A few months after his election to the BDA’s Principal Executive Committee (PEC), we caught up with Tony Kilcoyne to find out whether he can offer the same outspoken voice to the profession from the inside as he often has done as an outsider. We also discussed the powers of the BDA to effect change and influence politics, contract reform and the capability of the GDC to change…
Nigel Jones: So, Tony, you have been a member of the BDA PEC for a little while now, how are you finding it?
Tony: Seeing it from the inside, I can now appreciate the huge amount of work that the BDA does on behalf of everyone within dentistry. The biggest surprises for me was how much work is actually going on below the surface – it’s like watching a duck paddling upstream, relatively calm and quiet to the external observer but the legs are paddling furiously out of sight. It’s surprising how little that is actually appreciated because I consider myself fairly aware of and involved in dentistry, but even I didn’t realise how much is going on, on so many different fronts. I suspect neither does the profession and maybe the BDA now needs to be more forthright and communicate more widely and more often to all about what they are doing.
Nigel Jones: Many people were worried you’d lose your edge when you became part of the BDA. Now that you are on the inside, do you still think you can be the ‘critical friend’?
Tony: I can be more than that because being inside I can not only just say it, I can actually do something about it. So, I’m more than just an external, critical friend, I’m an internal proactive BDA actioner. I can synergise with the other great people inside the BDA who want more action as well, and I have more support and weight behind me. In that sense, it has been very reassuring, seeing it from the inside.
For those observing on the outside, now one of my other hats is a director of the BDA, I’m obviously far more privy to confidential information and plans that cannot go in the public domain just yet. So, it will seem to some people I’m occasionally quiet here or there, but it’s still relative. Instead of posting ten times a day on social media, I might only be posting three, for example.
Nigel Jones: Some people might say that you could actually make more of a difference offering that critique from outside, rather than by joining the fold?
Tony: Now I am on the inside I can offer my knowledge, expertise, opinion, help and drive, wherever I can. I think the biggest problem is that dentists and dentistry do not hold the power base. We’re stronger as an organisation, compared to individuals, but we don’t write the regulation laws for the NHS, the GDC or indemnity risks – and those are the things that are causing the biggest problems in dentistry because the people that are running those are, frankly, getting it wrong or not involving the right people at the beginning to get it right the first time around.
I think the BDA has a huge role in helping to make the best of a bad job by others. I understand people’s frustration when they say, ‘Why can’t the BDA make the GDC good? Why can’t the BDA make the NHS contract great?’ It would be wonderful if we had the power to do so, but we don’t, so we have to work in a way that convinces those in power that working with dental professionals is actually in the public interest.
Nigel Jones: How realistic is it then, that, as an organisation you can be involved with negotiating the best deal for dentists and patients in contract reform?
Tony: If the Government wants to impose a contract, there is nothing anyone can do about it. Absolutely nothing. The Secretary of State has the power, with one signature, to change everybody’s NHS contracts overnight against their wills. The BDA might say to its members, as it did in 2006, ‘Actually, this isn’t a good deal, there’s a lot of negative downsides to patients in this new target-based contract. We advise you to diversify as much as you can.’
At that point in 2006 I think 10% of the profession did go totally private…but 90% stayed on because they were in a catch-22 situation. If they went totally private, in many areas, a lot of their patients would literally suffer, for how long, no one could say and nobody wanted to take that risk. So, this is where too many professionals find themselves trapped because it puts us in a very difficult and ethical conflict. Frankly, the powers that be know that and they use it against us and I think that is immoral.
Nigel Jones: It sounds like you’re saying the BDA has very little power, so what can they actually do to help the situation?
Tony: I’m not saying we should give up. What I’m saying is legally, as a trade union, we cannot tell the profession to down tools or walk away. The BDA can advise on the pros and cons of doing different things but being a trade union we also, legally in certain circumstances, have to have a ballot and if the members authorise it to recommend industry action.
Nigel Jones: But from what you were just saying about the moral dilemma, surely that would never happen?
Tony: Exactly. An out-and-out strike is probably not on the cards. Having seen what the Government did to junior doctors…what chance would dentists have, realistically? So, I don’t think we could sustain it. However, one could do some very clever types of industrial action, ones that might even benefit patients, rather than harm them. The publicity and exposure for that might even help get the public on side and expose the Government as the true culprit in creating a situation that is bad for patients and professionals alike. Now, that has to be done very cleverly but it is very doable!
