As we enter 2012, most practices in Northern Ireland will have their sights set on November, the date when all practices must comply with the Best Practice requirements of HTM 01-05.

In Scotland, where remaining practices which required either a change of location or major building work must comply by the end of the year. In stark contrast, England, no date has yet been set for Best Practice. And in Wales compliance with Essential Quality Requirements will not be expected until April!

What a mess – it’s almost worthy of a Monty Python sketch! And it’s one we’ve raised with Health Departments in the past and currently with the OFT who are looking at regulation in the context of dental practice.

Their report is due out in March and it will be interesting to see what they say.

Denplan has a detailed Decontamination Manual specifically designed for Northern Ireland, which contains many helpful checklists and templates.

If you don’t have an online log-in already (most do) then please get in touch with your Practice Support Advisor  here at Denplan on 0800 328 3223. The Professional Services team are also happy to deal with any individual queries on this topic – you can call them free on 0800 587 1097.

Northern Ireland RQIA Registration

This continues to dominate in Northern Ireland and the RQIA advise that they will be visiting all applicant practices for the purpose of carrying out general pre-registration inspections between June 2011 and March 2012 so it’s likely that some of you haven’t yet been seen.

After that all dental practices will have an annual inspection, which may in the future, concentrate on specific areas such as patient records or dental radiography.

If you are still waiting for your visit then Denplan have produced an excellent RQIA Inspection Guidance Manual which is available online. Another resource from Denplan which you will need is an enhanced Access NI criminal records check. Denplan can arrange for a check to be undertaken on practice staff for a fee of £57.50 + VAT, please contact the Denplan Quality team on  0800 587 1097 or e-mail rqia@denplan.co.uk

It does seem that the CQC may look at any of the 28 Essential Standards of Quality and Safety and not just the 16 standards that required a declaration of compliance, or otherwise, as part of the application process. Most of the other Standards were in effect covered during the application, such as having a Statement of Purpose or the need to appoint a Registered Manager.

How to prepare for an inspection

During inspections, some dentists and their teams have been asked under what circumstances the CQC should be advised of issues arising at the practice. Such notifiable events include significant injuries or death of a patient, abuse of a patient, police involvement in connection with a missing person’s enquiry, assault, theft and service interruptions. All these events are highly unlikely, however, the regulations also require the CQC to be notified if the Provider or Registered Manager is absent from the practice for more than 28 days.

CQC Inspectors may also question staff, or indeed patients, about fees. A fees policy that all the team are conversant with is very useful. The policy should cover, and help patients to understand, treatment fees, payment terms, methods of payment, explanations, receipting and estimates.

Guidance from Denplan

This is by no means an exhaustive list of all the requirements that the CQC may discuss with practices during a visit. However, in light of recent learning, the Denplan guidance entitled ‘An Inspector Calls’ has been updated. To view this guidance on how to prepare for a CQC Inspection, alongside a wealth of information, templates, policies and protocols for all aspects of regulation and legislation, log on to your Denplan Online Account.

Interactive Workshops

We are also providing an interactive workshop, CQC Essentials, which will provide you with an overview of all 16 CQC standards, with an in-depth focus on confidentiality and data protection, child protection and vulnerable adults and equality and diversity. It includes practical and interactive ways to help you and your team understand on-going monitoring by the CQC in England and will equip dental teams with the confidence to answer questions when the inspector visits – definitely one not to be missed!

Further details and pricing is available at the Denplan Training and Events website.

Sarah Bradbury discusses the benefits of finding out what your patients think of your practice.

Communicating with customers is one of the most important things to get to grips with in business life. So, to get an idea of what your patients really want, why not consider using a quick survey?

This can be one of the most valuable and important audits you can perform because it can not only be completed in your waiting room, but can give you a really useful overview of your practice and an idea of where to go in the future. 

The right questions

By thinking about what you want to find out in your survey, you can then ask the most appropriate questions. For example, you could ask your patients to grade how they rate your customer service on a scale of one to 10 and break this down further into areas of attitude, listening, explaining and communication. Asking questions which only require a ‘yes’ or ‘no’ answer are not going to give you much insight and asking ‘textbook’ questions will only result in getting textbook answers and will not tell you much. In order to get the most objective results to your survey, it’s also worth making it anonymous and putting a box in reception to collect the questionnaires. People are far more likely to be open and honest if there is no chance of repercussions.

