The latest practice goodwill survey results have just been released by The National Association of Specialist Dental Accountants and Lawyers (NASDAL) and it does appear that the market as a whole is still buoyant. However, there may be a geographical divide opening up across the UK.

The survey did see an overall increase in average goodwill value of 4% in terms of deals done and the most recent sales data showed very high values achieved in areas such as London, the South East, Birmingham and Manchester – over 200% of gross fees for NHS practices was not untypical. But, this return is not always being seen in areas such as the North East, Cumbria and away from major conurbations.

Alan Suggett, specialist dental accountant and partner in UNW LLP who compiles the goodwill survey, said, “In general the market still seems to be in rude health. Nonetheless, I am hearing that in many areas the lack of associates means that contracts are becoming difficult to fulfil and therefore those practices become less attractive. There may be a Brexit factor at play too as many roles were carried out by EU nationals and the current political climate perhaps makes them feel less welcome in the UK?”

The goodwill figures are collated from accountant and lawyer members of NASDAL on a quarterly basis in order to give a useful guide to the practice sales market. These figures relate to the quarter ending 31^st July 2017.

NASDAL reminds all that as with any averages, these statistics should be treated as a guideline only.

The biennial Simplyhealth Professionals Dental Conference took place at Syon Park in September, with delegates enjoying a fantastic weekend of lectures, fabulous entertainment and the chance to meet with friends old and new.

The conference kicked off with the haka, the Maori ritual, which signifies a coming together of all individuals.

Caroline Coleman, Managing Director, then addressed the conference and talked about how businesses – Simplyhealth’s and its dental practices – are intrinsically linked. “The success of Simplyhealth Professionals within the dental industry” she said, “depends on its dentists. And with the services that we provide, from business planning and networking events, to our 50/50 dental partnership programme, these initiatives support the success of our dentists.”

Other highlights included a truly inspirational talk from Olympic rower Dame Katherine Granger , who spoke about how the motivations of others, when working to the same goals, really matters.

Everyone seemed to enjoy the conference’s unique mix of  camaraderie and company spirit, plus the chance to make new contacts within the industry.

The latest Care Quality Commission (CQC) State of Care report  shows that dental services in England have topped the league in providing high quality care.

Of the 1,131 dental practices inspected in 2016/17, the CQC found that 88 per cent complied with the regulator’s five key tests: Are healthcare providers safe, effective, caring, responsive and well-led.

100 per cent of inspected practices met the tests for ‘caring’ and ‘responsive’ to their patients’ needs and preferences, while 99 per cent were found to be ‘effective’ in achieving good health outcomes; 96 per cent were found to be safe, and 89 per cent were considered to be well led.

Community dental services again lead the pack offering the highest quality of care of all the community services, with 88 per cent achieving a rating of good or outstanding, compared with 72 per cent for the other three core community services.

The CQC has been collecting data on primary healthcare services since 2011, and throughout the regulator has confirmed that dental practices, compared with other sectors, present a lower risk to patient safety.

In April 2015, this low risk prompted the CQC to move to a model of inspecting just 10% of all practices each year.

The BDA calls the report’s findings, “a remarkable achievement and a testament to hardworking and committed dentists, in spite of research showing that morale in the profession is at rock bottom. The challenges facing dentists, include a 35  per cent  drop in earnings over the past 10 years, having to work within the constraints of a much-derided dental contract and without a penny of capital investment from government.”

A recent BDA survey revealed that over half (53 per cent) of young and newly qualified NHS dentists (aged under 35) intend on leaving the NHS in the next five years.

Mick Armstrong, Chair of the BDA, said:

“The latest CQC report represents another ringing endorsement for good practice in our profession, in spite of the huge challenges we face.

“Once again we see patients are at less risk when they visit their dentist than they are with most other healthcare professionals.

“Their teams have found dentists are providing low risk, high quality care, and where fault has been found practitioners have been willing to act quickly and solve problems. Does this really sound like the same profession that’s been asked to pay through the nose for the GDC’s services?

“Dedicated colleagues continue to provide a committed service, without a penny of government investment and in the face of an unprecedented collapse in earnings. Our patients deserve the highest quality care, and colleagues are having to subsidise it out of their own pockets.

“This ‘do more with less’ approach to health policy is not sustainable. Recruitment problems are already widespread and we now risk losing the next generation of NHS dentists entirely. The future of this service depends on sound strategy and effective investment. To date ministers have been unwilling to provide either.”

Key findings:

·         Out of 1,131 dental care inspections conducted by the CQC:

o   100 per cent of practices were found to be caring, where staff involve and treat people with compassion, kindness, dignity and respect.

o   100 per cent responsive, where services are organised so that they meet people’s needs.

o   99 per centeffective, where care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence;

o   96 per cent safe, where people are protected from abuse and avoidable harm.

o   89 per cent well-led where leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

·         998 (88 per cent) required no action, and just 22 (2%) required enforcement action.

·         Community dental services were found to be offering the highest quality of care in the community services, 66 per cent of services rated as good and 22 per cent as outstanding.

The prospect of conflict with partners is not something most dentists think of when considering the legal cover for their practice. They fail to look at the issue from the commercial context and that one day, they could be at loggerheads with their partner, associate, employee, expense sharer or even the dentist acquiring their practice.

Commercial drafting of agreements to formalise relationships will stand you in good stead. It is much preferred to waiting until the relationship is already in tatters, when it is far too late and your legal bills will be higher than drawing up the agreement in the first place.

