mouth and that includes social media. Digital marketing is a route that is worth exploring, providing it complies with GDC guidance and the Advertising Standards Authority. It is a subject that is frequently raised on Dental Protection’s telephone advice line.

Q

What is the value of communication between dental professionals, their patients, the dental regulator and other industry stakeholders in ensuring a high standard of service, and are there areas where this can be improved?

Q A

This question potentially warrants an article in itself, but there is only space to respond in general terms.

Consider the way that dental materials and equipment have evolved to produce more predictable treatment outcomes. The amount of information stored about all dental patients in digital forms offers a pool of data that could potentially be shared anonymously across populations to determine best treatment outcomes.

The regulations about collecting and sharing any digital data across boundaries is a complication that is insignificant when considering the calibration and standardisation of the language that will be adopted by the individual clinicians involved.

Meanwhile, from a business perspective, technology has speeded up the processes for stock-keeping, report generation, invoicing payments and matters of taxation.

Best of all, technology has improved the potential to communicate effectively with patients. As 70% of all the complaints seen by Dental Protection involve communication as a contributory factor or the primary cause, the future for reducing complaints about the dental profession looks most promising.

A

Communication, particularly between dental professionals, their patients and the regulator is vital.

Good communication between those working in dental practice and patients is the cornerstone of managing patient expectations, and is central to the consent process. Where there is a failure to obtain valid consent or manage patient expectations, complaints, and in some cases claims, can arise.

It is equally important for there to be good communication between dental professionals and the regulator. As it is the role of the regulator to set the standards for those working in the profession to adhere to, there must be clarity from the GDC in what they require from registrants so complaints can be avoided. Fitness to practise hearings can be incredibly stressful for participants, and it is important that only the most serious issues are escalated to the GDC. The GDC has already put procedures in place to deal with cases at a local level, when there is no realistic prospect

How has technology improved dental treatment standards, and what complications has technology created in conjunction with this?

Raj Rattan

MBE MFGDP FFGDP Dip.MDE FICD is Dental Director at Dental Protection.

Communication, particularly between dental professionals, their patients and the regulator is vital

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Interview

A clinic on the coast?

Interview with Dr. Sabine Pahl

Following studies into the effects different virtual reality environments can have on a patient’s pain experience, Dr. Sabine Pahl, Plymouth University, explained to us how different simulated environments can influence and improve a trip to the dentist, for both patients and dental professionals.

Dentists have told us they find it really stressful when patients are anxious and worried about treatment, and this should be a way of reducing this stress for the dentists themselves

Q A

Can you outline the purpose and methodology of your research into the applications of virtual reality in dentistry?

Dental anxiety is a huge issue. Some people in the general population say they feel a degree of worry about going to the dentist, but others suffer from severe dental anxiety. We were

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interested in helping people across this spectrum by improving the experience of the dental visit. We brought in a field called Environmental Psychology to do so. This has shown over many years that exposure to natural environments in particular has many benefits. For example, going for a walk on the beach or in a park relaxes people, helps

Interview

them deal with stress and refocuses their cognitive resources. We have shown in previous research that natural environments containing water or water features are particularly beneficial. But when you’re sitting in a dentist chair you cannot go for a walk in a natural environment, that’s just not possible.

Our idea was to bring nature into the surgery by using virtual reality to mimic these positive exposures. So we developed two different virtual environments. One was a coastal environment in the Southwest of England, near Plymouth, where we’re based. Another one was an urban environment, no particular city, just a typical UK setup with buildings and roads. We made sure that this was also pleasant; there was no graffiti or signs of danger, it was like a Sunday afternoon.

We even included a water fountain and trees in the middle of the city. These were interactive so people were given

A

When we compared the three groups of participants, the findings were indeed what we predicted (which doesn’t happen all the time in research!).

Patients who explored the coastal environment on their virtual walk reported that they had experienced less pain during treatment than those that explored the urban environment. In addition, those that explored the urban environment reported less pain that those in the control group (standard care).

This pattern is important because it shows that virtual reality helps with the overall experience across the two environments we used in our study.

Whether it was urban or coastal, both showed a reduction in the pain experience. But the crucial thing to us was that it also mattered what they were able to explore – clearly coastal nature was better than an urban environment.

This shows that it is not just distraction that helps people in these situations.

Some people in the general population say they feel a degree of worry about going to the dentist, but others suffer from severe dental anxiety.We were interested in helping people across this spectrum by improving the experience of the dental visit a controller while they were in the dentist chair and were encouraged to ‘walk around’ and explore. We ran a randomised controlled trial using these environments and including a control condition, consisting of standard care.

People answered questions about their experience immediately after they had finished treatment and we followed them up about a week later.

They also completed a standard pain questionnaire, which was our focal outcome.

Q

What were your findings, and were they what you predicted?

Q A

Do you feel the implementation of VR technologies in the dental profession could improve the patient experience, and do you foresee any practical challenges or resistance from the profession in this?

they would still be responsive. This was one reason why we did not include sound via earphones, although this would have enhanced immersion.

Finally, the system we used was not optimal in its user interface for the dental nurses and the dentists running it and required some training ahead of running the study. This is something that can be addressed in more ready-formarket technology, minimising the need for extra training.

I should also say that the technology moves so quickly it is a challenge to stay on top. We started piloting the approach with one particular VR headset but now different equipment is already available.

Q A

How could the utilisation of VR technologies improve things for dental practitioners?

Dentists have told us they find it really stressful when patients are anxious and worried about treatment, and this should be a way of reducing this stress for the dentists themselves and allowing them to concentrate fully on the treatment.

Q A

How will the utilisation of virtual reality more generally continue to develop as the technology rises in profile?

I can imagine the technology will become smarter, smaller probably, and easier to use, and there may be applications that we are not even thinking about at this stage!

Dr. Sabine Pahl

Associate Professor in Psychology at Plymouth University.

Yes, I think VR technologies have a huge potential in this context, but I would say more research is needed still (the classic conclusion researchers often come up with). There are challenges around integrating the technology into practice, in terms of practical considerations such as where to place the laptop that runs the VR and how to place cables.

Our dentists were also worried about communication with a patient who is exploring a virtual place and whether

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Editorial Board

Rethinking regulation

How is increased regulation changing the way dental professionals practice dentistry and the services that they provide?

Being a dentist in the 21st Century Andrew Legg

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 In over 35 years practising dentistry, I have witnessed a significant increase in the level of professional regulation. Looking back to my early days in general practice, dentists were expected to operate in a largely self-regulating, high trust environment. Today, dentists have several regulatory bodies to which they need to answer and all at significant cost. A common criticism is also that we have different bodies that serve to regulate the same activities.

Ultimately, the purpose of regulation is to ensure that patients receive dental care that has their best interests as the main focus. It should promote a safe environment for both patients and clinicians and, very importantly, the regulators should earn and attract the respect of the profession.

From the available evidence, young dentists in particular are finding it difficult to work in an environment where they feel continuously scrutinised. This is the next generation of dental practitioners, and yet this early loss in morale and enthusiasm will manifest itself in a change in the services that they provide. Practitioners will offer less advanced, technical procedures, on the basis that if it was to fail, they may face the increasingly litigious claims system. Long term, dentists will stop learning the more challenging techniques altogether.

Furthermore, less young dentists entering the profession will be willing to expose themselves to general practice, instead protecting themselves by seeking employment in a more sheltered environment, such as a hospital setting.

A significant number of experienced practitioners, who have already felt this increase in regulation, have moved into a non-NHS environment to offer a limited range of services within their area of expertise. Others have retired or sold their practice in order to reduce the personal stress of the dental profession. Given this challenging clinical environment, many practitioners also now refer a significant number of patients elsewhere for the more complex treatments. However, the NHS secondary care system is ill prepared to satisfy the increase in demand and many patients cannot afford the alternative in private dentistry. This dilemma will eventually result in patients being denied access to advanced dental treatment and, as a result, their oral health will suffer.

In conclusion, I agree that a level of professional regulation is vital to ensure the safety and utmost care of our patients.

However, the way in which it is currently administered could have an adverse effect on the level and extent of dental services we deliver and, ultimately, on the very people we are seeking to protect.

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Director The Campbell Academy Implant Dentist BDS MFDS RCS Ed I was chatting with a couple of colleagues this week and we were discussing the ‘good old days’ of dentistry. This was nothing to do with money or better contracts, but a time when patients were just appreciative that you could do something.

They were amazed when you could stick a white filling to their tooth (even if the colour was not quite perfect!). They were delighted if you could save a tooth with a root canal and a crown. They were astonished that you could replace a tooth with a dental implant.

How times have changed! Advances in dental material technology, the improving education of patients and particularly social media, have all raised the bar in what patients expect from their treatment now.

We therefore have two choices. We can sit around being grumpy and moan about the ‘good old days’, or alternatively, we can use it as a springboard to get better and push ourselves to deliver better dentistry.

There is no doubt that those that do not embrace this change will be left stranded in the land of corporate low value UDA jobs.

The good news is that high quality dentistry is in reach of most who want to get there. The bad news is that it takes time. There is no substitute for experience, training and mentoring.

Our philosophy We believe that people beginning to train in implant dentistry must undertake a five-year project to become capable, competent and ethical practitioners, leading to a situation where they are able to place a minimum of fifty implants a year. Below this number we feel that it is difficult for people to remain competent, and we are committed to assisting our delegates and friends who attend our courses achieve this goal.

The start of the five year project for beginners is our Year Implant Course. This gives dentists a tremendous practical foundation in implant dentistry. We then provide practice based mentoring support to help transition these treatments to their own patients.

Further down the line we can help build on experience with one of our advanced courses such as sinus grafting or full arch live skills. All the time helping and mentoring practitioners to stay comfortable in what they are doing.

If you are interested in becoming part of a community of likeminded individuals then we would be delighted to hear from you.

Editorial Board

Dental marketing

made easy Shaz Memon

Creative Director Digimax

How can a strong online presence alleviate the everincreasing pressure on practices to innovate?

Digital dental marketing changes rapidly, so speak to a professional who has experience in the industry. The initial investment reaps many long-term benefits and can very often turn tentative enquiries into real-life patients in your chair.

As clinicians on the frontline of primary health care, there is a very real need for dentists to stay up to speed with innovation within the industry. With every new way to deliver dentistry and with every new product launched into the market, the process grows ever faster as treatments become safer, more effective and more desirable – with demand keeping pace. It is the fundamental and age-old concept of economics – supply and demand – and, in order to grow any business, it is important to be a part of this.

For a dental practice, harnessing the latest technology, offering the newest treatments and making available the most up-to-date products fuels demand and meets raised expectations. But what of those practices that lack the time or funds to invest in the latest clinical innovations? What other avenues are open to them to strengthen their position in the market?

