If you’ve ever feared a call from the GDC or falling foul of today’s increasingly litigious working environment, this episode is for you.
Payman sits down for a chat with medical and dental indemnity expert Gary Monaghan about the challenges of covering the profession.
Gary talks about his early experience in plastic surgery and the parallels with dentistry. He reveals how his indemnity service PDI assesses risk, discusses defensive dentistry and describes what happens when the GDC calls.
02.45 – Backstory
06.40 – The surgical landscape
09.01 – The mutual model
12.34 – Dental Vs surgical indemnity
25.19 – Risk profiles and management
35.20 – A shoulder to cry on
41.55 – Call records
44.28 – Assessing risk and underwriting
48.18 – Iron-manning mutuals
53.30 – On fear
55.40 – The economic climate
57.31 – The future of PDI
59.48 – Educating clients
01.02.15 – Refusing cover and defensive dentistry
01.07.44 – Fantasy dinner party
01.10.41 – Last days and legacy
About Gary Monaghan
Gary Monaghan has been at the helm of several insured indemnity providers in the medical field. He is the co-founder of Professional Dental Indemnity ( PDI), specialising in cover for dental professionals. Gary has provided cover for thousands of clinicians over a career spanning more than two decades and is widely considered an innovator in the field.
[00:00:00] My opinion is when you get that letter from the GDC, if you want a dentist, you’ll ring a mate. If you want.
[00:00:06] Someone who knows what he’s talking about, though.
[00:00:09] Hopefully. Yeah, but how do you know? A dentist on the other end of the phone knows what they’re talking about. Because let’s be honest, it’s not going to be if you get a dentist at the other end of the phone, that will not be the person that sits with you in the case. The person that sits with you in the GDC case will be a lawyer. So what we prefer as a company, we prefer that very, very experienced and qualified lawyers take that first call because we want these cases addressed very quickly. We want them squashed very quickly if they can be. And the best way to do that is with the most experienced person you can possibly find. Now, if the dentist is speaking to a lawyer and thinks this guy or this girl doesn’t know what I’m talking about, of course they can talk to a dentist. But you know what? In five years it’s never happened. And in all my years with surgeons, it never happened. So I honestly believe that it’s of course, I got asked this last Tuesday how many dentists have on your helpline? And I said, No, they’re all lawyers. They’re all lawyers because that’s what you want. Oh, what if I need a dentist? Or if you need a dentist, you can have a dentist. But they’re not on the helpline. The lawyers are on the helpline because they’re the people that you need for a legal case or a legal a legal query. Now, even if it’s just I’ve got this patient a little bit annoyed, how do I draft a letter? You still need the lawyer to do that. Now, I’m not saying there’s not dentists perfectly capable of doing that. Of course there is. But we honestly believe that a highly experienced lawyer at the very first step is the way to go.
[00:01:36] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts Payman, Langroudi and Prav Solanki.
[00:01:54] It gives me great pleasure to welcome Garry Moynihan onto the podcast. Garry’s an insurance professional, not a dentist, but very involved now with dentistry. He’s founding partner at PDI Professional Dental Indemnity with Neil Bracewell, who is also a friend of the podcast. One of our earliest episodes was with Neil relatively recently in the last five years. Garry’s gotten involved in dentistry, and I’m going to try and unpack, obviously how his story and all of that, but also we want to try and get to the bottom of indemnity regulation litigation, you know, from from the professionals perspective. Where are we at and where are we going? Massive pleasure to have you on the show, Garry.
[00:02:43] Thank you. Pleasure to be here.
[00:02:45] Garry, tell me, how did you get to this position? Which how did you get into indemnity in the first place? Where did you grow up and how did you manage to get into this field?
[00:02:55] I think my my background is is probably easy to explain as a background in plastic surgery. I’ve been involved in plastic surgery for about 23 years now in various incarnations. I worked for a breast implant manufacturer for nine years and it was really that a chance meeting really. While I was working for the breast implant manufacturer that got me into indemnity, we realised through a chance conversation with someone that approached us that there was a gap in the market if you wish for an assured product. Having only had three options with the defence organisations for many, many, many years, so I was sort of enticed away from my position at the at the implant company to set up an indemnity company that was called premium medical protection. Now that was a very, very tough thing to do because I was in a very stable job, but I felt that the opportunity was enormous and I felt that the need was absolutely essential as well. We took counsel from some very, very high ranking plastic surgeons at the time. A lot of the input was given by the then president of the British Association of Aesthetic Plastic Surgeons, who gave us the data that we needed to go to an insurer. The insurer was happy to underwrite the scheme. It was a Lloyd’s of London insurer, which which gave everyone a lot of confidence in the product and so on.
[00:04:15] And we launched to plastic surgeons. That was very late, 2009. Now, what we couldn’t have foreseen is how that would have grown, because it grew incredibly. It wasn’t just plastic surgeons that were coming to us because they work with orthopaedic surgeons, they work with anaesthetists, and all of a sudden we found that all specialities were coming to us because we were making incredibly big savings and providing a very good service and providing a very good product. So there was clearly some discontent with the the offerings that were available to surgeons. We got a lot of abuse, particularly from one of the defence organisations who basically said this is just like St Paul’s, it will fold, it will never last and so on. Just for reference, it has lasted, PMP still around. It’s still it is the largest provider of insured indemnity to consultants in this country with several thousand consultants on its books. And it’s thriving. So know we were proud of the fact that we broke the mould. Really. We were the first company arguably ever to successfully do Mick’s speciality insured indemnity in the UK. I worked with that company for eight years, I think it was, and then I left. I missed the sort of day to day heart’s heartbeat involvement, if you wish.
[00:05:33] With surgeons, I’m used to working in theatres with surgeons and so on, and I started a consultancy business which still sort of runs in the background behind what I do. That sort of led me to a sort of chance meeting with Neil Neal, Jay Swan, who attended a meeting that I happened to be at. We got talking. Neil said everything that we’d heard seven or eight years ago with the surgeons. We’re frustrated. Our fees are go. We know what we don’t feel. We get what we pay for, we don’t feel we get the right defence and so on. So it was, it was a pathway that I’d already walked down. I decided to almost come back into the market if you wish. This time we’re dentists. Now, Neil was a perfect partner for me because I wouldn’t pretend that my contacts at the time in the dental world were anything like they were in the surgical world. So I needed a partner like Neil, who was very well connected, very well respected and understood the profession intimately. So we formed PD, delighted to say, five years later we’re here, we’re thriving. You know, our numbers are swelling and we’re proud of of being a part of the dramatic changes that everyone has seen in the dental indemnity market now.
[00:06:40] So what was in the medical field? In the surgical field, what was the catalyst that. Made it, you know, market conditions wise that an insurance product was was viable when you came into it, because I remember the Saint Paul. What did they do wrong and what did you do right? And what was what was the situation and how does that reflect in dentistry? I know there’s a lot of questions.
[00:07:04] I know. No, no, it’s fun. I think the Saint Paul, St Paul’s were along the right track. In my mind. They were potentially a little bit too to early in the game because I think where the perfect storm occurred was one of the biggest driving factors. And I hate to say this, but it is a reality. It was price, you know, plastic surgeons were paying 40, 50, £60,000. Now as a percentage of their income after tax, it was a huge amount. So some of them were even giving up private practice because it just wasn’t viable to do it. With the soaring indemnity costs and plastic surgeons were not in the highest risk category in the private sector, there were other specialities that were paying even more than them. So I think it was becoming unviable for many consultants to actually have a private practice. So I think that was one of the driving factors, if not the main one, to be honest, where I think the landscape change was, there was clearly an appetite in the London insurance market to do this and to get into it. But there wasn’t really a knowledge. There wasn’t really knowledge of how to do it and there wasn’t really an avenue to market.
