Month: May 2020

Intro Voice: 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.

Payman: Week nine, and some patients have been struggling with unbearable toothache now for two months of lockdown. A whole profession and a whole industry is waiting on the chief dental officer to speak about what we’re going to do regarding the unlock. Meanwhile, we’ve got the BAPD, who’ve done a survey of their members, and there’s a 97% of the group are saying they’ve got no confidence in the office of the CDO. We’ve got with us Luke Thorley, who’s one of the founding members of the BAPD. Hi, Luke.

Luke Thorley: Hi, guys, how’s it going?

Payman: And at the same time, we’ve got practises struggling, particularly private practises, while NHS practises seem to be paid quite well in this downtime. But private practises struggling with getting their insurance paid, their business interruption insurance paid. A group of them have come together, led by another young man in the industry, Laith Abbas. Hi, Laith.

Laith Abbas: Hey, Payman, how’s it’s going? Hey, Prav. Luke.

Payman: Good. Thanks for taking the time. I know both of you are really busy, so let’s just get right to it. Laith, how did it start regarding this insurance claim thing, and where are you at?

Laith Abbas: I’ve got two, three practises of my own, and they are private and one of them is predominantly private. Only a small contract, about 5% NHS. It was a position where one day after another, I remember talking to my brother. Every time we had one of those daily updates from the government, it felt like an episode of EastEnders. Because every day it was like, good news for others and bad news for us. It always felt like a cliffhanger. We always felt like there was news … And we knew that actually, it wasn’t relevant to us.

Laith Abbas: As the news sorted out, the business rate holidays, the business rate release, all of these grants. They weren’t relevant to us, and they weren’t relevant to a lot of private practises. Especially when the news of the NHS funding coming in … Which is great for them, really good. I don’t think anyone begrudges them the NHS funding. That’s great, and we hope that continues. But we felt like private practises were really being left behind. There wasn’t any help, and I looked into my policy. And in my policy, so I’m with QBE in one of my practises. It was quite clear, reading the business interruption, that I felt that I should have cover.

Laith Abbas: I started speaking to a few of my friends, including Luke as well, who may consider me a friend, I’m not sure. We started thinking about actually, there’s a lot of people not making claims, yeah? When we asked why, a lot of the insurance companies, as a default response would say, “COVID-19 is not covered.” There wasn’t any reason why it was not covered. Having a reason of COVID-19 didn’t exist is not a reason to say no. So we started a movement with a guy I never met, ever. Never met him before, a guy called Manny. The only simple thing between us is the fact that we’re both dentists, we both own practises. We’ve decided to really start to inform people, and we started digging and doing a lot of research.

Laith Abbas: Through that pressure, the endgame is starting to be achieved. People, about 30% of practises, or 25%, 30% of practises are with Axa Towergate. And Axa Towergate started accepting liabilities and making interim payments. Other policies like Allianz started making payments. Covéa started making payments. There’s still some policies that we’re trying to fight hard into accepting liabilities. Look, we can’t … I was saying to Payman yesterday. We can’t do miracles. If you’re not covered, you’re not covered. But what we’re trying to do is, if you are covered, or the wording is ambiguous, we need to really research that clause and find out, is there cover, and is it going to help our private dentists? Because if you’re NHS practise, you won’t get payments, because obviously you’re still getting income. But if you’re entitled to that payment, you should get that payment. So that’s what we’ve been fighting, and really for the profession rather than just myself.

Laith Abbas: Of course. Because I want to get my payment as well.

Prav: Laith, can I ask you a question about that? Is, what is it in your contract that you saw that made you realise, look, it’s so clear in my mind when I’m reading this that I am covered? And when you’ve read or looked at other people’s contracts, and it’s so clear that you’re not covered. Because I’m sure there’s a lot of people reading this thinking, “Am I? Am I not? What am I going to do?” What was it?

Prav: Then, do you have an idea of what it looks like in terms of the payment structure, what a practise can expect? Is it related to your previous performance? Or is it related to a sum that’s assured, a fixed figure that’s in the policy?

Laith Abbas: There’s a clause … There’s a few clauses, so there’s a few that are different. The biggest one that stood out for us from day one, and we were very confident they should get paid, are one that says, “Any business interruption or interference caused by an infectious disease, apart from any age-related disease, within the premises or within 25 mile radius of that premises.” That’s it. Nothing else to that, yeah? It didn’t specify diseases. It didn’t specify that you had to have a staff member. It didn’t specify you have to have anyone in the surgery. It specifies within a 25 mile radius. So if you’re a practise in any city, that’s a guarantee that you’ve got someone within a 25 mile radius.

Laith Abbas: And premises were being closed. We got … Look, I mean, there’s a lot of grey areas sort of going through now. But we were told to close, okay, because of the virus and what risks we can pose to ourselves and others. It wasn’t any extraordinary sort of response. It was a direct response to the fact that we had to close up when we can risk spreading infection.

Laith Abbas: That’s one policy. The other policies also state, for example, Allianz. Some policy of Allianz would say, “any closure of a premises by the government or public authority.” Again, that was black and white. There’s a few like that. Where it’s a bit more grey are things like when it mentions damages to the premises, because we’ve got to define what damage means, and also sanitary. So we’ve got to define also what sanitary risk is as well, because it can be argued that a virus is a sanitary risk.

Laith Abbas: There’s a few things that we can clarify. That’s the reason why from day one, I decided we’re going to get some top barristers involved, and that’s also one of the reasons why the BDA have got involved. Because of the fact that we need to support the profession by getting these policies assessed.

Payman: Laith, but the BDA is paying for your legal challenge, is that right?

Laith Abbas: Yeah. Yeah. Every single practise. Yeah, so anyone who’s got any policy.

Payman: Whether they’re BDA members or not?

Laith Abbas: Even you’re a BDA member or not, yeah. It doesn’t matter what it is. And this includes … Some people got some really random insurance companies. Some people have got insurances companies by Farmer’s Union. Northern Farmer Union. Really random, random dentist’s insurance. But even if you’ve got a farmer’s insurance, you’re still going to be looked at.

Payman: You’ve got this interesting question about, there’s some policies that were sold to dentists through the BDA that aren’t paying.

Laith Abbas: Yeah. Yeah.

Payman: Is that correct? The Lloyd and Whyte one.

Laith Abbas: Yes, and Lloyd and Whyte are the recommended insurance broker. So they’re a broker, recommended by the BDA. It’s a really grey area because obviously, I can only be thankful to the BDA that have supported our case. But at the same time, questions have to be asked, and they will be asked, and they’ve been asked by the profession in terms of, is there a conflict of interest against the Lloyd and Whyte and the BDA doing their investigations? The only thing I can say to reassure people is that that’s the reason why they took me onto their steering panel with the guy called Manny that I talked about earlier.

Laith Abbas: The whole point there is that I’ve got no interest in the BDA. I’m not part of the BDA. I’ve got no interest in covering for the BDA. That’s why they’ve got me involved. So then when I’m looking at Lloyd and Whyte policies, if I think Lloyd and Whyte have got something to answer to, I will come out and say that. To be fair to the BDA, they’ve instructed Ravi Nayer of Rudnick Brown, one of the top law firms, to look at every policy. They haven’t said, “Look at Lloyd and Whyte and try to see how we can justify them not paying out.” Absolutely not. They’ve told him to look at Lloyd and Whyte, and see if there’s any gaps in their policy.

Prav: Just from my perspective, how does this all work? The BDA had a recommended broker. That recommended broker advised on what policies you dental practises should take out. Is there some kind of financial arrangement between the insurance company and the BDA, or the broker and BDA?

Laith Abbas: I don’t know.

Prav: If somebody has been ill advised, let’s say my dental practise has been ill advised on taking out the wrong policy, for example. Then who … First of all, is anyone responsible? Because nobody could have predicted what had happened, and had this not happened, we’d just be sitting tightly and cracking on with running our practises. Do you think somebody has got something to answer for, and who is that?

Laith Abbas: I do. Yeah, I do, and the lawyers think that we may have a case against them as well. Not specifically Rudnick Brown, but we’ve spoken to lawyers that have said, “Look, actually, there is a liability claim against these brokers.” Because a lot of dentists, and you know what … I can’t believe, now thinking back, that business interruption insurance was just a tick box to me. Yeah? I can’t believe, looking back at something so important. We never knew it was going to happen, look, yeah. I mean, pandemics don’t come around … They come around every 50 years or 60 years.

Laith Abbas: But other things, like fire claims, et cetera. I’ve never checked these details properly before. Some of these claims, even for fire claims by the way, even the biggest claims which actually could happen, have a clause in there which says they will give a maximum of 25 grand. If you’ve got a million pound turnover practise and you get a payout of 25 grand, what’s the point? There’s a lot of insurance policies that really actually need to be looked at properly. Brokers are a serious consideration, because a lot of brokers are operating by, here’s a quotation, here’s the cheapest. What happens? Dentists go and purchase it because they think, “Oh, great, this one’s 900 pound compared to 1500.” But actually it covers eff all, right?

Laith Abbas: We need to really have a look at that, and completely change it. Yeah, I think that’s something to look at in the future. In terms of making claims against the broker, I think that’s something we’re going to have to look at. Because I mentioned, some people have got office policies, and office policies don’t even cover things like compressors. You’ve got compressed air going into your property, and it doesn’t cover anything against compressed air accidents, and that’s pretty dangerous.

Payman: Prav, I joined one of Laith’s WhatsApp groups, specifically the Lloyd and Whyte one. Your question of mis-selling, there’s people on there who’ve been advised that one policy is better than the other, more expensive than the other, and that policy hasn’t paid, but the other one has paid. You know, it’s a-

Laith Abbas: Another story, there’s a dentist that contacted me. He was with Axa Towergate, and Axa Towergate, remember, they’ve accepted liability. So they’re making payments, they’re making interim payments, yeah? There’s some dentists honestly out there getting 200 grand payouts. Which, by the way, is going to save their business, yeah?

Laith Abbas: But there’s a dentist that was with Axa Towergate who was contacted by a broker who left Axa Towergate two days before lockdown, and switched to Lloyd and Whyte.

Payman: Yeah. I heard about that.

Laith Abbas: Now, where he would have got maybe a 200 grand payout, he’s now got nothing. Yeah? From a two-day sort of mistake. It’s a big thing, yeah. This is what we’re trying to sort out.

Payman: You said that some policies were … It’s the same wording.

Laith Abbas: Same wording, yeah.

Payman: And one paid and one didn’t.

Laith Abbas: Yeah. QBE, exactly the same wording as Axa Towergate. There is not a word difference in Axa Towergate and QBE. I tell a lie, there’s one word, one saying ‘because’ and one saying something else. It’s the same message, one word difference, but it doesn’t mean any different. And QBE have refused to make a payout. Axa Towergate have. Now, whether that’s a commercial decision or a legal decision, we don’t know yet. That’s one of the reasons why the FCA are going to have a look at this. The FCA, by the way, are very interested in insurance companies like QBE. Because when one makes a payment and the other one doesn’t, for me, that’s avoidance.

Laith Abbas: Like I was saying yesterday, my concern … And I don’t want to say they’re planning this, because I don’t want to get a legal case against me by a top insurance firm. But my concern is, if you look at the policies, the policies state that if a company becomes insolvent, they are not due to make any payments. When you think about 20 to 30% of practises are going to become bust, well, that means 30% of savings for the insurance companies, if they have a claim that’s valid.

Payman: You know, but also the insurance companies themselves are looking at going bust, yeah? Because this is a massive event for them. We know, of course, other industries they haven’t paid, or some haven’t paid as well.

Laith Abbas: Yeah. Yeah yeah, yeah.

Payman: A complicated situation. Luke, did you have practise insurance? Business interruption insurance?

Luke Thorley: Yeah. Mine was with Covéa. I sent them an email, and they said they would respond within seven days, and that was maybe three weeks ago. I still have no update. I’m going to see what the fallout is from Laith’s situation. I think I fell a little foul to the situation, where I have an office policy, and not a surgery one. This was obviously not explained to me. The broker who I purchased the policy from obviously knew I was buying it for a dental practise, and clearly, for me, it’s no different to the way we consent patients, mis-selling of information. It’s very easy to walk someone down the garden path if it’s not the right way. At some stage someone has to say, well, who’s right and who’s wrong, and where is the legal ground, and who takes responsibility for that?