Brand awareness is key, and no more is this true than online, where most purchasing journeys (and that includes dentistry, by the way) begin.

Advertising is expensive, so see if you can arrange a quid pro quo agreement with a relevant business and exchange marketing material, which you both can advertise in your waiting rooms at zero cost to either party.

Network on all social media outlets. Amplify content on your practice website and reach out to potential patients. Offer added value by signposting key dental-related advice. A sociable account is a successful one. Introduce yourself on Facebook and Twitter and, if you’ve already established a presence there, consider an account with Instagram.

Just be sure to apply professional communication skills to your online relationships and behave as if your audience is at the front desk; aim to appeal to your target audience. If necessary, invest in a dental marketing expert who can tweak your website to give it a fresh look, improve function and attract more prospective patients.

Ensure your voice is consistent across all media platforms. Is your logo up to date? Recognisable visual cues that patients associate with your brand are important. Consider adding videos on all social media platforms. Anything that encourages more engagement and drives more visitors to you door is acceptable, whether it is educational of just a bit of fun. Reward patients for their loyalty, and if they retweet your content or repost on Facebook regularly, then thank them! It costs nothing but goes a long way.

Striking the balance Heidi Marshall Partner Dodd & Co

Do practices need to have expansion and growth on their radar in order to survive in a competitive market?

It is hugely important for any business to keep an eye on the market and what their competitors are doing. It is not good enough to rest on your laurels and “do what you’ve always done” without making sure that it is still what your patients actually want.

Even if you are happy with the size of your practice, the patient numbers and the profits, you need to ensure that your list size remains stable. You might not lose many patients due to service levels but some will move or pass away, so taking your foot off the accelerator is not an option. As technology inevitably means that dentistry will continue to develop, it is vitally important that you keep up with (or better still ahead of) the competition, to maximise your growth potential.

So do you really need to expand and buy to survive?

Absolutely not! I often see dentists trying to expand too quickly, and this only leads to a combination of cash flow pressures and spreading themselves too thin. Getting the basics of customer service right is extremely important and a small niche practice can do just as well, if not better, than larger organisations.

Finding the right balance between practicing dentistry and running a business can be tough, and most dentists will prefer one over the other. I usually ask my clients to think about their long term goals and see if what they are doing now actually fits in with achieving them. If your dream is to build up a mini-corporate and then sell out for millions, then expansion and purchasing new practices is paramount. If, however, you want to make a reasonable living, whilst spending as much time as possible with your family, then buying practices is not necessarily the right thing for you.

Your age and how long you have left to work is another significant factor. Someone who is 30 and has just purchased their first practice is going to have to think a lot harder about their plans, and how the dental industry and the NHS is likely to change over the next 20 years, than someone who is 58 and plans to retire on their 60th birthday. Exit plans are as vital as expansion plans to preserve practice value, and slowing down at any stage of your business life is simply not an option.

With regular reviews of your long and short term goals you can achieve the financial security and work life balance you have always dreamed of.

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Modern Dentist Magazine

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11/01/2018 16:40

Editorial Board

How can dentists benefit from developing a tax strategy?

Are UK dentists paying too much in taxes? In fact, on average, UK dentists are overpaying their tax bill by almost 57%.

While analysing the tax returns of a group of UK dentists, we found that almost all of them had paid more in taxation than they were required to do so. How could this be?

A combination of a lack of proactive planning, not taking advantage of tax allowances offered to them and the fact that they were not aware of strategies, were all major factors.

Everybody dreams about paying less in tax and spending more on themselves and their families, not to mention investing more in their dental practice. But frustrating as it is, the answer’s not easy to find. You’re probably currently paying: n Up to 45% in income tax n Corporation tax of up to 24% n 2% in national insurance contributions n Capital gains tax of up to 28% n And when the worst happens, you’ll pay inheritance tax of 40%

So it’s not surprising you’re worried about your personal profits, your business profits, your assets and your pension. Who wouldn’t be?!

trust’s funds are invested. What’s even better is that the returns from these investments go back into the trust. So they too are tax-free!

But there is a solution. Tax Trusts.

But the benefits don’t stop there. The Trust can make payments to a member (you) or their family. And if a member dies, their shares in the Trust are passed on, free of inheritance tax, so you can make sure your family are taken care of now and in the future.

Never heard of them? Or not exactly sure what they are? Well, simply speaking, they’re a legal arrangement that means you transfer your assets, including profits and pensions, to a trust. They’re held on your behalf and the trust receives interest, payments and dividends on the capital, all of which are tax deductible.

You then receive your payment from the trust free of tax.

One of the many benefits of setting up a trust means businesses can claim tax relief against the corporation tax and income tax they pay as an allowable business expense. And, there’s no liability to capital gains tax or national insurance, on any trust contribution, or trust growth either! You control exactly how the

We are all aware that dentists need to understand their tax liabilities, but dentists are dentists, not tax professionals. If dentists are to create a tax strategy that complies with legislation, they need to consult a professional tax consultant who understands the needs of dentists.

Issac Qureshi

Director of Client Services Ogilvy & Haart

A 3D future

How will the role of 3D printing in dentistry continue to develop in the coming years?

Every aspect of modern life has been touched by 3D printing, to a point where the principles are now applied to applications such as prosthetics, food production, cell growth and even the construction of buildings. The multiple applications of 3D printing within dentistry, along with the scale of this vast market segment, has resulted in considerable attention and resources being directed to the development of hardware and materials specific to dentistry.

The first successful implementation of 3D printing in dentistry was for the production of models for orthodontic applications where the material availability, level of detail and accuracy achievable was fit for purpose. Significant hardware costs made investments in this technology a barrier too great for many, and so it was limited to larger laboratories and service providers.

With time, commitment, passion, innovation and in some cases crowd-funding, the world of 3D printing in dentistry exploded into what it is today. The level of detail and accuracy that can be achieved through 3D printing has improved greatly and is no longer reserved for high price tag systems. Developments in materials, including Class IIa biocompatible materials, has led to a growth in the adoption of 3D printing among laboratories of all sizes and dental practices. A range of solutions are already available for printing metals, castable materials,

temporary crowns, final crowns, dentures, surgical guides, models and orthodontic appliances, and products such as Formlabs Form2 have made detailed and accurate 3D printing accessible to all.

Innovations in laboratory CAD/CAM solutions, chair side intra-oral scanners and software solutions are currently making 3D printing an integral part of lab and clinic workflows, which will inevitably make them even more commonplace. As public awareness of 3D printing and its application in dentistry increases, practice owners will invest in 3D printing systems as an indication of their commitment to technology and ‘state of the art’ patient care. For the most part, the adage ‘digital is better than analogue’ (along with the caveat - when used correctly!) is true, and with the resulting predictability in treatment outcomes, regulatory pressures to incorporate 3D printing and associated technologies will likely increase. Demonstrated and documented accuracy, efficiency and cost effectiveness of treatment will also see more widespread implementation of 3D printing in Dentistry.

The early adopters have adopted and masses are about to follow. It is only a matter of time before 3D printers will become as commonplace as grinders are in labs and curing lights are in clinics.

Mark Barry

Director ESM Digital Solutions

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Editorial Board

Forecast for

Ionising Cloud Radiations Regulations

Sophie Kwiatkowski

Stephen Green CRadP MSRP MIPEM

Radiation Protection Adviser Medical Physics Expert and Radioactive Waste Adviser Stephen Green and Associates I hope you are aware (if not where have you been, or rather more importantly where has your Radiation Protection Adviser (RPA) been by not keeping you up to date), but by the time you read this article, the new ‘Ionising Radiations Regulations 2017’ will have technically commenced on 1st January 2018. However, they do not officially come into effect until the 6th February 2018.

In response to the requirements of this change in the legislation, the Health and Safety Executive (HSE) are bringing in a three level ‘graded’ approach to notify them of the intention to use sources of ionising radiation (essentially related to low, medium and higher levels of risk of sources and uses). These are to be called Notification, Registration and Consent. The effect on the dental profession is that as users of x-ray machines (Intra-oral, Panoramic or Cone Beam CT), all practices will be required to apply for ‘Registration’ to indicate that you use these ‘electrically generated’ x-ray sources.

Sorry that I cannot give you the web address for this, but at the time of writing the web site was not up and running, and it has been suggested that it may not be open to do so until the beginning of January. But once it is you will need to go online to the ‘Registration’ section of the process, answer ‘yes’ to eight questions and pay a fee of £25 for the privilege of doing this by the 6th February 2018 (and breathe a sigh of relief if you own more than one practice as you can put all their details on one registration and will only have to pay one £25 fee for this).

Simple really, but please be aware of the following: the questions you answer yes to (and it has to be all of them otherwise you will not be given a registration confirmation) will be related to whether you have documentation such as relevant risk assessments, local rules and contingency arrangements for the work you undertake, and an appropriate appointed RPA (the HSE want RPA’s to be more accountable under this new legislation), and the HSE have indicated that they will be asking a number of practices to send examples and details of any or all of these as this is one of the ways they intend to police the new legislation.

Not done this yet? If in doubt, contact your RPA for help and advice!

Accountant PFM Townends LLP

The world of technology is advancing at an alarming rate, and with the internet at your fingertips, it appears anything is possible. The government have acknowledged the need for the tax system to enter the digital era, and the concept of Making Tax Digital (MTD) is on the horizon. The important question for practice owners is – ‘How can all this technology help you get the most of out of your business?’.

The answer – CLOUD ACCOUNTING The Cloud is essentially the internet. By bookkeeping on cloudbased software, you are enabling yourself to have access to your data, anytime, anywhere. It is a less time-consuming method of recording information and allows businesses cash flow to be viewed in real-time. This is vital to control the finances within a practice. As opposed to having to wait until a couple of months after the year-end to receive your Accounts and to know profit levels, cloud-based accounting means you can login at any time and see both your income and expenditure. This means you can budget throughout the year, as opposed to having to wait until the next financial year to make changes. It also enables tax planning before the year-end to make sure full personal allowances are kept, and any capital expenditure is purchased.

Key features On most cloud-based softwares, it can be set-up to automatically import your bank statements using live bank feeds. There are then features on the software that allow for personalised rules to be created, so items from your bank statements are immediately analysed and allocated to individual codes. This enables you to analyse your key costs in as much detail as you require to monitor spending and maximise your profitability. The real-time nature means errors, such as incorrect invoices, can be solved immediately, strengthening your cash flow position. This stringent control over your costs will add to practice value, which is a key concern of business owners in the present day.