[00:08:05] Insurers don’t go direct to clients. Insurers go through brokers or introducers. Now an insurer can have the desire and the ability to write a product, but if they don’t get clients to their door, it’s like having a wonderful retail outlet that you never open the door of. So I guess what we brought to them was, was, was often used into the market because I was very, very well connected in the surgical arena. So we were bringing them numbers. And with any insurance product, the more numbers you get, the more relaxed the insurer gets, the more it expands, the better the features become. And really that’s what happened. So St Paul’s I think was ahead of its time because there was when St Paul’s went under. My understanding is that there was no other insurers that would pick up all the clients that St Paul’s had. Now, if any insurer went under in the London market, now you’d have a dozen other insurers wanting to pick up the book. And that’s why I think the landscape now is very, very different.
[00:09:01] And what is it about mutuals that makes their business model so much more expensive?
[00:09:07] I think I mean someone from a mutual. May well have a different view on this than than I have but my view is that they’re picking up a lot of history. You know when when you’re with a mutual that the cases that you do with a mutual stay with the mutual forever. So there’s a feature called IBNR which is untrue incurred but not reported, which basically means there’s a whole lot of cases that are coming down the track that no one’s aware of yet, that there could be five, six, seven, eight, nine years in the making because people have, as I’m sure you know, people have a timeframe of three years to report a problem from the date of awareness. And that date of awareness is the absolutely key element to that. You could be blissfully ignorant of a problem for many years. So what we found is when a lot of surgeons started leaving the MDU, the US and the M.P.s, which is the medical arm of dental protection, they were going back to these companies as they were perfectly entitled to, to report cases of patients that they treated when they were with them. Now they were duty bound, these organisations, to pick those cases. So even though they weren’t getting any more revenue from the surgeons, they were still paying out. We also felt that the and this is just purely an opinion, I wouldn’t necessarily have any facts about this, but I know this is a it’s a very commonly shared opinion. We felt that there was a much higher propensity to pay out quickly rather than to fight, because the lawyers know when there is where the hospital is.
[00:10:43] They know that in certain cases it’s just easier and possibly cheaper to pay out and get rid of the case than it is to stand and fight it. Now, that’s fine from a possibly purely financial perspective, but what we found very early on was that one of the things that our clients wanted was defence. They didn’t want the lawyers to roll over because they felt that their their integrity, their professionalism and their abilities were being questioned. And they felt in many cases there was no case to answer. So we were encouraging the lawyers to fight and the lawyers said, look, it will potentially cost more to do so. And what was great was that the insurers stood behind it and said, We know that, but in the long run, we believe that’s the best strategy. Now, what we found, certainly in the group of plastic surgeons, was that the complaint per surgeon from the year one to year five went down by half. Now, we believe that was because we got a reputation for having a very nasty bunch of lawyers behind us, because when lawyers are putting cases as an attack position, they know that certain cases, they haven’t really got much chance of winning. So they hope there is just a simple payout. They win, the client wins. The only losers, I guess, are the insurers. But if you stand and defend those cases, they’re much less likely to pursue them because they know they’ve got less chance of winning. So we encouraged our lawyers to stand and fight, and they did. And we honestly believe that’s what led to a reduction in the number of complaints.
[00:12:15] So the call the attack lawyer, the attack lawyer is aware of who’s defending the particular medic up at that point?
[00:12:27] Exactly right. At a certain point, they will know that. And they will know them.
[00:12:31] They’ll know the reputation.
[00:12:32] Absolutely right.
[00:12:34] How interesting. What about what about the sort of is there a marketing case to be made for? We fight. We don’t settle. Are you finding. I know dentists certainly want that.
[00:12:45] Yeah, I absolutely think there is. I mean, you’ve got to you have to caveat it to some degree, though, because not every dentist wants to fight. Not every dentist is happy when a lawyer says, look, this may well go all the way to court. You may well be standing up in court, being asked a question by a barrister. Some dentists, quite understandably, would run a mile at that thought. So it’s not a case of we want the tail to wag the dog here. We want the dentists and the surgeons to have control to some degree over where the case goes. So if a dentist feels that I’ve done nothing wrong here, I’m happy to stand up in court with you by my side. Mr. Lawyer, I want this to happen. Of course, the lawyers are much more inclined to go down that road on exactly the same set of circumstances. Another dentist might say, I don’t want this hassle, just get rid of it. So the lawyers really need to undo the fall into line to a very large degree with what the dentists want them to do. Of course, if they think the dentist is barking completely up the wrong tree, they’ll advise on that as well, because it may well be that I don’t know that a personality is getting in the way of a clear vision sometimes.
[00:13:54] So we do get the client that because I’ve done nothing wrong, definitely nothing to do with me. The lawyers look at the notes and go. Not your finest hour. So there will always be that element where the lawyers may well lean a little bit heavier on the. Fantastic to just make them see that it’s probably not a case they’re going to win. But the critical thing is that it’s a two way process. It’s not an organisation running off with a case, sorting it in the background and the dentist not having a clue what’s going on. We get so many cases where we get the what’s called a letter of good standard from previous providers, and it’s actually a revelation to the dentist what’s on it. You know, we’ve had many cases where the dentist has gone. I didn’t even know that I’ve been settled. Now, I think that’s appalling. You know, that should never happen. It doesn’t happen because the dentist knows exactly what stage that legal case is at every step of the way, because it’s their right to. It’s their reputation. It’s their insurance record and so on. So, you know, that, I think is quite a significant change from the previous circumstances to where the insured market is now.
[00:15:01] With your experience in medical and in something that’s sort of emotional, emotionally charged as plastic surgery. Yeah. Do you find dental indemnity is easier than that or would you say it’s the same set of issues? No note keeping communication and all of that. Is there a nuance to dental?
[00:15:24] I think what I found, without doubt and I think this is very largely reflected in the number of cases that go to the respective governing body, is that surgeons, rightly or wrongly and frankly my view wrongly, put on a bit of a pedestal, maybe slightly more than your dentist. Now, whether that’s because they see the dentist more regular, whether that’s because clients see it as a less technical profession, I honestly don’t know. But there’s no doubt that that is the case. And I think that is also one of the reasons why dentists are far more likely to be taken to the GDC than a surgeon is to the GMC. It’s completely wrong, in my view, but those are the facts. Now, the number of times we saw a surgeon who had on his record or her record, a case with the GMC was few and far between. We see it all the time with dentists. You know, I know there’s great differences between the GDC and the GMC and the way they’re structured and the way they’re run and everything else. But I also think that there is that propensity of of a of a patient much higher to take a dentist to the GDC for those reasons. Now, dentists won’t want to hear that, but a lot of them will will probably agree with me that their profession is not necessarily seen in the same esteem as the surgical profession for for reasons that societal really nothing else, anything more.
[00:16:45] But then you’ve got the sort of the three variables there. If we’re comparing medical and dental, you’ve got the professional themselves. Yeah, you’ve got the what you just said, the way that the patients perceive that professional and then you’ve got the regulator. Should we go into the other two. What, what, what do you see as the differences between the regulation of GMC and GDC? Is there a lighter touch? Is it more sort of solutions orientated?
[00:17:12] Yeah, the GMC seems to be a much more. How can I put this sort of a rational organisation really? You know, they’re not they’re not looking for a reason to strike the doctor off. They seem to be very, very rarely. And it would have to be an extreme case that they would strike a doctor off. You know, some of the restrictions and the and the cases that we’ve seen from the GDC are completely different to the point where, you know, outside looking in, because often we arrive at these cases after they’ve finished in a way on a person’s record, we’re slightly baffled as to how the situation has developed to the position that it has. Now, I can’t put my finger on why that would be the case. I think it certainly seems to be historic. This doesn’t seem to be a recent thing, but surgeons don’t have favour with the GMC. They don’t want to be in front of it. But I think fundamentally they feel they’re going to get a fair hearing and they feel that it’s a regulatory body that is there for them as well as for the patient. And I just get the feeling that dentists feel that the GDC is a stick to beat them with. Now, I know a lot of insurers have tried to talk to the GDC and certain insurers that we’ve worked with feel that they’re making a bit of progress. But I think that’s a long haul. You know, it’s it’s it’s a tight turn around that will take years, I think, to get it to the same stage as the GMC.
