2020 - Dentistry

The 2020 Dentistry publication begins with forewords from cabinet minister Elizabeth Truss and Professor Ted Baker, the CQC's Chief Inspector of Hospitals.



F O R E W O R D S The Rt Hon Elizabeth Truss MP Professor Ted Baker

R E P R E S E N T A T I V E S Romsey Dental Care The Courtyard DJ Maguire & Associates Dental Group

Mark Tangri Dental Excellence Broadway Dental Boutique Forest Dental Loughton Access Dental Centre for Aesthetic Periodontics and Implantology cksuperdent Blackhills Clinic Fresh Smile Clinic

Rectory House Dental Practice Wembley Orthodontic Centre Nigel Newton’s Dental Care New Kings Road Dental Practice Cochrane Dental Care

F E A T U R E S Letter from Lord Pickles & Lord Blunkett Commentary from Andrew Neil

The Parliamentary Review is wholly owned byWestminster Publications Ltd. (Company No. 08154359). It is proudly independent of parliament and government. It is 100% funded by the representatives who write for it.




The Rt Hon Elizabeth Truss MP Secretary of State for International Trade, President of the Board of Trade and Minister forWomen and Equalities It is this excitement, optimism and ambition which I believe will come to define this government. For too long now, we have been told Britain isn’t big or important enough to survive outside the EU – that we have to accept a deal that reflects our reduced circumstances. I say that’s rubbish. With the right policies in place, we can be the most competitive, free-thinking, prosperous nation on Earth exporting to the world and leading in new developments like AI. To do that, we’ll give the brilliant next generation of entrepreneurs the tools they need to succeed. Since 2015, there has been a staggering 85 per cent rise in the number of businesses set up by 18 to 24 year olds – twice the level set up by the same age group in France and Germany. We’ll help them flourish by championing enterprise, cutting taxes and making regulation flexible and responsive to their needs. As we do that, we’ll level up and unite all parts of the UK with great transport links, fibre to every home and proper school funding, so everyone shares in our country’s success. 2019 was a year of brewing economic and political revolution. 2020 will be the year when a revitalised Conservative government turbocharges the economy, boosts prospects for people across the country, and catapults Britain back to the forefront of the world stage. With the right policies in place, we can be the most competitive, free-thinking, prosperous nation on Earth “

Even by the standards of the day – 2019 was one of the most exciting and unpredictable years in British politics. The election we’ve just seen marks a huge moment in our country’s history. This government is taking a decisive new direction, embracing the opportunities of Brexit and preparing our country to flourish outside the EU. As international trade secretary, I’ll be driving forward work on the free trade agreements that are going to be a priority for the government. Free trade isn’t just an abstract concept bandied around by technocrats. It is crucial for a strong economy and for the ability of families to make ends meet. Free trade benefits people in every part of our country, as British firms export to new markets and people doing the weekly shop have access to a wider choice of goods at lower prices. The essence of free trade is in the title – freedom. It’s about giving people the power to exchange their goods without heavy government taxation or interference. Commerce and free exchange are the engine room of prosperity and social mobility. I’m determined to tackle the forces who want to hold that back. One of my priorities is agreeing an exciting new free trade deal with the US, building on the great relationship between our two countries and the Prime minister and US President. But I’ll also be talking to other partners including new Zealand, Australia and fast-growing Asian markets. And with the EU too, we want a friendly and constructive relationship, as constitutional equals, and as friends and partners in facing the challenges that lie ahead – a relationship based on a deep free trade agreement. Our country produces some of the world’s most successful exports, and the opportunity to bring these to the rest of the world should make us all excited about the future.




Professor Ted Baker Chief Inspector of Hospitals, Care Quality Commission

Across all health and care services, CQC inspections shine a light on quality, enable the public to have confidence in the services they use, and highlight to providers where they need to take action to improve standards of care. Our inspections of nHS hospital services to date have shown many are delivering excellent care and where we have found concerns, we have seen evidence of hospital trusts taking action to mitigate potential risks and deliver timely improvements. The positive impact of regulation in driving improvement can be seen in the number of trusts that have increased their rating on reinspection. This includes 24 that have exited “special measures” following positive action taken in response to CQC’s inspection findings. The changes made by each hospital are a testament to the effort and determination of the staff involved. As a result, patients across England are receiving better and safer healthcare and providers are running higher quality services. But, the pressure facing nHS trusts continues to mount and we remain concerned about the growing demand for services in a sector where there are known workforce shortages. In some cases, we are seeing the impact of such pressures on patient safety. Urgent and emergency departments for example, continue to bear the brunt as the first point of contact for many people in need of care. The nHS long Term Plan makes a welcome commitment to improve local service integration. Breaking down barriers and co-ordinating the work of general practices, community services and hospitals is essential if we are to meet the needs of growing numbers of people with multiple and often complex medical conditions who receive care and support from a variety of health and social care staff.

