Dental Tribune United Kingdom Edition

15CommentFebruary 27-March 4, 2012United Kingdom Edition msc_ad_source_uk.pdf 1 03/08/2009 15:21:59 system, on a practical level many of these options are about as useful as a chocolate teapot. Unfortunately dentistry costs money; it is expensive and always has been. I think it is very unfair to place the new- est members of our profession into the untenable position of having to choose between 1) earning a living by playing the UDA game and 2) treating pa- tients as they were taught to do in dental school. Whatever happened to the concept of a fair day’s wage for a fair day’s work? I have mentioned the con- cerns surrounding litigation and clinical decision making for associates (as well as the profession as a whole). But why has this become such a concern? Well historically the legal standard by which health- care professionals were judged was based on that of the ‘Bolam test’ (Bolam vs Friern Hospi- tal Management Committee, 1957) which stated that “if a doctor reaches the standard of a responsible body of medical opinion, he is not negligent”. In this regard, one could ar- gue that a responsible body of dental opinion could be used to defend the standard of clini- cal care within NHS dentistry. Except that the Bolam case is now largely outdated following the ruling made by the House of Lords in the Bolitho v. City and Hackney Health Authority (1997), which has been seen as a departure from the Bolam test, whereby the standard of care was judged based on a sound body of expert opinion. This effectively means that, just because others in the pro- fession would have made the same decision, that alone is not enough to justify the standard of clinical care. Associates are therefore being judged by the very highest of standards, but it is clear to most of us working within the NHS that the capped funding system is often unable to deliver what experts might consider best practice, no mat- ter how much we want to be- lieve in the principle of ‘swings and roundabouts’ – sometimes associates can feel like they are faced with a terrible vicious cir- cle where they are confronted with endless roundabouts and, despite their dental school edu- cation and training, be pushed to make a living. This is surely not a fair way for associates to have to work. So what about the future for associates? Well hopefully many of these issues will be addressed by the new contract; through the current pilots we have a unique opportunity to test this in practice. Whether or not things will improve for the profession will depend on a number of factors, key ques- tions being: is fair for den- tists, fair for patients and is it financially sustainable by the NHS? Furthermore, will it provide a fair day’s wage for a fair day’s work for all mem- bers of our profession? Associ- ates have suffered a great deal since 2006. They have been manoeuvred into a very vul- nerable position, where prac- tice owners have the dominant role, setting targets and UDA rates to achieve their business goals, where associates have to aspire to the very highest standards on only limited fund- ing and where at the same time the culture of litigation is grow- ing exponentially. We need to see far more support for associ- ates, far more fairness and far more clear and realistic expec- tations. Let’s see what the new contract will offer. I’m on ten- terhooks. DT About the author Neel Kothari qualified as a den- tist from Bristol University Dental School in 2005, and currently works in Sawston, Cam- bridge as a princi- pal dentist at High Street Dental Prac- tice. He has completed a year-long postgraduate certificate in implantol- ogy and is currently undertaking the Diploma in Implantology at UCL’s Eastman Dental Institute. ‘Whatever happened to the concept of a fair day’s wage for a fair day’s work?’