Some payment plan specialists, such as Denplan, can not only help you put together your patient survey, but they can also offer a ‘mystery shopper’ service to rate your levels of customer service against those of your competitors, so you know what competition you face in maintaining patient loyalty. Tailor-made training courses are also available on topics such as customer care and complaints handling, which can all be invaluable when looking to retain and grow your patient base.  

Promote good feedback

You can even use the results of your patient survey to promote your practice, as great statistics offer really powerful messages to both existing and potential patients. Finding out what your target audience reads, watches or listens to will really pay dividends and will make the relationship with your target media more successful. And the best thing is…you can include this type of question in your survey!

Having identified publications you would like to appear in, it’s worth looking at what types of articles they feature and a few quick calls to introduce yourself to news-editors and journalists can be of great benefit. However, before submitting anything, always ask yourself ‘what’s in it for the reader’? This can help you create more valuable and informative copy, which is far more likely to be published. 

Some payment plan specialists also offer free PR services to their members, to not only write up news releases, but to research the most relevant media and liaise with them on your behalf.

Cycle of success

By promoting your survey findings, either to your local press or in your practice newsletter or literature, you are ensuring that the right people are seeing the right messages.  This means you are getting a good return on your investment, as this communication can often lead to the retention for your existing patients and the interest of potential new ones. You could also do a follow up survey the following year to see if your improvements and changes have paid off.

In addition to your patient survey, it may be worth asking any new patients to fill out a short questionnaire. This way you can record how and where people heard about you, which will, in turn, give you a good idea on where to focus your marketing activity in the future and where your current patients are likely to see your latest news. You could also offer some kind of tangible incentive to encourage your patients to refer you to a friend. 

Patient surveys can help you unlock what your patients really think about you. So, if you’ve been bogged down with regulation and recession over the last year, now is the time to reach out to your patients and drive forward your business once more.

Dentists tend to regard whatever is left in the bank at the end of the month as ‘profit’. This is after paying the rent, the staff wages, the lab bills, the associates etc and there’s often not much left in the pot.

However, making small changes to your practice and the way in which you set your fees and view your worth can have a huge impact on your business, not only ensuring that your practice is successful, but actually increasing profitability in the long run.

Fees

Setting appropriate fees is key in this process. It’s no good looking at all your outgoings then charging patients enough to cover them. This may work for a while, but with the current economic climate anything but stable, patients are sure to be shopping around. 

Therefore, it’s a good idea to investigate competitor prices in your local area – including supermarket and pharmacy prices for sundries. That way you will have a firm knowledge of pricing and where you stand, so you know what to say when someone says: “They’re cheaper in the supermarket”.

Some payment plan specialists can give you a comprehensive overview of your practices outgoings, including salaries and overheads, to advise you how much you should be charging for check-ups and various treatments.

It’s also worth bearing in mind that private fee-per-item patients are more likely to cancel or delay a check-up, than those patients with a monthly payment-plan. In fact, 31 per cent of people said that they would reconsider cancelling a dental appointment if they had a dental payment plan[1].  

Wages

In my opinion, the fact that the majority of practice owners simply view whatever is left at the end of each month as their profit is potentially risky.  It means that during difficult financial times or even on a ‘slow month’ there isn’t actually anything there to pay themselves – and the overdraft grows!

Now many business owners may simply conclude that ‘such is life’ in business and they must take the rough with the smooth. However, this is not the way most larger businesses operate and, by making very small changes, principals can ensure they make profits and get paid.

Firstly, it’s important that that every dental practice owner should pay themselves a ‘wage’. This should be based on your worth, including not only your clinical time but any additional time you spend on non-clinical work (evenings and weekends etc). This should then be transferred out of the practice accounts.  Only then should you view what’s left as ‘profit’. This view is shared with many dental professionals as well as experts in the accountancy world.  

At the end of the year, this profit should equate to at least 10% of the embedded value of the practice. So if a practice has a turnover of £300,000; that would give a goodwill valuation of about £280,000 plus fixed assets like equipment etc. The profit should, therefore, equate to something like £30,000+ each year – after paying the owner. This value should then be incorporated by your accountant in the net worth figure of the business on the balance sheet.