In some places we are already seeing the positive impact of effective collaboration between health and care services. But as our local system review work has shown, joined up system working isn’t happening everywhere. Until it is, individual providers will increasingly struggle to cope with demand and we risk quality suffering as a result. Advances in technology also present important opportunities for the future. Digitally enabled care is changing the way services are provided and the potential benefits are significant – for people who use services, families, carers and providers. Regulation must not stand in the way of such developments, but technology and innovation must never come at the expense of high-quality, person-centered care. In an environment of pressure and change, there are many challenges, but there are also opportunities to be grasped. Effective implementation of the workforce plan will be crucial. But alongside this, CQC will continue to play our part in supporting the system to adapt and services to improve, while maintaining our focus on ensuring that people across the country receive safe and effective care. In an environment of pressure and change, there are many challenges, but there are also opportunities to be grasped “ “


Amessage from Lord Pickles and Lord Blunkett

And it is why we, as former labour and Conservative cabinet ministers and current members of the House of lords, feel it is important to put aside our political differences and work together to ensure these stories are given the platform they deserve. In this publication, you will find an insightful take on the past year in politics from the BBC’s Andrew neil and a concise rundown of the key events in industry and parliament. most importantly, you will be able to read in-depth accounts from the individuals and organisations who make The Parliamentary Review what it is. It is our great honour and pleasure to have helped provide the platform for their insights to be aired. We hope that you find these articles – which begin on page 11 with a piece from Romsey Dental Care – as thought-provoking and informative as we do.

The ability to listen to and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. As Westminster looks ahead to a future after Brexit, it is essential that politicians have a firm understanding of the challenges with which British organisations must contend; and that leaders in both the public and private sectors are aware of the difficulties faced by those working in all levels of politics, from local government to the national arena. This is why The Parliamentary Review combines political content with stories from a wide range of organisations – small and large; new and old; those at the peak of their powers and those who have peaks to surmount. It is why these stories seek to inspire and challenge all who read them.

Rt HonThe Lord Blunkett Co-Chairman, The Parliamentary Review

Rt HonThe Lord Pickles Co-Chairman, The Parliamentary Review



Andrew neil

British politics turned upside-down It was a watershed election, up there with the Attlee Labour

infrastructure, most of it designated for the midlands and the north. These are not traditional Tory policies. The labour party likes to paint Boris Johnson and his government as hard-right Brexiteers. But when the dust settles on its leadership contest, it may discover that mr Johnson has parked his tanks not just on the centre-ground of British politics but on the centre-left too, leaving the new labour leader with room to be distinctive only on the further left. Broadly, Corbynism without mr Corbyn, as one labour shadow minister said to me. For business, the election has removed two major uncertainties: Brexit and a Corbyn government. The first is happening, the second will not. So there will be a modest economic bounce in 2020 as confidence returns. The UK economy ended 2019 limping along at one per cent growth; Brexit uncertainty had taken its toll. now even the ImF, congenitally gloomy about Brexit Britain, expects 2020 UK growth to be closer to 1.5 per cent, faster than the Eurozone and slower only than the US and Canada among the G7 advanced economies. I say “modest” bounce because, of course, all the uncertainty has not gone away. The UK now has to

relationship with the EU and until that is clear business investment, domestic and foreign, will not return in huge strength. But 2020 should be a more appealing climate for UK businesses, big and small. Government ministers speak privately about a wall of money ready to come into Britain now that the Brexit and Corbyn uncertainties have been resolved. But much of this will be hot money going into existing assets, whether property or equities. It can leave as easily as it enters. Real investment in new machines, plant and capacity will grow only gradually until it sees the shape of future UK-EU relations. The talks will be rocky. The UK wants trade to remain friction-free. The EU will say, fine, as long as you remained aligned to EU rules and regulations. This, the Johnson government is making clear, is not acceptable. When I asked a senior minister how the government would deal with this friction-free/ continued alignment trade off, he answered without hesitation – we would rather have more friction than remain aligned with Brussels. The government knows the private sector remains wary, which is why it will use its own balance sheet to boost the economy in 2020 until remaining uncertainties are resolved and business investment returns in volume and with confidence. This should be a good year for business: major uncertainties resolved, continued cheap money as far as the eye can see, expansive fiscal policy, increased growth, a new appetite for investment. And if the government screws it up, it will have nobody to blame but itself.