[00:18:32] Yeah. Although I mean, I know since you’ve been involved, the GDC has been in a real state, but it wasn’t always like this. You know, when I qualify 25 years ago, it wasn’t the feeling you had from the GDC. Of course, as you said, you don’t want to be in front of them, but you didn’t get stories of perfectly brilliant clinicians who’d had massive issues because of something someone had found in the notes about something they’d not written or whatever. What about the professional themselves? Are surgeons different to dentists? I bet there’s some egotistical surgeons out there.
[00:19:05] Yeah, there absolutely are. There’s no question about that. And what I found interesting was I did notice quite a difference between certain types of surgery. So your gynaecologist would be a slightly different personality trait to your plastic surgeon, would be a slightly different personality trait to your orthopaedic surgeon. So we did notice distinct differences like that. Surgeons themselves say, well, plastic plastic surgeons, plastic surgeons refers to themselves as the artists and they refer to orthopaedic surgeons as the Carpenters. Now, there’s a bit of ego in that statement alone, really, isn’t there? But I can sort of see where they’re coming from, because the genre that I align most with the majority of dentistry, I think, is the plastic surgeons, simply because it’s a very heavily laden self-pay market. So it’s got it’s got that level of expectation. It’s got the fact that it’s your money that you’re paying. So in private dentistry and plastic surgery, the patient expectation is is unfortunately slightly higher than it will be in other forms of surgery and NHS dentistry. And I honestly believe that leads to more claims as well, because if the expectation is higher, the fact that it’s your money, you are more inclined to be slightly more aggressive when it comes to a complaint and potentially taking a case legally. So we see a lot of similarities and particularly in areas of dentistry like implant dentistry as well. We can see very great similarities between between implant dentistry and plastic surgery.
[00:20:32] And was there an equivalent of dental law partnership in the world? There must be some ambulance chasers in the world of plastic surgery.
[00:20:40] There was a lot. We didn’t have the dental partnership, which is probably a blessing, but there was yeah, there was plenty of lawyers that were just simply out there for for medical cases. I mean, if I was working from home, I’d, I’d have Jeremy Kyle in the background sometimes. And I did a just a little straw poll of one morning and I counted five different adverts for medical and well for medical cases by lawyers in two mornings of one week. And that really sort of brings it home to you that it’s actually very, very easy to get to a lawyer who will encourage you and what you along that pathway to get you to sue a surgeon.
[00:21:22] I mean, we naturally have a sort of a dislike for that kind of lawyer, but I think we’ve got to accept the reality that it’s a massively profitable part of law, hugely to to I’ve heard stories, you know, nine figure sums for selling these companies. Yeah. And and the reality of that is but what annoys me sometimes is Gary, you get you read stories about dental law, partnership, lobbying, government, you know, organising as one company is one law firm, organising in a way that we as a whole profession haven’t managed to do. You see on on our side as far as we’ve got the BTA, do you do you see dentists as a sort of disjointed lot who can’t organise?
[00:22:12] I think interestingly I the similarities, the differences I see with dentists is certainly certainly plastic surgeons. Many, many plastic surgeons work on their own. You know, it’s not been until certainly the last few years that they’ve ever come together and working groups or practices where there is several that do different specialities. So one thing that was refreshing, of course, was the whole dental structure where of course, pretty much all dentists work with colleagues, which is really quite rare. I certainly was quite rare in plastic surgery. So that said, you’ve you’ve also got so many dentists with so many different views, it’s quite difficult to get anything like a consensus. I mean, plastic surgeons in the UK is in the hundreds, you know, dentists in the UK is in the tens of thousands. So that in itself brings massive differences in the opinions. And to be fair, I think the spread of the circumstances in dentistry is much broader than it is in the surgical world as well. You know, and associate dentists, we know obviously dentists income because every single one declares on their applications to us, some of them are earning below average wage right the way through to the very high end dentists that are earning seven figures. So I think the spread of of circumstances in dentistry also means it’s probably much more difficult to corral opinion and corral a consensus of a direction. We find it quite difficult to work with the organisations for that exact reason because you’ve got very large numbers, you’ve sometimes got a difficult consensus to find. We’ve got a couple that we’re very close to getting a scheme together with, but it has been difficult to do that because of the breadth of opinion, which is not a bad thing, but it can be problematic when it comes to getting things done. You know, when we approach customisations, they often. Say, Well, this would take a year or two. We’re like, why, why? Why can’t we get this done?
[00:24:11] I guess also from the perspective of expert witnesses, when you’ve got so many different opinions, yeah, that must be a real complicated I mean, in in plastic surgery, the if if the opinions are fewer. Yeah. It’s just easier to figure out what’s going on.
[00:24:27] Massively, massively, massively. And there are cases in plastic surgery where there are surgeons where you wouldn’t find an expert witness to go against him. Oh, it’s very difficult to. Which makes it so much easier to defend the case if if the expert witness, inverted commas and has done a quarter of the case is that the person who’s been sued has. So. Yeah, it does make it I think slightly easier. Alex It’s a much narrower profession. Everyone knows everybody else in plastic surgery. And of course you’ll always find someone to say to be on the other side of the witness stand. But in dentistry, it’s so much easier to do that.
[00:25:05] Let’s say, okay, let’s, let’s move on. Let’s say I’m with one of the big mutuals and I’ve had enough. Let’s let’s say I haven’t even had a bad experience. I’ve just had enough of paying too much.
[00:25:17] Yeah. Yeah.
[00:25:19] Now there’s a, there’s a set of insurance based companies out there that I could turn to. What would you say is PDI value add? I mean, obviously, generally in positioning your business, you can’t be everything to everyone. So what’s what’s the kind of dentist you’re looking for, number one? And number two, how easy is the process of moving from one of the mutuals?
[00:25:43] Okay. That that’s a really good question, because if I was in a position where I was with a mutual and let’s face it, then pretty much all dentists start with a mutual and they sort of grow up through their training. And so they’re always coming to from a position of, in some cases, real comfort in a mutual. Now we have cases where we actually discourage dentists from moving because we feel if they don’t understand, one, what they have to what we can provide. We don’t want a dentist to move. We don’t want anyone to move purely because it’s cheaper, because if they don’t understand what they’re getting and they don’t understand the implications, then that’s not a good move. You know, quite frequently we get people coming in two days before their renewal saying, Save me morning, I’ll just up the price I want to move. Now, we’d rather that person moved in a year’s time and was fully, fully clear of what we do. The moved just to save a couple of grand or whatever it might be. So I think the key thing is we have we have a number of products and we fit most, if not all. You know, we have a product for what we call distressed dentists, distressed emotionally and from an insurance perspective as well. These are dentists that have got a record that is not to their liking or potentially not to the liking of the mutuals as well. And quite often they’re just given a letter that says, we’re not going to renew you this year. Thanks very much. We get quite a large number of those because these dentists are basically cast out of the mutuals and don’t know where to go. So we have a product that works for them.
[00:27:12] That’s a higher risk dentist from an insurance perspective.
[00:27:15] It is. And I think where I don’t know what the insurance companies do, but what we do is we we sort of ring fence those dentists because one of the great arguments about mutuality is you’ve got everybody in the one pot. So in other words, if you’ve got 100 and this this is the best example I can possibly give you is from our first 20 applications. When we were back with the surgeons, we had our first 20 applications with some plastic surgeons. That was in the first 18. It was probably about 2025 claims between them, the first 18 and the last two, there were 39 cases between the last two. Now it makes no sense to me to put the last two in the same pot as the first 18, because that completely changes the dynamic of the whole pot. So what we do as insurance companies, I guess, is we go to certain insurers and say, right, we are going to be bringing you risks that are not necessarily the best risks, but we want you to specialise in them. We want you to give them robust defence. We want you to work with them and improve that record because there’s people that are not as not as capable in every profession. But we honestly believe that all dentists reach a certain level of qualification and ability. Some of them just need help, whether it be note taking, whether it be consent, whatever it may be. We don’t feel for a minute that a bad record will always and should remain about director. It can be improved. It may well be that we don’t get it completely clean, but we can certainly improve it. Now, our goal really is any any dentists that come to us and go into the distress scheme. We want them in the main scheme and we want to move them across on the basis that we’ve improved their record to the point where their record is can be compared alongside anybody else. So that’s sort of one way I think, which we.