The most effective option to address a conflict is to get in touch with experienced and trusted commercial dispute solicitors as soon as possible. At Goodman Grant, we are experts in the dental industry and offer a tailored litigation service covering all of your business and regulatory needs. We can advise you on your best options and most effective means of resolving the dispute.

Whatever the situation you find yourself in, Goodman Grant can help you settle the dispute – and let you get on with treating your patients.

For more information, visit the Goodman Grant website at www.goodmangrant.co.uk or call on:

Leeds office: 0113 834 3705

London office: 0203 114 2133

Liverpool office: 0151 707 0090

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Comment from Angela Harkins, DDU dento-legal Adviser

Saying sorry is an instinctive courtesy in social situations and it’s a misnomer to think that dental professionals should have any concerns about apologising if something doesn’t go to plan during treatment.

In June 2017, legislation came into force in Scotland which provides reassurance for dental professionals when apologising to patients. The Apologies (Scotland) Act 2016 makes it clear that an apology (outside of legal proceedings) is not an admission of liability. The legislation gives doctors and dentists in Scotland the same legal protection as their colleagues in England and Wales (under Section 2 of the Compensation Act 2006).   

Of course, saying sorry when appropriate is already an ethical duty for dental professionals throughout the UK. The GDC, along with other healthcare regulators, recognises a professional duty of candour when something goes wrong with patients’ treatment or care and which causes (or could cause) harm or distress. Under this duty, practitioners are required to tell the patient (or their representative) when something has gone wrong, apologise to the patient, offer an appropriate remedy or support to put matters right if possible and explain fully to the patient the short- and long-term effects of what has happened.¹

If you make a mistake during treatment, it’s likely that an apology will do more good than harm to your professional relationship with the patient. While patients might understand what happened was an accident, they will certainly expect and appreciate an apology too.

On the other hand, if you don’t acknowledge the patient’s feelings or empathise with them, you risk being seen as aloof or defensive which might itself trigger a complaint. A sincere, timely apology may go some way to preventing a complaint, or it could lead to aiding an earlier resolution if concerns are raised.

Saying sorry might feel awkward but the communication skills required are not very different from those you need in any other patient interaction. The following tips should help:

• Start by explaining immediately what has happened. Once there is context, an apology can naturally flow. You don’t have to give a full explanation at this stage as further investigation may be necessary.

• Speak as you would in a natural conversation – in the first person. “I am very sorry that this has happened” sounds more sincere and less defensive than “the practice wishes to express regret…”.

• Think about your body language. Saying the right words, but towering over the patient with arms folded may not seem like an apology at all.

• Take your time and ensure you won’t be interrupted.

• Think of a meaningful apology as part of a process and be receptive to the patient’s wishes. If a patient does not want to know the details of what happened, respect their decision but make it clear they are welcome to this information should they change their mind and ensure they know who to contact if they have further questions.

• You may decide to make a goodwill gesture in the circumstances, such as a refund of treatment costs, but this should never be seen as a substitute for a proper apology.

• Document discussions with the patient, including your apology and (if applicable) their decision not to have further information.

• Finally, if you have any concerns about apologising, contact your dental defence organisation for specific advice. n

Reference

1 Being open and honest with patients when something goes wrong, GDC, July 2016

[image shows Consultant Orthodontist Simon Littlewood telling one of his patients about the importance of wearing retainers for life]

BOS has created a captioned film for patients explaining the importance of wearing retainers for life. The Society has also created a short animation aimed at young people.

The ‘Hold that smile’ animation and a captioned short film which communicates the benefits of retainers are now available for orthodontic and dental clinics to share with their patients.  Hold that smile has the support of the British Dental Association and the Faculty of General Dental Practice UK (FGDP (UK)). 

The BOS is asking dentists to check patients are looking after retainers long-term as part of ongoing dental care. Simon Littlewood, the BOS authority on retention, (pictured speaking at the BOS press conference) says: “I think there are some misconceptions with retention. In the past, we used to think that once patients reached a certain age, their teeth would eventually be stable. Now we know that’s not true, there is potential for teeth to keep moving throughout life – it’s almost like a normal ageing phenomenon.”

He continued: “If a patient ever has a problem with their removable retainer or bonded retainer, it’s important that something is done about it as soon as possible because, without that retainer, teeth will relapse.” 

“Dentists can prepare their patients before they are sent to the orthodontist by informing them about the orthodontic treatment but also about the need for retention too. There is almost no point in proceeding with orthodontic treatment unless the patient is willing and able to commit to retention long-term.”

“It’s vital that the whole dental team has a role to play in stressing the importance of retention to our patients. That includes orthodontic therapists, hygienists and nurses, to make sure our patients are motivated to commit to wearing retainers for life.”

To add the animation or short film to your website:

1) Go to the official BOS YouTube Channel here: https://www.youtube.com/channel/UC8RClpuFPuPbKH0LCJQ6yqA 

2) Click the video

3) Click the ‘Share’ button below the video.

4) Copy the ’embedded’ code 

5) Add this link to your website.

To add the video to your waiting area screen:

 BOS members can email the administrator Ann Wright at BOS HQ  ann.wright@bos.org.uk and she’ll send you the file. Organisations that don’t belong to BOS will be invited to make a contribution to the British Orthodontic Society Foundation.