landslide of 1945 and the dawn of Thatcherism in 1979 as a general election that changes the course of British politics. The trends had been apparent for some time – and I’ve alluded to them in previous pieces for The Parliamentary Review – but the general election of December 2019 saw them come to fruition. For the first time ever, the Conservatives became the party not just of the non-metropolitan working class but of the poorest voters, among whom it enjoyed a double-digit lead, while Labour became the party of the well-off and the well-educated. Thus was British politics stood on its head. This is of more than psephological significance. It has huge import for the course of Conservative policy. Those who think the Johnson government heralds a new Age of Thatcherism for the 21st century are mistaken. Those who pine for a return to limited government, tax cuts and free market economics will be disappointed. The Tories need policies that will cement their new provincial voter-base with a blue-collar conservatism. So instead of tax cuts for the affluent, we will have low-earners taken out of national insurance. Instead of the free market, we will have the highest national minimum wage in Europe covering 25 per cent of the labour force (that would have given Mrs Thatcher the vapours!). Instead of cuts in government spending there will be more money for schools, hospitals and the police. Instead of bearing down on the national debt and the budget deficit, there will be a borrowing binge to finance £100 billion investment in

negotiate its future

neil believes that the Conservatives will appeal to their new voter base through “blue-collar conservatism”


Review of the year

The promise of change Alison Holt, BBC Social Affairs Correspondent

squeezed. In England, approximately half a million fewer people get local authority support now than did in 2010, despite the fact we are an ageing population with more older people needing help with such things as washing, dressing and eating. The number of working- age adults with disabilities is also rising. It is part of the debate which is often forgotten, but English councils now spend about half of their adult care budgets on supporting people under the age of 65. The charity Age UK also estimates there are about 1.4 million people who don’t get the level of support they need. The statistics tell a powerful story, but they don’t spell out the strain that puts on families. The prime minister’s promise of change came just a few weeks after two one- hour Panorama specials were broadcast on BBC One, which showed the human cost of a system in crisis. For the programmes, a producer, cameraman and I spent ten months mapping how difficult decisions made by Somerset County Council played out in the lives of eight families who desperately needed a care system that worked. The county has one of the fastest ageing populations in the UK, but the pressures it faces are being felt across the country. During the time we were there, the Conservative-run authority had to save £13 million from its budget or it would fail to meet its legal obligation to balance its books. One of the financial cuts that followed meant the closure of a dementia day centre relied on by Barbara, who is in her eighties, and her daughter, Rachel. It was a safe, familiar place for Barbara and provided Rachel with a vital break

After Boris Johnson became prime minister, he pledged to find a cross-party solution to the problem of social care

When Boris Johnson first arrived in Downing Street as prime minister on a sunny day in July 2019, he promised to fix the crisis in adult social care once and for all. He told the listening country that he had a clear plan prepared and it would protect people from having to sell the family home to pay for their care. It was an important pledge greeted with both hope and scepticism by those who work in a vital care system, which supports older and disabled people with day-to-day tasks. Hope came from a new prime minister setting out his stall with adult social care marked as a key priority. It was like water in a desert for a sector often overshadowed by the mighty national Health Service. The scepticism is the result of many years during which different governments have promised to reform the way we pay for social care – so far none have led to the significant change needed to ensure a care system that works for the long term. The fundamental problem is one of growing demand exacerbated by a decade during which councils, who run the care system, have had their budgets




from managing her mother’s severe dementia. Tearfully, she told us she was losing a lifeline. Then there was 37-year-old martine, who was in constant pain from juvenile idiopathic arthritis. Her husband, David, was caring for her 24 hours a day while looking after their three-year-old triplets and trying to work. There was no question they needed help, but the council support never seemed enough, even though David was quietly, uncomplainingly crumbling under the strain. Thirdly, there was Rita, 77, living with Parkinson’s and dementia. She had recently moved into a nursing home and was caught in confusing discussions over who should fund her care – the nHS, the council or her. She was adamant she didn’t want to sell the family home to pay for her care. It was a council house she and her husband worked hard to buy. Rita, martine and Barbara had families nearby to fight for them, but 84-year- old Pat was on her own. Increasingly isolated, lonely and unsteady on her feet, without regular help she was likely to end up in hospital in a crisis. It was an insight into an overstretched, underfunded and baffling system held together by many people doing their best in increasingly difficult circumstances – that included social workers and council officers trying to make budgets stretch as far as possible. Care companies providing support either in residential homes or in people’s own homes warned that local authority fees weren’t covering the real costs, so people funding themselves were often paying more to prop up the system. One frustrated care company boss told us, “Ultimately, this is a society problem; everyone in the country has to decide what they want out of their social care system, and once they have decided what it is then you’ve got to pay for it. And if you don’t want to pay