If your sums are not adding up quite so tidily after the first  few months, it’s probably time to make some changes and there are plenty of things you can do with little investment to achieve profitability.

Products

Your products are your practice, but without product knowledge, selling is virtually impossible.

Therefore it’s worth sitting down with your team and thinking about what things you could sell more of and the benefits of them to your customers. You could then develop a kind of ‘practice menu’ to show patients what you offer. This is different from a price list in that it sells the products to the patient based on the benefits of the product, rather than just an explanation of what it is.

You could also offer some kind of tangible incentive to encourage your patients to refer you to a friend.  Many practices fail to ask for referrals because they feel it makes them look ‘desperate’ for patients, but the trick is in the way you ask. Why not say “We’re currently in a position to accept new patients…” instead?   

Sales

Selling is not designed to push something on someone or to trick them into buying something they don’t need. Neither is it about trying to make as much money as you can out of your customer base. Ethical selling is about offering patients products and services you genuinely think they can benefit from and you don’t have to be a pushy sales person to make it happen.

Do you know:

• What patients you have in your practice?
• Where they live?
• How many you have lost or gained?
• How many are paying privately or on a payment plan?

Knowing this information is important for all team members, so they’re able to correlate their activities to the results you want to achieve. Simply handing someone a leaflet isn’t going to help you to sell – it’s up to you and your team to open your mouths and let the patient know what you feel are the best options for them.

Research shows that when patients were asked the question: “If we were able to save you money or provide you with a better service, would you want us to let you know?” – 91% of people said ‘yes’. This is not forcing your products and services down people’s throats, but giving the patients what they’ve asked for.

To get an idea of what your patients really want, why not consider using a quick survey to ascertain your patients’ attitudes. This can be completed in the waiting room and can give you an invaluable insight into where to take your practice to achieve the most profitable future.

It’s clear that making a few subtle changes to the way in which you view your business and how you sell yourself can have real benefits for the profitability of your practice, letting you get back to the patient-focussed care that you trained for.

The information above are just some ideas to get you started, but it’s important to remember that help is out there for anyone who worries about that increasing overdraft! Making the most of the opportunity, I will leave in your very capable hands.

[1] Denplan Dental Benefits Survey 2011

Louis Mackenzie describes how Minimum Intervention (MI) concepts are applied in general dental practice.

MI dentistry is a philosophy of patient care that has three main aims:

• The first is to do everything possible to prevent our old adversaries of caries and periodontal disease from doing any damage in the first place.
• The second comes into play if the first doesn’t work and involves early detection; diagnosis of disease activity and, if possible, non-operative management.
• The third aim arises when we do need to open the instrument drawer and employs a wide range  of minimally invasive techniques, all with the objective of providing the maximum benefit for the patient, while doing the minimum amount of dentistry and the least amount of harm.

Do no harm

In my opinion, the vast majority of private dentists are already practicing MI dentistry. Just making the move away from the ‘finding things to do’ philosophy which defines every NHS remuneration contract, provides a refreshing perspective and enables a more thoughtful and enjoyable approach to patient care.

Furthermore, dentists who have been caring for the same patients over a number of years are presented with an irrefutable evidence base, every time a patient opens their mouth for examination. This allows reflection on what works and more importantly what doesn’t work in the long term. I have been in the same practice now for over 20 years and firmly believe that many traditional operative techniques can be very bad for the teeth!

Prevention

In MI, prevention not only refers to traditional methods of preventing disease, but also encompasses prevention of the dentistry that might be visited upon the unsuspecting teeth and gums if disease does occur. Even a cursory study of the longevity/failure rates for both direct and indirect restorations makes for very bleak reading.

While we know that nothing we do lasts forever, when it comes to restorative dentistry, forever can be a very short time. Making prevention the main focus of our individual practices will be very popular with patients and in addition presents ideal opportunities for a whole team approach to dental care.