Laith Abbas: Here’s another scary point as well, which actually we believe about 30% of the practises are affected by. If you’re a limited company, and you don’t write your company name in the correct way. For example, Laith Abbas Limited, but I put down instead Woodbury Practise. You’re not going to get a payout, because you’ve got the wrong entity ensured.

Payman: That’s great.

Laith Abbas: Who does that go back down to? That goes back down to the broker again. Yeah.

Prav: My interpretation of that is this. When we speak to a patient, and we say, “I’m going to stick an implant in your mouth,” we take them through all sorts of consent, so they really understand what all the risks are. They understand the risk of failure. They understand the risk of infection. They understand the success-failure rates. The ins and outs of that I don’t get. But as practitioners, you guys have a duty of care to explain to your patients in the most idiot-proof language that they truly understand all the risks, and they sign a consent form. Am I right?

Laith Abbas: Yes, Prav.

Prav: Are there any standards like that, that apply in insurance?

Laith Abbas: You know what, it’s all there, isn’t it? It’s written down, but it’s down to the dentist to actually read it. But I think you’re spot on, it’s the same sort of way. We can also put it down on paper for a patient to sign, but the dentist is still expected to explain it back to the patient, right?

Laith Abbas: Look, when this is over, because it’s not a case of … I’m not going to just trying to get people paid out or get clarity. I’m going to try to get people to understand these type of policies. Not only limited to insurance. Look at different contracts we take out on a day to day basis, and these are contracts that are worth a lot. Our overheads, we spend a lot of money on various contracts, on upkeep and maintenance. Actually, if you go to any dentist, if I ask Luke right now what his service contracts includes, he wouldn’t have a clue. He wouldn’t have a clue, yeah?

Laith Abbas: I’m not just picking on Luke, because I know what he’s like. But I’m saying any dentist would find it difficult. Yeah, I think there needs to be a reform. There needs to be something in the middle, and that’s supposed to be a broker. That should be explaining the ins and outs of what you’re covered for and what you’re not covered for.

Luke Thorley: I actually do know what my service contract is, because I got sent it yesterday by the management company of the unit that I lease.

Laith Abbas: Maybe I’m different. Maybe I’m different, okay. A lot of people don’t. Look, yeah, I think you’re right, Prav. I think that needs to be reformed, and there will be … After this is over, that’s probably my next thing. Again, it’s not a benefit for me. It’s because actually, I’m learning a lot. I’m the personality that I want to learn about … I don’t like to just get told something. I like to research it and understand it, so I can understand ways around things, and how my business can change in the future.

Payman: Laith, there is a difference between doing a treatment on a patient and selling something to a business. One’s kind of a B2C thing, one’s a B2B thing. When I talked to the insurance guy, he said for something like this for instance, you definitely wouldn’t bother with the ombudsman. Whereas if you were just an individual who bought an insurance product, he definitely said you would go to the ombudsman. I guess as a business, you’ve got slightly more to look out for.

Payman: But you’re right. Who’s reading all this stuff?

Laith Abbas: I mean, look. What we know for sure is that this is just the beginning.

Payman: Yeah.

Laith Abbas: What we’ve started is definitely just beginning, and it’s going to grow. We’re going to join up with other professions I think at some point, because it’s going to go … We actually have got a hearing, a court case in July. At the moment, the whole point of what we’re doing right now is we are representing to the FCA. Actually, by 2:00 PM today, we will have made presentations to the FCA. We will make our representations at the court case.

Laith Abbas: Look, let’s see what happens. Let’s see what happens, but it’s going to be a difficult thing. What I would say to dentists is, don’t rely on this. I’m not trying to be someone’s saviour, Manny’s not trying to be a saviour. We’re not promising that we’re going to be successful. We’ve been successful in some cases. It’s not to give people false hope. I don’t want people to think that this is going to save their business. This is trying to achieve, if we can, we can achieve something, we’ll achieve it together. But it’s going to take a long time.

Laith Abbas: If it goes to the Supreme Court, by the way, it could take up to four years.

Payman: Wow.

Laith Abbas: Yeah. This is not something to rely on. You need to go previous there, get your loans if you need to get your loans. Try to think about how your future business plans are going to change. Think about your cost-saving exercises. Increase your prices if you need to, whilst you’re gaining back your traction, whilst you’re starting your business up again. Everything but your marketing. But this is not something to rely on. This is going to be a bonus if anything.

Payman: Laith, if someone has an insurance policy that they’re not sure whether it covers them or not, what do they do next? Are you guys giving some sort of … How do they contact you, how do they get onto the WhatsApp?

Laith Abbas: I am 99% sure that we’ve got every policy from every dentist pretty much now.

Payman: Oh, really?

Laith Abbas: If you haven’t sent your policy, it’s highly likely that another policy’s been sent it.

Payman: Okay.

Laith Abbas: We’ve had too many dental practises, and we’ve seen so many random ones. There’s probably about 19 policies altogether, okay, spread across all the dentists. Of those, five of them make up 95%. If there’s a policy that’s missing, then yeah. When we get down to further down the line, you can always contact me, and then I’ll put it forward to the barrister at the BDA. Because what the BDA have made clear is that no single dentists have been left out. If you’ve got a policy from DigiDuty, yeah, you still send it to me.

Payman: Yeah. Well, it’s very impressive, man. I don’t know how busy you were before all of this.

Laith Abbas: Yeah.

Payman: Well, good on you. Are we going to be seeing a Laith Insurance Brokers on top of design and build soon?

Laith Abbas: No thank you. I don’t want a pandemic, and then people just say, “Laith’s a bastard,” right? There’s no way that I’m going to do that.

Payman: All right, then. Let’s get on to you, Luke. What can you tell us about the latest with the BAPD? I mean, we saw it go from being an organisation of rebels to now, at the highest level talking to the government. Where are we at? We’re all waiting for the CDO. But what can you tell us?

Luke Thorley: Well I mean, I know as much as everyone else, because everything that the CDO puts out is public. At the moment, there is no official word on when we can expect to see a return to routine dentistry. There’s a lot of groups, a lot of people, and a lot of individual practises developing their own guidelines, that they feel are enough and adequate for them to provide care to their own patients. But we cannot and we will not as a group put out an SOP or a guideline that we’re just going to give to everyone and say, “Right, you’re okay to use this.” Because it would put us in a very difficult position if someone had a problem. Very much like the insurance companies, you know.

Luke Thorley: And like Laith says, I cannot promise dentists that we’re going to be the reason, where we kickstart that routine dentistry. But what we can do is we can voice people’s concerns, collectively, to the powers that be to ask them to make the changes that we feel need to be implemented in order to allow us to reopen.

Payman: If you look in the sort of broader political area, I don’t know if you’ve been paying attention the last couple of days. The politicians are blaming the scientists for the mistakes that happened. You know they’ve been saying, up to now they’ve been saying we’re following the science. Now they’re saying, “Well, why did so many people die in Britain?” And the whole care homes disaster. The politicians are saying, “Well, that’s what the scientists told us.” Is Sara Hurley and her office the scientist in this situation? Do you reckon that she’s going to take the hit from government, as sort of the fall guy for the disaster that’s happened in dentistry?

Luke Thorley: I mean, I’m not sure if that’s going to be the case. One thing I will say is that in the webinar, the first webinar. Sara said that she was receiving advice from NHS England, and SAGE. We have questioned as a group, we have a liaison committee and we liaise with the BDA and the ADG, amongst others, to try and find out what is going on. Whilst we’ve asked for a seat at the table with the CDO via the BDA and the ADG, who both at the time said it might not be possible, they did offer to put forward questions on our behalf. Both the BDA … We delivered a statement to the BDA, which we were advised would be sent to the CDO. Which we didn’t receive a formal reply from.

Luke Thorley: Then later, we asked questions of the ADG, in one of our meetings, to put forward two questions about where the science is coming from, about why dental practises are not allowed to reopen, and/or why there’s not a dentist involved in the mix at SAGE.

Payman: When you guys did this survey, this … The one about the CDO’s office, about the confidence in the office. When 97% of dentists or professionals say they haven’t got confidence in that office, are you translating that as what, as in the office itself is a waste of time? Or the current administration in the office hasn’t got our support?

Luke Thorley: I don’t think it’s a waste of time. The issue is, is that we want some action, and we want some clarity. Which I personally feel there hasn’t been a level of clarity for my patients, that are asking me what is going on, and I can’t give them a solid answer to what or when we may return, or to my staff. When we’ll return, what a return is going to look like, are they safe to go back to work, what sort of level of work we’re going to be doing. Our concern is that the office of the CDO are the ones that are getting the information from NHS England and SAGE. But we’re not receiving a daily or weekly updated situation on a timeline of when we’re going to get out of this, or how we’re going to get out of this, and what the future for practises looks like.

Luke Thorley: It’s been made very clear that NHS practises, they’re going to continue to receive funding, which is fine. But most NHS practises have a private sector, and they employ nurses based on the private revenue. At the moment, there’s nothing in the remit to suggest that there’s any protection for private practitioners, or associates, dentists, nurses, the businesses, the corporates, the trade, the lab technicians, you name it. There’s no protection in place. If we cannot get back to work, what is going to happen to the whole profession?

Luke Thorley: For a healthcare sector that is so heavily dependent on the private sector, it’s been clear that as a group, the private market is not well represented in a way that when something like this has happened, there’s been nothing in place to stop private practises go by the wayside.

Prav: There’s a lot of confusion out there, and I know the answer, and I know it’s very clear in terms of what are we waiting for? Because some practises I’m speaking to think they’re waiting for a nod from the GDC, from the CQC, et cetera, et cetera. Am I right in assuming there’s only one piece of information we’re waiting for before we can open up the doors to our practise?

Luke Thorley: I think when you look at the profession, the head of the profession is clearly the CDO. In her first webinar, she said, “You need to cease all routine dentistry.” Now, I don’t provide anything other than routine dentistry, so for me that’s close the doors, and we’ll let you know when it’s safe to reopen. Okay, no problem. But the information that’s been coming out has not been, in my opinion, has not been enough to enable the confidence in the profession from the public, for them to feel safe. That actually it’s okay to go back to dental practise, and the staff, and the whole entire workforce. There’s just so much ambiguity, and we need some answers really of where this is going.

Payman: What’s your opinion, Luke? What’s your opinion on the safety aspect? I mean, leave aside what you’re being spoon fed. As a professional yourself. Let’s say that she said, go ahead. You’ve still got to risk your life and your patient’s life and your nurse’s life. What’s your opinion on what needs to happen to go back to work?

Luke Thorley: I’ve been very clear from the start that actually, I don’t know … This disease, we’ve known about it since December. I’ve treated patients in that time, from December to March, that have been all over the place. I work in a practise in London, and a lot of the people that I treat are very well paid professionals, and they travel country-wide. Italy, Hong Kong, Singapore, Taiwan. You name it, they’re travelling all over the place. Whilst we put in some … We said you can’t come if you’ve travelled from some countries, we’re not to know that the patients haven’t told us where they’ve travelled to and from. There was no way of stopping this from happening.

Luke Thorley: In that time period, of those four months, no member of my team has been unwell. No days have been taken off. My wife hasn’t had any illness, my son who is two years old hasn’t had any illness, and I haven’t personally … I know there’s been some dentists in the profession that got COVID, but I don’t know if that could be traced to a dental practise. I think that was traced to a holiday resort where there was a large scale outbreak. I have to question, is the PPE that we already had in place before COVID-19 happened, was that adequate?

Luke Thorley: I mean, Laith, you must feel a similar situation. That actually, none of your team have come down with this.

Laith Abbas: The way I look at it … I look at different countries, right? I look at Germany. I look at Sweden, Sweden never stopped. Norway never stopped. I look at even Italy and Spain now are starting to resume dentistry. I’m looking at Australia, which has resumed dentistry. Hong Kong, et cetera, right? For some reason, in this country, we don’t tend to look at other countries so much. We tend to think that we’re a complete different science, it doesn’t make sense, right?