[00:29:06] When you say you put them in a different pot, we you’re talking purely talking from the cost of insurance perspective. Or do you handle them differently as well?
[00:29:17] I think you know, I think we do handle differently because I think what is really what is really clear is a lot of these dentists don’t really know how they’ve got into that position yet. Of course, they know there’s been claims made against them, but I think they don’t understand that it’s either a higher than average or they don’t understand what they’re doing wrong. Because if you do something wrong in in innocence and you keep doing it, it takes someone to sort of point it out as to where you can improve and what other direction you can take. And it may well be, and it often is that the lawyers will come in and say, look, we’ve seen your consent process. It’s got holes in it. Now, unless you’re told that, you probably don’t know. So you’re always going to get claims on that basis. So the lawyers will work with these dentists. So we tend to find that we spend a lot more time with these dentists because they have got a circumstance and a situation that is directly affecting not just their professional circumstances, but their personal circumstances as well. It’s very stressful to get a letter from a defence organisation saying either you give us 30 grand or we’re going to let you go. You know, either it’s crying down the phone to me that I’ve never met and you can feel the pain at the other end of the phone line. So we do tend to find it. We spend a lot more time with those dentists because they need it. It’s as simple as that. You know, it really is a case of if a dentist comes to us completely clear and understands the process, yeah, we will potentially have a lot less contact with them because they don’t need it. But other dentists that really do need our help and our expertise don’t get it.
[00:30:48] As far as claims. Have you got stats on different types of claims, different types of patients, different types of dentists?
[00:30:56] The lawyers will have we don’t have them off top of our head, but we can we can certainly pull them from the lawyers. Yeah.
[00:31:01] What does one of the one treatment modality must stand out as high risk implants, surely.
[00:31:08] Yeah. Yeah, it is. Anything period is quite high as well.
[00:31:14] Neglected period.
[00:31:15] Yes. Yes. You know, I personally feel I personally feel that the personality of the dentist is one of the most important factors as well and how you actually handle a complaint or a claim because a very, very good dentist who is technically brilliant may not have the personality to have his, his or her integrity and abilities questioned. And if they don’t handle that initial complaint well, it could easily lead to potentially a very, very high claim. We’ve seen it several times in plastics where the patient has just been pushed back, push back, push back till the point where they make a claim and then then the horse has bolted and the damage is done. So I honestly feel that the the the approach to claims is absolutely critical in this whole area. And that’s that’s a big area of education for us as well.
[00:32:07] So I guess that would fall under the umbrella of sort of risk management in dental practice.
[00:32:12] Very much.
[00:32:13] So. Go on outline key points there. Obviously handle complaints empathetically, right.
[00:32:19] Yeah. And pathetically quickly, effectively, consistently. I think they’re the absolutely key areas. Speed is probably as much as good as anything because when a patient makes a complaint at that point in time, that is the most important thing on that patient’s mind, potentially, potentially in their life, if it’s a really serious one. And the speed in which the complaint is at least acknowledged, I think is absolutely critical. I don’t think there’s anything wrong at all in saying, well, looking into your complaint, we’ll get back to you very quickly. You know, and it should be a process, a complaint process under siege, you see, anyway, that that you follow internally as to how a complaint is handled, managed and run. So I think it’s absolutely essential that the response is given to a patient as soon as you possibly can just to acknowledge it. Bit of a holding pattern if you wish. It is the attitude that I think is the defining factor in where these cases go. It really can be what you respond and the manner in which you respond. More importantly, that determines what the next step will be. I think there are some patients that are just hell bent on suing you. They’re almost unavoidable. But you’ve still got to show that you’ve handled that complaint properly because that will heavily weigh in your favour if it does go to a legal case, you know, because even a top lawyers will look at their own clients and sometimes think there’s any favours there and they’re much less likely to recommend that the case is progressed.
[00:33:44] What about NHS versus private patients? Is one more likely to take a claim, take on a claim than the other?
[00:33:53] We have seen some data a few years ago about the about geographical location, which which we found very interesting as well. There are certain areas in the country where there is just simply a higher propensity for a patient to make. And and interestingly it was very, very much NHS patients as well.
[00:34:10] So where’s that.
[00:34:12] North west. Liverpool was very high. Really? Yeah. Liverpool came up very high in that as a mancunian. That’s not an anti Scouse comment because Manchester is very high.
[00:34:22] It was very high as well. Well, the difference between those two towns.
[00:34:28] It’s just an East Lancs road between us and I live right in the middle, so I am on the fence. Yeah. Yeah, it was. There’s a lot of detail in claims data and we are we’ve we’ve had a recent discussion with the lawyers about can we have more data? Because in a way I see I see indemnity very similar to dentistry. It’s very much about prevention rather than cure. Dentists don’t want patients presenting with problems. We don’t want dentists presenting tools with problems because at that point, you know, it’s stressful. The lawyers are involved, it costs money, etc., etc. We would much rather we did get a single call from our clients all year and in the nicest possible way. I mean, inevitably that’s going to happen, but it’s very, very much a situation that we can work on the prevention element rather than just handle the problem well when it pops up.
[00:35:20] So on the dreaded day that a letter comes in from the GDC.
[00:35:26] Dentist contacts you guys?
[00:35:29] Who do you speak to? I wonder one of your clinical advisor types, right?
[00:35:32] A lawyer. I was a lawyer.
[00:35:34] Not a dentist. Yeah.
[00:35:36] Now, I’ve got this debate many, many times now. This is my opinion. My opinion is when you when you get that letter from the GDC. If you want a dentist, you’ll ring a mate. If you want.
[00:35:49] Someone who knows what he’s talking about, though.
[00:35:51] Hopefully. Yeah, but how do you know? Dentist on the other end of the phone knows what they’re talking about. Because let’s be honest, it’s not going to be if you get a dentist at the other end of the phone, that will not be the person that sits with you in the case. The person that sits with you in the GDC case will be a lawyer. So what we prefer as a company, we prefer that very, very experienced and qualified lawyers take that first call because we want these cases addressed very quickly. We want them squashed very quickly if they can be. And the best way to do that is with the most experienced person you can possibly find. Now, if the dentist is speaking to a lawyer and thinks this guy or this girl doesn’t know what I’m talking about, of course they can talk to a dentist. But you know what? In five years it’s never happened. And in all my years with surgeons, it never happened. So I honestly believe that. Yes, of course. I got asked this last Tuesday how many dentists have on your helpline? And I said, no, they’re all lawyers. They’re all lawyers because that’s what you want. Oh, what if I need a dentist? Or if you need a dentist, you can have a dentist. But they’re not on the helpline. The lawyers are on the helpline because they’re the people that you need for a legal case of a legal a legal query.
[00:36:59] Now, even if it’s just I’ve got this patient a little bit annoyed, how do I draft a letter? You still need the lawyer to do that. Now, I’m not saying there’s not a dentist perfectly capable of doing that. Of course there is. But we honestly believe that a highly experienced lawyer at the very first step is the way to go. One thing I should mention, the choice of lawyers is very, very personal. Neil spent weeks chatting to the lawyers to make sure that he was happy with them, how they did things, what they did. And then by a really happy for us development the law firm to be two law firms I know really well I know Clyde and Co really well they were our lawyers of choice on the surgical scheme. And there’s a company called BLM Law who were our preferred lawyers on the dental scheme. They’ve just merged. So if I was going to pick two law firms to merge, it will be those two. So we’re delighted with that merger because it’s formed. I think I’m right in saying the largest medical and dental malpractice team in the country, and they’re the lawyers behind us. So we’re absolutely made up about that.
[00:37:59] And look, I expect they’re so used to getting that call that this question might seem obvious to you, but to me, it doesn’t seem the answer doesn’t seem that obvious. People call up in all different states, don’t they?