Promoting the MI message can help to differentiate the care and support offered to patients. Advertising contemporary, evidence-based MI dentistry not only reassures existing patients, but will attract new patient enquiries. Forward thinking payment plan specialists now offer patient-facing materials and provide verifiable CPD courses, with lectures and interactive hands-on seminars outlining how to integrate MI into practice,

Detection and diagnosis

As dentists we’re brilliantly trained to spot what’s wrong and, given long enough to look into a patient’s mouth, we will probably find a restoration that could be replaced, or improved upon, or a tantalising early lesion begging for an appointment with some high-speed diamonds.

The real skill and satisfaction in MI dentistry comes from having the time to detect problems early and correctly diagnose when non-operative techniques, or restoration repair, will provide the best long-term solution for the patient.

Minimally invasive dentistry

Despite best intentions, operative dentistry will always form a large part of our working day as restorations fail, cusps fracture, pulps die and patients somehow fail to be motivated by our pleas for exquisite oral hygiene.

Here, MI concepts transform clinical dentistry, allowing treatment plans to be entirely based upon biological principles and a thorough understanding of disease processes, rather then the mechanical principles required for traditional restorative techniques. It has been proved beyond doubt that non-cavitated carious lesions may be arrested and that sealing and maintaining a seal over incipient lesions will stop the disease. Likewise, early detection and management of periodontal disease can restore supporting tissues to perfect health.

Recent developments in dental materials and equipment are revolutionising restorative dentistry, as more and more dentists worldwide adopt direct composite as their material of choice. Contemporary adhesive techniques (both direct and indirect) promote conservative dentistry, which respects and preserves the maximum amount of natural tooth tissue. Cavity preparations may be confined solely to the visualisation and removal of disease without the need for further resistance and retention form.

Management of deeper carious lesions has evolved remarkably over the last 20 years. Contemporary excavation focuses primarily on the preservation of pulpal health, by removing only irreversibly demineralised tissue, safe in the knowledge that the dentine-pulp complex has an almost ‘Rambo-like’ capacity for self repair.

Minimally invasive dentistry is not only concerned with the teeth we are working on. Operative procedures are plagued by iatrogenic damage to healthy adjacent tooth tissues. Crowns and proximal box preparations are the worst offenders, with various studies recording damage to adjacent teeth ranging from 64 to 100 percent of cases. Careful use of a variety of techniques can reduce this incidence and help prevent unnecessary treatment in the future.

It’s a well established fact that we all form different opinions while studying the same clinical situation. While an ‘unified theory of dentistry’ will never be a reality (and would be quite boring!), placing MI concepts at the centre of all our clinical dentistry makes for a much more rewarding, refined and enjoyable experience for patients, dentists and team members alike.

Having been part of the global AXA group for 12 years it has been announced today that Denplan will be leaving AXA and becoming part of Simplyhealth. Simplyhealth is committed to Denplan’s brand and strategy of providing a full range of added value services and support to dentists, practice teams, patients, brokers, businesses and independent schools.

Denplan’s Managing Director, Steve Gates commented: “We are confident that we will benefit from the fact that Simplyhealth is solely focused on health, as well as being a UK based organisation based on mutual principles which shares the same values and ethos as Denplan.”

As the UK’s largest provider of health cash plans Simplyhealth has a rapidly growing presence in the private medical insurance market and this new relationship with Denplan gives Simplyhealth the opportunity to become better known for providing services to dentists and help more patients with their dental health.

Des Benjamin, CEO of Simplyhealth also commented on the acquisition: “Over the past ten years, Simplyhealth has been on a path of growth and diversification. By joining with companies that share common values, we have been building a strong organisation for the future that can help more people, in more ways, to look after their health. Our goal is to become an important, high quality part of the new health system as it emerges over the next few years. The acquisition of Denplan is an important step on this journey.

“Denplan will find a strong and natural, strategic home within Simplyhealth. Both companies share a strong focus on customer service based on a fundamental belief in helping people access high quality healthcare and a culture and ethos which promotes staff engagement.”

Dentists and their teams can be reassured that they will still benefit from access to the resources, guidance, staff and support of Denplan’s national consumer facing brand, all from the head office in Winchester.

Steve continued: “This change also provides Denplan with some very exciting opportunities to further enhance the services and support that we can provide our dentist and patient members. As we go forward into 2012, our absolute focus will remain on supporting them.”