In July, the House of lords called for the roll- out of free personal care, a policy which is already in action in Scotland

for it then, excuse my French, you’ve just got to lump it, haven’t you?” last July, the lords economic affairs committee described the current situation as a national scandal. It also took the bold step of recommending that free personal care should be introduced, providing everyone with a base-line of support. Twenty years ago, the idea was rejected in England as being too expensive, but the system was introduced in Scotland. It is said one benefit is that early help for people reduces pressures on the nHS. In the past, proposals for reform have become political footballs or been dubbed too costly by the Treasury, so it’s particularly striking that this was a cross-party committee, which included former Tory and labour chancellors. On winning the election in December, Boris Johnson reiterated his pledge to reform the care system and promised cross-party talks within his government’s first 100 days. The sceptics will point to the more than 1,000 days that have passed since the last Conservative government promised to publish a green paper on care reform, and mr Johnson’s clear plan has yet to emerge. But with such a large majority, this government could make important and lasting change – a true legacy for future generations. The many families who need help now are already watching and waiting.



In April 2019, dentistry fees for patients attending nHS services in England rose by five per cent. The new charges saw the cost of a routine check-up increase by £1.10 and the cost of a set of dentures rise by £13.80, to a total of nearly £270. Justifying these price rises, the government said they were necessary to ensure the future sustainability of nHS services. The increase was met with criticism from dentistry leaders, however, who warned that practices were becoming increasingly financially reliant on these fees and that soon, without further support from central government, dentistry would become an nHS service in “name only”. Henrik Overgaard-nielson, the former chair of the General Dental Practice Committee, argued that the price rises were covering for “savage cuts” and said: “Unless ministers change course, within a decade our patients will be putting more in at the point of delivery than government.” Patient charges rise

Under the new pricing structure, a Band 1 treatment, covering examinations, X-rays and polishing, will cost £22.70. Band 2 treatments, which cover fillings and root canal work, will now cost patients £62.10, and Band 3 treatments, which include crowns, dentures and bridges, will cost £269.30. This increase in prices is part of a greater trend of dental services being funded by patient charges. According to the British Dental Association, dental charges now account for 30 per cent of the funding for dental services, an increase of 10 per cent from 2010. The increase in the importance of patient charges has been caused by the reduction in central government funding. The government currently spends £2 billion a year on dental provision, a reduction of £500 million in real terms since 2010. Government funding is not equal across the UK, and England has the lowest level of government spending. In England, government spend on dental services works out at £36 per

Every year, the government spends £2 billion on dental provision




Defending this increase in price, a spokesperson for the Department of Health and Social Care said: “These charges contribute towards the running costs of the whole nHS, including delivering world-class front- line patient care, and we continue to protect the most vulnerable through exemptions and the nHS low- income scheme.”

person per year; in Scotland and northern Ireland, spend equates to £50 per person. Both Scotland and northern Ireland have different systems to England, however, with patients paying 80 per cent of the cost of their treatment, with this capped at £384. In Wales, the cost for different bands of treatment is between a fifth and a third lower than the rate in England. In november 2019, the BBC released analysis which claimed that more than two million adults in England were unable to see an nHS dentist. Using the GP Patient Survey as a foundation, the BBC were able to construct a picture of the number of adults who are currently not accessing dental services as well as the reasons for this. Of these two million, it was estimated that 1.45 million had tried and failed to get an nHS appointment, with the rest placed on waiting lists or put off from booking an appointment completely because of the cost. The findings, which were based on data released by the nHS, also stated that a further two million adults had assumed they would not be able to access care near to where they lived. If the two figures were to be combined, it would suggest that nearly one in ten adults miss out on dental care. Although issues were found in every region across the country, the severity of the issue did depend on location. Bradford, Brighton, Cornwall and parts of Kent, Surrey, norfolk and london were found to have the lowest rates of access, with almost one in six adults not getting the dental care they need. According to the BBC analysis, the level of unmet need has remained fairly consistent over the last five years. The nHS itself monitors the number of

millions unable to access nHS dentistry

Of the estimated two million adults who did not access any form of dental care, 1.45 million were unable to get an appointment

adults accessing high-street dentists and found that roughly half of adults have accessed nHS care in the last two years, but these figures do not include those accessing specialist services, those who use private dentistry and those who do not require any dental care.