Laith Abbas: I think we need to take a leaf from other people’s books, and really try to think about what we can do to prevent the risk, or try to reduce the risk. Dentistry is full of risks. We are a profession which has a risk. As soon as you see a patient, there’s the risk of transmission of a number of diseases. That’s something we’re used to. But also, cross-infection in dentistry should be amongst the best. There’s not many professions that carry out cross-infection like we do. I mean, I don’t know about you guys, but when you go to a GP … And they’re doing all sorts of minor procedures, et cetera. They haven’t got half the cross-infection facilities that we do, not even close.

Laith Abbas: For me, I think we need to make sure we’ve got agreed SOPs. And yeah, we should start resuming dentistry. Whether it’s routine dentistry completely, I’m not so sure about. I’m undecided. But that goes back to again, the CDO. The reason that people are voting no confidence CDO is because I think there’s a lack of communication. That’s the only reason that we are actually against the CDO’s attitude, is that she doesn’t believe … Or maybe they don’t have time, maybe they’re doing their own thing. But there’s a lack of communication. The communication that’s going through is very watered down, it’s wishy-washy, and it’s infrequent, okay. That’s the issue.

Payman: Yeah. I mean, I think her tone didn’t help, that headmistress tone didn’t help.

Laith Abbas: Yeah.

Payman: But at the same time-

Laith Abbas: I mean, what I say, because I know the CDO is probably watching this. Luke has got to be really careful what he says, because he’s a representative of BAPD. I don’t have to be careful as much, because I’m maybe a little bit more loose in what I can say. But I don’t think she’s representing everyone, and that’s not the aim of the CDO. I think the CDO hasn’t done a fantastic job, okay. There may be reasons why, but if she came and communicated the reasons why there’s been infrequent contact, et cetera, I think people might accept that.

Payman: Yeah, I agree. I agree. I’m going to-

Luke Thorley: I agree. If at the start, someone would have come out and said, “Please give us some time to get this right. We know that you’re concerned, please understand we’re working tirelessly behind the scenes, but we’ve got your back and we’ll update you as soon as we can,” in the same way that the chief medical officer came out. I think the response would have been very different. But I think a lot of people felt very, almost attacked in the first webinar. I think that the difference between the first and second webinars, and the attitude and the sort of tone, it was chalk and cheese. I think someone must have played it back to the office of the CDO, or said something like, “You need to ease off the gas a little bit, go easy on the profession.”

Luke Thorley: Because we were looking for leadership, and guidance, and in the first webinar I didn’t feel like we got it. I mean, I think that it’s a very difficult job that she has. She’s in a position where if she says, “Right, you’re okay to go back to work,” and then something happens, she is then liable if something happens to a patient or a member of staff or a dentist. That is a very difficult position to be in, and I fully accept that that is her position. It’s one that, whilst it’s a grey area to give a firm answer on to dentists, patients, and staff, we still need some clarity and some guidance of a pathway of where this is going.

Luke Thorley: Because we had one webinar, I think it was towards the end of March. The second one was two weeks later, and since then there’s been very very limited information that’s coming out. You’ve got dentists guessing about what PPE to buy. You’ve got people setting up PPE companies without any clear guidelines. It’s just … For me, it’s becoming a little bit farcical, because at what point is someone going to say enough is enough, we need a decision to be made about how we’re going to take this forward? The BAPD have battered on the door of the BDA. They’ve been very welcoming, and working together with them, we’ve worked together with the ADG.

Luke Thorley: What options are left? We’ve approached the office of the CDO without a reply, and I sort of made … Something like I said to my wife before is, “If you’re wearing a hearing aid and you turn it off, you can’t hear what’s going on.” That’s just to me what is happening. They just want to turn it on and off when they want to hear what they want to hear, and when they don’t want to hear it, they just flick it off and go, “We’ve got other stuff to do.” I understand she came out and said that she may have been redeployed. I just think if that’s what the government thinks of the profession, that the leader of our profession can be redeployed. I mean, what does that say about NHS dentistry?

Payman: We’re small, basically, we’re small. We are small. Dentistry is tiny.

Laith Abbas: Yeah, we are small-

Luke Thorley: It is small, but you can’t allow a medical condition where something can cause so much pain to a patient to just be let go by the wayside. I mean, we’ve got people taking their own teeth out, and people begging dentists to show them how to do this, and lend them instruments to do that I mean, you know,

Payman: Luke, would you say, would you say-

Luke Thorley: People are buying stuff off Amazon, you know. There’ll be dental kits on Amazon, and … I don’t understand.

Payman: Yeah. What would you say to, let’s say a group of dentists. Let’s say the 600, whatever it was, that group, just for the sake of the argument. Yeah? If they said, “Listen, we’re going to follow Germany or France or Ireland SOP and we’re opening, and we have our own professionalism. We can see what’s going on. Our patients are in severe pain, some in A&E, and so on. We’re going to open en masse.” What would you say to that?

Luke Thorley: I mean, it’s their position to do so. They’re well within their rights to do so. My indemnity have confirmed that they will cover me should I need to see a patient, and it’s my duty of care to the patient. I think that it’s a little bit premature, and I think now at this stage, where the cases of coronavirus are going down quite dramatically, I think that actually another one or two weeks isn’t going to make a huge difference, to wait until we do have some clear guidelines. Because it cannot go on another month like this. Because you’re right, people are just saying, “Enough is enough, we’re going to open. Whether you create SOPs or not, we are opening our doors.”

Luke Thorley: There’s different dates being bandied around. The first of June, the end of June, the first of July. People are setting where they’re sort of saying enough is enough for them, and enough is enough for their patients. It puts them in a very very difficult position, but they also have a duty of care to their patients. It’s not the right positions for dentists to be put in. We should have had these questions answered.

Laith Abbas: Yeah. If you look at the situation at the moment, it’s actually crazy, right? We don’t know whether it’s legal or illegal to see our patients. That is an absolutely absurd position to be in, right? You cannot have a position where you do not know, some people are saying it is, some people are saying … It is absolutely crazy, and it wouldn’t take a lot for there to be a full and proper statement. Yes, you can see your patients if you follow guidance, and this is what you’ve got to follow, or no you must not see, and if you see them we will shut you down.

Laith Abbas: But everything’s been so wishy-washy. The CQC statement changed last night. The CQC statement last night became, “We cannot enforce closure.” What? What is that about? Can we see patients or not?

Payman: Well you know, you guys are young, yeah? You’re used to … You grew up in this era of being scared of the GDC continuously. But for me, it’s a shame. It’s a shame that we all have to just … I don’t practise anymore, but if I was a practising dentist, I’d look to my own professionalism, you know? I don’t really need the Chief Dental Officer to tell me what’s safe and what’s not. Especially as Luke’s point, she’s not telling us what science she’s looking at. Of course, it’s easier to say when you haven’t got that problem.

Laith Abbas: We don’t know who is regulating us. I can’t remember who put a post up the other day. It was a question about, do you know who actually regulates us? There’s so many different regulators, we don’t know which one has the final say.

Luke Thorley: I think this pandemic has unearthed a lot of problems that people knew existed before, but didn’t have the time to address them. The reason why the BAPD has sort of come together is that we all can be united on an issue that we all agree on, and we all know existed before. But no one took the bull by the horns, and no one really went for it and said, “This isn’t right, but how do we make it right?” It would be very easy for me to say my personal opinions and create fireworks on this interview. But I think it’s better to save those for Bonfire Night, and for me to stay professional to the BAPD and say, we have done everything within our power to try and get the collective voices of the profession over to the CDO, the BDA, NHS England, Matt Hancock, you name it. Keir Starmer, every single person has been contacted.

Luke Thorley: If we did it in a way that was, like you said at the start, we’re the rebels and the renegades. They just sort of bat you down the corridor. But now this morning, we’ve received a reply from the CDO. She is listening to what we’re trying to say, but now what we’re going to ask for is a direct meeting with the CDO. We’ve asked before via the BDA and the ADG for a foot in the door, to try and get us at the table. Now we’re going to be asking for a meeting directly with the office of the CDO.

Luke Thorley: We don’t want to cause a problem. We want to create a solution. Not just for NHS practises, but for private practises as well, and for every single person that is within dentistry. Whether that’s a lab technician, a nurse, a hygienist, a therapist. We’re not exclusive to just representing dentists. It’s just that the dentists were the first people to come together and get this sort of ball rolling. But we’re ready to represent the whole profession.

Prav: Luke, how will we go back? You know, come rain or shine, we’re opening our practise on the first of next month. Simple as that. That is our current position right now, in our practise. However, pretty much like yourself, it’s a fully private practise. We do a lot of want-based dentistry, is probably the easiest way to describe it. Our business financially relies upon that. We could not possibly survive as a business, let’s take the whole … We do this to care for our patients, and there’s a huge element of that. If we just went back doing emergency dentistry … What I’d like is to all go back, full blown AGP, let’s crack on.

Prav: According to what I’ve read, a lot of advice from Dominic and what’s been put across, it’s clear to me that the risk AGP versus non-AGP, is in my mind, as the science describes it, nonexistent. Let’s say the CDO gives us the nod. Is the CDO going to turn around and say, “Yes you can go ahead, with these caveats?” Or do you think that’s going to be down to the individual dentist’s discretion, and their own SOPs? Or is it something that perhaps you guys are going to be looking to prescribe as the BAPD in terms of what your advice would be to our … Being the voice of private dentistry.

Luke Thorley: I think if the … I’ll say one thing. If the CDO or the office of the CDO come out with guidelines, they’ll be open to interpretation anyway. In the same way that the advice that they’ve given has been open to interpretation, and they’ve not pinned the tail on the donkey and said, “This is the way it’s going to be.” They’ve not said, “For veneers you have to do this, for crowns you have to do this.” They’ve said, “Try and avoid certain things.” Then there’s a circle that you can always trip up on.

Luke Thorley: There’s always going to be room for interpretation. What I will say is that the BAPD have been working on a set of SOPs with the FGDP. But the process is slow, and we need it to be quicker. That is not always at our end, and it’s not always at their end. There’s always something that seems to be taking some time. We need to get this process going, and like you say. The evidence from what I’ve seen, from what’s been collated by the group, is weak at best regarding whether there’s an increased risk of aerosols, or there isn’t an increased risk of aerosols.

Luke Thorley: Because the virus hasn’t been around long enough, and we haven’t been able to put some things in place and see, “Does this work or does this not work?” It’s very difficult for us to say, “This is what we need to do.” But what we’re generating is in a sort of FGDP style, which would be a minimum, an accepted, and a best practise guidelines.

Payman: I mean, Luke, the thing is we’re looking at a recession, the chancellor said today. We’re looking at the practises who are getting their insurance and not getting their insurance. There’s so many different things we’re looking at, as far as opening up, that I think this sort of obsession with the date itself is … It’s putting people’s minds on that, where their minds could be on, “How am I going to survive, and how am I going to thrive when we do open?” I think Prav, you guys have been so busy with your virtual consults and all of that, and I’m getting contacted left right and centre. “What day is it? What day is it?”

Payman: It doesn’t really matter what date it is.

Luke Thorley: I agree.

Payman: But we’ve all got major challenges going forward, you know. As dentists, as … Me and Prav, I guess. Prav owns practises, but we’re suppliers to dentists. We’ve all got major challenges going forwards. We need to focus on, how are we going to survive, thrive, in that future going forward?

Laith Abbas: The profession’s split in terms of, some practises are going to go back to work and just do emergencies. Some practises are going to go back and just do emergencies and exams, no aerosols. Some are going to go full blown AGPs, yeah? I actually don’t know which one of those I fit into. Prav, are you going to be doing AGPs, full dentistry from the first?

Prav: The thing is, I am a business owner. I’m not a clinician. If the decision was up to me, I’d rock and roll, full blown. Full steam ahead, day one, all or nothing. A bit like I am in life, all or nothing. But I think it comes down to, from the clinicians and the principals in our practise to make those decisions. I think we’re going to take an approach whereby we’re going to minimise the number of people walking into the practise. Have them waiting in the car, and then maybe start off first of all by taking care of those patients who’ve had a little something that’s come loose. Just tidy up those patients who are in need.

Prav: And then sort of slowly start integrating, and hopefully the guidelines will come along. A little bit more waiting time between patients. Looking at the science, and being a scientist myself, I’d just say, listen, business as usual, guys. I truly believe, based on what I’ve read, based on what’s been presented to us and summarised by Dominic predominantly, that our PPE pre-COVID was sufficient.