[00:38:12] Yeah, absolutely.
[00:38:13] Yeah. I mean, it’s very, very I’ve heard that the number of times I’ve heard suicidal ideation from dentists going through this process is more than ever I’ve ever heard it from anyone else. Are they trained to handle that side of things? The sort of do they sometimes refer the dentists to a counsellor or.
[00:38:31] Yes, very much they do. They watch. I mean, the welfare of of the dentists is absolutely critical. I mean, yes, of course, the lawyers are they’re lawyers. Lawyers can handle a person who’s distressed. But there is a certain point where it is beyond their trade and it’s beyond what they should be doing, and they absolutely know that. So of course, they would bring in counsellors or the professionals as well if they felt that there was any possibility that there was that was potentially going to be harm to the dentist, whether it be whether it be mental or physical. So, of course, they would they would contact other medical professionals as well or peers. You know, we’ve got people that we can use within the company, Neil being one of them. Neil’s very, very experienced dentist. If people want to chat with Neil purely as as a dental professional, he’s always there for that. And we have other dentists that we can call on for that as well. But yes, the lawyers are there prima facie to to give the legal advice. They’re not counsellors. They do know how to handle and calm people down, because, as you rightly say, well, as I said to you about 10 minutes ago, I have people ringing me in tears. So the lawyers will get that as well, because I’ve never been sued such what I can imagine, it’s horrendous. I can imagine it’s even worse when it’s someone that you know, someone that you’ve treated possibly over many years and someone that is alleging things against you that you might know 100% not to be true. So the mental side of all dental cases really shouldn’t be underestimated.
[00:39:57] And the stakes the stakes are high. That’s the thing, right? Because massively high. Most look, I used to be a dentist and I stopped being a dentist ten, ten years ago, and not because of any sort of legal claim or anything, but because of the the company and work and everything. But I remember even then, even then, stopping practising dentistry seemed like such a massive step because you’re so super specialised so early that you think there’s nothing else you can do. Now, if you’re a proper dentist, that you have a practice, you have kids in school, school fees and the like, the stakes suddenly are I might not be able to pay my.
[00:40:33] Feels right. Absolutely huge.
[00:40:35] On top of all the things that you said about the, you know, the patient knowing that you’ve done the best for the patient and so forth. And, you know, we’re going to we’re going to try and delve more into this on the podcast and try and talk about more cases. Hopefully you can help us with with some of that later on, Gary.
[00:40:52] Yeah, I think so. To jump in, I think one thing that people really do need to hear is that they’re not alone. You know, they’re not it’s not the first time it’s happened. I can pretty much guarantee every single case we ever see has got precedent, circumstances, you know, of the dentist of the case, whatever it may be. So and there are people to help them. You know, it’s called a helpline for a reason, that it’s there to assist you. It’s there to give you the best support that they possibly can or to pass you on to other people if they if if the need arises. But it must be very, very distressing. We know it’s distressing. You know, I wouldn’t mind me saying this. One of the reasons that Neil was so aggrieved with the defence organisation that he left was the one he’s ever had. It stressed him out for two years. It was completely exonerated. Nothing happened. But he felt that the defence he got was well below the standard that you would have expected and it personally affected him for a long time. So we have a very, very real example within our own companies as to how it can affect somebody.
[00:41:55] Gary, in the industry, is it true that you’ve got a record of all the calls the dentist has ever made to indemnity wherever it went?
[00:42:07] Yes. Yeah, yeah. We have to look those. That’s right. Yeah.
[00:42:10] No, but but to previous indemnity companies.
[00:42:13] Oh, yes, that’s correct. So when we ask for what’s called a letter of good standing, that letter of good standing tells us is is all the activity from all the previous providers. Now, sometimes they come with limited information, sometimes they come with quite a lot of information. I think the key thing is that I know dentists feel that that counts against them and we would very much turn that around. If you don’t win your indemnity company when you’re facing a problem, there’s a very real possibility that you’ll handle it wrong. There’s a very real possibility you’ll potentially prejudice the case. But when it does reach the insurer of or the or the indemnity company, it costs them more money because of your innocent but erroneous actions in trying to deal with it. So we would encourage people to pick up the help line because if they don’t, it could actually be much more damaging to them personally to see the costs and certainly that their insurance record. I mean, you know, we expect claims it’s as simple as that. That’s the environment that dentists are operating within in this day and age. So we expect pretty much every dentist will ring that help line at some point. That’s just the law of averages.
[00:43:25] That’s just what happens. So, no, we don’t punish them. Now, I’m not going to sit here and say if you make claim after claim after claim, it won’t affect your premium, because of course it will. Just like driving your car into a wall will affect your premium in car insurance. But equally, the communication is absolutely key. You know, we worry if we don’t get a call from a dentist for, say, five years because no one will tell me that that dentist has never had a patient that has either threatened a complaint or brought a complaint, because I’m afraid that’s just the environment that we’re in. But it’s not used as a stick to beat that with not by yours anyway. I can’t comment for the companies and I know the perception, but it’s not used as a stick to beat, to beat them with. And I think that’s really down to the quality and experience of insurance underwriting that we use because these underwriters know how to interpret these these claims records. They don’t just hold the numbers and say, right, you know, it’s a simple algorithm. Therefore there’s your price. There is an element, a large element of of good feeling and then human experience that goes into underwriting.
[00:44:28] Interesting. So then you’ve someone the previous example like if someone’s leaving a mutual comes to you, you said if they’re high risk or distressed, you put them put them into one pot. How many pots are there? Is it just those two pots or. Yes, depending on my mentorship, the courses I’ve been on. Do you ask those questions as well?
[00:44:47] Yeah, we do. I mean I mean, potentially there’s there’s as many pots as we want in a way, because we’ve got access to the whole London market. So arguably we could go to as many shows as we want. That doesn’t make sense because there are different products. So we tend to use access underwriting that we use to our brokers on Metro because access only pro of access exclusively, it’s a very, very good scheme. We know the team there, we know the team. Ahmed Pro, we’ve chosen to move to our metro in the last six months because of their relationship with access. The more you work with underwriters, the more you get from them what you want. In other words, it may just be a case that you think they just need to take a little bit more of a punt on. You know, you’ve got that rapport with them to do so. So your vanilla dentist, if you want to call it that, which is probably I’d say 85% of the market will come to us. We’ll put them into access underwriting. They’ll give them two options. Claims made, claims occurred. We work with the dentists for them to understand the differences and what’s best for them. And it’s not it’s a million miles and pressure sell and certainly for us insurance it’s a case of it’s educational rather than pressure selling.
[00:45:53] There are other schemes though for the specialists and without mentioning the name of the organisation, we’re working very closely with one of the implant associations because we do feel that there is distinct differences in in what they do and how and how the scheme should work. I mean one of the elements I give you is damage to reputation. You know, implant dentists feel, I think that their reputation is they need to safeguard it maybe more than an associate dentist. What? Because associate dentist, I guess if you want, it’s probably a poor choice of phrase, but it can hide within the practice. An implant dentist can’t. They’re almost like an island that goes from practice to practice. And, you know, the press release falls firmly on them individually. So. So for implant dentists, for example, we may well or we will have very soon a completely separate scheme that fits them and their circumstances particularly well. So I don’t subscribe to this school of thought that basically says, you know, you can all go to one insurer. I really don’t. I never have it. I never will. I’ve worked with too many insurers to know that one size does not fit all. You cannot cram 40,000 dentists into one product. It just doesn’t make sense to me. And I think we are unique in that.