Commenting on the BBC’s findings, Dave Cottam, the chair of the General Dental Practice Committee, described a “perfect storm” of underfunding and recruitment issues. He said: “These access problems are no longer affecting a few ‘hotspots’, but are now the reality for millions across every English region. “The public are entitled to access care, but the system is stacked against them. “Those losing out are the patients who need us most. The next government owes it to them to ensure this service has a future.” Alongside being put off by cost, another reason for this low level of engagement was patients being turned away and the belief, among

Theresa may, the prime minister, provided a budget settlement of £20.5 billion to be divided over the following five-year period, 3.4 per cent of which has been set aside to ensure the plan can be sustained. On January 7, 2019, the nHS long Term Plan was published by the prime minister and the chief executive of nHS England, Simon Stevens. The plan marks a distinct move away from the Health and Social Care Act 2012, which worked towards a policy of competition across the nHS in England, first seen in the early 1990s. The current plan has been referred to as indicative of a “fundamental shift” in the way the public and the nHS interact. In order to create partnerships between the two groups, staff are being trained to take on a more supportive role, ensuring that patients are able to make the best decisions for themselves, while also being appropriately informed of treatment options. patients, that appointments were not available. In order to explain this, the BDA put forward two key reasons: practices struggling to fill vacant posts and a 29 per cent fall in funding per head, over seven years, accounting for inflation. The union also criticised the way dental contracts functioned, specifically the fact that when dentists have met their quota, they do not get paid extra for taking on other patients. In order to lower these figures, nHS England said it was “actively working” to better understand and address these issues. In order to tackle the problem of patients not knowing about services in their area, an nHS spokesperson said patients should consult the nHS website.

The nHS long Term Plan

Theresa may and Simon Stevens, the

chief executive of nHS England, published the nHS long Term Plan in January 2019

In the summer of 2018, the government asked the nHS to create a ten-year plan in order to establish how funding should be used in the coming decade.




As the biggest employer in Europe, the nHS has seen increasing pressure on its services over the past decade. Additional funding will be used to increase clinical places by 50 per cent between 2020 and 2021. GPs currently provide 400 million face- to-face appointments a year, which the plan aims to supplement with the introduction of digital consultations. The nHS believes that this, alongside an overhauled outpatient service, could save over £1 billion a year. Through enabling individuals to become more responsible for their own healthcare, the plan aimed to progress towards a “shared responsibility for health”, focusing on the personalisation of care.

A move towards integrated care systems was a hallmark of nHS policy of late. Intended to cover all of England by April 2021, the focus of the ICS model will be the overall health of the population. The plan will allow for flexible interpretation of the model on a local level. Boris Johnson has remarked that the plan demonstrates that “this one-nation Tory party … has already embarked on the biggest cash boost for the nHS for a generation.” As The Parliamentary Review goes to print, many of the Conservatives’ pledges surrounding the long Term Plan have been fleshed out. It remains to be seen, however, how they will be executed.

The plan marks a shift towards integrated care systems with a focus on the overall health of the population



Romsey Dental Care

Practising ethical dentistry with a view to reducing clinical waste

Founder and Principal Samantha Price

F ounder and Principal Samantha Price established a small private general dental practice in central Romsey, Hampshire, over 20 years ago in 1996. Operating from an attractive Bath stone building, Romsey Dental Care’s team of ten includes two dentists and two hygienists, and offers a wide range of the latest dental and cosmetic treatments. Samantha tells The Parliamentary Review about sustainability concerns in the dentistry sector, leading with one issue that dominates today’s climate policy debate: plastic waste. We are committed to offering evidence-based care for our patients, but in recent times, I have seen that the cross-infection control recommendations accepted by my profession have led to a ridiculous and unnecessary amount of waste. We are in the midst of a climate emergency, and official advice from Public Health England suggests that we should risk-assess our own environment and make decisions based on that. This doesn’t happen for a number of reasons. Firstly, there is simply too little time left over after meeting all the other compliance requirements to analyse each and every scientific article upon which such recommendations are made. Secondly, these articles are not readily available, and our compulsory training on cross-infection control never questions the recommendations. Finally, if we challenge the accepted wisdom individually, we have to justify this to the CQC, which can be an arduous process. This can lead to worse outcomes for patients, something demonstrated by an official PHE response we received: “It is easier sometimes to recommend not to use something rather than specifying under what circumstances something can be used.”

FACTS ABOUT Romsey Dental Care

» » Founder and Principal: Samantha Price » » Established in 1996

» » Based in Romsey, Hampshire » » Services: General and cosmetic dentistry, implants, tooth straightening and cosmetic facial treatments » » No. of employees: 10 » » www.romseydentalcare.co.uk