Acting like an old fashioned 20th Century trade union isn’t so clever, but acting in newer 21st Century industrial action or synergistic ways, perhaps never tried before, is how the BDA can still push forward proactively. That is the only power we have against those who have the ultimate power of systems and regulation over us. There is a growing professional frustration and the mood is ever closer to wanting to see national action and public exposure of centralised folly and spin.
Nigel Jones: Talking about those who do have power over the profession, do you believe the GDC is capable of reform?
Tony: Reform is definitely needed but whether it’s capable of it is still 50/50 for me. At the moment, it’s probably the worst regulator in all healthcare.
It’s still clear from what they do, that the GDC do not understand the unique relationship of trust and care between dental teams and their patients. Any bodies that interfere with that relationship, or compromise it, are working against the public’s best interest and undermining dental care on a national scale, and they just don’t seem to understand this basic tenet.
Without a shadow of a doubt, the GDC need to look at what the CQC did to turn themselves around when they previously went off the rails which was, listening, accepting feedback and acting on it. The CQC are now a great model for the GDC to follow. When the GDC had more dentists and dental professionals involved, with a dentist chairing it, they were a pretty good regulator with the occasional grumble. They’ve now gone hugely the other way and have lost focus and are just using big sticks with very few carrots. They desperately need the help of the BDA and our profession to turn things around and mirror what the CQC have done. There are some early signs of that hope, such as the Shifting The Balance document, but there are still huge concerns and the profession frankly doesn’t trust them. Ultimately, they can’t work properly without that trust or credibility.
Nigel Jones: You’ve mentioned the power of the Government. What influence can the BDA have politically?
Tony: This is where the BDA’s strength is enormous. It has a lot of connections in Parliament with existing MPs and, of course, it’s making connections with newly elected MPs. We can approach all political sides and if we can get a consensus going, we might even be able to put on more political pressure to get positive changes for patients and the profession. But the BDA needs to know it has got the backing and the strength of the profession behind it. Arguing amongst ourselves is not helpful.
There is no other body that’s representing dentistry that has either the size or the acknowledged, established respect to get things done in dentistry. You have this tightrope to walk in the BDA of wanting to cooperate and be nice to politicians and encourage them to get on board and understand it’s not some warped relationship of dentists versus patients. Whilst on the other hand, you want to go on the front page of the newspapers and says, ‘Government needs to be doing something about the new contract, they need to improve things for all dentists’. The public needs to know there are limited systems and there’s only so much anyone can do as a human being.
Nigel Jones: Which of course, is something you have done in your letters to The Telegraph which said NHS dentistry is ‘catastrophically failing the public’ and calling for it to be removed from politicians’ ‘incompetent’ hands – do you still feel the same?
Tony: That wasn’t just my isolated opinion, over 1,000 dental professionals signed and agreed with that letter. I know it was quite a harsh thing to say but it is backed up by what has happened to dentistry year after year; the Government’s track record is abysmal across all parties!
What I see going forward is a BDA that’s more proactive, is probably willing to be both a critical friend of the politicians, and also willing to be more outspoken. The BDA manifesto we launched at the election in June pulls no punches, it points out the failures so far, which are the responsibility of the Government and of the GDC too. We are now starting to see NHS dentistry described as ‘limiting’ or a ‘limited dental system’, which is encouraging from a candour point of view.
Nigel Jones: Which is something you used to refer to as ‘the big lie’ – that dentistry cannot be all things to all people, as the Government has tried to promote – do you think that is something that is no longer being perpetuated then?
Tony: The BDA is definitely using the words ‘limited’ and ‘limiting’ more and I think we as a profession need to follow suit and just start using it routinely and almost put the word limited in front of NHS dentistry all the time. It’s a fact and we have a duty of public candour too.
Nigel Jones: Some people might feel they could get in trouble with the GDC for doing that though…
Tony: Not if it’s a true concern. The national statistics in England are that NHS dentistry can’t even make one contact over two years with just 50ish% of the population. Clearly, it’s not meeting all clinical needs for everyone if you can’t even make contact once every two years. Also, how do you provide annual oral cancer checks if you are only seeing maybe a third of the population? With politicians and civil servants intimating there’s no more dental funding, telling NHS contractors to stay within existing resources and with almost £100million clawed back annually and then disappearing from NHS dentistry, there’s no guaranteed minimum and, most likely, conditional limitations in real terms.
Maybe the GDC itself should raise concerns publicly about such national limitations, if it’s truly an independent body?