For more information about Simplyhealth, please visit www.simplyhealth.co.uk

We all know gym membership in January goes up as people start to “feel the pinch”(literally) from over-indulgence during the Christmas festivities, hence gyms will do much of their marketing in this month to encourage us to join.

For practices, January can be a month when many consumers are looking at their direct debits and how they can reduce their costs. It’s an ideal time to market the benefits of budgeting for your dental care.  Continue to show your existing patients the value of their Denplan membership and the value of being a patient of yours.

This can be done with literature in your practice highlighting the benefits and showing price comparisons. Use Denplan CommsBuilder to design your own literature and make it personal to you.
Many practices now use “what you would have paid today” statements. These can work with both your Denplan patients and the PFPI patients who you would like to encourage to join Denplan. If you are not already using them ask your consultant for advice.

What do you do if a patient rings to cancel their membership because they are “feeling the pinch”?

• Empathise with them, show them you understand
• Try to ensure that cost is the only reason they are thinking of leaving you
• Ask questions like “ May I ask what arrangements you have in mind for your future dental care
• If they answer “I would like to stay with you as a private patient and pay as I go”, offer to send them a copy of your fees but look back on their records and let them know what the cost would have been for treatment they have received had they not been on Denplan
• Promote the benefits of budgeting and break down the costs for them by perhaps working out how much a day they are paying. Compare to cost of newspapers/magazines etc
• If you have other plans available (i.e. Care, Essentials, Membership) tell them the benefits of being in a plan rather than just paying as they go. People like to have payment options and if you would like more information ask your consultant for advice
• Above all sell in the benefits of being a patient at your practice and the benefits of regular attendance and preventative dental care

Always remember Denplan is here to support you. Some of the initiatives we have in place are:

• If we have your e-mail address we can e-mail you when one of your patients cancels at Denplan. This enables you to contact the patient sooner
• If one of your patients calls to cancel their Denplan membership we can see what other products you offer and with your permission offer an alternative to retain them at your practice.

Finally, from everybody on the Champions team at Denplan we would like to wish you all a very merry Christmas and a happy New Year. We look forward to working with you all in 2012.

Associate earnings lower

As usual this misses the point (and indeed distorts it). The article failed to point out that Associates – who outnumber practice-owning dentists by a factor of more than two to one – by and large, earn significantly less than this, at around £65,000 a fall of more than three per cent over 2008-9 figures.

Rising expenses

It also failed to point out that practice owners, who have shouldered the greatest expenses in complying with CQC and HTM, have also suffered a loss of net income compared to the previous year.

Despite this, gross income did rise slightly at this time, but as the above figures demonstrate, more and more of practice revenue goes into the expenses element, to meet not only the regulatory costs, but also the rising cost of staff wages following the mandatory introduction of registration for dental nurses in the previous year.

Materials, laboratory and capital equipment costs are also rising steeply, as the pound has suffered against the dollar and euro, with most of these items being imports.

Income from all sources

There is always the implication, too, that at a time of constrained NHS expenditure, dentists are profiting unduly. This entirely misses the point that the figures used in the report include private fees and indeed income from all sources, and that the private dental market has continued to grow over time.

Unfair targeting

There are, I’m sure, many readers who like me have had occasion to use legal services recently and who recognise that such fees will frequently be based on hourly charging rates in excess of £200 (and significantly more in many cases).

Our legal colleagues do not have the technical and regulatory expenses and overheads we face, but I have yet to see an OFT market report challenging lawyers’ costs. It’s all too easy to target our profession, it seems to me.

You’ll recall that a furore was created when one of these private treatment options turned out to be provided by a company wholly owned by the GP partners themselves. The PCT immediately issued a statement that while it did not intend to: “…routinely commission these services” (such as in-growing toenails and wart removal), it “recognised there may be exceptions”.

This brought to mind past official statements that while dental implants may not be available routinely, there may be patients for whom such treatment could exceptionally be provided at specialist centres and therefore it was not possible for dentists to state that they were not available on the NHS.

Privileges for dentists?

The GP story did however remind me that in some ways, NHS dentists, even in these nGDS contractual times, still enjoy some privileges that are denied to their medical colleagues, who are unfortunate enough to have to inform their PCT in advance, I understand, of any suggestion to patients that private alternatives might be available.