THE PARLIAMENTARY REVIEW Highlighting best practice

The two papers concluded firstly that disinfecting a patient’s skin from a spray bottle prior to injection caused a serratia marcescens infection, and secondly that a bottle which had not been washed before refilling caused a similar infection in a patient during heart bypass surgery. Serratia marcescens is recognised as an important and potentially hazardous pathogen, commonly involved in hospital-acquired infections, particularly catheter- associated infections, urinary tract infections and wound infections. It could be a life-threatening infection, but there are a number of reasons why this recommendation is incorrect. Serratia marcescens is naturally occurring in water and soil, even sometimes in the mouth, and is an opportunistic pathogen. This means it will cause harm when it gets into the “wrong places” but is otherwise harmless. Crucially, the evidence and research are hospital-based, and the reported incidences upon which the recommendation is based are unrelated to the procedures used in a dental practice. There are some significant issues with conclusions drawn from the papers, with both the unwashed bottle and injection through skin being causal factors, plus the fact that the operation took place in a sterile body cavity using contaminated equipment. These must also be seen as contributing factors. In conclusion, I suggest that, in a dental practice operating environment where spray bottles are used to disinfect surfaces between patients, there is no evidence of an infection risk from this bacterium. We do not disinfect or inject skin, unless in a medical emergency, and we would then use individually packed sterile alcohol wipes. We do not

The latest dental and cosmetic treatments, available in the heart of an historic market town

An example: plastic waste Recommendations state that we must throw away refillable plastic spray bottles that are used to spray disinfectant onto the surgery surfaces between patients. A plastic item that can easily be washed and reused is turned into a single-use item that goes to landfill. I vehemently object to this and approached Public Health England to access the clinical papers upon which this recommendation is based.

Our media constantly feed the public with misleading statistical analysis

Iconic stonework at our Romsey premises



operate in a sterile body cavity and we do not deal routinely with severely ill patients. Beyond this, we can easily wash our bottles before refill. In fact, I would suggest that in terms of perceived risk to the end-consumer, there is little difference between spraying a dental surgery surface and spraying a restaurant table. My dental nurses spend at least an hour a day, on top of normal surgery hours, sterilising, packaging and resterilising instruments as well as covering all equipment with plastic. They then must throw away all this plastic as well as the plastic impression trays and other items that previously we could sterilise or disinfect. All this goes into clinical waste, for which we have to pay a premium – not to mention the cost to the environment, which is huge. The need for change It’s time to task an organisation with expertise and authority, like the National Institute for Health and Clinical Care Excellence – or NICE – to thoroughly review all the clinical evidence and the cost of all these recommendations against the risk they pose to patients and the environment. Some years ago, a similar exercise resulted in a reversal of a previous recommendation to give prophylactic antibiotics to patients at risk of bacterial endocarditis before any procedure. The reasoning was that there was more risk to the patient from taking the antibiotics than from the bacteraemia – bacteria forced into the blood stream from the oral cavity – and that in any case a bacteraemia was caused every time someone eats or brushes their teeth. Our media constantly feed the public with misleading statistical analysis, causing fear and uninformed decisions.

A sustainable dental surgery

One perfect example is the increased risk of breast cancer caused by hormone replacement therapy. Many women were denied this drug and suffered years of misery when the added risk is actually only 0.5 per cent. My profession is being encouraged to cause unnecessary damage to the environment, and this is not evidence- based practice. We now have to put the environment as a priority consideration when considering relative risks in healthcare and make pragmatic decisions to reduce “one use” items in particular. The benefit of this could huge: millions of pounds saved in our NHS as well as a positive impact on our target to meet carbon emission targets and reduce the amount of plastic polluting our planet.

We now have to put the environment as a priority


THE PARLIAMENTARY REVIEW Highlighting best practice

The Courtyard

The Courtyard Clinical Academy H uddersfield dental surgery The Courtyard is an award- winning practice that provides check-ups and hygienist appointments for more than 1,500 patients. Founder Marcos White tells The Parliamentary Review he believes that all dentistry should improve the health and appearance of one’s smile. It is this, Marcos says, that means patients look forward to visiting The Courtyard. He talks about the digitally-led service that he and his team provide. Intra-oral scanners were brought to the profession to replace traditional impression- taking. The digital intra-oral scanner takes thousands of photos every second and stitches them together to form a 3D image of your teeth which is effectively a time-stamped colour record. The efficiencies and cost savings that this will bring to the profession will be game-changing, but this is not the most important thing to highlight. Instead, the existence of a colour digital file will entirely change consultation, visualisation and digital consent. Digital consultation When a new patient attends for an initial consultation at my practice, they do not see me but rather one of my treatment co-ordinators. At this initial appointment, colour digital scans are taken of their teeth and gums. For over 200 years, we have seen teeth one at a time in the reflection of a dental mirror. Now, for the first time, we see the dental system as a whole. This provides an entirely new perspective for both the dentist and the patient. For the first time,