The up-to-date availability of your financial information is becoming increasingly useful in today’s economic climate. Banks are adding additional terms and conditions when lending and may require quarterly management accounts. By having your practice’s books online, this enables any demands to be met in a timely fashion, freeing up valuable time for you to focus on expanding and managing the business.

Overall, using cloud-based accounting, once the initial setting-up is completed, simplifies bookkeeping for your business. By moving into the digital era in your practice, you can get ahead and boost your profitability.

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Editorial Board

Apprenticeships: an attractive proposition Lorraine Nadel

Managing Director Tempdent Recruitment & Training

How are apprenticeships suited to the needs of a modern workforce, and how do you see their profile in dentistry changing in the next year?

Investing in an apprentice is a great way of attracting enthusiastic talent with fresh ideas or up-skilling existing staff. With apprenticeships now open to applicants of all ages, it has opened up the opportunity for government funded and targeted training to the whole workforce, which can have a significant impact on the dental industry in terms of career progression for DCPs. Many apprenticeships are now delivered through blended online learning, offering the flexibility needed in the modern workplace and allowing for greater employer involvement than traditional classroom models. Furthermore, with new apprenticeship standards having been created by employers, these are specific and relevant to the actual job role.

There are more exciting times ahead. Last year the brand new Dental Practice Manager & Dental Technician Apprenticeships were launched as well as updated dental nurse standards. There are going to be a number of new apprenticeships introduced into dentistry this year, and over the coming years that all DCPs, and even dentists, will be able to access enabling growth of the workforce in a modular way.

Apprenticeships are excellent value. The government funds 90% of the apprenticeship for non-levy paying employers and there is a generous £1,000 incentive to SMEs employing 16-18 year old apprentices. Further savings are made through not having to pay the 13.8% employers National Insurance contribution for apprentices under 25. Employing an apprentice is an affordable way to train all dental staff.

Health Education England (HEE) has recently launched a review of dental training aiming to reform dental education to deliver the right workforce for the future. One outcome of this review may mean the introduction of new apprenticeship training to enable growth of the workforce in a modular way; introducing groups of skills based on workforce demand. This will lead to apprenticeships such as the Oral Health Practitioner enabling Dental nurses to undertake one work based training programme that would have traditionally required four separate post-registration courses. Furthermore, apprenticeships may be launched to enable smooth transition into Dental Hygienists/ Dental Therapist roles. This will have a significant impact, enabling individuals to continue to work in practice whilst undertaking training, meaning less impact on the business operation. And as mentioned previously, with government funding available for all age groups, this makes an attractive and economical proposition for both employers and employees alike. www.tempdent.co.uk tel. 0208 371 6700

34|Modern Dentist Magazine

Get ready for

GDPR

How can dentists ensure they remain compliant amid increasing regulations and legislation?

Kirsty Wainwright-Noble Head of Sales and Marketing Towergate Insurance Brokers

Unless you’ve been under a rock for the last few months, you’ll be aware that one of the biggest topics of regulation at the moment is the new data protection legislation coming into force on 25th May 2018, with which compliance is not optional.

The General Data Protection Regulation (GDPR) is a significant change to current data protection regulations, superseding the Data Protection Act (DPA) 1998. In summary, the GDPR increases privacy rights for individuals and imposes stricter laws to ensure that organisations securely manage any personal data that they hold.

GDPR extends the data rights of individuals and requires businesses who hold personal data, particularly sensitive data such as medical records, to develop clear policies and procedures to protect this data and adopt appropriate technical and organisational measures.

Personal data is any data that can identify a living individual, which can include anything from email addresses to religious beliefs. GDPR states that you can hold data, but only when necessary and for legitimate reasons, such as to deliver dental care. However, collecting nice-to-have or just-in-case data is not allowed. We therefore recommend that you review any forms or other data collating materials you have, to ensure all information being requested is necessary to deliver your services.

In addition, we would also encourage you to think about any information you may store outside of the practice system, such as on mobile devices. This can even include images taken of patients to demonstrate the services you have provided. Due to the lack of protection for mobile devices, and the ease of which they can be lost or stolen, dental practice staff should avoid taking and storing images on phone, tablets or laptops. Instead, practices should have a dedicated camera to take images, download them to a protected device and then delete images from the camera quickly.

As penalties for non-compliance can be up to 4% of annual global turnover or €20 million, whichever is greater, GDPR is not something to be ignored. Other things we suggest practices do to prepare are: • First, and most importantly, familiarise yourself with GDPR and the full impact it could have on your practice • Ask questions and gain clarity if you are unsure on any aspect of the regulation or what you need to do to comply • Define your data retention and deletion policies • Define roles and responsibilities in your practice so only those that need to access personal data can • Audit and update all your data protection policies regularly

Editorial Board

Exciting times

What are the most important areas of continued development and training for the 21st century dentist?

Today’s dental patient can, quite rightly, expect a vastly different experience from their dental visit than patients of 30 years ago.

Today we have potent anaesthetics that work quickly and extremely effectively, we have handpieces capable of 350,000 rpm plus, through handpiece irrigation and effective aspiration systems. All of this combined should result in a visit for the patient that is quicker, painless and with less after effects.

We are also blessed with an enviable range of materials and technicians that make works of art by way of ceramic reconstruction in crown and veneer fields. Combine this with the advances in bonding and adhesive dentistry even since I trained (twelve years ago) and we are restoring teeth more beautifully than ever before, more conservatively and with higher

success rates regarding marginal seal and post op sensitivity.

hygiene and their expected lifespan is around double that of a bridge.

CAD/CAM allows for single visit indirect restorative treatments, scans of preps or whole arches with accuracies within microns to ensure crowns and inlays that fit first time and tighter than ever before. We can even manufacture orthodontic appliances from these scans, without the need for the patient to go through the unpleasant experience of impressions, and with greater accuracy to ensure the best possible tooth movement efficiency.

With this in mind, I feel today’s dentist should focus on continued development that they have at their core; at least a knowledge of implantology, an understanding of when and how orthodontics can be utilised to create beautiful smiles, reposition teeth to minimise preparations for veneer treatment, or enhance the restoration of the dentition.

A focus on digital advancements, chairside scanning, I feel will become a must have, rather than a preserve of the elite in a very short time frame. In their spare time, after covering all of this, they could develop their skills in the use of composite bonding; there are myriad mentors in this field. What truly exciting times we are working in!

For the patient with a missing tooth, the option of choice is the dental implant. The benefits of the implant versus its predecessor, the bridge, be it fixed-fixed, fixed-moveable, cantilevered or bonded, are so numerous that listing them here would fill the article ten times over. Suffice to say, they do not require heavy tooth removal of two teeth either side of the space, they should always have fewer inaccessible areas for dental

Dr. Richard Brown

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

Buying a practice?

You may need more than just a valuation Two recent cases have prompted me to comment that there are prospectuses issued by major sales agents in circulation, which make statements that are at best disingenuous, and they certainly contain traps and pitfalls for the unaware.

These generally relate to a significant overstatement of the potential profitability of a business. The key is to separate out the true trading expenses from the non-trading expenses. The non-trading expenses generally comprise items such as depreciation, which is a financial adjustment to reflect the fact that things wear out, personal motor and travel costs, personal subscriptions and other. In some cases, items such as repairs and renewals, which are actual expenditure costs that are incurred year in year out by every dental practice, are being added back into calculations. Suddenly you are buying a perfect building that needs no repair and equipment, that does not need to be serviced and that does not break down; a bit far-fetched in my view. There also seems to be a trend to forget upward adjustments where costs are likely to increase, for example, adjustments to rent. In some cases these figures can be significant.

A further important consideration is the prospective structure of the dental team; I have had very recent experience of a case where outlandish assumptions were made as to the prospective shift in balance between work carried out by associates and work carried out by the principal, even to the point where you had to consider whether

the assumption was being made by the sales agent, constituted an ethical delivery proposition.

In the headlong rush to buy and sell practices, there is a strong temptation for corners to be cut. With at least one major corporate currently offloading practices, it is clear that not every deal makes rational sense, and it is imperative that the practice that you are purchasing works for you on every level and that you have a good understanding as to how it will work for you based on your own needs, objectives and circumstances. Recently we have achieved significant reductions in the price paid against the advertised selling price, which is clearly to the benefit of the purchaser. I firmly believe that the tide is turning and I’m hopeful that equilibrium will return with price paid matching more closely fair value of the practice.

Mike Hughes

Principal Dental Practice Consultancy Service

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Features

First-class Patient Experience: A code for success

Ed Challinor,

Smileworks Liverpool, discusses the importance of the patient journey and how Smileworks have built a successful practice by providing an excellent patient experience.

In business years, Smileworks is a toddler. We’re less than four years old but we’re punching above our weight in terms of patient numbers, five star reviews, happy customers and a world class clinical team. Our four surgery practice is brimming with beautiful, highly motivated and committed patients.

I was delighted to be asked to write for Modern Dentist because I believe we are a truly modern practice. In fact, our practice has been purposefully designed and optimised to achieve maximum delight for the people of Liverpool. We’ve completely and deliberately ignored everything that’s come before us.

The vision Smileworks was founded 34,000ft above the Atlantic. It’s a beautiful thing to look out of those little windows at the dazzling sky and the glittering ocean. To hear the friendly

voices of the crew and the confident banter from the cockpit about altitude, airspeed and weather.

It’s peaceful and awe-inspiring at the same time.

But more than that it’s also an absolute marvel of process, professionalism and physics. Every aspect of the environment (except for the odd crying infant) is precisely controlled.

So it was in that cabin, in that perfect context, that we came up with something unique.

Dentistry is just like air travel.

Nobody really wants to go to the dentist just like nobody really wants to be crammed into an aluminum tube with a bunch of strangers for nine hours. But take a moment to watch the faces of the elegantly-suited business travellers and watch them get a kick out of turning left towards business or first class. I’ll bet that never gets old.

So Smileworks was born. Business Class Dentistry.

Modern consumers expect a flawless user experience, immediate delivery, problem free execution and exceptional service at every

If dentists stopped thinking about teeth and their associates for a few minutes they might see the bigger picture. They might start to embrace the future and spend less time bemoaning the past |37

Modern Dentist Magazine

Features just amazing to me. And when we hit execute and the thing worked we celebrated. We felt like pioneers. We had no idea that future generations of that little black box would eventually recast the workings of the entire world.

Since 1992 technology has done just that.

But now instead of learning a new language you can simply google your problem and get the answer immediately. There is literally no technology in 2018 not capable of being mastered with the resources we have available. These are simply time, effort and willingness. There’s no excuse any longer for not knowing the answer.

