save the nhs?

"I WILL NOT SUE THE NHS". -Kevin Lewis NEC May 13, 2022.


If you get the chance, see Kevin Lewis. He is a great speaker, and I first listened to him in the 80's explaining how we could provide prevention on the NHS by exploiting the grey areas. Like me, he is no longer worried about getting off by the GDC. Those still working in practice aren't so fortunate, but perhaps those of us retired or about to retire can at least express our opinions and help the profession.
The statement " I will not sue the NHS" was the final slide of his presentation "Outside the Box". It's safe to presume he was referring to dentistry. But ?. It's interesting how dentists working in the NHS can get sued as individuals, whereas if a hospital has a problem, the NHS gets sued. If a dentist working for a corporate gets sued................ It is a minefield out there.


And talking of mines, the NHS was set up by a miner. Nye Bevan, who left school aged 14 to work in a coal mine. It would be interesting to speculate on what he thinks of our NHS now. One principle was the NHS is free at the point of delivery, so the principle of the NHS has not applied to dentistry for some time. I remember my first boss telling me dentistry was doomed as the fees went up to just over £10, covering all treatment in a system that paid on the item of service. He also advised that I buy added years for the excellent NHS pension. It's why like doctors, I could retire early. It was a long time ago. Back in the 70's our NHS started to be questioned, as in this audiobook.

​





Accidents do happen, or in legal speak, poor outcomes. As you will know we need to point out that we learn from mistakes, as shown by the airline industry and the black box. If an error occurs, it's a learning process. While immediately after a plane crash, human error is deemed responsible, just as with the Boing 737 Max. The company tries to blame the pilot. Humans don't have a black box, and often the maintenance of the body isn't great, and we all respond differently to different assaults to our fuselage, which is why some procedures have poor outcomes. But it isn't always a mistake. Few sue a good outcome following a poor procedure. If we kept having excessive poor outcomes in the past, an RDO could intervene, ideally before the lawyers and the GDC. As outlined in "The Design of Everday Things" by Don Norman, humans often make mistakes and errors due to the working environment, materials, training, and equipment. We aren't brain surgeons, but we try to "Do no Harm", as discussed by Henry Marsh. 


An interesting observation of the air industry development was that the Wright brothers started it with limited resources and education, unlike Samuel Pierpont Langley, who had both. The plane got off the ground by trial and error from a passionate, enthusiastic group, not by the top academics with massive funding. 


Many dentists went down the private route around 2006 with a negative misleading media spin. Most dentists I know went private years ago to provide a better service for their patients. Often for less money. The high earners that everybody heard about were working mainly in the NHS at the time. We could get the media on our side by using existing technology to deliver prevention through our Dental Health Service, provided by general dentists from a bottom-up business model rather than a beurocratic top-down one. We can deliver some basic oral health advice using the technology the public carry with them 24/7. 

---

If we collaborate, we can distribute a free trustworthy resource for the general public. It will cost us buttons as a group. Raising the bar, however slightly, will positively influence the public's general health. That will help reduce the burden on the resources of our NHS. It will also help change the usual hostile media we used to get, which finally seems to be landing with the politicians, not the profession.
No matter which practice you work at good oral hygiene is the basis of good outcomes. The teeth4life App has a traffic light system to engage the user to take ownership of their health. It also help highlight oral and skin cancer awareness. We don't have to work in the NHS system, but we can all support it.


General dentists are nervous about carrying out relatively straightforward procedures because of the potential poor outcomes. As dentistry has "progressed" it has become more specialised so that certain incremental changes in treatment produce minor improvement in outcomes at a much greater cost. Does this serve the general good of the nation? Can we change the perception?


As general dentists working to provide an excellent service, we should not be stressed by the worry of litigation. Invariably there will be occasions when things do not go as either the dentist or the patient would like. If there was a ceiling in the cost of litigation dependent on the service provided. The more you pay for a procedure, the greater the compensation in the rare instance you get a poor outcome. If you are seen on the NHS, that bar should start as low as Kevin suggests. 
All evidence shows you get better outcomes when none of you are stressed; this applies to the dentist and the patient. Spending five minutes talking to your patients, rather than ten, writing up the notes will reduce litigation. There was a case recently where a patient complained six times to the dentist about a persistent ulcer. She mentioned it to the hygienist, who referred her to the hospital. After treatment of the SCC, the upset patient complained. No action was taken against the dentist, as he hadn't written up the notes. 
​
This video I made before I retired, it was a bit controversial, so I used the software to change the language to Spanish using the AI in the software. A future version of a teeth4life App could be available in multiple languages utilising pre-existing AI, or even with your authentic, trusted voice in the videos.