I’m not listening

Since this is the time for new year resolutions, here’s one for you. The current default ‘gloom and doom’ state of the UK media may be squeezing every last drop of confidence and optimism out of the UK economy, but I would suggest that we could collectively agree to take no notice of all this gloom-mongering and instead surround ourselves in a bubble of positivity.

On the Newtonian basis that for every action there is a reaction, we know that whenever there is a bad news story somewhere, there is an equivalent good news story somewhere else – which is why the media consistently goes searching for second and third bad new stories of a similar nature to any first bad news story that they uncover. Good news, it seems, is no news.

Falling interest rates are great news for borrowers (and especially those that are heavily borrowed) but they are less good news for savers. The reverse is also true, of course.
As the property market continues to slide downwards, it’s bad news for sellers, investors, estate agents and conveyancers, but very good news for buyers and companies in the home improvement and DIY market. The majority of sellers are, incidentally, also buyers and, as some other sage pointed out, all things are relative.

As more patients start to feel the pinch, and/or qualify for exemption/remission of NHS patient charges, this might actually be good news for many NHS practices. But it’s bad news for some mixed practices who are desperately trying to grow their private sector, and find that patients who may just have been in the market for some private treatment, will think again.

But what the TV and newspapers will never tell you – because it’s a rotten story – is that some people do exceptionally well at times when others are suffering badly. Many private dental practices that cater for these very people (i.e. the winners in the above equation) will not even be able to spell the word ‘downturn’ let alone understand it.

The practice that is highly geared (i.e. heavily borrowed in relation to assets) will not benefit from the fall in property values, but they will significantly benefit from the dramatic fall in interest rates and the recent modest lowering of the rate of VAT. Dentists gain disproportionately from the latter
because of our zero-rated VAT status that prevents us from recovering input VAT.

When every news story is of job losses, redundancies and company collapses, employees of other, less-exposed businesses might attach a greater value to their own job and the security they enjoy from it. Sensible businesses don’t abuse or take advantage of this fact, but they do try hard to obtain leverage from it. Is it not time that we all stopped listening to the relentless negativity of the media, and started concentrating on making our own business as successful as it can possibly be? In dentistry, we achieve this one patient at a time, one visit at a time.

Travelling through London in a taxi the other day, in the run-up to Christmas, I was having my
customary conversation with the cabby (aka the source of all human knowledge and opinion and a refreshing alternative to the evidence base).

He drew my attention to the fact that although the streets were full of people, remarkably few of them were carrying any shopping bags laden with Christmas purchases. He was absolutely right, and he went on to express his gratitude for the fact that cabbies don’t have to endure ‘window shopping’. If the punters flag them down and get in, then there is nothing left to sell.  They’re in business. It’s like that in dentistry in a roundabout kind of way (excuse the motoring pun), although I grant you that some dentists manage to ‘find’ more work to do than others.

But don’t tell me that it isn’t the same when your car was last being serviced (or some household repair was last being carried out). And while we are on the subject, the recent TV ‘rent-a-gob’ programme was actually quite restrained, I thought, by previous standards. You would have thought that even TV reporters and their producers would by now be saying ‘Done that.  Move on’. Obviously not.

The danger of a downturn in a fee-per-item environment is that dentists’ motives are called into question if they prescribe more (rather than less) treatment. For NHS practitioners, their motives may still be called into question if they end up providing less treatment when being paid by block payment. Indeed, this very suggestion has only recently been made by the Department of Health along with the regularly repeated allegations of dentists ‘splitting’ courses of treatment to the detriment of patients and to enable UDA targets to be met without improving access.
In a fee-per-item system (which still exists in Scotland and Northern Ireland, even in the NHS, of
course, although only privately in England and Wales) the standard ‘downturn’ response patients – which is to extend treatment intervals and perhaps postpone treatment – doesn’t help the practice finances.

But in a ‘block payment’ system (as currently exists in the NHS in England and Wales) a less frequent attendance by NHS charge – paying patients might well be more than matched by a recovery in attendance amongst exempt and remitted groups.

Whether or not this becomes an extended period of hard labour in Band 2 at 3 UDAs a time, varies from one area to another. But if patients slightly defer their attendance in a private capitation scheme the patients are happy, the practice is happy and our friends at NICE are (presumably) ecstatic. Further proof that no matter how dark the clouds overhead, there is always room for celebration somewhere on the planet.

Let’s have a little more of it in 2009 please. There are many, many people out there a lot worse off than us.

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