If dentists stopped thinking about teeth and their associates for a few minutes they might see the bigger picture. They might start to embrace the future and spend less time bemoaning the past. Most dentists I meet are working hard to get better at chasing their own tails. Success is just around the corner for us. I’ll tell you this: Unless you change your thinking it’s really not.

stage of the relationship. Modern consumers are also not afraid to vent frustration or shower acclaim on your business from any of the now twenty social media platforms with over 100 Million users. Your entire reputation can be wiped out in an instant without even a word being spoken.

So there’s a great deal at stake, and your commercial and clinical decisions should be taken carefully. You need to craft a unique way of keeping the patient at the centre of what you’re doing.

The patient journey The patient journey was not conceived by dentists or even dental consultants. It was put together by a millennial entrepreneur with an interest in software, digital marketing and helping people. And like most entrepreneurs in 2018, making money and growing a successful business is no longer the goal. It’s

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now about much more than just revenue and profits. And four years on we still give more than we get by an order of magnitude.

Dr. Rowland-Warmann comes from a world where dental practices are constructed of glass and steel, not bricks and mortar, and her extreme talent gave me breathing space in the early days to think critically and design models that would duplicate and scale her ability to delight her patients.

The code for success The first time I saw machine code was on my brother’s ZX Spectrum when I was about eight years old. Along with some seriously dodgy games it came with an inch thick manual explaining machine code. Watching my father reading the manual and keying in that language was transformative.

A new language only spoken by machines was

A great mentor of mine once said, “the past is past and the future has not happened yet. There’s only now.” So when it came to building a business, the solution for me was a simple one. You just need to learn how to do it.

I discovered that business, just like my brother’s 1984 speccy, only understands numbers. And I found out that you can literally program a business with systems and processes. You can program your people with training and time just like you can program an 8 bit computer. So I set out to build a code. A system that was elegant, simple and structured. A system where each individual part had a purpose and a served unique function. A machine that would deliver good dentistry.

Building the machine So the prototype patient journey was just a list of rules to accomplish a series of aims. I got my aims from reading about companies like Ford, Pandora, Google, Amazon and SpaceX. I studied the methods of automotive, luxury travel and professional services, but mainly software companies.

Features what Mo Farah does to win gold medals. They simply cannot improve their technology or performance in leaps and bounds. They are so good that there’s almost nowhere to go.

So they will focus instead on becoming 0.1% better in 1000 different areas. This is where success comes from. It’s a compound effect.

This is not innovation; these principles have been around for decades.

So we simply divided each stage of the patient journey (first to final interaction) up into its constituent parts, then analysed its quantitative and qualitative elements and found ways of measuring them. So interactions, conversations, documentation – everything.

Our aims and outcomes are not, by any means, innovative: • To make patients feel happy, cared for and valued • To eliminate anxiety and demonstrate clinical brilliance • To make it easy for patients to accept their full treatment plan • To be talked about and recommended • To produce ‘wow’ dentistry These goals were translated firstly into workflows for our front of house and sales teams and then, once working, we integrated them with the clinical teams.

There is no ‘secret sauce’ kept in a vault somewhere or a magical strategic playbook that we keep locked away. There’s a simple reason for this. Contrary to all this ‘think big’ and ‘think even bigger’ stuff that you read, business is not about giant leaps, it’s about small wins. Continuous and cyclical improvements and relentless small victories.

Don’t try to be 50% better at marketing or get 20% more leads, you’ll just fail and feel bad. If you’re thinking in terms of ‘if we just had more patients’ then you’re not even close.

You’re trying to get better at chasing your own tail.

Instead you need to do what the formula one teams do to win the Grand Prix, what SpaceX does to fly satellites into space or

There are dozens of steps, and hundreds of data points and numerous inputs and outputs all with different values. If you look at each step and really think about how to improve it 1% or 2% then the compound effect will astound you. Just as I was astounded that day that little green ball bounced around my dad’s TV screen after an hour of careful hexadecimal coding.

Performance and metrics Numbers will always surprise you, and intuition is sometimes your worst enemy.

But you must measure everything. Our basic performance metrics follow the same pattern as a digital marketing campaign, but we’ve expanded it into the real world of dentistry.

So for digital marketing you’d measure Impressions, clicks, click through rates, optins and conversions. But at our practice we measure greetings, compliments, handovers, referrals, patient reviews, treatment plan uptake percentages and of course, revenue and profits. We measure everything. If you

can’t read the score how will you know if you’re winning or losing?

Measuring and testing not only guarantees improvements to KPIs but also helps everyone feel that they understand what they’re doing.

Nobody comes to work to do a bad job and it’s your responsibility as a practice owner to write the rules and translate them into a language your patients, staff and stakeholders can understand.

Ultimately it’s not just you anymore. You have family, patients, staff, associates and stakeholders relying on you. So it’s your responsibility to learn the code of modern business and it’s your responsibility to execute it with elegance, ingenuity and flair.

Ed Challinor

First Officer, Smileworks Liverpool.

Contrary to all this ‘think big’ and ‘think even bigger’ stuff that you read, business is not about giant leaps, it’s about small wins. Continuous and cyclical improvements and relentless small victories

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Modern Dentist Magazine

Features

2018

is the year to unlock the profits in your practice Andy McDougall,

Spot On Business Planning, details some of the mistakes and misconceptions about business planning and explains the steps practices can take to maximise their profits this year.

When you plan an unfamiliar journey in the car you set your sat nav to the coordinates that will lead you to your destination. You know where you are starting from and you know where you plan to finish, and throughout the journey your sat nav will report on your progress: how far to go in miles, what time you expect to arrive, and, if there are any issues along the way such as traffic jams, it will propose alternative routes.

The same principle applies to your business.

You undertake your business journey year in, year out, but are you aware of your starting position or where you are aiming to finish? It is very common that a business owner has a

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vision but is not aware whether the strategy being pursued will make the required level of profit in the years ahead. How dangerous to pursue a strategy that is not proven to be financially viable.

numbers, you will achieve success and open the case. Likewise, in business planning terms, by following the right process, in the right way, you will unlock the profits hidden in your practice – it works every time!

How do you go about generating the correct level of profits?

The business planning process essentially answers four fundamental questions: 1. Where are we now?

2. Where do we want to be?

3. How do we get there?

4. How will we know when we have arrived?

Luck is not a business strategy, but that is what you are basing your success on if you have no business plan. The business planning process is widely misunderstood and mistaken for a financial budget. When done properly, business planning really means running your business to maximise profit.

Your dental practice will flourish if you apply a structured approach to planning your business success. It’s like a combination lock on a briefcase. Guess the numbers and you stand very little chance of success. Get the right numbers in the wrong order and you still can’t open the case. By following the steps in the right sequence and knowing the

Looking at your business from every angle The process starts by undertaking an indepth analysis of your business; looking at it from every interlinked perspective. Analysis of historical and current financial trends, profitability by treatment type and clinician, analysis of the cost structure, borrowings, people, brand position, marketing and processes - the list is endless.

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You must ensure your plans have financial integrity before you pursue them or you could end up in a worse position! yours. For instance the financial performance in terms of profit; cash, stock levels, number of new patients, gaps in the book etc. Monthly management accounts and KPIs and these tracking systems are the method by which you can know for sure that ‘you have arrived’.

Year one of your plan will be broken down into a budget against which you will report the monthly results via management accounts. After three months you will need to reforecast (and this should occur for every quarter of the year) to accommodate and reflect events that are unfolding as the year progresses and which will influence your originally planned result.

Stage one analysis provides the clues to what needs fixing.

Having a clear vision of the future where do we want the business to be?

Taking the results of our position audit above, a three-year strategic plan that underpins the realisation of doubling your net profit is determined. By financially modeling how we get from A to B, we can make mistakes on paper before committing to a strategy that feels realistic and achieves your financial objectives. The aim is to ensure our ladder is leaning against the right wall before we run up it. There’s no point in getting to the top of the wrong mountain, so before you start climbing, be clear about your final goals.

To illustrate this all-important point, during a recent prospect meeting with a practice, the

manager told me she had already determined a strategy and had no need of our input.

When I asked her what profit it delivered she looked at me blankly. Her plan had no financial integrity and had it been executed, would have resulted in the deterioration of that business’s performance.

You must ensure your plans have financial integrity before you pursue them or you could end up in a worse position!

Measuring and managing your performance How do you know when you have arrived?

This requires setting up the correct, tailormade management information systems that are specific to your practice and again, the measurement systems will be financial and non-financial. Some metrics are necessary to every business and others will be unique to

Luck is not a business strategy, but that is what you are basing your success on if you have no business plan

Management accounts act as your business sat nav; they advise you on a monthly basis of how you are performing against your starting position and your planned finish. It’s important to measure progress because if you veer off track you are warned early enough that you can take corrective action quickly.

In their truest form, management accounts don’t just report the result; they measure performance against plan and against prior year. Because your plan has been determined from the business planning process, any variances can be analysed and where necessary corrective action taken.

This is a time-tested method that works every time Business planning ensures you run your practice efficiently and makes certain that your business model is robust enough to deliver the profits you need in 2018 and beyond. It is a time-tested methodology that works every time - if you follow the steps with the correct level of detail.

Practices not undertaking this methodology will have profits locked away. It’s not just about working hard, it’s about ensuring you have set your business up to work for you - nothing special, just a common sense approach to unlocking your profits.

What outcome can you expect if you follow the process? Our clients would tell you to expect to double your net profits every three years.

Andy McDougall

owns Spot on Business Planning.

Contact info@spoton-businessplanning.co.uk to request a FREE initial consultation.

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Modern Dentist Magazine

Features

Hygienists and Therapists:

A bright and shiny future Dentist Alif Moosajee shines a light on the pivotal role Hygienists and Therapists can play in a dental practice.

I‘ve been a dentist for thirteen years, and for the first ten I didn’t work with a Therapist or Hygienist. Three years ago I bought Oakdale Dental, which had a team of Hygienists and a defined treatment sequence. It took me a while to get used to the new ways of working, as I had been looking after every aspect of my patient care and rarely referred anybody for any treatment. I soon realised that having a dedicated Hygienist was a fantastic addition and enhanced the level of care patients received. They benefit from two dental professionals examining, monitoring and maintaining their periodontal health. Two sets of eyes means nothing is missed.

The Hygienist is dedicated to providing the full scope of hygiene treatment, from polishing to RSD. They have been trained to a high standard to carry this out and are passionate about doing so. I think we should be more honest, admit there are certain treatments that we don’t enjoy and enlist the help of somebody who wants to do it, so that all of our patients get the best standard of care. I can diagnose and explain periodontal problems to my patients, and then the Hygienist discusses treatments and costs.

