No, not this Kevin – a completely different Kevin. The one to whom I refer is Australian and arguably one of the funniest and most irreverent stage acts you could ever hope to encounter.
His name is Kevin Bl***y Wilson (KBW) and one of my most cherished possessions is a t-shirt acquired by one of my offspring, in celebration of one of KBW’s DILLIGAF concert tours. Contact me if you would like any further explanation of this acronym. The t-shirt carries a personal message to me from the pen of KBW himself, and reads: ‘To Kev. Tell ‘em **** ‘em. Love Kev x’.
You may be wondering what this could possibly have to do with UK dentistry.
For those who are not familiar with his profound artistic portfolio, KBW’s repertoire includes classic lyrics such as ‘Santa Claus you ****, where’s me ****ing bike?’ and ‘You can stick your ****ing phone up your ****ing ****. You’re supposed to ****ing help, not make it ****ing hard.’ These immortal lyrics are very difficult to forget although I have no doubt that some will consider it well worth the effort. But Kevin was nothing if not a prophet and visionary, so my t-shirt may yet become a collector’s item one day.
I have lost count of the number of times I have spoken to dentists – and particularly, practice owners – who believe that the process of looking after patients and providing dental care and treatment for them, has been actively impeded and made infinitely more difficult by the endless raft of regulation and legislation descending upon them from all directions. By this I do not mean the General Dental Council (GDC) specifically, but the combined impact of all the agencies in and around healthcare, inside the NHS and with their long tentacles already making deep inroads into the private sector. And on top of that, all those other well-intentioned agencies that have sprung up out of nowhere.
The Care Quality Commission (CQC) is in the mix of course (along with HIS, HIW and RQIA in the countries of the UK outside England), along with safeguarding, data protection, ionising radiation, medicines and medical devices, health and safety (and infection control), employment legislation, a plethora of legislation flowing from European directives, a veritable tsunami of guidelines and protocols and enough NHS contractual obligations to keep you busy without ever needing to see a patient. You won’t have time anyway. And then the GDC and Advertising Standards, the Ombudsman and the Office of Fair Trading and patient and consumer organisations. Need I go on?
Ticking the boxes
I vividly remember talking to a dentist in Australia a few years ago. Acknowledging that he had been continuing to practice for many years in blissful ignorance of an awful lot of legislation and regulatory requirements, he added that he was just a ‘simple’ dentist and – he believed – a pretty good, decent, ethical and caring dentist.
I found out later that he was far from being a ‘simple’ dentist, having been trained at some of the outstanding postgraduate institutions in world dentistry. He had rubbed shoulders with many of the greats and invested hugely in developing his skills and becoming the best dentist that he could be. In his prime I suspect that he was an exceptional dentist in every sense of the word. I remember him more than anything else because of his burning passion for dentistry and caring for his patients was still there – dimmed and blunted by recent experience but still clearly visible.
I asked him whether he felt that all the regulation and bureaucracy was getting in the way and he said that there was so much of it, it had taken all the pleasure out of his work and his profession. He was in one sense a victim of changing times and shifting priorities. He no longer ticked enough of the boxes – indeed the only one he really ticked was that he was (still) a pretty good, decent, ethical and caring dentist. He had also become a very frustrated and disillusioned dentist because these qualities didn’t count for much any more, unless and until all the other boxes were ticked. And he was not the sort of dentist who placed an enormous value on box-ticking.
Study after study has confirmed that the amount of mid- and late-career disaffection is growing. Call it ‘burnout’ if you will, but fashionable labels sometimes conceal the reality and the sadness that lies beneath. We should be concerned that dentists are less happy and content than their peers in many other professions. We should be concerned that dentists feature so prominently and so consistently in the suicide rates amongst professionals and in comparison to the population at large. It is not in the public interest that two of the professions that they look to care for them (medicine and dentistry) are themselves in need of treatment.
Wellness and happiness
The BDA’s excellent ‘wellbeing’ study published in 2015 suggested that salaried dentists can be just as unhappy as general practitioners; associates just as unhappy as practice owners. What I did find interesting (and revealing) though, was the finding that dentists who worked mostly in the NHS were significantly less happy that those who worked mostly in the private sector.
The simplistic assumption is that it must be about income levels but I would be surprised if that were the case. More likely, I think, is the extra layers of third party interference and control that comes with working within the NHS. There is an awful lot of it, and more than 60 years after Tattersall coined the ‘treadmill’ analogy and stated: ‘There is no future for the profession, or indeed for general dental practice, as an art and a science in the system of remuneration as presently operated.’
Tattersall was referring to fee-per-item, of course, but he could equally well have been referring to UDAs. But in those 60 years everything else has changed too, and therein lies the greater problem.
Layer upon layer of extra regulation really has made life so much more onerous for everyone, and there is a growing consensus that it has gone too far. There is a genuine crisis in primary care medicine because it has all become just too hard and unrewarding and at last there seems to be a glimmer of understanding that things need to change if the Government wants to fill all those empty places for GP training before too many other GPs decide that enough is enough and head for the exit.
Each new set of guidelines, each new piece of legislation, each new or revised NHS contract, each additional layer of regulation, is no doubt well intentioned but it drives another nail in the coffin. As KBW reminds us, ‘You’re supposed to ****ing help, not make it ****ing hard.’
Although he appears to be slowing down a bit as he reaches his late 60s, KBW says he can’t retire because he has never really had a proper job. While other people got stuck in jobs that they never liked in the first place, or liked less and less with the passage of time, Kev found something he really enjoyed and stuck with it.
KBW has had more farewell tours than the Rolling Stones, but not being able to resist thumbing his nose at ageing stars who come back to haunt the stage once too often, his most recent appearances before adoring audiences in four continents are dubbed ‘The first of the final farewell tours’.
Perhaps we can persuade KBW out of his non-retirement for a final guest appearance at the BDA Conference, so that we can all sing along to the chorus ‘You’re supposed to ****ing help, not make it ****ing hard.’ Somehow I doubt that his message would reach those who most need to take it on board, but hoping isn’t a crime. At least it wasn’t when I last looked. But then again…