Founder Marcos White

FACTS ABOUT The Courtyard » » Founder: Marcos White » » Established in 2001 » » Based in Huddersfield » » Services: Cosmetic dentistry » » No. of employees: 25 » » www.courtyarddental.co.uk



they see their own problems in colour, on screen. In addition, there is no reliance on trusting the dentist; they trust what they see, and from this digital consultation, we have seen patients commit to change in a way we had never seen before. We have taken this digital consultation further by using the technology to allow greater communication throughout our 25-person team, and the colour digital scans taken on one of our three iTero Element scanners are saved in the cloud as standard procedure. They are password protected but available to visualise on any laptop. This means that both my senior team and I are able to have a digital case conference once a week to discuss the patient’s presenting issues before I ever meet them. This creates an immediate and profound benefit to the planning of complex dental treatment. Digital consent Digital consent is a commitment to never carrying out complex dentistry until it has been completed in the digital world first. Put another way, we commit to providing our patients with a visual demonstration of any proposed outcome before we begin to aid their decision-making process. Following the digital consultation process, we will have discussed a number of different options and techniques to deliver the outcome. Once we take the initial scans of the patient, we activate software built into the iTero scanners that runs an orthodontic outcome simulation. These are time- stamped and recorded in the cloud as evidence that we demonstrated this approach to the patient. This visual instantly shows the patient what Invisalign can deliver, and 90 per cent of the time, a patient is amazed and requests to move forward with

3D printer: able to produce a model in 30 minutes

treatment. This is digital consent; the patient has seen a visual of what we can deliver, confirmed it is what they want and understands the risks and benefits of the technique being used to deliver it. This visual forms a contract between us and the patient that we commit to deliver on. In certain instances where teeth are broken, worn or have irregular shapes, the orthodontic simulation we set in motion will not deliver an image that satisfies the patient’s needs. It will, in fact, highlight that additional dental techniques are required to repair and restore the teeth surfaces. In these instances, we carry out a different visual demonstration as described below.

Now for the first time we see the dental system as a whole

3D printed models ready for use


THE PARLIAMENTARY REVIEW Highlighting best practice

it is the present. It is technology we already own and deploy at our practice on every single new patient we treat. The next step is artificial intelligence and dental monitoring through smartphones. I have recently become a key opinion leader for Dental Monitoring, one of the most forward-thinking digital companies in dentistry. They have launched technology that allows an Invisalign orthodontic patient to track the fit of their aligners and the success of their ongoing treatment by scanning their teeth with their smartphone. The patient is given a ScanBox which holds the smartphone in the correct position. Then, 4,000 digital photos are taken, assessed and subjected to artificial intelligence algorithms that can detect and advise aligner fit, oral hygiene levels, inflammation of the gums and recession. They advise the patient if they are allowed to change their aligner or if they should attend the dentist for a hygiene session. What we are seeing is the enabling of remote tracking of a patient’s orthodontic process from anywhere around the world. We are seeing this data being analysed and compiled into global trends and patterns that can speed up or slow down treatment time based on what it sees. We are seeing a patient’s oral hygiene compliance assessed and regulated through their smartphone. There is a recognised lag between technology being introduced and habits being changed. Unfortunately, those in the dental profession that lag with digital record-keeping may well be depriving their patient of the most comprehensive consent, while also leaving themselves open to increased litigation. It is our responsibility to educate and lead.

Unparalleled visualisation and accuracy

The scans are sent on to our digital technician who designs an image in CAD-CAM to demonstrate what could be achieved through crowns and veneers to restore the damaged enamel surfaces. These visuals are then presented to the patient alongside their initial scans as a “before and after” comparison so they can once again visualise what we could deliver. The mere act of taking a scan and demonstrating digital outcomes is not only more comprehensive for the patient, but it also protects the clinician. When carrying out irreversible preparation of teeth, especially when an orthodontic outcome could have delivered a similar outcome, proving that the patient wasn’t just offered options but saw both solutions achievable from both techniques will confirm that the best-possible informed consent was given and obtained. When these processes become acknowledged as the accepted minimum, then dentistry which does not present digital outcomes before commencing will be deemed as negligent. The next step forward It may be hard to believe, but what I have described is not the future;

Digital consent is a commitment to never carrying out complex dentistry until it has been completed in

