Stand up, speak up, shut up

We all have our own individual learning style and, when I went to work for a defence organisation some years ago, I realised that mine was the ‘kitchen towel-style’ – thick, but very absorbent.

There was a lot of new information to take on board then, and I recall being instructed in the action to take when appearing in court, before the GDC or in a disciplinary case. The secret, I was told, was to answer the exact question posed and to avoid, at all costs, the temptation to add any extraneous comments or opinions.

I’m sure that similar advice is offered to members of the government front bench, when responding to those tricky questions thrown at them by the opposition. In fact, I guess that there is a sort of ministerial training school which irons out any tendency to rabbit on, and to maintain the kind of measured calm which is evident from the transcripts of debates in the Houses of Parliament.

So, it was with some surprise (and then concern) that I read the report of a recent innocent-sounding exchange in the Commons. Mark Lancaster (Conservative, Milton Keynes North East) asked what the Health Department’s response would be to the BDA’s proposals for amending the Warburton NHS dental contract.

I have little doubt that Mr Lancaster has actually gone into the detail of this new (new) contract on his own account, but this question was prompted by the association itself – and the reply was, to say the least, ‘interesting’.

Ann Keen, minister for dentistry, replied that the new contract was a ‘template’, which is now ministerial speak for a ‘draft’ – although we know that PCTs more often than not take such drafts as the finished article.

She went on to add that the ‘template’ had ‘taken into account’ representations made by the BDA. More code: it means that they have listened to the proposals and decided to largely ignore them.

At this point, the minister should have, if she had followed her training course, simply sat down (or at least put down her pen, as this was a ‘written question’). But she added that while the new template included ‘quality standards, as recommended by Professor Steele (remember him?), they would be piloted carefully before making changes to the GDS and PDS contracts.
I don’t really believe that Ms Keen – or the advisors who drew up the response on her behalf – were actually overcome with the desire to add to Mr Lancaster’s store of knowledge about Warburton. Nor were they ignoring the advice given in my opening paragraphs. This was a clear signal of the way forward and done to avoid any doubt as to the future path of travel for dental contracting.

Until this point, it was seemingly made clear by the Department that the Warburton contract was for additional and ‘new start’ contracts, that is for extra UDAs for which the Department has amazingly found budget in these austere times.

But now it appears from this exchange that this is only the beginning for Warburton: in time his new apportionment of payment by quality standard targets, with all that implies for practices, could be ‘retro-fitted’ to existing contracts.

So, start practising your spreadsheet skills and order in lots of paper. Preparing monthly reports on up to 24 Key Performance Indicators (288 reports a year for the PCT), not to mention
negotiating with the Trust when they audit your achievements, will take up most of your front desk team’s time.

I have an idea. Given that nearly 50% of the practice’s income will be generated by the achievement of quality standards, and the new requirements of HTM 01-05, why not turn the surgery into a decontamination room and the waiting room into an admin office?

No patients, no hassle, and everyone’s happy.

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