However, this might be a path down which dentists might have to trail their GP friends (unlike CQC where the traffic was the other way).

Leading campaigner against conflicts of interest

The President of the Royal College of GPs has become a leading campaigner against the current trend towards Clinical Commissioning Groups (aka GP Consortia) towards which the Health and Social Care Bill is moving.

She rightly points to the conflicts of interest that will soon affect all medical practitioners. Not only will they be directly in the front line of health care rationing – distasteful in itself – they will also, if they are legally a part of a ‘willing independent provider’ find themselves obliged to put forward alternatives to patients, like the York practice, which potentially could add to their earnings. That patients might benefit from such choices is immaterial.

Current dentistry pilots

In dentistry, the current pilots suggest that dentists might be spared such raw rationing decisions, saved in this instance, by the chairside computer. No longer will dentists say (usually around the beginning of March each year) “I’m sorry, but I have no UDAs left to carry out your treatment on the NHS”. Instead, their practice software will dictate what treatments are, or are not available to a patient with a particular oral health risk profile.

Some pilot practices are experimenting with a ‘pot’ of funding for advanced care (which in this context means metal-based dentures, endodontics, advanced periodontal treatment and indirect restorations). If this particular aspect of the pilots makes it through to the new contract, one can expect that such a pot will be invariably used up within its allocated year, when further such treatment will not be possible on the NHS.

But here the lessons of York may be salutary, for whoever is (by then) actually commissioning dentistry may be able to say “Well it’s not routinely available, but if we say so then it is”, and yet another (dental) practitioner will find themselves in the dock in the court of summary media justice and social outcasting.

Healthcare rationing already a fact

The blunt fact is – although no-one wants to say so – that healthcare rationing is a fact. It may be disguised as waiting lists, commissioning decisions, NICE rulings or simple contractual exclusions, but it is a necessity of any public health funding that does not eventually go on to bankrupt its population.

We laugh now when we look back at the 1940s concept, as espoused by Nye Bevan – that when good health care was made available free of charge to the entire population, widespread sickness would drop and the NHS budget could therefore be reduced in the coming decades. But that was the view.

Clinicians on the front line

For many years, funding has allowed clinicians to be remote from rationing decisions. Faceless NHS managers have most recently been in the firing line when such activity takes place and suffering patients are championed in the headlines. Little wonder that while clinicians are mostly praised, managers come in for public criticism.

Maybe they’ve had enough. Or maybe this Government just wants to encourage frank exchanges between practitioners and their patients. Either way –and even with a computer system to cleverly make the decisions for us – telling it straight to patients is going to become a whole lot harder to manage. Even without Dispatches!

We were founded in 1986 as the first dental payment plan specialist. This year we  mark 25 years of patient guidance and practice support by hosting company-wide celebrations from our head office in Winchester.

We revolutionised private dental care in 1986 and our heritage of support has resulted in more than 6,500 member dentists across the UK – caring for around 1.8 million patients.

Our Birthday Celebrations

To celebrate all of our achievements over the last 25 years, we held an 80’s theme day for our employees on the 14th October, where staff were delighted with birthday cakes, presents, 80’s fancy dress and a big ‘thank you’ from our Managing Director, Steve Gates.

Steve commented:

“I firmly believe that a business is only as good as its people and Denplan could not ask for a more passionate, dedicated and professional team. I’ve been Managing Director since 2001, and I’ve seen the Denplan team rise to new challenges and challenging times many times over – as well as seeing all their hard work pay off. Denplan could not offer the incredible service and support to its members without them and I congratulate them and thank them from the bottom of my heart. Happy Birthday Denplan…here’s to another 25 years!”

We  shine as a leading employer in Winchester

Steve Brine, a member of the All-Party Dentistry Group in Parliament, said: “Denplan is a key employer in Winchester so I’m keen to maintain an excellent relationship with them and to help where I can. I was struck by how friendly and welcoming everyone was and the 80’s dress code was the icing on the cake. If I’d known this celebration was taking place I would have donned a white boiler suit and gone as Doc Brown from the brilliant Back to the Future films but maybe that’s for another day!”