[00:47:08] I think we are unique and that we don’t just try and hurt thousands of dentists in one direction. This is why I mean, you spoke about this many, many times. I don’t think we’ll ever of 20,000 clients. We don’t want 20,000 clients. We want a good number of clients. It gives us clout with the insurers that know us, that know me personally, that know Neil personally, that pick up the phone. It was quite often before they pick up the phone to the lawyer. I think we get more calls directly to me, Neil, than the lawyers do now. We don’t ever try and give legal advice, but we’ll certainly say, don’t worry, we’ll sort it, we’ll get the lawyers to call you and so on. So I think dentists feel with PD, I would argue more than any other organisation that it’s personal. They’re not just a number and they don’t just send us a cheque every year. The cheque got a hold of mine. They don’t just send us a bank transfer every year and that’s that’s their only contact with us. You know, they can contact us any time. Neil prides himself on this. Neil prides himself on the face to face contact that he can get with clients. And when we’re proud of that.
[00:48:07] Yeah, Neil certainly is very good at that. It’s always got a way of breaking down complex things into simple bite size. He’s very.
[00:48:15] Methodical. He does it very methodical.
[00:48:18] Very methodical. I’m going to ask you something a little bit, sort of maybe unfair now, but I wanted to make the case for mutuals.
[00:48:30] Then I think.
[00:48:32] You know, they can’t all be bad.
[00:48:35] You know, I don’t think they are. But, you know, I think they get. There is a lot of scaremongering that goes on with with mutuals. And I don’t subscribe to, you know, this whole. They’re going to go bust and they’re not going to be there to pick up the past. I don’t think they are going to go bust. If someone ask me how they’re going to go bust and it’s a yes or no answer, I would say no they’re not. I know one organisation in particular is peddling that. You’ve got to be with officers when the mutuals go bust, nobody’s going to be there to pick up the pieces. I just can’t see that happening. The government, I just can’t see the government allowing so many medics. I’m not talking dentists with a mutual we’re talking dentists, GP’s surgeons, physios. You know, the MP, for example, look out for 200,000 people on their books in many countries. So it’s been oversimplified, the, the financial structure of the mutuals and yes, of course they’re under pressure. Of course they are, because it stands to reason if more people leave than arrive, prices are going to go up. So at some point, that becomes a critical that does become a critical point where they’re under pressure. And one of them in particular, I think everyone’s seen their public accounts. They’re not in a stronger position as they were ten years ago. That’s quick. That’s quite clearly the case. But I don’t think that dentists and doctors should necessarily run for the hills and think that any of the mutuals is going to go under in the short term.
[00:49:56] I just don’t think that’s going to happen. And the other thing that is pedalled is this it’s almost random whether they protect you on this element of discretion. Now, no one is going to argue successfully. I don’t think that discretion is better than insured certainty, but it is not a lottery. When you pick up the phone to a mutual that they’re going to help, they’re going to assist you. You don’t cross your fingers and go, am I going to be the one that don’t help? That’s just not the case. And again, some of our competitors are putting it across like that. You have no idea whether they’re going to help you. Of course you have an idea they’re going to help you. They will help you on that. There is a reason for them not to know. In my experience, the reasons that they don’t help people is sometimes when there’s a dispute, it may be it may be a premium dispute or a fee dispute. They would they would argue it may well be that they feel that you haven’t acted as you should by reporting it in the right way. And there could be activity, just a Patterson case. The MDU pulled out with that in the middle. But I think to be fair to the MDU, they were probably citing criminal activity there.
[00:51:04] So you know, it’s not as black and white as well. It’s not as great as discretion can be, can be used and you don’t know when it’s going to be used. Yes, they can use it. Yes, they have used it, but I don’t think it’s used anywhere near as much as he’s being portrayed. I still think and the government thinks that there is a much stronger case for a regulated organisations. You know, that was the recommendation that the Government made just before COVID happened that they were much more in favour of a regulated mutual body. Now regulated in this country means it falls under the Financial Conduct Authority. So in other words, it’s in my view, it’s likely at some point that the mutuals will go to an insurance background. Now, that will be interesting because immediately they’ll be they’ll have to levy IPT insurance premium tax. So that’s 12%. They’re going to go on your fee straight away. The other thing is you’ve got to find an insurer to pick it up. So that will be an interesting step if it happens. I believe it will. I think the government will pick it up and run with it again at some point. I think without COVID, it would already be much closer to that position than it than it has been than it is right now. But it will be a very interesting change of events. When that happens.
[00:52:17] Would their cost not go down and become more sort of direct competitors to you?
[00:52:22] I don’t believe they will, no, because I think I think this whole model of putting everyone in the same pot is potentially a problem because. In the pot with dentists. And this this is the. This is this was our age argument when we started premium medical protection. We could choose who we took as clients. We could we could say to someone who had the worst record we’ve ever seen, you just don’t fit our model. Now with a mutual everyone was in there. We have seen some absolutely horrendous insurance records where individuals alone will rack up millions in terms of payments. Now, no one will convince me that those cases do not have a direct impact on the on the fees of other cases, because, of course, they do. And it is it is a fact that a relatively small number of people rack up a very high number of claims. Now, if your model is to put everyone together, you’re naturally going to be under a lot more pressure at the median line than a structure like ours, where we do take cases that are distressed, but we move them separate to the larger body of medical professionals.
[00:53:30] I think it’s a credit to you, buddy, because in in an environment where I mean, it’s a fear based area right now for dentists, you’re choosing not to use fear as your you know, the reason why people come to you. And and it must take discipline to do that because because it’s about fear. And it is.
[00:53:50] It is about fear. Well, thank you. You know, it’s it’s probably I would say our growth has probably not been as as big as one or two other companies because of that.
[00:54:01] Because of it.
[00:54:02] But I don’t care. Neil doesn’t care. You know, we want to do the right thing. We want to do the right thing for for dentists. And we don’t think scaring the pants off them into moving is the right thing. We don’t think moving for price is the right thing. You know, the acid test and we’re under no illusions what we’re doing here. We’re selling the ability to pick up the phone, get help, but help as and when you need it. Nothing else. We’re not selling anything other than that. That’s what that’s what dentists want. Now, we believe that and this is borne out by our numbers. When people move to PD, they don’t move anywhere else. Now, that is the best compliment that we can have. Our retention rate is almost perfect. So people join us as they understand what we do and they don’t leave because we don’t let them down. Now, what we don’t want is people to move on mask as it’s cheap or because they’ve been blind panic and then suddenly realise, oh Christ, this is almost as bad. But the leader in me last week who for obvious reasons will remain nameless, who move to one of our competitors.
[00:55:03] And she rang and said, I’ve been with this other company for two years. They’ve utterly let me down. I didn’t know what I was going to. I was in a panic because I got a problem with a with a mutual and I don’t know what to do now. And we spent absolutely ages going through her case, making sure that she absolutely understood what we were about and what she wanted. And we said to it at one point, we said, look, if we don’t fit what you want, don’t come because we don’t want clients to come and go. We don’t want a revolving door for clients. We want people to come. We do what we say we’re going to do. We support them. Prices will go up to some degree, but they’re never going to go on a curve like that. If we get it right and people are happy, it should be a piece of paper that you’re sticking your jaw. You use it when you need it, you get the defence you want. It keeps you focussed back where you want to be and that’s in your dental practice. That’s how it should be.
[00:55:54] All right then. You’ve been around long enough to see recessions. Does that affect your industry or do you expect more claims during a recession? Yeah.
[00:56:07] Yeah. I mean, people get more. Yeah, there’s no doubt about that. You know, economic factors, they do influence people. You know, they it pains me to say so, but I’ve got a friend who’s pretty much said that exactly to me. You know, he actually said to me the other day, he said, I probably wouldn’t normally be looking at this, but I’m a little bit desperate at the moment, so I’m going to make a claim. And I just shook my shoulder and said, look, you you’ve got a right to make a claim. We would never, ever, ever diminish the right for a patient to make a claim if something’s gone wrong or it was just a bad day, whatever it may be, we would never, ever, ever seek to diminish the right for a patient to seek compensation. We don’t like the use of this process as a means of income. That is what it shouldn’t be, and that’s when it really does come down to the robustness of the legal defence and the balls, if you pardon the expression of the legal defence, to actually stand their ground and push these cases back. So unfortunately, it’s very, very easy to bring a case. Very easy. You make one phone call to a lawyers, they handle it. If you’ve got a sniff of a chance of winning. Sometimes they’ll just take a punt. And there we go again. There’s another legal case that we’re fighting. But I do think that the economic climate makes a direct impact on the number of claims. Yes, I do.
