You never promised me a rose garden

So, there we have it. A new Government. I do apologise for the delay in commenting, but (as recently explained) the lead time for printed copy publications does not permit an instant, real-time response. By the time you read this you will probably be asking ‘what election?’

As for that ‘other’ delay – between ballot box and the steps of Number 10 – it was actually the fault of us all because we got what we (collectively) voted for. Or what 60% or so of us voted for. Or, more accurately, what about 60% or so of that 60% or so voted for. Well, what quite a lot of that 60% voted for, even if not all of them. Or most of them, anyway. Bet you can’t wait for electoral reform, so we can have fun and games like this every time we go to the polls.

Incidentally, what do you call someone who has recently described you as the best joke in British politics? The answer, I gather, is ‘Prime Minister’, or ‘my cabinet colleague’. Or, in private, ‘Dave’.

The Westminster village is having to learn a whole new language and methodology, and do it not only while the world is still spinning, but also in the full glare of public scrutiny. Not easy. Living as we do in the age of spin and presentation, Conservative and Lib Dem
politicians will (I hope) not be foolish enough to try to re-define what they meant when they were rubbishing each other’s policies (and each other) so very recently. The smartest option is precisely as outlined by DC in the Downing Street rose garden, when we saw the world premiere of his enticing pas de deux with his new bestest friend, NC. A bit of nifty footwork if ever I saw it – and after so little rehearsal time, too.

I thought, therefore, that it would be a timely moment to clarify some of the new lexicon that our political masters (or reflecting recent rhetoric, our political servants) will be using in the weeks and months ahead.

• A ‘year-on-year increase in real terms’ means that there will first be a series of cuts and efficiency savings, and some of this money will then be used to fund ‘increases’
• ‘Ring-fencing’ means that a virtual pool of funding that exists only in press releases and keynote speeches will be earmarked for clearly and tightly defined purposes. Meanwhile, any real money will be moved around as circumstances dictate
• ‘Robust ring fencing’ means that the arc through which the real money can be moved around from its clearly and tightly defined original purpose, will be strictly limited (to 360º) and tightly policed to ensure that this is not exceeded
• ‘Practical synergies’ and ‘policy confluence’ means that there will be a world of difference between the headline rhetoric and the fine detail, because a fudge of some kind is needed to overcome wide differences in both ideology and policy objectives
• ‘We face tough choices’ means you will have less money in your pocket
• ‘Tough decisions will need to be made’ means that you will have no money in your pocket
• ‘Some very tough decisions will need to be made’ means that you will have no pocket

But the politicians are not alone in having to adjust to the realities of life in the new and unfamiliar world in which they find themselves.

(Re-in)carnation
The GDC is reeling from a shake-up of catharctic proportions in the first six months of re- incarnation. We will end up having had four different registrars/CEO of one kind or another in less than a year and it has certainly given a whole new meaning to the word ‘interim’.
Internally, some staff have jumped, others have been pushed and many have been moved to a different role.

It has become something of a novelty when the phone is answered by the person you actually rung up. With a really packed agenda at the present time, another Section 60 Order already in the legislative queue, a GDC which already needed to readjust to its new smaller, non-elected structure and a lot of first-time GDC members, led by a new chairman rather than by a president, this was never going to be easy. Freezing the annual retention fee (ARF) was clearly a mistake because self-inflicted budgetary constraints have been added to the Council’s woes.

In England and Wales, providers and performers are once again having to wrestle with the
implications of the latest new variation on the new, new dental dental contract, where UDA delivery becomes only half of the evidence of adequate performance, and a mixed bag of Key Performance Indicators (KPIs) delivers the rest. But on what basis does a performer get paid when some of these KPIs relate to things over which they have little or no control, or where the financial cost of the infrastructure which delivers the KPIs is met by the provider, not the performer?

In the real world of politics and public spending, everyone understands that the sums have to add up, and a reduction in funding leads in most cases to a reduction in service delivery.
The focus then becomes that of prioritising, and you don’t keep pretending that there is enough money to pay for everything because you know full well that there isn’t. But the clearly stated purpose of the new dental contract has been to increase both the volume and quality of service delivery – but all for the same money, and while keeping public expectation as high as ever.

On the other side of the same coin, you can’t put the same amount of money on the table and expect to get more in return for it – yet implementing HTM 01-05 is just one example of precisely this.

In Scotland, at least, new money was put on the table for decontamination but that was of course before the financial meltdown was even a twinkle in Vince Cable’s eye. The Treasury is free to ration the funding of the DH, and everyone understands and accepts this because it’s not a bottomless pit and a line needs to be drawn somewhere. The DH can then ration the allocation of money to dentistry, NICE can ration the availability of drugs and other treatments, NHS Trusts can ration their own delivery of care and services to meet their own budgets. But different rules apply if dental practitioners feel the need to ration the treatment they provide to patients in order to stay solvent. The double standards are not just unfair and difficult to justify – they are a disgrace because the system is purpose-designed to deflect blame away from Government, and away from the commissioning PCTs, and to finger the practitioner instead.

Venus fly trap
And we should brace ourselves for more of the same under the new post-Steele commissioning model, when the practitioner becomes the gatekeeper of advanced care. Isn’t it rich when one considers that the practitioner’s head was on the block for providing too much treatment under fee-per-item (even when the treatment had been subject to prior approval – for those of you whose memories go back that far), and it will now be on the block again for providing too little treatment. And, if the practitioner dares to suggest doing any or all of the advanced care on a private basis, or in stages, then the trap will have been laid, baited and sprung.

Secondary care has its own financial constraints right now, and both dentists and patients are unfairly caught between a rock and a hard place. The difference is that patients have several places to complain to, and remedies available – while practitioners are left to complain to each other. Nothing new there, then.

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