Luke Thorley: I agree.

Prav: Otherwise, dentists would be dropping left, right, and centre with just flu, with viral load with that. That’s my take on it. Yeah, it’s a tricky thing in terms of deciding what to do. But you guys, Laith, Luke, as private practise owners, what are you going to do? Luke, you open your doors tomorrow, and you’re just providing emergency only service. You might as well be sat at home with your son.

Luke Thorley: I’ve taken that decision, that I’m not going to open on that basis. Because my practise is a want practise, it’s not a need practise. I will provide an emergency service of course for my patients, but it doesn’t make sense for me to open a full blown staffing system from a business perspective, and be treating three or four emergencies in a day. I mean, unless the patients are will to pay 500 pounds to have an exam and a checkup on a loose filling, then it just wouldn’t make any sense. I think that that is a position that a lot of practises are going to find themselves in, and it’s going to affect associates probably more than people think.

Luke Thorley: Because if you own a practise, and you’ve got four associates, but the owner of the practise could go in and deal with all the problems in a day. You’d have to pay your associates four times, and four nurses, and two receptionists. It’s just not going to happen. I think there needs to be a degree of protection in the pathway back, and it has to be that the profession is going to have to say, “Well, I’m not going to shaft my associate, and I’m not going to let my hygienist go. I’m going to create some sort of pathway back for everyone.”

Luke Thorley: I think that’s why it’s important that at the BAPD, we do represent everyone, and we won’t just let people down. I won’t let my associate down. He’s sent me a message and said, with a nervous smiley face, “I’ll see you when this is all over, hopefully there’s a job in place for me.” There will be one for him. It will be a different one, for sure. But I’m not going to change the way I’m going to do things with him, or the way I’m going to do things for my staff.

Luke Thorley: You talked before about, some will thrive and some will die, and that just comes down to attitude and application. I have enough energy to feel like actually on the other side of this, there’s actually quite a good opportunity for people who are of my age, younger or slightly older, to go, “Actually, now’s the time for me to open my own practise.” There’s going to be loads of emergencies floating around. Go for it. Get Laith to build you a squat practise. Get going with it. Because I’ve done it in 11 months, and it just requires hard work. It doesn’t require anything else, other than hard work.

Laith Abbas: Look, forget COVID for a bit, for a second. This whole situation, like a switch from lockdown moment, whenever it was. 14th of March, I can’t remember the exact date now. It’s the biggest influence and change in dentistry that we’ve had in 50 years. Dentistry is going to change a huge amount pre and post lockdown. As with everything, dentistry is going to change in terms of how the associates will be paid, how the practise will be run, how a business will be run, how we’re going to see patients, cross-infection. Awareness of patients from hygiene sort of reasons.

Laith Abbas: I mean, it is going to completely flip the whole landscape of dentistry. I don’t think people quite realise that yet, because our attention at the moment is getting back to work. I can guarantee you, a year today, we are going to look back and think, “I can’t believe how much has changed.”

Payman: Laith, how many associates and how many staff have you got in your … You’ve got three practises.

Laith Abbas: Yeah. Associates, probably about five, something like that. Staff, maybe 15. 15 staff members. A lot of them are part time, so we’re flipping between different things. I mean-

Payman: Have you worked out who’s going to pay for PPE? Is it a patient charge, or are you going to change your associate split?

Laith Abbas: Depends how you do it. I’ve got a very small contract in one of my practises. 5% contract, 95% private, and how on earth NHS … I mean, I don’t know. If you’ve got a big NHS contract, that for me is the biggest concern. Because I don’t know how that’s going to be run. If we’ve got to wait for [gaps] and we don’t know how the actual agreed SOPs are going to be, but PPE cost … Did you look at aerosol generating procedures, for example? An aerosol generating procedure used to cost 33 pence per patient. It’s now going to cost around 38 pound per patient. The average UDA value is 22 pound, 23 pound.

Payman: Yeah.

Laith Abbas: Explain that to me. I don’t know how it’s going to work. So dentistry is going to change a huge amount, and I think it’s the next discussion, and it’s something BAPD need to get involved with. I really hope the BAPD works closely with the BDA. Because actually, I don’t want a separation of unions. I want it to be a really strong union, and I would encourage both parties, all parties, to join the BDA and the BAPD.

Payman: Does the BAPD have a position on this? What would you like the NHS to look like, Luke?

Luke Thorley: I mean, there’s some people that are saying certain things, and this is not coming from within the BAPD, this is just some things I’ve heard that I find quite interesting. That actually suggest that, is the government and NHS England using what’s going on right now to see, does an NHS core service work? Is it something that actually they can reduce from the NHS burden and the budget? Can they actually pull out of some of the NHS contracts and allow dentistry to move more to a private model, with a core service in place for emergencies, taking teeth out, getting dentures, things like that.

Luke Thorley: I think it would be an interesting time to look at that from the NHS perspective, but I don’t know whether that is what’s going on.

Payman: Is that what you’d like to see?

Luke Thorley: Not really. I mean, I think that would just hammer business, and I’ve got a lot of friends who have NHS practises, and big NHS practises. I just don’t think that that would be the right thing to do, or to use it as a reason to do it now. I think that that needs to happen in a very very staged manner. I know we talk about phased manners and staged manners, but I really feel that if you’re going to reduce the NHS contracts dramatically like to a core service, then businesses will need a significant amount of time to prepare for that, and I don’t think that it’s something that should be implemented overnight. I can see Laith’s got to rush off, so.

Payman: Let’s just thank Laith. Thank you very much.

Prav: Thanks for your time, Laith. Really appreciate it, sharing everything today.

Payman: I know you’re busy yourself. Thanks for doing this. And well done.

Laith Abbas: Thanks, bye-bye.

Luke Thorley: Cheers, mate.

Laith Abbas: Cheers.

Payman: Well, you know, for me, I get what you’re saying about our friends who have NHS practises, and whatever the sort of incremental steps are to get to this. But if the government’s spending, they say 3% of health spending on teeth, for me, spend that 3% on a core service, and let everyone else pay for it. Then the private market will split into the classical private and independent, or different prices of private dentistry. You guys who sort of are at the peak of it right now will be the expensive private dentists, and then these new NHS guys will come in, they’ll be the cheap private dentists.

Payman: I mean, I think that makes sense as a system. You’re right, getting to that, there’ll be quite a lot of blood on the streets, isn’t it? If someone’s bought a practise with 2 million pounds, based on the NHS contract, or the corporates.

Luke Thorley: Yeah, I think it’s inevitable that at some stage there’s going to be more of a … And it’s no secret that the government are trying to do that, and they have been trying to do that for years. If you keep squeezing the NHS contracts and you keep the UDA value at 25, 20 pounds, the cost of PPE is 15, 16, 17 pounds. Then it doesn’t make sense for you to have an NHS contract. You’d be better off to hand it back. I’m not suggesting that that’s what will happen, but-

Payman: Yeah, but pre-corona, pre-corona if a friend of yours … I mean, friends of mine all the time, they say, “I’ve got toothache, where shall I go? Shall I come find an NHS dentist?” Definitely not, you know. It’s a sad situation, you’re telling people not to go. For sure, don’t go to an NHS dentist for an RCT. It shouldn’t cover everything for everyone.

Luke Thorley: I think that that’s probably very unfair for me to say not to go to an NHS dentist, because I’ve got some great friends, and great clinicians who are NHS practitioners. And they’re very ethical. Of course in every profession there’s people that are good and people that aren’t good at stuff-

Payman: Would you do that, would you send your younger daughter, your younger sister, who needs an RCT? Would you say, “Definitely go find yourself an NHS dentist, they do it cheaper?”

Luke Thorley: But if it was based on the fact of skill, and I could find someone that could do it, it wouldn’t matter who would be NHS or private.

Payman: It’s not-

Luke Thorley: But the reality is, is that most specialists are private, and I would want for my family member the best outcome. For that, I would send them to a specialist. But if they were an NHS … Some specialists work in the NHS and privately, so it’s not quite an easy way to split the two.

Payman: I’m not saying anything about the dentists themselves, I’m talking about the system, you know?

Luke Thorley: What are you asking me about the system?

Payman: I’m saying the system was broken before corona.

Luke Thorley: I’ve only really worked in private practise, so it’s very difficult for me to have an understanding of the NHS system. So I don’t know … I worked in it when I first left VT for two or three months, and then I got a private job. I haven’t really had much experience dealing with the NHS, or the system. I hear of the people, what their concerns are, the people that work inside it, but having not really had loads of experience or exposure to it, it’s difficult for me to say one is better than the other, because I just simply don’t know enough about the situation.

Luke Thorley: That’s partly why I can, despite my lack of years compared to the other people that are in the BAPD, I’ve been a private dentist for 10 years. I wasn’t an NHS dentist for 10 years and then a private dentist for 10 years. I’ve been a private dentist for 10 years.

Payman: Take us back to when you started BAPD. What happened?

Luke Thorley: How it happened?

Payman: Yeah.

Luke Thorley: I can’t remember, someone put a post up about they weren’t happy with the response … I don’t know if it was to the CDO or the fact that we hadn’t had any guidance of what was going on. I made a comment, and Jason messaged me, and then we got talking. I was speaking to Tiff in the background about this anyway, and Tiff, Zaki, Rahul, James, and a few others, Bertie. They were already sort of moving towards this idea of a new union for private dentistry. Myself and Jason didn’t know what was going on, because I keep myself to myself, and I only know Jason through the internet.

Luke Thorley: It was clear that when we set the group up, that they already had this situation going on, and they had a website ready to go, and they had logos designed, and they were ready to launch it. When it got down to the nitty-gritty, it was clear that we had the same ideals about where wanted to take private dentistry and how we wanted to be represented. It didn’t make sense to be separate anymore. It made sense to join together, use our pool of resources, and try and help the profession and guide it in the right direction. I think a lot of the guys who have more years of experience have been through the change in NHS contracts, and they didn’t want to see that again. They didn’t want to go through that all again.

Luke Thorley: Having heard about that, I didn’t want the profession to be buried in something that they didn’t really partake in without any input.

Payman: Yeah. Well, it’s very impressive to see you stepping up like this, man. We were talking about it, saying you don’t need to. You could be sitting out in the sun barbecuing at home, but you’ve stepped up. It’s like-

Luke Thorley: I could be. I could be sitting outside. I’ve got a two year old son, and for me, this has actually been a blessing, because I spent the first two years of his life, I spent not around. I’ll be honest, and be very candid, that I was not a very good husband because I was tied to the practise. I’d opened the squat practise, and I was there, and I actually spent more time with Laith during the build process, you can ask him, than I did with my wife. Because it meant so much to me and to my family to get this practise off the ground, and we’d invested everything we had in it. I put the house on the line. Everything was going for it, and now I’ve got this time off.

Luke Thorley: Okay, it’s been forced, but the practise is in a good position. It will survive whatever is the outcome of when we can or can’t open. We will be fine, and we’ll bounce back better. But what I can’t allow to happen is the amount of work that I put in to try and get it up and off the ground, to provide a better life for my son, and the sacrifices I’d had to go through, missing birthdays, his first steps. Seeing all these things on a phone. I couldn’t just allow this, what I felt was an injustice to keep going on. It’s not okay to just sometimes sit back and go, “Oh, well, someone else will sort it out.”

Luke Thorley: At some point, you have to stand up and say, this is not acceptable and it’s not good enough. I’ve not put in my whole life on the line for someone who has the position of power to then say, “No, you can’t do it, we’re doing it this way.” When you don’t agree with the way out, or the pathway. To help guide that pathway, and … We needed a voice. I’m glad that what I thought was then … It was heard by the other members, and it’s been well received and promoted by 10,000 other people joining in the space of four weeks.

Luke Thorley: I’d say that as a group in dentistry, we’ve achieved more in four weeks than some have achieved in their existence. And we’ve done it without any funding, we’ve done it all on our own accord. I just think, if we had this voice before, a private, well-funded, well-reserved big voice in the profession, would we have got this far down the line before we were opening our practises? I have to say, there’s no way it would have happened. Because I feel like if we had the same voice immediately as the BDA did at the start of this COVID situation, there’s no way we would have allowed this to happen. The voices that are supporting us are too strong, and the people behind it, they just will not take no for an answer.