Meanwhile, I am able to look at periodontal management from a global perspective without having to worry about the detail, which allows me the ‘headspace’ to assess other aspects of my patients’ care. I have more time to perform more satisfying and lucrative treatments.

The next step Currently in my practice the Dentists are responsible for carrying out whitening

Two sets of eyes means nothing is missed 42|Modern Dentist Magazine

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Win a trip to

California treatments, but the next step for me is to pass this over to a Therapist. Armed with a prescription they can take impressions and provide the whitening treatment. In addition to maximising clinical time, it also makes their role far more interesting and fulfilling. I want to be looking at my Therapist’s scope of practice and encouraging them to do as much of it as possible from taking X-Rays, large fillings, paediatric extractions and preformed crown placement on children. With careful implementation this will be a huge asset to the practice.

If the idea of passing over treatment scares you, spend time with your Therapist mentoring their skills, practicing filling

I asked him if he had considered taking on a Therapist, as this would allow him to still maintain the relationship with his patients by seeing them for examinations, but then to delegate more of the work away so that it could open more time for him to do more high-value treatment, like placing the implants that he attended the course to learn how to do. By the end of the conversation he was clear on what he had to do if he wanted to expand.

Fantastic Therapists and Hygienists I was recently with Pat Popat; a Therapist who is a shining example of what somebody with the right attitude can accomplish from training other Dental Professionals

I soon realised that having a dedicated Hygienist was a fantastic addition and enhanced the level of care patients received preparation and placement together, or going together to a composite course will give you both the confidence. You never know, they might even teach you a thing or two.

There are still so many things that only a Dentist can do and I want to focus my endeavours to those procedures, whilst delegating as many responsibilities away as possible. I think it’s a win on all fronts because the patients receive better treatment, Therapists feel more fulfilled and it also makes good business sense too. What could be better?

Clear expansion I was speaking to a Principal Dentist on an implant course who was looking to expand his single-handed practice and worried about taking on an Associate because he was unsure about how receptive his patients would be and didn’t know how to adequately attract a candidate who would have the same values, would be able to communicate with his patients as effectively, and would also have the clinical skills to be able to carry out the treatment his standards. He was also concerned that he would lose the relationships he had cultivated with his patients, which could ultimately result in patients leaving the practice.

to providing dental care in Uganda. I was talking to another dentist about how much Pat’s achieved and they asked “Well why he doesn’t just get the BDS then?” This is an old fashioned but widely held view. There are fantastic Therapists like Pat Popat and Megan Fairhall who own practices, providing high-level cosmetic dentistry like whitening, as well as facial aesthetic treatments. They are engaging with patients on social media, building brands, lecturing and inspiring others.

Other Hygienists who have are really shining brightly include Anna Middleton, who has only been a Hygienist for two years and yet she was shortlisted for a Private Dentistry Award 2016 for “Most Invaluable Team Member” and was a finalist in the Dentistry Awards 2017 for “Dental Hygienist of the Year”. And Melonie Prebble qualified as a Master Neuro Linguistic Programming Coach, offering her business development expertise in addition to her hygienist skills.

Your Hygienist’s chance to shine – and win a trip to California Philips Oral Healthcare is shining a light on the work of Dental Hygienists and Therapists and their commitment to improving patients’ oral care through its new ‘Shine On’ initiative. The campaign includes a digital hub - www.philips.co.uk/ shineon - featuring videos, industry news, educational resources and exclusive giveaways.

Excitingly there is also a chance to win a trip to the 2018 California Dental Association Conference in Anaheim, California. Dental Hygienists and Therapists are also invited to participate by sharing their own Shine On moments on social media, tagging their posts with #shineon and #philipssonicare.

If Hygienists and Therapists keep pushing the boundaries, and if Dentists embrace their role wholeheartedly, I think the future will be very bright and shiny for all of us.

Dr Alif Moosajee

is the Principal Dentist at Oakdale Dental and author of the book ‘The Smiling Dentist’.

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Features

Encouraging improvement in practice John Milne,

CQC, explains CQC inspection methodology in the dental industry and why inspections should not be seen as something to be feared.

The Care Quality Commission (CQC) has regulated dental services since 2011/12, and in this time our relationship with the sector has evolved considerably in line with what we have found on inspection and the changes we have made to our models. In a true spirit of coproduction and a shared commitment to ensure people are cared for in a safe, high-quality and compassionate way, we positively engage with the dental profession and its national representatives, and we listen carefully to what we are told about how our processes can be improved.

Royal Colleges, indemnity providers and others.

This lively group feeds into the decision-making around our regulation of dental services and is an invaluable source of help.

Central to this is our Dental Reference Group, which meets quarterly and brings together CQC staff, the British Dental Association (BDA), NHS England, the General Dental Council,

What we look for

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In addition to this, CQC staff visit groups of dentists regularly, speaking at Local Dental Committees and at national conferences, where presentations are given to explain our methodology and attempt to dispel the fear that sometimes lingers in the background when CQC is mentioned.

The first point to emphasise is that when CQC inspects a dental practice, our starting

assumption is that the practice is good and meeting the required standards. Based on what we know about the sector, this is reflected in the fact that we plan to inspect 10% of registered practices in England each year, outside of any urgent inspections that we decide are necessary in response to incoming information of concern. The second point is that the rationale behind our scheduled

It is the presence of an empowered individual in the practice that can make all the difference

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back on where improvements can be made ahead of us sending our draft inspection report in advance of its publication on our website, so that it can be checked for factual accuracy.

What we’ve found

We take an appreciative enquiry approach, starting with the practice telling us about their practice, what is successful and any areas for improvement

inspections is to encourage improvement.

Our inspections are structured around what matters most to patients: are services safe, caring, effective, responsive to their needs, and well-led? We ask these five key questions across the whole of healthcare and also in adult social care. The inspections are carried out by teams that specialise in dental practice, and they are normally made up of a CQC inspector and a dental registrant.

CQC does not have a ‘tick box’ approach; our approach is far more than an assessment of compliance against regulations. We take an appreciative enquiry approach, starting with the practice telling us about their practice, what is successful and any areas for improvement. We explore the evidence we are presented with against the five key questions on our inspection to gain a detailed understanding of how the practice provides care to patients. We will look at policies and procedures, cross infection control, emergency drugs and equipment. Fuller details on what we consider are available on our website in the ‘provider handbook’ and ‘what to expect on an inspection’ in the interests of openness and transparency. During the inspection we will speak with both staff and patients. A comments box is delivered to the practice a week or so before a visit to help us gather these views. After the inspection we will feed

Having introduced our current regulatory model for the sector in 2015, the overwhelming evidence of the last two years of our inspections is that dental practice in England is of a high standard. The vast majority of practices provide caring services that are responsive to the needs of their patients, and the care that is given is effective.

Dental practices can rightly be proud of the impact they have in improving the oral health of the population.

Around 10% of practices we inspect do not meet one or more of the five key questions, and in the vast majority, the issues we have identified can be remedied by the practices themselves. While we would not hesitate to take this level of action if we felt it was in the patients’ very best interests, it is extremely rare that CQC needs to suspend or cancel registration of dental practices.

The most common failings we identify arise under the key questions around safety and leadership. This is consistent with the other sectors CQC regulates in England.

Within dental services, safety concerns might relate to the absence of appropriate emergency drugs or equipment, a failure to follow expected guidance in decontamination and infection control within HTM01-05, and poor records of recruiting staff with the absence of references, DBS and identity checks.

Sometimes problems arise because of poor management and leadership. For example, the systems to check the expiry of drugs or materials may not be in place. Also, CPD of staff may not be monitored and audits of the quality of radiographs or infection prevention may not be carried out.

These are things that we would make known to the provider immediately following the inspection, would state clearly in our

published reports and that we would expect and check that providers remedy.

What practices can do The world of dentistry is changing rapidly.

More practices now belong to corporate groups. These may be large, comprising of a few hundred practices, and there are also a growing number of so called ‘mini corporates’, which have a small number of practices. One thing is clear though: it is the presence of an empowered individual in the practice that can make all the difference. Usually this is a practice manager. Good practice managers ensure policies, procedures, audits and so on, are actually implemented on the ground.

Good leadership encourages professionalism and reflective practice. It makes sure that lessons are learned when things go wrong.

This is equally true in the small practices with only one location.

It’s worth taking a look at a few inspection reports on our website. The latest reports can be accessed from our homepage, and new ones are published weekly. Also, we have a series of ‘myth-busters’ on our website, which contain advice about many topics relating to our inspection process. If you have heard something about our inspection process that we could dispel – let us know! Look out too for examples of notable practice, this is good stuff which can be shared across the country.

Conclusion

Rather than something to be feared, CQC is an agent for encouraging improvement in practice, sharing with the profession to improve dental care for the public.

Get in touch:

Follow us on Twitter (@CQCforProfessionals) and sign up to our monthly e-bulletin for all the latest updates - www.cqc.org.uk

John Milne

is a Senior National Professional Advisor, Dentistry at Care Quality Commission (CQC).

When CQC inspects a dental practice, our starting assumption is that the practice is good and meeting the required standards

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Modern Dentist Magazine

Features

Who are the Dental Schools Council?

Chris Deery, Dental Schools Council, explains how the organisation is working to improve the quality of education and the availability of staff in the dental industry.

Since our inception in 1930, the Dental Schools Council has worked to ensure that undergraduate and postgraduate dental training in the UK remains world-class.

As a membership organisation, it has representation from all the dental schools within UK universities, and in 2015 this extended to Irish institutions. In 2017, Professor Chris Deery, Dean of the School of Clinical Dentistry at the University of Sheffield, was appointed as Chair.

Historically, the Dental Schools Council sought to be at the forefront of discussions relating to the requirements of study and examination for the licensing of students in dental surgery and dentistry, providing a single national voice for dental schools.

Following the Second World War, for instance, dental schools came together to form plans for emergency dental accommodation in the event of destruction to dental schools. Disaster planning for dental schools is still of relevance, and dental schools have plans for how to maintain the flow of dentists following ‘low-’, ‘medium-’ or ‘high-impact’ disasters. In the event of a ‘low impact’ disaster, such as a small

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clinical area being affected, dental schools would look to rearrange clinics so that students remain at the university, with weekend or evening sessions considered. For a ‘high impact’ disaster, dental schools in the event of a clinical area being affected by a catastrophic event, then dental schools would seek to locate clinical access locally or nationally for final year students as a priority, with thought given to the suspension of certain years and courses.

Today, a key role of the Dental Schools Council is to monitor the numbers of dental clinical academics.

