It’s no wonder so many principal dentists and associates are looking to leave the profession, Robert Donald says.

It’s sometimes difficult to see the wood from the trees, particularly when your back is against the wall. However, don’t let that distract you from being alert to the many changes being planned for professional indemnity south of the border.

Many of these changes have been driven by medical rather than dental ‘scandals’. Remember Shipman, Mid Staffs, Bristol Cardiology, Bawa-Garba and the ongoing Paterson enquiry? The latter enquiry is due to be completed over the summer of this year. Unfortunately, dental indemnity, as usual will be caught up in the coat-tails of any government action.

As I write, state-backed indemnity for English and Welsh GMPs is being driven relentlessly towards implementation in April of this year, even though it remains a great unknown. Many of our medical colleagues will be frustrated over the complete lack of detail and its impact on primary care services and staff. For example, the scheme will not cover my medical colleagues for non-NHS work, representation at inquests, GMC hearings and disciplinary investigations. It has been estimated that 60% of cases handled by one of the major UK defence organisations in the past 12 months would not have been covered by the new state-backed indemnity scheme. Separate cover for the above will therefore be essential.

Further change is coming with the government’s recent announcement of a 12-week consultation on the regulation of clinical negligence indemnity cover. The consultation will consider whether regulated healthcare professionals (including dentists) who will not be covered by any state-backed scheme, should continue to be permitted to hold unregulated discretionary indemnity cover.

By the time you read this, the consultation will likely be over. I am sure that when the dust settles, this consultation will be seen by healthcare professionals as yet another missed opportunity to tackle the real issues that drive rising costs. Instead of supporting choice and proposing concrete actions on legal reform that would make a real difference, the government is seeking to impose a cost increase on health professionals – including dentists – by moving to an insurance-based model that will attract a 12% insurance tax premium.  Unfortunately, patients will not be better protected.

The document even acknowledges that there is no evidence of harm in the UK from the current discretionary model! Dentists will certainly gain no benefit. The only winner will be the Treasury with its additional 12% premium tax income. Where is the evidence to support their proposals? What are the problems they are trying to solve – other than by increasing competition and transparency?

Why change from a discretionary model to a regulated one?

Overall, the discretionary model has served my dental colleagues and their patients very well for over 115 years. As for transparency, my own defence union (MDDUS), which has a 69% dental market share in Scotland, regularly publishes its liability details and how these are and will continue to be adequately funded.

In fact, its last latest annual report released in the summer, set a new benchmark of transparency. Unlike statements from other MDOs, my defence union shows the details that illustrate that its reserves are more than comfortably adequate to meet both its known and anticipated liabilities; that is, the claims and no claims matters that have already been reported to it as well as those where the incident has occurred but is not on its radar. Not all of the competition does this.

More importantly, my defence union is a mutual membership organisation. It is the member’s interests as opposed to shareholder’s interests that are at the heart of everything that it does. Unlike commercial insurers, my union is not in it for the profit, and it doesn’t have shareholders to pay. It’s run entirely for the benefit of its members and delivers a highly valued, constantly improving and developing service that in my opinion is second to none in its professionalism, responsiveness and value. That’s why I have continued to enjoy the benefits of MDDUS membership ever since I qualified as a dentist over 36 years ago. How many of the commercial alternatives available would be able to match that?

Real-terms pay cut

Meanwhile, the latest evidence from the UK government’s NHS Digital research continues to paint a very bleak picture for my self-employed dental colleagues in Scotland. All parts of the UK have seen huge drops in taxable income over the last 10 years with the trajectory of Northern Ireland showing the worst trend.

This bleak outlook is set to get even worse. You only need to look at the Scottish Government’s Draft Budget for 2018/19 and 2019/20 for further proof if needed.

It stated that funding for General Dental Services would increase by 0.2% (from £414m to £414.8m) for 2017/18 to 2018/19 and increase by just over 0.4% (from 414.8m-416.6m) for 2018/19 to 2019/20.

With inflation currently around 2.5%, this obviously represents another real-terms reduction in funding for NHS dentistry in Scotland.

In contrast, over the same period the Primary Care Services budget is set to rise by 110m or almost 14%. The 2018 Scottish General Medical Services (GMS) contract includes an additional £23 million investment in the GMS to improve services for patients where workload is highest.

Is it any wonder then that with this blatant disparity in funding between the two services, the latest NHS digital survey results on morale and motivation of the dental workforce come as no surprise? They show 69.3% of Scottish principal dentists and 57% of their associates often thought about leaving general dental practice in 2017/18 – compared with 57.1% and 45.8% respectively in 2015/16.

Any guesses on what the survey results will be this year?


The opinions and views expressed here are personal to the author and do not reflect the policy of any organisation with which he is associated.