Luke Thorley: We need to see a change. We need to see one very soon.

Prav: We’ve got one final question for you, and it doesn’t relate to the BAPD or all of this, it’s just I’ve just extracted something out of something that you’ve just said, that really resonated with me. Is that this whole lockdown period has given us time to be better husbands and better fathers and all the rest of it. Certainly, reflecting on my own life, there’s so many silver linings what have come out. I know for a fact that some things are going to change for the better, forever. Is there anything that you’ve taken away from this time, where you’ve had that breathing space away from the business where you think, “I’m going to change this in my life, and this is what it’s going to be.”

Luke Thorley: Yeah. During setting up the practise, and the first year of the practise, I suffered with crippling anxiety. I’d never suffered it before, and I suffered with crippling anxiety. Actually, it was all related to the pressure I was putting on myself to deliver the best care to the patients, make the most money, do the best treatment, keep the patients happy, keep the staff happy. But it was coming at the loss of my family life, my relationship with my wife, and definitely my relationship with my son.

Luke Thorley: I can wholeheartedly say that for the first 18 months of his life, I had no connection whatsoever to him. It’s hard to say that, as a father it’s hard to say that, but that’s the reality. Dentistry made me be like that. But what I’ve actually learned in this period is actually, I love being a dad, and I actually really enjoy spending time with my family. Actually, dentistry needs to play a second role in my life, and not be the first role in my life. Going forward, yeah, there’s going to be some changes. I’ll still work as hard, I’ll still be giving my all to my patients. But I won’t be doing things that I was doing before, and I’m not going to go back to the same ways. I’m not going to be on the minute, I’m not going to be buying meal deals and living a life in a car and on the road.

Luke Thorley: I had three jobs, and it just wasn’t necessary. Until you take it all away, I don’t need all that stuff, because actually what I already had is enough.

Prav: That’s lovely.

Payman: Lovely, man.

Prav: That’s lovely. Thanks for sharing that, Luke.

Luke Thorley: Well, I think it’s important, because I think that a lot of men in dentistry probably feel the same way, and a lot of them would never say those things. They would feel it a lot, and I think that the mental health of the profession was a little bit bad before. After this it’s going to be torn apart, and the rebuilding of what happens afterwards is very important. I think that the office of the CDO and the people who make the decisions have to be acutely aware that actually, they have a duty of care to the profession, to make sure that there’s still jobs in place for people. Because it’s okay saying, “Well you know, rich dentists, they’ll get back to it.”

Luke Thorley: But the reality is, is that it’s probably going to be a long time before we see any normality, and for some people that won’t be enough. The words will not be enough. They’re going to need to see some action. I’m not sitting here trying to be the Tyson Fury of boxing, and the mental health ambassador, or anything like that. But I’ve been through it all, and I know exactly how it feels. I think a lot more people feel like me than don’t feel like me.

Payman: Thank you very much, buddy. I like your summary, and I just want to take this opportunity to thank you for taking time out and standing up for the whole profession, you and the whole team behind you. I know there’s a massive group of dentists, both from the committee and … Let’s face it, 10,000 dentists behind that. Thank you so so much, buddy.

Luke Thorley: No problem, guys. Any time.

Prav: Thank you. Thank you so much. From my perspective, you guys have just brought a lot of sense to the profession, you know. When dentists are scrambling around looking for answers and not knowing which way to turn, or whether they should buy this air purifier or that purifier or this mask or that mask, and the science, and what you guys have brought is what the profession has needed for a long time. Huge thank you from me as well.

Luke Thorley: No problem. Well, long may it continue. We’re not going to stop afterwards, after this is all over and the dust settles. There’ll be something else that private practitioners need support on, and I’d like to take the opportunity to thank the people that are involved in the BAPD, because there’s no reason that they should take their time, and use their expertise to try and help the whole profession. But they are doing. We’re doing what we can, and we’re trying our best, so you’ll just have to be patient. I think something is coming very soon, possibly this week, and I hope everyone sees something positive from the outside of this.

Prav: Thank you.

Luke Thorley: No worries.

Outro Voice: 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.

Intro Voice: 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.

Payman: What do dentists have to make sure they get clear before they go in and what would you do in your case in the first few weeks and months?

Christopher Orr: I think it’s probably fair to say that my overall feeling on the PPE situation is that we don’t have enough information. Unfortunately, we do have to, many times, make decisions on the basis of incomplete information. And you couple that with our national mentality of being very cautious and it’s understandable why dentists in the UK are tying themselves up in knots because many people seem to want this nirvana of 100% safety no matter what they do. And we see it at the moment with some of the teaching unions who are saying unless you can guarantee it’s 100% completely safe we’re not going back to the classroom.

Christopher Orr: And that is perhaps an unrealistic expectation. There’s always been an element of risk in dentistry that existed long before COVID came along, and the question really is what do we do to really try and mitigate that risk? First group of people we have to make feel safe is our staff. And I’m aware that in terms of what we do, and again particularly around the issue of protective equipment, we have this basically, probably three ways you can look at PPE. There’s what’s proven to be effective, there is what is recommended by guidelines, and there is what’s available. And frequently we’ve seen that what the guidance is fitted to what’s available, and that’s about as good as we can do at the minute because there’s an absence of absolutely concrete proof [inaudible] on what personal protective equipment is necessary.

Christopher Orr: The FFP2 versus FFP3 thing. The consensus opinion seems to be that FFP3 is not necessary in the dental practise unless you’re treating somebody who actually is suffering from a COVID infection at that moment. And we look around the world, most jurisdictions seem to have settled on an FFP2 mask and a gown for doing an aerosol generating procedure. That’s the basis on which the French dentists went back to work, I think it was at the start of this week, on Monday. In Germany they’ve paid long attention to transmission data coming from Wuhan province in China, which seems to indict that the dental surgery is a much lower risk in terms of transmission of the virus. So the German dentists, they have not closed. Met a man in Berlin, has been seeing patients throughout the entire lockdown period. He’s been doing that at about 60% of the normal speed. They’ve been wearing visors and some masks and that seems to be about it.

Christopher Orr: And I think we’re probably overthinking things. There are a few confounding variables that have come out from the conversations over the last couple of weeks. Some people have been suggest that FFP2 masks need to be fit tested and FFP2 masks, probably the majority would fail fit testing, if you look around the opinions of people who know what they’re talking about. the FFP2, it offers additional protection for you, but whether the additional protection of the FFP3 is necessary, that seems to be fairly negligible for dentists. That was Mark post on dental health.

Christopher Orr: So we will have to settle on something. My hope is two things, one, that whatever it is is commence work with being able to do some dentistry. Even though you can put yourself in all sorts of protective gear, but if it actually gets in the way of doing your job then what’s the point? And the second thing, which I think was either quite correctly said yesterday on webcast, was that these things, when we have these kind of standards we never seem to come back from them. Jason gave the good example of single-use endo files. We’ve not yet got to the point where we can say it’s actually we know it’s okay to re-use these things if we sterilise them. The second thing that I would hope for is something that actually, it’s a temporary situation. And whatever is in the legislation has an expiration date, a sunset clause, whatever you like on it, that can be reviewed and renewed, but otherwise, it falls away when the situation that we’re in hopefully has past. Because if it’s a permanent change to all the personal protective equipment, I think it’s a very seismic change in dentistry, which I think would grossly affect the nature of what we do.

Christopher Orr: So in terms of getting back to work, I think the staff, most important, staff being reassured that the work environment is safe. Is safe for them. And most of the PPE stuff that has been recommended, a lot of it is coming from the point of view of protecting the healthcare worker. To a lesser degree, we’re protecting the patients from us because if you look at all those filtration things, they filter the air on the way in, but not on the way out. Particularly the valued ones. So therefore, there’s not a lot for the patient to stop them getting stuff from you but you’re not getting things from the patient.

Christopher Orr: So in terms of return to work, whatever date you pick, we’re going to have our staff in for probably two or three days before we start seeing any patients. Those couple of days would be used to, number one, reacquaint them with the practise, which they probably haven’t been in for a couple of months. Number two, update them on the new procedures to how we’re going to be doing things. Make sure they can put their PPE on, make sure that they’re able to do that correctly.

Payman: You envisage writing down all of these policies as in risk assessments and so forth. Would you say every practise now has to do a big-

Christopher Orr: Yes, absolutely. There’s a number of reasons for that. I know there’s been some discussion about whether the CDO has any authority over private practises. And the answer, it’s a Vicky Pollard answer. It’s yeah, but no, but yeah, but no, but kind of. In terms of statutory authority, no. In terms of indirect authority, yes. And many of the other organisations we know and like, like the CQC, like your indemnifiers, they will be looking to what the CDO is saying to give them an indication as to how things ought to be going.

Christopher Orr: So whilst there are some people who are saying if you wish to run a private, urgent dental care centre you should crack on, and you can take a view on that, my advice would be that you need to be very, very clear with your indemnifier as to whether they’re going to cover you for that, and have that response from them in writing before you start cracking on and throwing the doors open.

Payman: But what would you say… Chris, when you say that are you saying that the GDC rules are you need indemnity so that’s that, or are you actually thinking of a worst case scenario where, I don’t know, a member of the public or your team goes down with COVID-19 and blames you, the practise owner?

Christopher Orr: In theory, yes, that is the risk. Proving that the dental practise was the play, the onus of proof is on the accuser. But in theory, and of course in Britain, we like to tie ourselves up in knots on theoretical risks of this and this and this. And what you don’t want to have is being sued by somebody and your indemnity provider say, well, actually, we’re not going to cover you. And exactly what is acceptable to the different indemnifiers or insurance providers, it will vary from person to person. My advice for your listeners is they need to have that conversation.

Payman: But they might say that… Let’s say we get a disruptive indemnifier who really wants to make their name now and says, as long as you’ve got CQC and PPE and all this in place, we’re backing you. So then let’s say we start practise and your hygienist catches Coronavirus in McDonald’s and then sues you and says that there was nothing written for whatever it was, procedures. At that point, your indemnifier may not pay anyway. It’s not that you’re going to be left… It’s a discretionary thing. It depends on… For me, is it a GDC thing or is it we’re really going to have these problems? I’m not so convinced one way or the other.

Christopher Orr: We can argue this all day long. The GDC, I don’t believe it is their statutory function to determine when practises should be open and for what. Their job is to protect the public, protect patients by controlling who is allowed to do the dentistry. When those people are allowed to do the dentistry, I believe, falls outside their remit. And I know they’ve taken a bit of flack for sitting on the fence or pointing people towards the CDO, but at the end of the day, that, I believe, is the mechanism.

Christopher Orr: Now, this whole crisis in dentistry has highlighted one of the problems that we do have, that we have numerous different competent authorities who don’t seem to communicate terribly well with one another. It seems they communicate by telegram almost. This minimum amount of information goes from one to the other. They don’t seem to coordinate. Now, of course, in this country, the way we have things set up, in other jurisdictions, the dental society, the equivalent of the BDA, acts as licencing body, trade union, and in some cases offers indemnity as well, depending on how things are set up. In the UK we don’t have that. At least not for dentistry. Some other professions perhaps. And the reason, of course, things were set or split up was that at some point, somebody in the past has argued that the profession should not be allowed to regulate itself unless you’re a lawyer, because the law society do get to do that. But if you’re not a lawyer then you’re not allowed to regulate yourself because there might be a conflict of interests. Therefore, we better get some lawyers to run the GDC and regulate the dentists because they’re not capable of doing it.

Payman: So if you were the king of the world, Chris, what would you-

Christopher Orr: Unlikely, but yeah.

Payman: … would you stick the BDA and the GDC into one organisation? I think it would make sense because it would make the GDC more of a wet-fingered organisation.

Christopher Orr: You could do. And it’s difficult where you’ve got government stuff, private stuff all in the same pot, but it could be quite interesting to look at if you merge those bodies. But at the end of the day, again, that’s a conversation we can have over a number of glasses of wine later. I haven’t really answered the question about going back to work, which is probably what the listeners are interested in right now rather than navel gazing about whether we can merge the organisations.

Christopher Orr: So in terms of back to work, staff safety, staff training, number one. Things do have to be written down. When you are returning to work things are clearly going to be different. The CQC are probably going to want to be reassured that things are safe because that’s obviously their job to make sure that everybody’s safe, brackets apart from care homes, but that’s not our problem at the minute. So everything needs to be written down, staff need to be trained, and then within some limitations we can probably start seeing some patients again.

