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From GDP to CDO


  Posted by: The Probe      20th November 2020

How did an ordinary general dental practitioner become Chief Dental Officer for England? Barry Cockcroft looks back in part one of a new series, reflecting on his career and time as CDO

What were the ensuing challenges? Discovering who was helpful and who was not, doing the right thing about new dental schools, cross infection control guidance, including resisting pressure for all dental instruments to be made single use, and water fluoridation, coping with crises at the GDC, working with ministers and advisers at Number 10, dealing with EU regulations and, of course, contract reform, as well as dealing with (by ignoring) personal abuse on social media.

During my time at the DH, and later NHS England, I worked with some amazing people, both within and outside the system, especially my deputies when I was CDO, and met many wonderful people just trying to do a good job for their patients. Lots of things happened that make for good storytelling but, sadly, many cannot be told. I also met many people who thought they should be the CDO, several of whom are still active.

Now that I am semi-retired, I spend some of my time working with dental students as part of the Alumni Leadership Mentoring Programme, which Birmingham University established nearly ten years ago and, every year, at the first meeting with my new mentee, we discuss career planning. I have two fundamental thoughts on career planning: (a) have a career plan; (b) be prepared to change it in response to circumstances.

In some ways this is based on my own experience. I graduated in 1973 and spent time developing my career in general practice, helping bring up a young family and getting involved with my profession locally through the BDA section and the LDC. Circumstances began to change in 1990 when, after years of complaining about the treadmill of the item of service-based dental contract, along with everybody else, I was elected to the General Dental Service Committee (GDSC) of the BDA. This put me in contact with the leaders of the profession from Wimpole Street and those on the other side of the fence in Whitehall.

There had been great dissatisfaction with the dental contract for years and access to dentistry was becoming a national issue, so, in the dying days of the John Major administration, legislation was passed enabling pilots to be set up looking at alternative ways of remunerating dentists and, following Tony Blair’s victory in the 1997 election, this continued. The new Prime Minister emphasised how important getting to grips with dental access was when he referred to it in his keynote speech at the Labour Party annual conference in 1999. The DH had been holding workshops around the country explaining to dentists what was happening in the pilots but were being met with a lot of scepticism. I was asked by DH officials to join them and explain how things worked in our pilot, which was based on adult capitation for routine treatment and had gone live in 1998. This was a life changing time for me – the then CDO, Dame Margaret Seward, asked me to contribute to a paper setting out how dental services could be changed. This paper became Options for Change (OfC) which was published in 2002 and was well received.

At the time, I was vice chairman of the GDSC at the BDA and had aspirations to be the next chair but I was approached, out of the blue, by people from the DH and asked if I would consider applying for the newly created post of Deputy Chief Dental Officer, with a view to implementing the changes outlined in OfC.

It was a difficult decision for me and my family as it involved a reduction in annual earnings of about £30,000, purchasing a base in London as the role definitely did not involve nine-to-five working hours, and stopping working clinically – something I had enjoyed for 25 years. Eventually I did apply for the role, the DH agreed to me continuing clinical practice on Saturday mornings, I accepted the reduction in earnings and took out a huge mortgage to purchase a base in London.

I had written in OfC that any change in GDS regulations should not involve a “big bang” but should be done carefully, over time and in consultation with the profession, which had responded well to the content of the paper.

I started working as Deputy Chief Dental Officer at 9am on the 4th November 2002 and at 9:20 I was told about the proposed Health and Social Care Bill, which was already in the legislative timetable and represented the biggest big bang there had ever been in dental terms. A series of meetings with DH officials took place, during which it was explained to me that transferring a budget from one that is centrally held to a devolved one that funds local commissioning could not be done gradually and that the direction from the very top was to get this done as quickly as possible.

I expressed my view that moving to a capitation-based system and introducing local commissioning at the same time was almost certainly impossible in the timescale we were working to but was assured that the primary legislation would allow significant flexibility to reform the contract currency after local commissioning was in place. I don’t think anybody then thought it would take so long but the massive access problems that existed across the country at the time meant that implementing local commissioning and tackling those access issues was the number one priority.

This was a significant introduction to understanding how important political pressure and support could be and after a few more conversations I was in for the role.

I don’t think that I had a good understanding of how diverse the role would become but as far as I was concerned it was an honour, as a primary care dental practitioner, to be appointed just to the deputy role and it was the start of an interesting twelve years.

Next time I shall talk about the lead up to the implementation of local commissioning in 2006, the decision to open two new dental schools and the origins of ‘Delivering Better Oral Health’.

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