the digital world first



DJ Maguire & Associates Dental Group

Owner and Principal Dentist Dr Derek J. Maguire D erek J. Maguire is the principal dentist and owner of DJ Maguire & Associates, which owns and operates 11 separate practices across Northern Ireland. Having worked for over 30 years, his first practice consisted of just two surgeries. Today, Derek’s group employs 180 people, with over 50 associate dentists, and provides services to some 61,000 NHS-registered patients. Derek tells The Parliamentary Review about the practice’s history and growth. Throughout our continued growth, I have ensured a focus on the highest quality and always complied with regulations. As an organisation, we have achieved Investors in People at Gold Level and came first in the UK in the healthcare sector at Gold Level. We participate in the British Dental Association Good Practice Scheme, ensure full compliance with the Regulation and Quality Improvement Authority and have previously been awarded Randox Healthcare Practice of the Year. Our largest practice currently consists of 11 full-time surgeries. Recently, we have looked at the areas that seem to be the biggest cause of stress for dentists in general practice. Unquestionably, the biggest fear is of complaints or litigation, although this was closely followed by the complicated world of business and compliance with regulation. With that in mind, and enjoying training in all aspects of dentistry, we have created a trainee dental nurses’ programme, including a “buddy scheme”, to ensure high- quality training for dental nurses. This matrix also pairs them with a mentor in their practice – similar to a dental foundation trainer and trainee relationship for dentists. This year we have 15 new trainee dental nurses around our 11 sites.

Dentist and Operations Director Dr Leonard J. Maguire

FACTS ABOUT DJ MAGUIRE & ASSOCIATES DENTAL GROUP » » Owner and Principal Dentist: Dr Derek J. Maguire » » Dentist and Operations Director: Dr Leonard J. Maguire » » Founded in 1989 » » 11 practices across Northern Ireland including 50 associate dentists » » Over 61,000 registered NHS patients » » www.djmaguiredentists.co.uk » » www.thedentistsacademy.com » » Services: Dental care » » No. of employees: 180


THE PARLIAMENTARY REVIEW Highlighting best practice

“The Maguire Way” Each of our practices offer a mix of NHS and private treatment, and we attribute part of our success to the fact we would never turn away someone in need. While we recognise it is important to be financially viable, we also believe there is a way to practice as a caring profession, and we instil our values in our dentists. We believe it is important to offer our patients options in terms of treatment, although we understand that there are times when cost is a barrier. Of the 1.8 million people who live in Northern Ireland, 1.2 million are registered with a dentist. As one of the largest dental groups in the country, we care for one out of every 20 registered patients in Northern Ireland. Our appointment books are often filled six to eight weeks in advance and we have a very loyal patient base.

The Dentists Academy Each of our practices has a central role in their community. For example, we created an “autism awareness pack” for patients and parents, which shows images of the surgery and what to expect at a visit for an autistic patient. We champion access to dentistry for all patients – including those who are housebound or in nursing homes. We carried out over 500 domiciliary visits in Northern Ireland last year. Our “domiciliary care pack” for nursing homes for use with their patients, families or carers ensures the oral health of this cohort is maintained. Throughout the last 30 years I have been fortunate enough to have had some influential mentors, and I decided to provide the same experience for colleagues – thus, The Dentists Academy was born. The academy is an online platform and each member can benefit from the training, reports,

Created a trainee dental nurses’ programme, including a “buddy scheme”, to ensure high- quality training for dental nurses

Derek and some of his management team with their Investors in People Gold award



Left: Secrets of Successful Dentists , by Derek and Leonard

templates and interviews on any device at any time. Often non-clinical areas of stress are common among colleagues worldwide and we have members from Australia to Canada. With my passion for mentoring and teaching dentists I studied what causes high levels of stress in our profession. In The Dentists Academy we look at areas of opportunity and risk in general practice which are often not covered in the undergraduate setting. This includes both personal and professional areas of growth and development, clinical and non-clinical. Of particular focus is how to transition from graduating at dental school into Dental Foundation Training and, after this, embarking on life as an associate dentist – a crucial time in any dentist’s career. Education is changing and we’re teaching colleagues the knowledge, skills and behaviours to be even more valuable to their patients and practice. Our staff are one of our most valuable assets and we work hard at nurturing them. From practice family fun days to Our most valuable asset

providing an allowance towards their children’s school uniforms, we believe it is so important to have the right attitude and a willingness to learn. Fifteen new trainee dental nurses joined us in September, across our 11 sites. I have also co-written a book – Secrets of Successful Dentists – with my son, Leonard Maguire, who is also a dentist and operations director within our group. The book includes our “PACE method”, which enables dentists to discuss their treatment plans comfortably, including financial discussions, how to accelerate the dentist-patient relationship and to deliver true value. Furthermore, it shows how they can be confident obtaining valid, informed consent and consistently manage patient expectations predictably. We continue to grow, both in terms of our practices in Northern Ireland and the help we provide out of house. Dentistry has provided a lot for my family over my lifetime, and it is my firm intent to use my position to give something back – to patients and the profession. Secrets of Successful Dentists

Right: Some of the DJ Maguire reception team

Of the 1.8 million people who live in Northern Ireland, 1.2 million are registered with a dentist. As one of the largest dental groups in the country, one in every 20 registered patients across Northern Ireland are registered within our group


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