Christopher Orr: Prior to the lockdown, and I think there was probably a period of about two weeks where we could all see it coming if you were watching the news in any capacity, during that time, what we did at our practise was we went through all the patients who were under treatment, about to start treatment, or were due to come in for consultations. And we broke them down basically into three different groups: people to be worse off, people who will be okay if we wait, and people who we better not start things on. And the reason that was relevant at the moment is when we open up again, there are going to be that same stratification of patients. The ones who need urgent care. So the ones who have something that is broken or come off, or have a toothache they’ve been managing with AAA protocol. Those people need to be gotten in quickly. Patients who you needed to do something on and you couldn’t get them in before lockdown, again, those sort of people. So things like orthodontic adjustments, people with active caries, people who can be moved onto the next thing. So those are the people you probably need to see first.

Christopher Orr: Second group of people who will not be any worse off if there’s a delay in treatment, those are, maybe, I don’t want to say priority, but they are less urgent to get in. And people in the third group, the ones who you need to be sure you can complete the treatment on, that’s a group of patients in some practises which the dentist I think need to give a little bit of thought to. So for example, if you’re doing implants and you have a patient on whom you’re planning to do some autogenous bone grafting, you do the autogenous bone graft, there’s a clock ticking. And unless you get the implant in pretty quickly, the bone’s going to go away again. So the problem, I don’t why I’m perhaps smiling, the problem potentially is if we have a second outbreak and a second lockdown those people are not going to be able to complete treatment and you end up actually with them no better off or even worse off when they started. So a little bit of caution rather than throwing open the doors to everybody.

Christopher Orr: And again, please don’t ask me question about bone grafting. This purely comes from a conversation with George our oral surgeon. And we were having this conversation yesterday and he was saying the patients who need that type of bone grafting I’d rather not start until we’re sure that we can remain open for long enough. If we’re doing particularly the bone grafting in a patient, that is much more stable and therefore, if that was the procedure that’s planned then we can get on with doing that one. Because if we have another lockdown for several weeks the window of opportunity, if you like, is longer. So I think a little bit of caution who you get in and how. And that needs to be done on a patient by patient basis.

Payman: Prav, you were saying your practise, you’ve got loads of patients who’ve paid for their treatment already. And-

Prav: Yeah. Go on, sorry, Payman. Carry on.

Payman: Patients who’ve paid for their treatment already and are desperate to get going and desperate to finish off.

Prav: I think, pretty much we’ve certainly not been as analytical as Chris on this, but in terms of categorising I think it’s an incredibly sensible thing to have done. But I think this really hit us all pretty hard pretty quickly and so a lot of our thinking came into place on lockdown. So one of the things we realised is there were a lot of patients… So we looked at the business from several aspects, and one of them obviously, was the needs of our patients, and then the other one was from the financial aspects of the business for it to be able to survive, and how we could meet those demands. And obviously from those patients who were mid treatment, so to speak, they just needed some reassurance really. There wasn’t much we could do at this point in terms of treating them. So what we ended up doing is launching the video communication really, really early and inviting those patients to have rather than a telephone conversation, see the whites of the eyes of their practising dentist, their clinician, and just have a conversation with them. Saying, listen, we’ve put lots of things into place. We’re going nowhere. Everything’s safe but we’ve had to put a pause on your treatment.

Prav: If they were an orthodontic treatment, let’s say some kind of aligners, just keep wearing your last aligner. If that patient was due a set of aligners, let’s say that week, then what happened was almost like a doorstep appointment where they came and picked it up from outside the practise. But other than that, it was more, to be honest, these patients, they just want some reassurance that you’re still going to be there, you’re going to finish off the treatment. By the way, you’re holding onto my money there, is everything going to be okay?

Prav: Then we had those group of patients who hadn’t even started any treatment and they’d handed over a substantial sum of money, especially patients who were talking about implant dentistry. We do a lot of immediate load stuff. Same day teeth treatments in our practises and they put down some hefty deposits for that and booked surgery days and clinicians. Sometimes we have clinicians travelling in to do that sort of treatment. And so there was that side of things, and we had quite a few patients getting to us asking for refunds. And what do we do to manage that process whilst we’re trying to keep the business afloat as well and you’ve got two conflicts. So the first thing we said to those patients is 100% absolutely you can have that money back, it’s yours. And no problem at all. However, on a couple of them we had offered them a heavily discounted rate at that time, so we wouldn’t be able to honour that in the future. And then the second thing was with those patients was actually their place in the diary. Now, we’re going back to dentistry on the first of June, and that’s the date we’ve set. May not be the date we go back, but that’s what’s mentally in everyone’s minds and all the patient’s minds. So we’re booking those patients in from there onwards.

Prav: And what happens as we get closer to that date, we’re having conversations with those patients. That’s happened a couple of times now. It’s incredibly time consuming but what it does is it allows us to keep in touch them along. And so those patients who’ve paid upfront, who had surgery dates booked in and whatnot, they’re going to be seen earlier. And so we have had to make some substantial refunds, understandably. Whereas some patients have said look, hold onto my money. They just wanted that reassurance that we’re still here, we’re not going to go pop. And they’re still in need of that treatment. They still want that treatment and they want us to do that treatment. It’s just they wanted that reassurance. So I think opening up that communication has been fundamental to just giving those patients peace.

Prav: Your practise, have you had any team members who have been anxious about the thought of coming back to practise or just said to you, I feel anxious, is it going to be safe, those sort of things? Because there’s so much in the press at the moment and we’ve heard quite a bit of negative press about dentistry we’ve had some of our team members express some concerns about that. Have you had anything similar at all in your practise?

Christopher Orr: Couple of things there. You were talking about patients and things. I have to be honest and say 99.9% of our patients have been extremely reasonable and understanding and I think they realise that we are all in the same boat together. So the issue with pre-payment and discount and things, that’s not how we operate, but had we been in that situation we probably would have approached it in a similar way. Staff members, I’ve not had any of our staff come to us and say we don’t feel safe. During the time when a lot of our staff have been furloughed, we’ve had small meetings, basically over a cup of tea in the mid morning with everybody just over Zoom, just talking to them and saying how are you? What have you been doing? This is where we’re at. And we’ve not had any of them coming to us saying we don’t feel safe coming back to work. But I think what comes out of what you’ve just said, and I guess the answer to both those questions, it is all about communication.

Christopher Orr: And one of the cliches that’s come out on the internet a lot in the last month or so is there’s a lack of leadership in dentistry. Higher up, certainly there’s a lack of leadership. But every person, every dentist is leading a clinical team. That is from the practise principal leading the whole practise through the associates who are leading a very small clinical team in their surgery. I think it has to come from the, not just what is in place, that will come from the practise principal, but the implementation of that. Everybody has their role to play to make sure that all of our team feel completely safe and confident that they can get back to work.

Payman: Chris, have you been in touch with your patients as well?

Christopher Orr: We’ve sent a couple of newsletter and things out. We put the video consultation thing into place very quickly. I should give credit to who’s one of my associates. just came up with that completely by himself and said, is it okay if we do this? And that’s been working extremely well. We’ve had, honestly, relatively few patients calling us. People have contacted. We have been able to give them advice and things over the phone. For the most part, they’re generally well-cared for patients, they generally look after themselves, and there have been, I think if anything, we’ve had probably fewer people ringing up with emergencies than we would have in a typical four weeks, eight week period if we were open.

Payman: So Chris, it seems like in private practise, which both of you guys seem to be talking about, there doesn’t need to be massive changes. An element of triage, risk assessment, PPE. But the timings will suit it. What’s your feeling, if you had to guess, for an NHS practise? They’ve been doing quite well right up to now being paid for sitting on the phone, but going forward, what do you think’s going to happen and what should happen?

Christopher Orr: I think a lot of that is going to depend very heavily on PPE. Availability of PPE, what standard of PPE is required or said to be required by Public Health England.

Payman: Let’s imagine there was PPE available.

Christopher Orr: Now, the next question is how much is that PPE costing the practise? Because if you can imagine, you’re going to do a band one NHS treatment, which may include some scaling. So an aerosol generating procedure. And at the current price levels, that represents, depending on who you buy it from, 25, 35 pounds worth of PPE per band one treatment. So that therefore means that it may be financially inviable for the practise to actually do that unless the NHS assort so much PPE that they’re able to supply it to NHS dentists in high volume, which I think is unlikely given that I read on the news earlier this morning that some doctors are expressing concerns that they are being told not to speak in public about PPE shortages in hospitals.

Christopher Orr: So the PPE’s going to be a problem, and I think it may… In terms of an NHS practise, there’s one of two possibilities. It either makes it completely inviable or the government is going to apply a very big dollop off financial fudge to funding for NHS practises for probably the next 12 months. They will pay them their money, UDAs may get recorded, but whether the service levels for it are enforced, I think, is highly doubtful. And that did come across quite a bit in the CDO’s webinars. I didn’t understand a lot of what the NHS payment people were talking about, but it did seem that that might be what they’re… They’re going to be just get your money as normal. You see as many people as you can. They will keep tabs on that in some way. Because otherwise it’s not going to be feasible to open your doors because it was just about feasible to open your doors doing NHS stuff before that.

Payman: And what about for your courses, Chris? How do you see your courses being affected by all of this?

Christopher Orr: Well, a few different answers to that. If we look at the last big crisis, financial crisis that hit the world, in the time after 2008, we actually saw more patients wanting elective treatment than before. So I think the demand for treatment will be good, and therefore the demand to scale up will be good. The time after 2008 was actually one of the years where we ran more sessions rather than less. And the mindset of the dentist, we think, was that they realised there was going to be a bit of downtime and it might not be a bad time to skill up. So we would be running our programmes. and I were speaking to the people who do our website this morning, working out exactly the date we open bookings. We are planning to run the programme as normal and we will see what unfolds. Quite how you do that, it depends on how social distancing and how much social distancing is coming. But by that stage, I would imagine that restaurants would be open as normal, bars and other places would be open as normal so it should be, I hope okay, for all of us.

Payman: I think the evidence-

Payman: … I think the evidence from abroad is that the patients are prioritising healthcare. Have we lost Chris? Patients are prioritising healthcare in the return. I don’t know if you guys yourselves have thought about this, but you think about when we go back, it’s realigned your priorities and what’s important and what’s not. And healthcare seems to be, it’s in my mind as hey, look after yourself a bit more. So I think we’re good in the medium term as far as that goes. Chris, we were talking on the phone and I was saying to you it’s a funny situation because if we were a dentist a 100 years ago in the last pandemic you could have more influence, sort out more problems than as a dentist now. And I looked it up. Two AM last night, I looked it up.

Payman: In 1921 there were 5,000 registered dentists and right now we’ve got how many UDC? They claim 400 UDCs doing the same treatment really. It seems to be extraction treatment. Hopefully we’ve got better PPE now. But how do we next time, I don’t want to go finger point this time, next time there’s a crisis, and there will be one, whether it’s a financial crisis or something like that, how do we next time not end up in the mess that we’re in this time as a profession? Because you can see other countries reacting much better much quicker, and much, much more scientific way. And we’ve got to rely on one dentist sitting in Leeds who’s doing a lot of reading to come and tell the government what the latest science is, while the government’s telling the whole nation that they’re letting the science decide what they’re doing.

Christopher Orr: Well, it’s interesting actually. This is a point that I’ve heard Dominic O’Hooley raise a couple of times. That there is not a huge amount of transparency in where the information the CDO was basing their decisions on. I think at the end of the day, there’s a universal problem that politicians are reelected every roughly five years and they tend to want to have things that they can show to the electorate within that time period. So they can say hey, look what we’ve done for you, let’s get reelected. The difficulty we have here is that by many accounts, the government will present with a lot of information on how they shouldn’t prepare for this and they didn’t really pay attention to it. So they were a bit hamstrung and they missed the boat on a couple of occasions. So I think in terms of preparedness, there’s an awful lot that we will learn from this pandemic. If there is another one in our lifetime then hopefully we will be in a better place to respond quickly, and that probably means having stocks of PPE and things ready so that there isn’t this sudden shortage of it.