[00:57:27] It’s a shame.
[00:57:29] It is a shame.
[00:57:31] We’ve had it good for a while. Gary, going forward, how do you see the industry developing? So you said about you think the mutuals might get an element of insurance. Within them. What are your plans going forward?
[00:57:46] Well, our plans is in many ways, many of us have the feeling that we’re not going to necessarily worry about what everybody else is doing. We’re worrying about what we do. You know, we’re constantly trying to evolve the product. We’re constantly trying to improve the product. One of the reasons we moved to Metro is we felt that there was a real chance that we could improve the product because of their association with access underwriting. So that’s one of the main reasons for moving there. So we’ve very much focus on ourselves. We like the fact that there’s competition because it pretty much endorses what we do as as insurers. I mean, one of the biggest challenges we faced right at the very start when we formed premium medical protection, was we were the only one. So people were scared to come to us because because this whole pulse thing was being thrown around by the media in particular, and people were scared to move. So there was very much a you move first and I’ll see how it is in a year. So we found that by year three when the fallacy that they won’t last a year was completely obliterated, it went through the roof in year three because people were then looking at the savings that we were making and the defence that we were giving and the support we were giving.
[00:58:56] And they were saying, You know what? Maybe it’s time for other options. So we like the fact that there is a good number of healthy competitors out there in the market. We don’t like the fact that there is a huge amount of it’s lack of education, mis education or or selling. I don’t know which one is it? Maybe a combination of all three, because we see dentists moving for reasons that causes a little bit of concern. That’s how it is. It’s a big market, competitive market. You always get that. But we’ll very much focus on what we’re doing. We’re constantly trying to improve the product. We’re constantly trying to stabilise pricing and keep them as as flat as we possibly can. And we’ll listen to our clients and it’s really listening to our clients that we we constantly harassing the brokers and the insurers to do this, do that, do that, and that’s on the back of the feedback that we get directly from our clients.
[00:59:48] So on that education point, yeah, it’s definitely in your interest to educate your customers, your dentist. Do you have like a formalised way of doing that or is it more to do with case by case?
[01:00:03] It’s not formalised, it probably should be more formalised. And one of the things that we want to do is, is, is, is, is podcast with lawyers is face to face meetings, hallelujah again with the lawyers where sometimes they go through like a mock case. They’re difficult to do because you’ve got to try and get 20 or 30 people in one place, which is never easy. But with the advent of Zoom and and forums like this, it makes it a little bit easier for us to get these sort of things organised. So unfortunately with the big merger that client and BLM were going through, these sort of things got a little bit of a back burner, but they’re right there at the forefront now. So, yes, we very much want to do that. Your second point was on an individual basis, that’s where the real work does happen, to be fair, and that’s where the communication directly between the lawyer and the client and sometimes referrals as well really makes a difference. The reason we get involved is there is this element of, as we touched on before, about, I don’t think I should report it or count against me. You know, this is where the insurers and ourselves with the brokers can step in and say, no, that’s not the case.
[01:01:10] That’s not a question for the lawyers. That’s a question for the insurers. You know, if you don’t report a case, it’s more likely to be prejudicial. And if you do, we’re constantly stressing that. We’re constantly stressing it because there is this fear factor. You know, I saw a claims history not long ago and there was about 12, 12, what we call circumstances on it, spread over about seven years. That was a perfectly, perfectly reasonable and normal claims history. There was two cases, I think, that paid out. One was about 600 in legal fees, was almost certainly just a couple of letters going backwards and forwards and another one that paid out with a couple of grand. That is an absolutely normal, 100% acceptable, unexpected, you know, case history from a dentist. It really is. And the dentist rang me in a bit of a panic that his claims history would count against him. And when I got it, I was like, there’s absolutely nothing wrong with that. That is fact. It’s probably below the law of averages in terms of the actual activity that we saw that actually led to a complaint, a legal a legal case, rather.
[01:02:15] What percentage of dentists do you refuse to insure?
[01:02:20] Eye. That’s incredibly small. In fact. I can’t actually remember, to be honest. I can’t honestly remember one that we’ve not at least got a prize for now. Obviously, sometimes the price is not what they want.
[01:02:35] What was the highest price you’ve heard? God. God, let God go on me.
[01:02:41] It’s over. Six figures looking for it that way. And I don’t mean £9,624, 84 PPI. I mean over on the ground.
[01:02:55] I mean, the surgical in the surgical world, I think the largest one we ever saw and we did place it was about 238 ground 240 ground. It was something.
[01:03:05] Like that for insurance.
[01:03:07] Insurance? Yeah. Yeah.
[01:03:10] What about the largest claim that the payout. The largest payout.
[01:03:14] Of just the dentist. It’s not high. You know, we very, very, very rarely see it go above 100 grand. Very rarely. We’ve had thousands of people apply to us. And I can’t remember going above 200. Hmm. I can’t remember. That’s not to say there aren’t cases out there, because, of course there are. But we haven’t seen them above 200. I can’t remember one being above 200. There’s a lot on ten grand in dentistry. It’s much more frequent than it is sizeable. In the surgical world. It tends to be the other way around. You know, orthopaedics might not get a claim for five, six years and then it’ll be 50,000. So it’s the surgical market is very, very different to them. And the dental market, you tend to not know what’s coming until it hits you. Whereas dentistry, you probably do know what’s coming and it’s a little bit more pain free. Very different dynamics, though.
[01:04:08] Gary. You know, you’ve got we’ve got this I mean, I don’t know if you see it this way, but me and a lot of dentists see this way, that regulation and litigation is out of control and it’s definitely not correct. Yeah. And I know you’re in the industry, so you’re navigating those those seas, right? But if you were the king of the world and you could change one or two things. What would be one or two things you would change to make this whole process, let’s face it, benefit patients as well as dentist. Patients aren’t getting the best right now because we’re all being so hyper defensive.
[01:04:44] No, no, you’re absolutely right. I mean, I think there is no doubt there is a large amount of what we would call defensive dentistry, but in practice, it stifles innovation. It stifles the progression of certain treatments because dentists don’t want to be the one that takes the leap and does something new or slightly outside the boundary, because it may well be that the food on the back of it and they don’t have a leg to stand on. And that’s that’s bad. That’s bad. Nobody wants that to happen. What would I do? I would make it I would give the ability to the lawyers to sue the other side for legal fees, for legal costs. That’s what I’d do, because that would make a lot of lawyers people.
[01:05:23] Wouldn’t that be a worry, though? Wouldn’t that be a worry, though? Because then the patient wouldn’t wouldn’t, you know, a patient who feels like they’ve been wronged?
[01:05:31] It’s not yeah. It’s not the patient. I wouldn’t it wouldn’t be the patient getting getting the getting the getting the cost. It would be the lawyers. Because that would make the lawyers. That would make the lawyers think about taking the case on. In other words, they’ll take well, that’s as I said before, I’m not advocating for a minute that a patient shouldn’t have a right of recourse. Of course they should. But equally, I we are appalled by some of these absolute fishing trips that we see where there is clearly not in there. And the lawyers are just simply trying to build a case to get some money. It’s as simple as that. And there are a number of those, obviously.
[01:06:02] That’s very interesting, isn’t it? Because that should be the counterbalance.
[01:06:06] Exactly. It just needs to sharpen the focus.
[01:06:08] The counterbalance to no win, no fee. If you’re going to involve yourself with no win, no fee lawyering, you should have that risk as well. On top of the notion.
