It was perhaps surprising that there were few mentions in the national press about the tragic suicide of a dentist in Leeds. This is particularly so, when the inquest heard reports that in the few days prior to his death the dentist felt harassed and bullied by ‘NHS chiefs’.
In previous issues I have been vocal with criticism of the British Dental Association, but on this occasion its response was absolutely right. The chair of GDPC wrote to Earl Howe, the Minister with responsibility for dentistry, asking him to conduct an independent inquiry into the events leading up to the tragedy, and seeking assurance that those responsible for dentistry within the new NHS structures make sure that when they investigate concerns the practice staff are given details of support that may be available.
For let’s not be under any illusions, the powers that the NHS has are considerable. It controls and manages performer lists, and removal from these lists means a practitioner cannot provide NHS care. For many, this will threaten practice viability and the livelihood of the dentist but this may only be the start of problems. I understand that primary care trust staff sometimes mentioned the possibility of GDC referral if full cooperation was not forthcoming. It’s hardly surprising then, that dentists who find themselves the subject of scrutiny by outside bodies such as PCTs, their successors or the CQC, find the stress almost intolerable. That is why the BDA is right to point out that when investigations are necessary, and they will be from time to time, that those under the microscope should be pointed in the direction of help, support and assistance. This might come from the indemnity providers, the Local Dental Committees, or the BDA, but it is important that support is made available.
The Mid-Staffordshire Inquiry has shown that there has been a culture of bullying and harassment at almost endemic levels within the NHS as targets are relentlessly pursued, coupled with an obsession for reducing costs. This culture must change, and must change from the top.
Dentistry has not been immune, as we have seen so often. Every opportunity has been taken by PCTs to reduce the UDA values paid for service without recognition that safe and good quality service cannot be provided cheaply. A change of ownership is often accompanied by a reduction in UDA price. Many contracts exist with unworkable UDA targets at unrealistic costs, piling pressure on the dentists and their teams. It is true that sometimes dentists themselves have accepted these unrealistic conditions to gain entry to the market, but we cannot ignore the fact that commissioning that only looks at price is incredibly unwise. Dentists of course are professionally accountable for their ethics as they seek to deliver care under any contract, but irresponsible commissioning plays a part in producing pressures on practitioners that are completely unacceptable.
The profession in England is watching with interest the development and pilots of new ways of working that hopefully will enable quality care to be provided. But in this interim period, dentists are still struggling with the malign effects of the 2006 contract. The LDC Conference at the beginning of June endorsed the BDA’s call for an inquiry, but they also called for interim changes to reduce pressure on dentists in the meantime, and an end to bullying behaviour by the NHS.
NHS England now has the responsibility for commissioning dentistry and managing the performance against the provisions of the existing contracts. It must recognise its duty of care towards the providers of dental services and the need for sensible management and commissioning.
The Minister has an opportunity to reject the bullying culture where it exists. I hopes his inquiry will be thorough. There must be no whitewash, and the need for change should be made clear.