Christopher Orr: The other thing that I think is quite interesting if you look around the rest of the world, again, one of the issues in, or the lack of issues in Germany, stems from the fact that they make, in Germany, the vast majority of their hospital equipment, whereas we outsource it all. And in Germany they had a period of time where for a couple of weeks supply levels were low and they did not like that. It was unacceptable that there wasn’t enough stuff. But things got back to normal quite quickly, whereas here we were ordering stuff from China. A lot of the places in the early days of the Chinese lockdown, the regions where the factories were were all locked down as well and the supply chain, it’s still not back to normal. There’s lots of stuff that you can order on Amazon, for example, where if I order it today I’m going to get it in July. So I think better prepared, and it’s better management of stocks and trying to order things in advance so that we have them, knowing that some stuff might not necessarily get used. And again, there’s a balance that we have to accept there where if you plan for overcapacity there is going to be some wastage there.

Christopher Orr: And I think really I was very disappointed couple of weeks ago. I can’t remember which government minister it was. The talk about the Nightingale hospital in London had only seen handful of patients and [inaudible 00:32:46]. And yes, of course it was [inaudible] you don’t want to have bodies piling up in the streets and in A and E. So the fact that the government spent that money, there is going to be some spare capacity, which unfortunately is lacking in the NHS because everything is pared back to the bone. So better budget for the NHS. And sorry to say it, that actually might mean higher taxes for us to pay so that we have that in the system when we need it.

Payman: Do you not think it’s more of a systemic issue though? There are dentists now who have PPE who can’t work. PPE isn’t what’s stopping them. For me, it seems to be the speed of decision making in our profession is slow. And in the end, we’re looking to one human. All right, she’s got an office, but again, she’s the head of the NHS. So shouldn’t the profession now set itself up in a way that there’s a scientific community, a scientific board that can look into things if there’s a scientific issue quickly? Because look, that’s all I see. I see the politicians saying it’s the scientists. And then we look where we know what’s going on in our area and there’s no science. We’re relying on one Dominic O’Hooley to teach us to read the work. What have you thought, Chris, when you’ve read all of this work from the different SOPs you’ve seen? Do you feel like that’s what’s happened? Is that there’s such a vacuum of information from the top that the grassroots is pushing information up? That’s my sense of it.

Christopher Orr: Yes and no. People are responding because they feel they need to try and make sense of the world around them. That’s a normal human response. I do not envy anybody in the Department of Health, their job, just at the moment. The problem that you’ve got is that if you issue advice it needs to be well-written and fairly robust so that the number of exceptions and queries on the advice is absolutely minimum. I can imagine there is somebody in the CDO’s office right now, a team of people, probably rewriting standard operational procedures for when NHS practises are going to reopen. And when they’ve finished that task it needs to be checked, et cetera so that it’s valid, and then it can be passed down. So people who like firing stuff off without any kind of validation, I think it’s counterproductive because, again, that national mindset of caution. People like to be told very clearly in black and white this is what you do, and then you go on and do it.

Christopher Orr: So could we respond better for that, possibly. A committee of dentists who make recommendations. And again, the question is who do you put on to such a committee, and how do you actually feed them into the whole process? How do you get everybody to say yes, we agree with that, because we have a large number of clinical standards and standard setting organisations. So the FGDP and NICE and many other organisations, and there are so many guidelines that come out that it’s almost impossible for anybody to keep track of what you’re supposed to do under normal circumstances, never mind right now. So yeah, less bureaucracy and speedy decision making, I’d love to see that. How you would actually go about achieving it, I really don’t know. Head scratcher.

Payman: Prav, going forward, your [inaudible] your marketing now. Are you thinking you’re going to be coming out of this in a better way somehow? Do you think there’s an opportunity in it? I do. I think there’s a land grab. If we’re talking in those terms, I think that the practises who focus on [inaudible] people working from home is what I was going to say. People working from home who are relatively getting richer right now.

Prav: And do you know what, even if I’m looking at my team, and I’m talking about the team in my digital agency rather than my practise, speaking to them, they’re getting richer because they’re being paid, they’re spending less money, they’re not going out. But do I see it as an opportunity? Well, I think initially we’re going to go back phased approach, less volume. So what you’ve really got to think about is how you’re going to phase that comeback. And if you go out and launch some marketing campaigns and get a truckload of leads coming in, and then start processing them and having conversations with patients, where are you going to fit them in? And so from our perspective, what we’re doing, initially, for at least a short to medium term, we’re extending our hours.

Prav: So we’re going to do six days [as standard 00:38:13]. We’re going to do more evenings. And [inaudible] patients [ought] to take care and look after our existing patients who’ve been waiting patiently for so long. So to get that out of the way, so to speak. Are we running marketing campaigns now, yes, absolutely. And we’re having video consultations with patients and they’re all subject to an in-person clinical checkup. So we have a conversation, we build some rapport with those patients. We talk to them about the way we do dentistry. We give them some approximate price guides, saying it’s from this to this. But for you to get a treatment plan, you need to come in and have a comprehensive assessment and this is what the investment in that assessment is, and we’d be looking at getting you in around this period of time.

Payman: Prav, as a marketing guy, are you saying that you’re going to be marketing safety as well? I think it’s an error, personally, but have you bought fogging machines and air purifiers and all of that?

Prav: So what we’ve done is we have bought PPE. The various masks, visors and gowns. We haven’t bought air purifiers, and that may change. And the reason being… Actually, do you know what, if I segment my two groups of practises. In one we have, in one we haven’t. And in actually the one we haven’t, we’ve bought three that go into rooms that have no windows. So that’s the three [inaudible] that we’ve bought. But to be honest, a big part of the purification [line 00:39:56], it’s not my area to go [inaudible] the patients, and we’ve had certain team members who’ve expressed some concerns. But we haven’t gone all out and bought 11 purifiers for 11 rooms, for example. And so from a marketing perspective, back to your question, are we going to be marketing safety? Yes, but not as a USP. I think more in terms of reassurance. That saying, as dental professionals, it’s always been an incredibly safe environment to come into.

Prav: We’ve put some additional protocols in place to step up that level of safety, which will include a oral mouth rinse, less people in the waiting room. No escorts allowed into the practise anymore, et cetera, et cetera. It’s according to the SOPs. Am I going to be using that? If a patient is choosing their dentist over an SOP, over an air purifier, we’ve got something seriously wrong.

Payman: I think it’s a mistake.

Christopher Orr: No, I agree. The issue of air purifiers, there is no proof at all that they reduce the risk of transmission. And such evidence is unlikely to be forthcoming. So from my point of view, the air purifiers are there if you wish to make your team feel you’re doing everything possible. Fantastic. But the 2,000 pound a surgery ones, absolutely not. Again, I agree completely with you, these are not devices that we should use to market our services and try to claim that we’re better than some other practise, because in the absence of proof that they actually do what we’re implying they are with such marketing, we’re misleading patients. So yes, perhaps to make your team feel better. Perhaps if it makes you feel that you can turn around rooms more quickly, particularly those without windows, fantastic. But otherwise, no, it’s not a marketing ploy.

Payman: What I would think about air purifiers is they’re a good idea in general pre COVID. So if you’re that cat, if you’re the person who wants this thing that cleans your air in general, fine, absolutely fine. But I’ve been thinking about this a lot and what we’ve done with our team is we’ve focused our team on finding mom influences around each of our regional centres. And mom influencers have much more engagement than pretty girl influencers with their audience. And so in each town there’s two or three moms who’ve got massive Instagram presences and we’re going to be reaching out to them and saying come and have a free teeth whitening, as soon as that’s an appropriate thing to say. Because let’s say in a town like Leicester perhaps, where you’ve got those two practises, or you’ve partnered in those two practises, there’s literally three or four of these types who set the agenda for the moms. And the reason I’m pointing out moms is because mom is the safety representative in the house. So what I’m saying is marketing safety comes in many ways, many forms. We mustn’t just think I look like a spaceman, here’s my fogging machine. That might make us feel safer but I don’t think patients want to see that in marketing.

Christopher Orr: It implies there was a problem that we weren’t dealing with before. At the end of the day, we’ve had aerosol and the knowledge of aerosol for a long time. We had it when HIV came along, and we have not had anybody catch HIV through aerosol transmission in the dental surgery in how many years of being aware of it.

Prav: I do feel if, and to be honest, I’ve actually seen some campaigns already go out, with people who’ve made videos about their whole protocol. And it’s almost sending a message out to those patients along the lines of this is a very dangerous place to come to, guys. But because we’ve got all this stuff on, you’re going to be safe.

Payman: It’s just very one-dimensional thinking, isn’t it?

Prav: Yeah. And I think the other thing is that everyone’s pushing this message out as though every person walking through your practise is COVID positive. And they’re not even taking into account that hold on, we’re doing these pre-screens. There’s a level of risk mitigation that’s going on prior to a patient even being allowed to step through your door. But the measures that some people are taking, it’s almost as though you’re having to treat these people in a space because you’re assuming every single person [has got it 00:44:46].

Payman: But then [crosstalk] a thing that I accept that. It’s the marketing of it that I find strange. There are smarter ways to market safety than saying I’m wearing a spacesuit. Chris, going forward, what’s your message to principals and associates? [Because we’re going 00:45:06] to have to work together now.

Christopher Orr: I think there’s a lot of stuff that we’ve already talked about. It’s really number one, make your team feel safe. Number two, make sure that everybody is trained and comfortable before you start seeing patients. A phased approach, you’re not going to go back to a full book of patients. You need to think about who needs care the most. And I would encourage all dentists to go through their patient books, the patients whose appointments were cancelled or deferred before the lockdown, those people need to be the priority. We mentioned also, and Prav, you talked a lot about patients who’d prepaid for treatment, there are the patients who are on maintenance plans. So the Denplan, Privilege Plan, those sorts of things. Those people, again, the ones who did not cancel [inaudible 00:45:54], their loyalty to the practise needs to be recognised. So in terms of getting people in at the appropriate moment, those people need to be prioritised. Because again, that’s where the business aspect of things comes in. You need to thank customers for their loyalty. So principals point of view-

Payman: If one of your delegates said, listen, I’m going to open, I’m going for it, would you advise them to go for it?

Christopher Orr: … I would advise them that they have got indemnity cover in place and that has to be in writing from their indemnifier. They need to have carried out their risk assessments and probably have some up to date standard operating procedures. It’s interesting to see that a lot of the new dental societies and associations and groups are staying away from writing standard operating procedures. That they seem to be waiting for the CDO to come out with some things. But I think the major thing, really, is making sure that everybody’s safe and making sure that you are indemnified. And like I said early with your indemnifier, you need to be crystal clear with the indemnifier about exactly what services that you’re planning to offer.

Payman: Let’s say you have. Let’s say you’ve got all of that down and some new indemnifier, TVS, one of those PDI whatever, says you’re covered. Can they go?

Christopher Orr: Yeah.

Payman: Advise them to [inaudible 00:47:23]?

Christopher Orr: Go for it. As long as everybody’s happy, everybody’s safe and you’re indemnified, I don’t see why not.

Payman: I’d agree with that. I’d agree with that. Especially as we’ve seen it. We’ve got the advantage of being three weeks behind so many other virus regions and we can see what’s happened over there. Prav, you going to open up soon?

Prav: Like I said, we’ve set a provisional date and I think I am not the person to make that decision. I’m just the guy that brings the patients in and helps with the patient journey and the communication sides of the practise. So for me being a non-clinical member of the team, I’m certainly not the right person to be making those decisions.

Payman: What’s your date? 15th of June?

Prav: No, first of June we had provisionally, but we’re moving patients along 15 days at a time. So I’m definitely not that person to make that decision. Having heard everything that I’ve heard, and listened to the science from Dominic, I’d open tomorrow if I could. 100%. And I don’t think with the way dentists and how our practises have been operating pre COVID, I just think we just need to respect a little bit more distancing, a little bit more space. And I think a lot of these are SOPs that have probably taken things to a level slightly above to be additionally cautious, so to speak. And Chris, as you said earlier, going over the top with these masks and some of them the inspire there is protected but the expire there isn’t, and stuff like that. So there may be an argument for sticking a normal mask on on top of that.

