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Bad workmen blame their tools

In his latest blog Michael Watson gives his opinion on the recent open letter to The Telegraph.

'Bad workmen blame their tools'. I was reminded of this favourite saying by my father (and many other fathers) 60 years ago, when I read the letter in The Telegraph from Anthony Kilcoyne and 100 others, which was reported on this website. I fear I am in a minority of one or two in being a sceptic. Most posters on GDPUK, where it was initiated, fully support the letter.

Most also blame the General Dental Service contract and Units of Dental Activity (UDA's) and some dentists’ inability to meet their targets in this respect. The implication is that if you can achieve your UDA target you must in some way be ‘gaming’ or cheating to give it its proper name.

The statement that ‘it is frankly impossible’ to deliver ‘all dental clinical health needs’ and ‘to the highest standards’ is an opinion of the author and signatories, not a proven fact. It is a slur on those hard-working NHS dentists who provide a good and ethical service to their patients and meet their UDA and other targets.

It is NHS England’s job to commission services through contracts, which they then monitor for compliance. It is the dentists’ responsibility to so manage their time that they can deliver improvements in oral health for their patients. It is all too easy to blame the contract and the UDA's, which are only the ‘tools’ if you are a ‘bad workman’.

The other problem I have with the letter is one of the trust that patients have in their dentist. They have more trust in their dentist than their GP according to a recent survey. As a profession we come way above politicians, estate agents and journalists. Our patients know that the NHS cannot provide everything, but they do expect to be offered for all their ‘dental clinical health needs’ to be met and to be of the highest standards.

The fact that most patients are loyal to their dentist speaks of their trust in him or her. Were I still in practice I would resent a group of self-opinionated dental professionals telling my patients that they couldn’t trust me to do a good job and act ethically while meeting the NHS’s targets.

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It is unfortunate that the author can not distinguish 'system' flaws on a National scale. It is a common 'mis-direction' to blame the workers, middle-management, other agents and even the weather these days, ANYTHING but take responsibility centrally for imposing a BAD system for Patients upon our Dental Profession in England, it seems. Since this letter has gone public I have been SWAMPED with many more wanting to add their names. What would Michael Watson have us do, stay quiet for several more years until there are SO many casualties, the BAD system is undeniable like happened at Mid-Staffordshire Hospital ??? Of course not, we have a duty to raise such serious concerns publicly after the Francis report - that is what we have done and what many others are doing too. So can the establishment admit such serious flaws publicly, or will it stay stuck in Denial and engage in the 'blame-game' when the English Dental DH has all the Power and imposed UDA and other volume-Targets upon our Profession nationally, to the detriment of the people Nationally? Yours still very concerned, Anthony Kilcoyne
Both Tony and Michael bring experienced insights into the world of dentistry. Tony is to be commended in being possibly the first to actively take on the sacred cow that is the NHS (in this case dentistry). I have no doubt, as Michael says, that there are many dentists delivering good dentistry to their patients on the NHS but each year this number reduces. Given the funding structure of the current UDA based system it is difficult to see how any practice could survive financially without some sort of cross subsidy if they are to deliver 100% NHS dentistry. This "thin end of the wedge" subsidy has become an increasing part of the ability for an older generation of dentists to artificially support the system. The more recently qualified dentists don't have that ability and thus are suffering most. It is the slow erosion and increasing subsidy which makes it so difficult for the whole spectrum of the profession to unite at a certain point to say enough is enough as they can't agree at which point, for them, it becomes too much to bear. The system has been deteriorating year on year since I qualified in 1982. I made the decision to withdraw from the system in 1991.
It is interesting to read the comments of a retired dentist who presumably have not spent a day working within the shambolic UDA aka "Nectar point" system and so completely dismiss the concerns of hundreds of active colleagues who have to deal with the consequences of a disastrous system using a nonsensical (in relation to the profession of dentistry) phrase. We are not talking tools, we are debating a farcical system here. Could dear Dr Watson remove a partially impacted wisdom tooth with a pare of pliers, ("bad workman, blame their tools") instead of proper elevators and forceps? We are criticizing a system that is bad for the patients, bad for the dentists and is de-skiling young, newly qualified colleagues. The day we as a profession will be happy to be compared with estate agents and pleased that we score higher compared with them, is the day we all should feel sorry for what has happened to us as a collective. Maybe in a few years time, we will be lucky to find ourselves in higher esteem, than, "used car" salesmen and proud of it !
Can you please confirm that the author is seriously saying that any practitioner struggling with the UDA system is a bad workman?