These are dentists who work in teaching, research and clinical practice. This makes them extremely important in creating future generations of dentists as well as evolving the dental treatment itself. As well as this, many clinical academics hold leadership roles in dental hospitals, universities and elsewhere, making them key figures in the future course of dental education.

Surveying staffing Since 2000, the Survey of Dental Clinical Academic Staffing Levels has kept the sector aware of their importance, as well as revealing trends that otherwise would have gone unnoticed. The 2017

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survey identified a 24.8% increase since the first survey in 2000. Within this, however, the number of clinical academics on research contracts had declined between 2015 and 2016. Knowing things like this helps dental schools know where to make adjustments – and where it is not in their power to do so, it helps them make the right arguments to the right people.

This year, dentals schools fed into Health Education England’s ‘Advancing Dentistry: Education & Training Reform’ proposal. With life expectancy increasing, dentists may treat a patient up to five generations at a time, but does the current workforce support a

Preparing for preventative care The heads of dental schools meet three times a year to discuss current issues in the dental education sphere. This year the heads were invited to discuss how we are to prepare dental students for the delivery of care in a mixed economy of NHS and private practice. This provided a platform for discussions around the tension between restorative and preventative aspirations, and dentistry as being ‘about’ private and NHS care. Themes such as these are of immense importance as industry and dentistry are progressing at such a greater pace than at any time in the last 40 years. Students are now expected to be equipped to build

Industry and dentistry are progressing at such a greater pace than at any time in the last 40 years

It has been acknowledged that there are dental treatments that could be performed by dental professionals, removing the reliance on dentists multigenerational model? The General Dental Council September 2017 report showed that there were 110,116 dental professionals registered, 41,631 dentists, 3,087 dental therapists and 7,082 dental hygienists1. It has been acknowledged that there are dental treatments that could be performed by dental professionals, removing the reliance on dentists. However, to make this sustainable, it is the view of the Dental Schools Council that there would need to be a contract reform that supports this.

It would also be necessary for there to be a training model that develops competencies based on flexibility in the workplace. Dental schools have considered this, and have given thought to how a dentist, hygienist and therapist can be taught alongside one another, outside the traditional educational model. This has seen many dental schools promote co-learning, with Bachelor of Science and Bachelor of Dental Surgery students being taught the core components of their programmes alongside each other, to encourage team working.

on this knowledge, utilising both old and modern technologies. The Dental Schools Council ensures that it has a dialogue with Chief Dental Officers, the General Dental Council, the Association of Dental Hospitals and other stakeholders such as the British Dental Association.

For 2018, Council will continue to monitor the level of clinical academics, looking at the balance of research and teaching contracts in clinical academia to ensure that the research component is not depreciating. As of 2018, the 2004-2016 data will be more accessible and readily available via the Dental Schools Council website. This move towards the digitalisation of the data will permit users to identify new trends according to their own research aims.

In addition to this, the Dental Schools Council will continue its supports of Priority Setting Partnerships for Oral and Dental Research, which are facilitated by the James Lind Alliance and hosted by National Institute for Health Research. Priority Setting Partnerships

involve patients and clinicians working together to identify uncertainties about healthcare interventions to prioritise research, and to ensure that those who fund health research have an awareness of what is of importance to patients and clinicians Dental practice is always changing. In part this is driven by the needs of patients, and in part it is by developments in practice and technology. Dental schools will remain at the heart of this process, showing future generations of dentists how they can meet the needs of the patients of today – and tomorrow

Professor Chris Deery

is Chair of the Dental Schools Council.

1 General Dental Council (2017) Registration Report- September [online] Available from:https://www.gdc-uk.org/about/who-weare/facts-and-figures

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Measuring and maximising success with KPIs Lisa Bainham,

President of the Association of Dental Administrators and Managers (ADAM) discusses the value of Key Performance Indicators in assessing and motivating practice staff and boosting patient care as a result.

Over the last 20 years, I have introduced many different Key Performance Indicators (KPIs) into my work systems. Whilst reporting and measuring has always played a part in dentistry, it now seems to be more of a prerequisite to running a successful dental practice. Not only does it allow me to feel confident in my planning, but it also comforts me to have a true picture of what’s going on outside of my office door.

The evolution of KPIs as part of a practice management toolkit now seems to encompass not just financial, but also clinical and performance related measurements, allowing you to function as efficiently as possible without just a finger in the wind or the use of your spider sense.

In our practice, we measure almost everything. This may sound annoying, but once you start measuring, it becomes a little addictive, and the control you feel is certainly a comfort blanket you will not want to let go of. Engaging the whole team in various forms of KPIs allows them to manage themselves.

There is hardly any point in using KPIs and not sharing the relevant information with those who are part of the performance, unless of course you have superpowers to do every job in the practice!

The recent innovation of cloud based accountancy systems have been key in allowing us to do more real-time measurement of KPIs.

Where to begin?

So, the starting point is what to measure?

Every practice will be slightly different

depending your goals. I started small – ensuring that you know where you are month to month financially is a must. Also, looking at your chair/surgery analysis and diary availability will provide a host of answers to allow you to tweak and plan marketing or admin duties, such as recalls and appointment reminders.

The following certainly won’t be a “to-do” list for everyone, but will give you some ideas to build your own KPI dashboards. I have 4 different types: Income Centred: Clinical hourly rates, overheads, plan patients, private patients, UDAs. Measuring the chair times of individual performers combined with their gross earning (before or after variables such as lab fees). Either is fine, as long as you keep your measurements consistent.

Patient Centred: How many patients missed their appointments, and who with, and what time? What type of patients are you attracting? What are the average wait times for different lengths of appointments? Recall percentages and diary problems can be managed very easily by setting targets and goals for the whole team.

Marketing Centred: How many new patients have you seen? From what target demographic did they come? How many new patient enquiries were there? What was the referral source? How many had a TCO appointment and were then converted to treatment take up, and how much income did that individual conversion create? Combining this with the referral source means that you are able to learn what your return on investment was on your different marketing platforms.

Workforce related: We use a dental software system that gives us a clear picture of which

employees are performing well, or if there are any skills gaps to address. The average length of time of patient enquiries from contact to treatment compared against conversion rates is a great indicator of the employees that are working well on reception to take those all important new patient enquiries.

Software combined with a clever phone system allows this to be done very easily. We are building on this section of KPIs and have now included how many email addresses are captured, who asked for patient feedback and other productivity counters associated with reception/admin duties.

Provide excellent patient care

Using KPIs as part of your performance reviews is priceless and can really help to keep staff motivated and efficient, or in some cases highlight if a change of role is needed. Either way, it takes the headache out of HR for sure.

It makes it not so personal, as the KPIs speak for themselves.

A few years ago, I definitely considered myself a bit of a KPI geek! Nowadays, as there are more and more of my fellow PMs adopting the systems and seeing the benefits, I feel it is becoming a fool proof way to run a successful dental practice and team, and provide excellent patient care both clinically and from a customer service perspective. As a PM, providing your team and practice owners with a simple dashboard of what’s happening within the practice allows them to feel confident that everything is under control.

It becomes fun, trust me!

Lisa Bainham

President of the Association of Dental Administrators and Managers.

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The Global Parallels

The parallels and the differences between the challenges and opportunities currently present in the US and UK dental markets, reported by the Dentacoin Foundation.

Dental markets around the world are finding themselves stuck between a rock and a hard place when it comes to accessing federal funding and bringing in enough revenue to provide adequate prevention and treatment for the world’s population. In relation to their dental markets, two countries in the world are worth watching as they navigate the challenges and opportunities found in their regions. The dental industry in the United States and the United Kingdom are as similar as they are different, yet, they are both faced with the same kind of roadblocks and opportunities as they work to improve their respective industries.

financial burden for citizens in both the US and the UK. However, the burden for patients is only lifted if they have access to jobs that offer dental coverage; dentists continue to lose out on opportunities to care for patients who don’t have access to such plans.

At the first examination of the two markets, one might not immediately see the resemblance. After all, the US population is nearly five times larger than that of the UK, and the dental market in the US is almost 20 times the size of the market in the UK. Even though both solve problems with unique approaches, when a closer look is taken it appears that both are working to improve the dental industry.

On a positive note, both the US and the UK are seeing more interest in prevention, rather than reactive treatment-based dental programs.

This is evident in the number of elderly citizens who continue to attend dental appointments in both areas because they have more of their original teeth. With a focus on treating seniors, the US and the UK both have opportunities to capitalise on more revenue streams for patients who are well into their senior years. In addition, more senior care programs are being established that offer some level of dental coverage, and this is likely to keep patients coming through the doors.

Parallels between the US and the UK

The US dental market is expected to continue growing at approximately 2% over the next five years, replicating the growth it has seen since the economic downturn of 2008. The UK was affected by the EU referendum and is continuing to climb back to a state of growth.

Both regions of the world are dealing with strict guidelines for regulation and change.

The costs of dental treatments continue to rise across the two regions. The number of company sponsored benefits programs have increased over the last five years, and they seem to be carrying a big portion of the

Some reports say that as many as 40% of people wouldn’t seek dental care unless they had access to some kind of funding option.

What’s more, both the US and the UK suffer from heavy segmentation throughout the dental industry. It is even more cut off from the healthcare industry, which gets the bulk of the funding in both parts of the world.

Differences between the US and the UK

Both countries are struggling to figure out how to manage pricing models while keeping revenues streaming in. The US is currently dealing with a lot of change in its healthcare reform, making the future of dedicated health care and dental care uncertain. Meanwhile, the UK is still in rebuilding mode with some opportunities that are testing the waters

Both the US and the UK are seeing more interest in prevention, rather than reactive treatment-based dental programs. This is evident in the number of elderly citizens who continue to attend dental appointments in both areas because they have more of their original teeth.

50|Modern Dentist Magazine

for new ideas and product developments, particularly where the dental industry is concerned.

The sizes of the dental markets are very different between the US and the UK. In the US alone there are over 1 million people working in the dental industry, whereas the UK only has a fraction of that, at about 100,000 people in the dental workforce. In the UK, 30% of the dental practice is made up of private industry and only 10% of the dental industry is supported by corporate dental programs and agencies.

Given that the UK has a smaller population size, it’s interesting to note that the rates at which the dental industries grow are fairly even in both countries. Nevertheless, it must be said that there could be a correlation between the size of a country and its dental care coverage. A small country generally has the chance to get more people dentalcare covered than in a larger country. The comparison of the UK and the US indicate this trend.

The future of dental markets

Like all service industries, dental professionals work hard to deliver a high level of customer care and try to maintain customer loyalty.

