Insights on a changing profession

Dentistry magazine ranked her number five on their 2013 top 50 most influential people in dentistry and she is currently chair of the Education, Ethics and the Dental Team Committee (EEDT) at the British Dental Association. Having qualified from Liverpool Dental School in 1997, she has practised in almost all spheres of dentistry, most recently as principal dental surgeon in Bullingdon Community Prison.

What are the main issues facing dentists today and in the future?
Dentists are all very different and issues vary but one issue we all face is increasing burdens of regulation.This may be due to contracting requirements, professional regulation or changes to legislation.

A constant drive to control, measure and report is undermining the very nature of being a profession. This is not unique to dentistry – we live in a cynical, questioning world where mitigation of perceived risks is taking priority over the traditional values and ultimately our ability to serve our patients.

Uniting and facing the challenge as one profession is key, together with engaging the public directly and ensuring we retain their trust in us.

Are you concerned about the trends thrown up in the latest Dental Working Patterns Survey suggesting dentists are working longer hours, doing more paperwork and taking fewer holidays?
Very concerned. Even on a personal level, in my surgery each year more time is spent on administration, with increasing costs impacting on overall profit. We are risking poor health and increased stress, all dangerous for our patients and their care.

Fair funding for NHS teams and reasonable expectations from commissioning bodies are essential. The BDA continues to fight in this key area. Legislative changes must clearly benefit patient care and be supported by additional funding.

The dental workforce has changed dramatically in recent years. How should the profession adapt?
For about the past 20 years undergraduate dental schools have been admitting increasingly higher proportions of women. Looking at the General Dental Council register we are now a predominantly female profession, with most of our DCP colleagues female.

Research has consistently demonstrated women dentists tend to see fewer patients, spend more time with patients, are less likely to own practices and will take career breaks. Society and legislation have moved to support both partners in relationships with caring responsibilities with paternity leave.

The generally accepted trend is that the profession will be less productive in terms of volume of clinical work and this has significant impact for workforce planning.

More controversially, women tend to be less likely to be involved and join unions. The risks are twofold. Without protection and support, working conditions and remuneration can easily deteriorate. Without engagement from all, representation will become more focused on narrow groups who do get involved. This can become a downward spiral of disengagement from significant sections of the profession, one that would ultimately undermine us all with the loss of negotiating powers and professional support.

There have been increasing calls for CPD to be more “valuable”. How can it be improved?
Professional development is fundamental to being a dentist and has been codified by our regulator. However, the basic tenet of ensuring we are fit to practise and develop new skills cannot be divorced from being a professional and should not be undermined by legislation. Reducing CPD to merely counting hours or, worse, a narrow range of subjects was not the intention of the legislation but has sadly been one of the results to date.

CPD must be owned and directed by the individual. Some form of protected time and regular review would also be the ideal. We are at a crossroads. The changes that are currently being proposed to our existing CPD scheme are a clear step towards revalidation, an area for which our medical colleagues have had financial support. The changes must be reasonable, relevant and not add to the burden or regulatory red tape that our profession is increasingly suffering from.

Are increasing patient expectations putting pressure on dentists?
The trend of patients engaging fully in their care is not in itself a pressure but a reasonable development in society’s attitudes. The informed patient is often a joy to work with and the classic Parsonian role is less common now. This is helpful because working in partnership with patients engenders mutual respect and engagement, with better health outcomes and fewer complaints.

The pressure perhaps comes from some patients expecting unreasonable results driven by partial information, usually from the media, a desire for quick fixes and a consumer mindset.

What is prison dentistry like?
I initially got involved by accident, due to a job offer, but it soon became an area that was interesting and challenging. We all manage demanding patients: fear is often the biggest issue and prison is no different. Our patients have very poor oral health and minimal experience of dental care in general. They attend in severe pain or with infections – breaking the cycle is essential to improving their health. Through education, we aim to empower our patients to take charge of their health and understand their decisions. Chaotic lives, addictions and mental health problems combine to offer very challenging patient management needs. It is incredibly rewarding when we do see improvement and engagement.

As a regular Twitter user, is social media a valuable professional tool?
The GDC guidance is there to ensure a practitioner’s social media presence is professional with some very robust warnings to registrants, but the realities are very different in my view. This relatively new form of communication is changing the way we all express ourselves and I believe there are huge opportunities for patient engagement on open social media platforms

For me, using social media simply as a means to disseminate information rather misses the point. The value both to individuals and organisations is the interaction, building relationships and debate. When we use social media, we must always be conscious of our responsibility to patient confidentiality and our profession, just as we do in normal life.

You have been named among the most influential people in dentistry. Are there particular ways in which you have helped shape the profession?
Many of the issues are ongoing and develop over time, the work is never complete. Most issues are interrelated and very complex and the key is to be well-informed and aware of the potential future developments. Influencing these takes huge amounts of time and patience. To name or take credit for a particular subject would be disingenuous as it’s always a team of BDA staff and dentist colleagues on committee.

Tell us about your work with the BDA.
The EEDT Chair is an additional responsibility to being an elected member of the BDA principal executive committee. We cover a huge variety of interlinked areas. Highest profile areas would be regulatory issues and GDC, foundation training and workforce planning. Almost all issues have an ethical dimension and so the remit of the group enables us to explore and become involved in all aspects of our profession.

Describe a typical working week.
Each week is very different and never typical. My clinical work is usually across three or four days, most evenings and weekends are devoted to BDA work, with usually a day of physical meetings in London. The vast majority of my work is electronic - it’s difficult to comprehend the time before email, perhaps the world moved at a slower pace.

Interview by Joanne Curran, associate editor of MDDUS publications