[01:06:20] That there is there’s no risk. There is no risk. You know, what they’ll do is if they see that, if quite often the process is, they’ll they’ll put they’ll put a letter saying, we want to see the notes. The notes come back. It’s very easy to find something in the notes where you can say, oh, that’s not quite right. It’s not quite done. It’s also very easy for a patient to say, I didn’t I didn’t understand. It’s very easy to say that. So the onus is very, very much on the surgical and the medical, dental profession to make sure that the patient fully, fully understand everything. And that’s very difficult sometimes because the patient would just go, oh, I was bamboozled, didn’t get it. So. Lawyers rely heavily on that lawyer. The lawyers. The lawyers. We rely heavily on the fact that, you know, sometimes that no matter how often you’ve had it explained to you, you’ve tick the box and you understand it. You just didn’t. So I think I think that just needs to be just that cap, I guess just to stop this stream of cases that I’ve got no substance whatsoever. I’m not a genius. I’ve got to come up with the idea that will do it. And one day somebody will hopefully. But it can’t keep rising unchecked. I think I think I think I’m right in saying the biggest single cost in the NHS is the legal payouts and again not saying for a minute a lot of justified, maybe a lot of them are, but equally there’s probably a lot of them that aren’t and it just has to be a bit more of a balance. It really does.
[01:07:44] You. Well, it’s been a massive pleasure understanding your health a little bit more. We we tend to finish on the same two questions on this podcast. We didn’t do the whole life story bit, but you can at least end to end it in the way that we normally end it. Go fancy dinner party.
[01:08:08] Three guests, dead or alive. Who do you have?
[01:08:12] I would have that lovely lady who is called, I can’t remember her surname, Sabine, who used to drive vans around the Nürburgring. Top Gear Ace because I think what she achieved in her world. I’ve been to the Nürburgring many times and I’ve been to her restaurant many times, and she’s a legend in those parts, and I never had the pleasure of meeting her. So I would love I’d love to have her at the table in her restaurant. She definitely be one of them.
[01:08:40] She passed away.
[01:08:42] She did? Yeah. I think I think about 12 months ago. And we were in a restaurant this year only only eight weeks ago. And her legend lives on all over the walls. And I did meet her mother, so that’s as close as I got. But yes, she definitely one of them. I’ve got to say, Sir Alex Ferguson, because of what he did over such a long period of time, which the longer we go without success at United, the more we appreciate what he did and on what he sustained and what I do as a third one. Tony Blair. Tony Blair Yeah, I think all my questions will end off at Tony Blair, but I think that would be absolutely fascinating. Can I have a fourth? Of course. Bill Clinton, because I have heard that if you can get a and after dinner speech with Bill Clinton, you absolutely have to move heaven and earth to get there, because apparently as an orator and as a as a raconteur, he’s absolutely unbelievable. So, yes, I think that would be my four.
[01:09:47] And Tony Blair. Tony Blair. I’ve got to you know, at the end of the day, history remembered him about Iraq. But yes, recently when I’ve been listening to him on that Restless Politics podcast, I think you’ve seen that you feel like now nowadays you’ve got such a low standard of politician that Blair seems like a little like intellectual genius.
[01:10:12] Exactly. That’s exactly how I feel about it. It’s like I think somebody said to me about six months before the the perfect storm. Can you imagine it if Boris Johnson and Donald Trump both get in at the same time? Well, don’t need to mention it, do we? But yeah, you look back on Tony Blair now, and maybe he’s maybe his place in history will change as time goes by. And this almost procession of imbeciles keeps coming to us on both sides of the Atlantic.
[01:10:41] And the final question is more of a personal one. You’re on your deathbed. You’ve got your nearest and dearest around you. Three pieces of advice for them for the world.
[01:10:58] Don’t think about work 24 hours a day. I used to, and it’s nothing wrong with being passionate about what you do, but it shouldn’t ever consume you. Family life is incredibly important. It goes by unbelievably quickly. I speak as someone that took I think we talked before. My son is now in America at university. We’re missing him like Matt. And you look back on all the years you grew up and it’s like, you know, did we really appreciate those as much as we could? I think we did. But maybe we could have spent even more time as a family together. That’s definitely number one. No matter how bad something seems, things do get better. That’s an old cliche, but it’s absolutely true. You know, I’ve had challenging periods in my life and I remember them very well because there’s not been too many, fortunately. But I honestly feel that I’m much, much, much stronger as a person having come out the other side. When we started PMP, we were lambasted left, right and centre by defence organisations and other people as well. I was really tough. I left a very good solid job to do that. That was really, really a struggle for me and the fact that we came out the other side, the fact that we built something that lists to this day and I’m very, very proud of that. It’s really made me much tougher and an a stronger person.
[01:12:16] But the best company. Were you. Were you in finance?
[01:12:20] No, not at all. My my sort of jump into the finance sector was was really with someone that understood the insurance market. I had no clue. So I was the I was the gateway to the to the surgeons, basically.
[01:12:34] W difficult not being from that industry, right?
[01:12:38] Oh, massively. I had to learn the difference between claims made and claims occurrence. Like to learn all the sort of intricacies of the Financial Conduct Authority. I actually do all the the courses that are mandatory to become part of a regulated insurance company. Actually, to all of them. It was very difficult because I’ve been extremely comfortable in the aesthetics arena for well, by that stage probably 12, 13 years. So it was a gamble. And I think that’s potentially one of the other things that I advise on as well. If you see something and and everything is telling you, you know, if you don’t do that, you will regret it, then do it and it’s better to do it. And it may be not quite work than forever. Think, Oh, I wish I’d done that. You know, leaving that very solid job with an implant company that I really enjoyed was one of the toughest things I’ve ever done. But if I hadn’t have done it, I would have regretted it, and I certainly wouldn’t be doing what I’m doing today. So, yes, it was tough. Yes, it was brave, some people would say, but it was definitely the right thing to do. And every bit of me was telling me to do it and I did. But a lot of people sometimes stay cosy. They stay in their own comfy environment, and sometimes looking outside of that isn’t a bad thing at all. Even if you end up going back, even if you end up, you make the job doesn’t work, go back.
[01:13:57] So that’s the critical that’s the critical point, isn’t it? You can go back if you want to. Yeah. You don’t think that and.
[01:14:05] You don’t know. And I think my fourth bit of advice is never burn a bridge, because I honestly don’t think I’ve ever burnt a bridge in my life. So it’s amazing how often people, circumstances, companies come round again and you see these people storming out of offices, swearing and you know, F-you, I’m going to do this, I’m going to do that. And before you know it, fate conspires to put you right back in in their sights again. So I’ve never I’ve never been a bridge with anybody. And I don’t intend to either, because life’s too short. And certainly the industry, I mean, it’s very small.
[01:14:39] Amazing. All great advice. Really was. Gary, I hope we get we get to talk to each other again on this subject because actually, we just just sort of introduced it from from the insurance perspective. But we’ve got all the other parts of this, the dentist themselves, the legal perspective, the regulator. There’s so much to unpack there. And I want to I want to really thank you and pay tribute to you for for first of all, doing PMP, a pioneering move like that as a fellow business owner. It’s always so, you know, the fear of going into something new. And, you know, it really is agony. And ecstasy is this ecstasy of getting it right and and the pain of it, but also your move into dentistry and how interesting that’s been.
[01:15:30] And I’ve loved it. I’ve loved it. And I, you know, I dentist have very different decisions as we touched on in a little while ago. But you know, this dentist now, I can count as my friends because they are very, very engaged and very, very professional profession. And I would say, arguably, I enjoy dentistry more than I do the surgical world. And that’s that’s a statement from someone that spent a lot more years in the surgical world. I just think dentists are probably a little bit a little bit more engaged than surgeons. If you wanted a very broad statement.
[01:16:05] Does that does that chair side manner piece, isn’t there? There’s a lot of surgeons who don’t have that bedside manner piece, but dentists have to be able to talk. I think you’re right.
[01:16:14] I think you’re right. And the fact you could do you’ll deal with as many people in in one day as some surgeons do in a couple of weeks. That’s right. So I think that’s a very large element to it as well.
[01:16:24] Massive. Thanks for being on the show, Gary. As I say, it’s lovely to continue. Thank you so.
[01:16:30] Much. Very much. I hope so, too. Thanks a lot.
[01:16:34] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts Payman, Langroudi and Prav. Solanki.
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