The need to build strong relationships with patients is evident in the lack of quality feedback and market research that is being done to support growth and development in this industry. Because the dental industry is highly fragmented, meaning it is separated from other forms of health care and has a high degree of individualisation, it is no wonder that the opportunities for collaboration continue to be missed.

Dentacoin is introducing a number of Blockchainbased tools to the dental market that will help close the gaps that currently exist and bring about more opportunity for the dental market to succeed on a global level.

Features

Does Size Matter?

David Worskett,

Association of Dental Groups, identifies the current challenges UK dental groups are facing, and where there are similarities and differences in these across the dental industry.

Dentistry faces a particularly demanding set of challenges at present. Despite all the uncertainties, dental practices and practitioners remain responsible for delivering quality treatment to all their patients. Throughout the political, economic and NHS turmoil, they must still adhere to the appropriate regulations, while abiding by the fundamental principles of patient care and professionalism. A key question is whether doing so will become easier or harder.

For now, the immediate challenges faced in delivering care continue to centre around availability and clarity of NHS services and issues with obtaining Performer Numbers whilst meeting patient expectations. After the UK leaves the EU, greater strategic challenges will arise regarding recruitment of dentists and, almost certainly, increasing pressure on NHS dentistry funding. These problems will affect all practices; NHS, mixed, independent, corporate and community.

The immediate and the long-term Looking first at the more immediate issues, it is worth remembering that how a practice operates is irrelevant in terms of its NHS contract. The same banding system, the same need to fulfil UDA targets and the same types of treatments available under the NHS banner apply. The same uncertainties regarding the contract reform process are being voiced from all corners of the profession too. While contract reform

is long overdue, we need to ask whether the current timetable allows enough time for proper evaluation of data from the prototypes. Rushing ahead for the sake of ticking a political timetabling box would risk repeating the mistakes of earlier attempts at contract reform.

The problem in supply of Performer Numbers and the performance of Capita is causing concern across the sector, with some dentists reportedly waiting an alarming eighteen months. Disruption to both independent and corporate businesses is clear. So too is the financial damage, at a time when sustainable finances has never been greater. There is equal concern for the affect this could have on patients. With fewer dentists to provide essential dental treatment - the lack of professionals is also often more apparent in areas of higher deprivation – local populations will suffer. Many parallels can be drawn between independent and corporate practices, but none so important as the shared passion for helping patients improve their dental and general health.

It is still not clear that the full impact of the performer numbers problem is fully appreciated

by NHS England.

Strategically, the big worry is that these issues may be only a taster of what’s ahead. UK dentistry is hugely dependent on dentists from elsewhere in the EU, with 22% of NHS UDAs delivered by dentists from other EU states. That supply is already drying up because of the uncertainties and negative signals created by the Brexit vote. A possible outcome of Brexit negotiations would be even more restrictions. This could have profound effects on access to dental care throughout the nation, and all dental practices would be affected. The difference is that corporates and groups, who are now delivering some 22% of NHS dentistry, would notice the problem first as it would be present on a larger scale. Alarmingly, it is still unclear how this gap can be prevented.

The outcome of the Brexit negotiations is still very uncertain; there is silence on the possible terms of a new immigration policy, and funding for dental education continues to fall when rationally the converse should happen. The read-across between contract reform and these “macro issues” is mainly notable by its absence.

Major change afoot As the Association of Dental Groups (ADG), our members include businesses of similar structures but varying sizes from large, single practices, right up to the biggest corporates in UK dentistry. With such a range of providers working together, we are able to identify and monitor broad trends quickly and efficiently. What we do, the changes we fight for and the areas of concern we address at different levels of government, are not simply for the benefit of groups and corporates. Above all, we focus very much on helping our members deliver the very best patient care, always putting patient interests first. It is true that in order to provide efficient and quality treatment, a provider must operate in an effective way, with access to a pool of properly trained professionals. But other than “scale”, this is no different for a single practice, or a group managing 500 practices.

We all face essentially the same challenges. With such major change afoot, in the ADG, we feel this is the time for dentistry as a whole to step up its efforts to provide knowledgeable advice and guidance to those in government charged with implementing the changes. If changes on this scale go wrong, patients will suffer and that is a “red line” for the profession as whole.

David Worskett

Chairman of the Association of Dental Groups.

For more information about the ADG visit www.dentalgroups.co.uk

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Modern Dentist Magazine

Features

Discover five secret strategies to make 2018 your best ever Ashley Latter,

the author of ‘Don’t wait for the Tooth Fairy’ and ‘You are Worth it - How to Discuss fees with self-confidence’, offers some suggestions so that you can make 2018 your best year ever.

Whether you like it or not, 2018 will be survival of the fittest. From the crossroads, there are two choices.

Path one, stay as we are and hope for the best (hope and prayer have never been great business strategies), or path two, which is the path where you embrace the up to date marketing and sales strategies and be pro-active so that you can secure your future and a practice that will thrive.

There is no middle path anymore. Here are some suggestions to grow your sales and profits by at least 20%.

The receptionists are the most important people in your practice.

The receptionist is the most important person in your practice. They can make or break whether a patient visits your practice or not. Every enquiry into your practice is potentially worth £3000 at least if they stay with you for say ten years; that does not include referrals to family and friends or having any treatment done. Another thing to

52|Modern Dentist Magazine

think about is that if a patient is contacting you about your services, they are probably ready to make a purchase.

Does your Reception Team answer the telephone if the patient is worth £3000.00p? I recently did 107 mystery shop telephone calls to practices enquiring about their services and prices. No one asked me my name or how I heard about their practice, and no one asked me to make an appointment.

Train them; they are the most important people in your practice. They can make or break how successful, or unsuccessful, your practice will be.

Marketing - how many legs has your practice got?

To fill my programmes I undertake over 17 different types of marketing. These include 1. Sending two newsletters out each month 2. Writing articles 3. Speaking at conferences 4. Asking for referrals 5. Following up with clients after my courses And much more!

How many marketing activities are you undertaking in your practice? A chair has four legs. If one breaks, the chair can potentially fall down. That is the same for your business/practice; you need to be undertaking at least six different marketing strategies to ensure that you maintain patient numbers and also grow them at the same time. Marketing is full time to be done all the time, not just when you are quiet, and the easiest way to grow new patients is asking for referrals. I could write a ten page article on asking for referrals, but there’s one thing for sure; it is the easiest way of growing your new client base, and at the same time it virtually costs nothing - just a thank you card or small gift.

Ask all your nice patients for referrals and they will introduce you to their nice friends. That is how the world ticks, and you will be surprised at the results. Just asking will significantly increase the opportunities of receiving and generating more patients.

If you ask for referrals and keep doing this every day, you will build up a steady stream of new patients. You need to thank the people that refer new patients to you. Simply by sending a thank you card and maybe a small gift, such as bunch of

Features Marketing is full time to be done all the time, not just when you are quiet, and the easiest way to grow new patients is asking for referrals salesperson, or the company, just to say thank you and to see if you are enjoying the service or product that you purchased? I think it happened once in my life, and when it did it made a real impact on me.

So why not call a few patients a day at home to see if they are okay, especially if they have had a challenging procedure, and just ask them if they are alright and is there anything you can help them with? It will take probably less than five minutes to do per patient, but think of the impact it will have. Your patients will be not only impressed, but over the moon. They will tell their friends.

Ask all your nice patients for referrals and they will introduce you to their nice friends.

That is how the world ticks, and you will be surprised at the results

flowers for women or a book for a man, you will delight your referrers, and it just might encourage them to send you more.

After all, how do you feel when you receive a card and a small gift as a thank you? It does not happen that often.

Learn the skills on how to sell without selling - it is all about asking questions Sales legend Zig Ziglar once said, “You will get all you want in life if you help enough other people get what they want”. You know what, it’s true!

To me, sales is all about giving your patients what they want and need, and in doing so will give you the income you want, need and deserve.

Ask lots of questions, listen attentively to their answers and watch what they do.

Never talk to your patients about what you do and can offer; ask questions, be quiet and they will then tell you what they want. Yes, want.

Because that is what patients spend money on, things that they want. There are probably thousands of pounds worth of opportunities in

your existing database if you ask them lots of questions.

The biggest mistake dentists and sales people make is that they try and sell the services before they truly find out what the patient (customer) requires. It is the biggest sin, and when you do this patients think they are being sold to.

So my advice is to get into the habit of asking lots of questions and become an outstanding listener.

When you do this, then you become a world-class solution provider and not a salesman. No one likes to be sold to!

Pick up the telephone Twenty years ago, I rang two dentists six weeks after they had taken one my courses to see how they were progressing and if they needed any help. Since then I have delivered my two-day Ethical Sales & Communication Programme to over 16,500 delegates worldwide, spoken at every major UK dentistry conference, wrote two books, have friends all over the world and have an incredible lifestyle. All because I made two telephone calls. Have you ever made a purchase and then received a telephone call from the

Now if you did this five times a day, five times a week, over 52 weeks, you will touch and be impressing over 1000 patients. Do you think that will make an impact on your relationships?

So pick up the telephone - it is good to talk!

Increase your fees I have trained and coached thousands of dentists all over the world. What I have discovered is that many dentists find the discussion of fees challenging, and because of this they are not charging enough for their services. I have found that many practices have not increased their fees for years and many discount in their head.

Just by increasing your fees tomorrow by 10% you could increase your profits by 28%. Very few patients based their decisions to do business with you based around the fees that you charge, and you don’t really want the ones that do. A small increase can make a massive difference to your profits.

Ashley Latter For the last 20 years, Ashley Latter has personally coached over 16,500 dentists and their team members on his legendary two days Ethical Sales & Communication Programme all over the world. He is also the author of two books. Visit his website www.ashleylatter. com where you can watch over 50 videos to help grow your practice profits.

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Modern Dentist Magazine

Features

Silver Jubilee for FGDP(UK): Helping shape the UK’s dental healthcare landscape for 25 years

As the dental industry looks ahead to what 2018 will bring, Mick Horton, Faculty of General Dental Practice UK, reflects on the past quarter century of general dental practice and discusses how the Faculty plans to continue to assist and represent its members in the next year.

Annual milestones give us all the opportunity to reflect on past successes, think about how we can learn from experience and plan to do things differently. The turning of the New Year and individual birthdays are often seen as personal milestones for such reflection. They also of course allow us to look ahead to the future with renewed vigour and enthusiasm, often having consulted family and friends over dinner about what the next phase of our lives might have in store.

