Do you think that the results of the latest NHS Confidence Monitor survey are a true reflection of the mood amongst the profession? In your opinion, what are the key influencing factors to this?
I do recognise that this is a true reflection of the dental profession and interesting as a broad brush approach, the answers follow the Pareto 80:20 ratio.
I think one of the most significant factors to this response is the way the profession has been educated – information dense with the expectation that they regurgitate the ‘party line’. This compounded with fear of litigation has disempowered dentists to explore other paradigms to the NHS model. As funding has been cut, workloads increased and dentists and their teams have to work harder and become busier to stand still, they have been depleted of time, money, energy and resources to allow them to reflect as to whether the approach they are taking as an individual and as a profession is appropriate and sustainable for the dental profession, patients and funders.
I am reminded of the question ‘How do you boil a frog?’ – put it in a pan of cold water and slowly turn the heat up.
87% of dentists asked said they are less confident that dentistry in the NHS will provide the right balance of treatment versus prevention in the future. Why do you think they hold this opinion? What do you think is the correct balance?
I think this is because as dentists and dental team members, we are faced with a constant flow of primary and secondary disease. Prevention is definitely under-funded in the NHS and if we compare the UK dental budget with the combined marketing budgets of the food and drinks manufacturers, what chance do we really stand in changing patient habits to reduce sugar intake or changing behaviours that will reduce disease?
70% of survey respondents indicated that they would not recommend dentistry as a career to a friend or family member. Why do you think this is the case? Would you?
I don’t think that dentists would recommend the career to friends or family members because most of them are tired, overwhelmed, feel that they can’t offer the most appropriate care to patients, are fearful of litigation, work long hours, are doing difficult work and are under remunerated.
Would I recommend it? Yes, absolutely, I am in the 30% that thinks that dentistry is the most amazing profession that gives you the opportunity to serve your patients and live an interesting varied life. I would ensure that in addition to recommending dentistry that people understand that it is not enough to learn and hone your clinical skills, you must take time out to learn and study the ten essential components of the business of dentistry; which include:
• Time management
• Communication skills so they can speak the same language as their patients
• Patient-centred sales
• Looking after themselves – mind, body and soul.
To be a great dentist, you must be much more than a great clinician. I would also encourage them to develop the skills of independence and interdependence so that they never become dependent on one paymaster.
Do you think that the Government have any interest in these results and the mood of the profession?
I think there is an interesting conflict between the desired outcomes of the dental team and politicians. The politicians have a duty to provide treatment for as many people as possible in the most cost-effective way. Clinicians want to provide the best quality of care to as many people as possible.
There are fundamental laws to nature such as gravity; in business, there are also fundamental laws, one of which is the time (quantity), price, quality triad which states that it is impossible to have all three.
The politicians want high quantity and low price that, by definition, means that quality will be compromised. Clinicians want high quality and time with patients which requires funding.
Do I think the Government really cares? No, I think their primary objective is to stay in power and in the big picture. Dentistry is so low down on their political agenda, they will not give it any more than lip service.
If dentists want to change the way they feel, they must step up and make the changes for themselves and their patients, and not wait for the NHS to provide the solution which is a pipe dream.
Do you think that there is a different mood amongst private dentists and are they benefitting from the disillusionment of the NHS dental providers?
Absolutely, I think that there is a difference in the mood between NHS and private dentists. As I work with dentists all over the UK, into Europe and beyond, I recognise there are three personality types of dentists.
Dylans, who like Dylan from The Magic Roundabout, sit around bitch and moan about how bad things are and are always expecting someone else to solve their problems. Because no one else will, their situations stays the same or worsens and they remain miserable.
Dills as in Dill the dog from The Herbs, who spend their time racing around chasing their tail, attending lots of courses, learning lots of things, spending time with coaches, trainers and mentors, and ending up exhausted in the same position they started because they did not actually apply any of the learning.
Bobs as in Bob the builder ‘Can we fix it?’
‘Yes we can.’
Bobs recognise a problem and are not prepared to accept it; they find the experts to help, build a team around them and take all the action it needs to change the situation to the outcome they want.
Dentists who chose to step outside the NHS will experience better working conditions and a greater sense of reward and will often (not always) earn more than the NHS dentists, however their quality of life is improved.
I am sure patients don’t want to be treated by depressed, burnt out, soulless dentists who are running late who feel they are restricted in techniques or materials. Patients are consumers and they want to be seen by passionate, enthusiastic dentist, who can provide the best and give patients the time and attention they want and need. Of course, there will be some who don’t want that and that is a choice for dentist and patient. Patients trust their dentists and will follow them out of the NHS.
As with supermarkets, there is plenty of market share for Waitrose, Tesco and Lidl. What market will you choose?
Do you see dentists ever getting to the same point where they take strike action in the same way as junior doctors?
Dentists don’t need to strike to say no; they just need to say no to their contract and work privately. Striking did not get the junior doctors what they wanted, a new contact was imposed. The only way to get the contract you want is to write it yourself and stepping away from the NHS will enable you to do that.
Now that the prototype contracts are live, what is your opinion of them? Do you think that they are a viable contract? How closely do you think the prototype contracts will resemble the finished article?
Silk purse and sow’s ear spring to mind. We must remember that ultimately the Government wants to provide as much treatment as possible for the smallest investment possible. Has there ever been a contract reform since the introduction of the NHS that has increased the level of funding to NHS dentistry?
I suspect that the contracts will be played around with until some statistics can be produced that can be used to justify another new contract. If I were to look into my crystal ball, I would predict that any changes to the NHS contract would involve increased activity, either patient or items of treatment or both, increase compliance and a reduction in fees which will ultimately lead to a decline in standards.
Whilst there is uncertainty as to when the new NHS contract will be launched and what it will entail, do you think that it’s possible for the confidence levels of NHS dentists to improve?
While dentists cling to the lifebuoy that is the NHS, I think it is very difficult for them to remain confident.
As soon as they decide they are going to leave the NHS, and have a plan to learn and implement the skills they must have to succeed independently, they will immediately notice their confidence increase.
To read the full results of the Third NHS Confidence Monitor, click here.
Jane LeLean is an international Dental Business Coach, trainer and speaker.