It is in this vein then, that the Faculty of General Dental Practice (UK) (FGDP(UK)) is celebrating its 25th anniversary. We hosted a dinner in October at Draper’s Hall in London to mark the occasion, which gave us the opportunity to celebrate with members, friends of the Faculty and dental professionals from across the UK. We also hosted a ground-breaking ‘thought leadership’ conference in November to showcase current thinking around holistic dentistry and how the mouth should be, and is increasingly, seen by dental professionals as a window to general health. The keynote speech was delivered by Professor Iain Chapple of the University of Birmingham and considered the global challenge of chronic non-communicable diseases and the role of periodontitis in co-morbidity and in premature morbidity. He said:

54|Modern Dentist Magazine

Features

The oral health of the general UK population has improved exponentially over the past 25 years. This is something we, as a Faculty and as a profession, should be incredibly proud of.

“It seems time to put the mouth back into the body. Periodontitis may produce systemic effects that contribute to cardiovascular and other non-communicable diseases.

Periodontitis is common, preventable and treatable at relatively low cost to the healthcare economy. Dental healthcare practitioners need to see their role as much wider than that of custodians of dental health. Through our regular scheduled contact with patients we are best placed to signpost other concerns and must begin to see ourselves within the wider healthcare landscape.”

This belief resonates with me and many of my colleagues at the FGDP(UK) as we look to the future. There is so much more we can offer within general dental practice than is currently provided. Involvement in multi-disciplinary, shared care of patients is certainly the way forward if general dental practitioners are to meet future patient needs and expectations.

Currently, in the public environment, we provide a service commissioned by the NHS. With revised commissioning, there are many other aspects of health that could be delivered through high street dental practices – we need more joined up thinking and we see an increasingly important role for the FGDP(UK) as a thought-leader and influencer in this regard. As the Faculty celebrates its quarter century, its Board has concluded that the next phase in its history is best taken as an autonomous organisation, independent of its current parent college, The Royal College of Surgeons of England. This will allow the organisation the freedom to develop and nurture its membership, offering a greater level of support for general dental practitioners to progress their career, and will give the organisation the opportunity to

reach even further; building its relevance in a fast-changing environment of healthcare and associated policy, technology and economy.

A voice for practitioners But before looking too far ahead, perhaps it’s important to first reflect on how the FGDP(UK) has reached this point. When the Faculty was established 25 years ago, the intention was always that it would eventually become an independent body. There is recognition from several national bodies that this is exactly what the profession needs to foster self-improvement. We see our role in helping to strengthen the support of the broader healthcare community for general dental practitioners as custodians of general health.

Thanks to the FGDP(UK), the general dental practitioner (GDP) and members of the wider dental team now have an academic voice and a place they can call home. The GDP is the first point of contact for most people seeking dental care, and the role of the GDP as leader of the dental team in oral health education, prevention and quality care provision is more important now than it has ever been.

The FGDP(UK)’s standards, which through the Open Standards Initiative are freely available to professionals worldwide regardless of membership status, underpin a valuable role for the Faculty in sharing evidencebased best practice. We also deliver highly regarded educational courses in areas relevant to today’s multi-skilled general dental practitioner, such as implant dentistry, restorative dentistry and minor oral surgery.

The Faculty is recognised and now wellestablished in the profession as having a defined role, and sits on all bodies relevant to primary dental care.

Something to be proud of But we can’t continue to shape the general dental healthcare landscape in isolation.

We rely on our members to give us the mandate and knowledge base to proceed with confidence and relevance. We offer a membership level to suit all registered dental practitioners, and we are committed to supporting all our members to advance their career and build their professional portfolio.

We foster a community committed to quality and dedicated to lifelong learning and professional development. We are supportive, educational and collegiate; we are not an inspectorate nor a regulator. The Faculty also helps to facilitate international collaboration between individuals and organisations worldwide, sharing quality improvement and best practice. Moreover, the FGDP(UK) is unique in that it doesn’t simply support NHS funded dental activity, but improves standards and education across the expanding spectrum of mixed practice. In addition to our world-class post-graduate clinical education we are developing ways to support practicewide skills such as mentoring, leadership and management.

The oral health of the general UK population has improved exponentially over the past 25 years. This is something we, as a Faculty and as a profession, should be incredibly proud of. The Faculty’s standards and commitment to quality have certainly been a contributing factor, and there should be recognition of the fact that this improvement is something that has been achieved by the dental team for the public and the profession. The FGDP(UK) looks forward to building on this, and adapting to the complexities of care, such as that of an ageing population and the consideration of oral health within a wider health context, and we embrace this challenge as we look to the future of general dental practice and provision in the UK.

Dr Mick Horton

is Dean of the Faculty of General Dental Practice (UK).

To find out more about the FGDP(UK) and to become a member visit fgdp.org.uk.

Involvement in multi-disciplinary, shared care of patients is certainly the way forward if general dental practitioners are to meet future patient needs and expectations |55

Modern Dentist Magazine

Case Studies

Long-lasting crowns made easy with DMG’s LuxaCrown DMG’s new LuxaCrown enables simple, quick and cost-effective chairside fabrication of long-lasting crowns. The result is an incredibly precision-fit, aesthetic and long-lasting restoration, which can be worn for up to 5 years.

masticatory function. LuxaCrown is particularly recommended if a long-term observation of the treatment success is necessary, when bridging the gap for healing phases and in difficult restoration situations.

Long-term stability

The practical Automix system guarantees a quick, clean and productive application. Eight shade variations open up a variety of creative possibilities, even for the highest aesthetic demands.

LuxaCrown is very hard with a Barcol hardness of 54. In addition to excellent flexural strength, it also possesses outstanding fracture toughness, which ensures long-term stability of semipermanent restorations. Several in-vitro studies have confirmed its high mechanical strength.

Standardised chewing and wear simulations of masticatory behaviour with artificial aging verified a lifespan of up to 5 years for LuxaCrown.*

Versatile

Its unique indication as a semi-permanent crown and bridge material with outstanding wear, allows for a wide range of indications. LuxaCrown can be used to protect the remaining tooth as well as to restore the anatomical form and the

Efficient and aesthetic

With LuxaCrown, Dentists can offer their patients a long-lasting semi-permanent solution with excellent results, and a costeffective, attractive alternative to laboratory fabricated crowns.

LuxaCrown restorations are ideally suited for the elderly who do not want to invest in more expensive longer lasting restorations, patients with a limited budget and children requiring a space maintainer following tooth loss. *In a vitro study of LuxaCrown; N. Albrecht, S. Duy, Germany , FEB 2016.

For further information contact your local dental dealer or DMG Dental Products (UK) Ltd on 01656 789401, fax 01656 360100, email paulw@dmg-dental.co.uk or visit www.dmg-dental.com

mikrozid – effective against TB

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A leading expert in infection prevention has warned against complacency in the UK about the potential threat of tuberculosis (TB), saying that: ‘Given the right conditions, TB could become a significant problem and cause of mortality.’ Dr Evonne Curran spoke at the Infection Prevention Society’s annual conference.

Although the current risk of TB transmission in the UK is low, Dr Curran highlighted that ‘the UK recruits healthcare workers from areas where there is a high incidence of TB and people are also moving from these countries to the UK.’ Effective cleaning of surfaces between patients is essential to protect both staff and patients from the risk of cross infection. mikrozid® and mikrozid® universal are effective against bacteria including TB, as well as viruses like norovirus.

Both products offer dual cleaning and disinfection of surfaces, contain added surfactants to boost cleaning performance and are available in both liquid and wipes. They are rapidly effective against bacteria, and viruses so are ideal for use between patients.

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Modern Dentist Magazine

10 Minutes with...

Q A

Our task is to support the dental sector, providing dental technicians with innovative solutions for the manufacture of patient cases. We were the first company to create monolithic full-arches in zirconia, obtaining very good results in terms of both precision and aesthetics. This was an important milestone to reach in the dental sector and the reason why I can affirm that Zirkonzahn has contributed to its growth. Our software solutions are also a complete novelty in this area of the market. The software allows our clients to work reliably, with more predictability and better control on the production of restorations, improving the cooperation with dentists. We have always been able to reach our goals because we have always tried to not let fear impact our way of acting. A fearless attitude gave us the necessary strength to try, face the unknown and then attain our objectives. Of course, we also failed, but failing is an important lesson to learn.

From our past failures we have learnt how to manage our weaknesses and improve, and therefore we are gaining in expertise.

Enrico Steger,

Master dental technician, Inventor and CEO at Zirkonzahn

Q A

the monolithic full arch completely made with Prettau® Zirconia (Zirkonzahn).

A mock-up made with Multistratum Flexible, resin featuring a multicolour natural shading (Zirkonzahn).

58|Modern Dentist Magazine

On the other hand, this is also the reason why we have been copied.

Of course, this may happen in every business, but it is still sad.

Q A

Having been part of the dental sector for a long time has made me aware that good dental technicians are those who foresee, study and suggest the best solutions for the manufacture of patient cases. Our materials are very refined, which makes them expensive, but our clients are willing to pay more for them

Who inspires you and why?

My main source of inspiration is found within literature. I like philosophers and psychologists, such as Richard David Precht. I like reading, and I do read a lot. I am interested in culture and I keep myself well-informed about business management.

Steve Jobs is one of the famous figures from whom I get my inspiration and my sense of ambition. Some of my favourite reads are the books by the Italian writer Luigi Pirandello. I sympathise a lot with the messages he wanted to convey through his books, saying that we do not have to accept the masks, the roles that our society imposes on us, but that we always have to strive to discover and raise our true selves. I identify very much with these concepts; when I was young, if I hadn’t had the courage to try to go beyond the limits and the requirements, I would have never discovered my potential, and I would have never released my inner talents.

Talents are what make us who we are and we always have to strive to cultivate them to bring forth new ideas.

What have been the key positive/ negative changes in your area of the market?

If I think of my company’s position specifically in the dental technical sector, a positive change that has occurred relates to the fact that we have managed to instruct our clients well when we developed our systems.

By doing this, our technologies gained a foothold in the market very quickly.

We put our efforts into strengthening the dentists’ and dental technicians’ knowledge. Our hardware, software and materials are all produced in-house to ensure a perfect underlying logic and we assist our clients in mastering their tools completely in order to make the most of them.

The Prettau® Bridge,

because they are aware of the quality.

They want to deliver high-level end products, providing added value to the restorations.

How has Zirkonzahn changed the dental sector?

Q A

Have you had mentors? If so, what was the most valuable piece of advice they gave you?

Yes, I have had a couple of mentors in my life. Yet, the most important mentors were my parents. The education they gave me and the values they passed on to me are at the essence of what I do and mirror the results that I was able to obtain in my life.

Q A

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

If I had to take another working path, I would choose science. I like science, especially some of its branches such as physics, chemistry and mathematics.

Doing research, discovering and bringing benefits - these are my passions.

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Modern Dentist Magazine

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