Christopher Orr: I’ve heard that said. To be perfectly honest, the whole thing with the masks, I think we are overthinking it. Very, very classic dentist way of looking at things. We try to over-engineer and we get to a point where you actually can’t do anything because you can’t make a decision. So from that perspective, it’s really just about recognising that we can’t do everything to be 100%, but 95% may be the level that we have to accept.

Payman: Well, thanks a lot, Chris. And hopefully we’ll get back to some form of normality. Thanks for injecting some common sense into it.

Christopher Orr: Thank you.

Payman: There’s information overload.

Christopher Orr: I think it’s been information overload for the last about three months. And that’s the problem. That this continual need to make decisions and change things as we’re going along and evolving situations. It’s very stressful. Very stressful indeed.

Payman: All right, Chris.

Christopher Orr: But hopefully back to normal soon. [crosstalk 00:50:18].

Prav: Have you got an opening date, Chris?

Christopher Orr: Beg your pardon?

Prav: Have you got an opening date?

Christopher Orr: I am going to have the staff coming back, I’m thinking either first of June or eighth of June. And we start booking patients in towards the end of that week and gradually ramping it up over the next couple of weeks. So early to mid June. Exact date to be determined.

Payman: We’re waiting for the chief dental officer now, with the legal situations kind of clarified yesterday as well. I guess we’re just waiting for that. Brilliant. Thank you, Chris.

Prav: Thank you. Thank you so much.

Christopher Orr: Thank you very much, both of you. Thank you. Take care. Bye-bye.

Payman: Bye.

Outro Voice: 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.

Prav: Hey guys, and welcome to the Dental Leaders podcast. Thanks for tuning in and today’s interview was with Mark Topley, the CSR Coach. Before I met, this guy didn’t have a clue what CSR was, and how you go about implementing it in a business and he educated us a lot. His journey about the charities, the struggles, the fraud, and the challenges that he faced really, really interesting conversations, and a really nice guy as well. Pay.

Payman: I love that, but I knew the stuff he was up to. I knew that CSR stands for corporate social responsibility.

Prav: Meant nothing to me.

Payman: But what I didn’t know was that sort of combining charity with business kind of idea. You always think with charity, sort of just people who want to do good and somehow there’s a there’s a demarcation between the charity sector and the business sector. It’s very interesting how you combine those two together and if you want your business to be more accountable to your team, accountable to the society around it, then he’s your guy. He’s the guy you go to and I love that. I love that he’s made that connection between those two worlds which I wouldn’t normally connect.

Prav: And super niche, right? He’s really niched down on what he does and who he serves.

Payman: And great guy, great guy. Lived abroad and done a bunch of work and there’s lots of dentists have done their bit through Mark and his organisations. Excellent. I think you’re going to enjoy it.

Prav: Enjoy.

Payman: When you were living there, what did you miss most about the UK, outside the family and friends?

Mark: Real ale.

Payman: Was there no ale? No, I guess not.

Mark: Fizzy lager. Fizzy lager.

Payman: Was there not an Irish Pub somewhere?

Mark: No, there was. So in Dar es Salaam, where Prav’s dad comes from, there is an Irish Pub.

Payman: There’s an Irish Pub in every city in-.

Mark: There’s an Irish Pub in every country in the world.

Intro Voice: 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.

Prav: Today, we’ve got the pleasure of having MarkTopley here, who is the CSR Coach and has got a long standing history with lots of dental charities, which a lot of you will know about. I think would just like to kick off by saying, thank you very much for making the trip to come and see us today and share your story with us. I just like you to give the audience a bit of a background of your backstory, how you grew up, and then your first career and how you ended up finding yourself here working with dentists.

Mark: Of course, yeah. Well, thanks for having me. It’s a pleasure to come in. So where do you start? I’m a boy was born on the south coast and lived in a place called Bognor Regis right down the south coast, which some people would have been on holiday to. A lovely little town. I did a bit of time there. I grew up in sort of West Sussex, and then when I was about 10, 11 years old, my folks decided that they were going to up sticks and move to South Africa for a couple of years, which we did. We did a couple of years overseas.

Mark: My dad at the time, had been working in a variety of jobs and had an opportunity to learn dairy farming. So from that age on, I was a farming boy. We did a couple of years in South Africa, had a great time, came back, lived in the New Forest for a while, continued with school, and then went off to college and did a teaching degree in Southampton, which was a lot of fun and still live near Southampton nowadays.

Mark: After college went off to Havant and taught in a place called Leigh Park, which is just up the road from there. Did four very happy years as a primary school teacher and from then on a whole variety of things. I think I got itchy feet when I was a teacher, I really enjoyed education but wanted to travel, wanted to do stuff. So got into community projects, then ended up in the music industry, working as a tour manager, as a drum tech, did some production management.

Payman: What’s that like?

Mark: What’s it like? I wouldn’t want to do it now as a married guy with three kids but as a guy with who was newly married, it was a lot of fun because it was a lot of time away travelling, blocks of time away. Yeah, a lot of fun. A lot of fun. You got to see the inside of a lot of venues and not a lot else because you get on the bus at the end of the day and then off you go.

Prav: What’s the craziest story you’ve got from back in those days?

Mark: See, the guys I work with a fairly tame when it came to the whole sort of alcohol thing. I guess the most challenging thing was working with people that were teenagers in bands because they just haven’t got an organisational bone in their body. So trying to get teenagers through airports was an absolute nightmare and I guess the closest, I never ever missed a plane. I did miss a ferry once, driving into Dublin and getting completely lost on the way to Dún Laoghaire, which meant we did actually miss the gig the next night in Liverpool.

Mark: One day I decided to give one of the guys who was working with us the responsibility of planning the trip to the airport. So we turned up at the time that we were supposed to and got in the bus and off we went, and then somebody forgot something which they always did and then we ended up, anyway, on the way to the airport, we realised that he hadn’t planned to be there when checking opened. He’d plan to arrive when checking closed, which meant that we were now going to be half an hour after check in had actually closed.

Mark: So we made a mad dash got to Heathrow, threw the stuff on the floor, ran through the terminal, ran onto the plane and sat just as they closed the doors, and he never was given the responsibility of planning that again.

Payman: Well, you’re not telling me that’s the craziest road story. We’re thinking more of sex, drugs, rock and roll.

Mark: Do you know what, those guys weren’t really into that-

Prav: Was it the same band all the time?

Mark: No, no, I worked with a variety of different people and it was mostly stuff where you’re working hard. Although, I think at certain levels of the music industry, they get above a certain level where you’ve got enough money to be able to kick back and do those sorts of things. A lot of people who work in music just working really, really hard. They’re working jobs as well. So we had fun, but was somewhere next to get to the next day, and something else to do and then you have other commitments you got to do, recording and those sorts of things. Yeah, not much in the locker, I’m afraid.

Prav: Thinking about growing up as a kid, we’ve interviewed lots of people on this podcast who are dentists and we ask them what did you want to be when you grow up, and a lot of say a dentist. So I guess your first stage in your career ladder was a schoolteacher? Is that what you always wanted to be? When you were growing up as a kid, did you think I want to be a schoolteacher or were there other ambition?

Mark: Do you know, I had no clue about what to do. I kind of found my way into teaching because it seemed like a good thing to do, and one of my best friend at school, his mum was a lecturer at a teacher training college and I found out there was a ratio of nine girls to everyone, bloke, and I thought, well, that sounds like a good course to go on, but I kind of happened into it and I was okay at it.

Prav: What sort of teacher were you?

Mark: I was the hard taskmaster who had a lot of fun. So we laid the law down, and we could be serious when we needed to be, but we had a lot of fun as well. We had a lot of laughs and I’m still in touch with a couple of people that when I started teaching they were working and then they’re head teachers and it’s great because their schools are exactly that sort of thing. High standards, but they have a lot of fun as well.

Prav: Did your pupils get good results?

Mark: I don’t know. I was a primary school teacher. This is pre SATs era. So before any of that nonsense came in, and people started measuring whether people could pass tests or not.

Payman: I know you spend a lot of time in Africa, though and do you see the difference between the status of teacher over there compared to over here, because certainly, my experience with other third world countries, teachers actually, massive job in those countries, well respected and well paid. Whereas here, you’re almost relying on the sort of vocational sort of aspirations of the teacher and the goodwill of the teacher to give a job to someone who’s a quality person. Someone who really wants to do something right, but is happy not to have a career that pays the mortgage. Do you know what I mean?

Mark: Yeah, certainly for Tanzania as an example, teachers were undervalued, underpaid, demoralised.

Payman: Really?

Mark: Yeah. I’ve seen it. I have seen it people held in higher esteem elsewhere. I think it’s one of those professions where, unfortunately, it’s always going to be undervalued, unless people really need to have a teacher or work closely with a teacher and then you see the value of people. In some ways, those sorts of professions, you don’t really want people going into them that are in it for the money. You want them going into it because they care about the kids and that doesn’t mean that you should then pay them less because they’ll put up with more, but inevitably, you’re going to end up with the people that want to do it for the right kind of reasons.

Payman: I’m thinking of a friend of mine, who was very talented. Went to Oxford, wanted to be a teacher but he could earn 10 times as much doing computer science somewhere, like being a computer guy for a bank. In the end, ended up doing that.

Mark: Yeah, and that’s always going to be the case because you can’t compete with the salaries that the commercial sector can offer but it certainly should be better than what it is, and conditions could be better as well. Unfortunately, education like health care is a political football and whatever government in power we’ll use it for their ends, largely.

Prav: So just fast forward in from teaching if you just summarise your career and how you ended up landing in the world of dentistry.

Mark: So while I was working as a teacher, I was doing a lot of travelling, I did community projects overseas, worked in Ethiopia for a bit, bit of teacher training in a slum school. That’s an interesting thing as a 24 year old and while I was doing that, I realised that I needed to make a change because I was running out of holidays. Hard to believe, but I was running out of holidays to travel.

Mark: So I ended up starting doing some communities projects, play schemes, that sort of thing for a church that we were part of down the south coast, they then brought me on staff for a couple of years. While I was doing that, I did some charity startup works, because all sorts of little projects offer that kind of organisation. Then from that I had mates that were in bands and needed somebody to carry the gear on a weekend and then they got more and more successful.

Mark: So we started not shoving at the weekends, but touring in blocks of time and then from that, people pick you up and use you for other things, which is when I then started ushering teenagers through airports. Then from that, what basically happened was that I was about to take on a major national musical in terms of production management. So left my job, got ready to go and then the contract was cancelled.

Mark: So I took a month off and learned to play golf, which I still play very badly, so it wasn’t a really month well spent, but it was a beautiful month, and gave me a bit of time and space and that’s when somebody phoned up and said, look, can you do some work for us, and it was in Wilson from Bridge2Aid who just started. They needed somebody to help him with their systems and stuff like that.

Prav: How did you know Ian?

Mark: So him and his wife Andy he had moved down to the same city that we lived in, in Chester and we found ourselves in the same church at the same time. They were one of the unusual couples that we didn’t have kids at the time, they did. They were one of the only couples we could find to have a drink with on a Monday night, because everybody else was like, oh no, you’ve got to put the kids to bed and that sort of thing.

Mark: So we would hang out with them and just chat and have fun together and then we waved them on their merry way when they moved out to Tanzania in 2002, moved into their house, rented it from them. Then that’s really when things started to kick off in the whole oral health world because we started to get involved with Bridge2Aid.

Payman: Is your charity work informed by your religious beliefs or not?

Mark: The charity itself was started off the back of a couple of people who had spent time overseas doing things from a church context and wanting to start something from that sort of motivation. For us it was, that’s where our friendship originated, that’s what tied us into to them. I think, we hang a faith tag on what we do, and the drive behind it, other people do it for other reasons. With Bridge2Aid, we wanted to make it a charity, where people were clear about the fact that we were believers, we were Christians, but actually anybody could come and do their bit without any sense of judgement or whatever.

Mark: We had a number of people who came to work with us who have been to other organisations and not had the same response and that was something that we were determined to not have happen. Certainly nowadays, it’s a charity which retains those kind of values at the core in terms of relationships, people, caring for the poor, justice but it’s not an overtly religious organisation in that sense.

Payman: The world of charities, do you think of competitors in the way we do in the commercial sector?

Mark: Yeah, absolutely. I think it’s a difficult one because people are working towards similar aims. People are working for the common good but the reality is, is that for every one pound there is out there, there are seven charities chasing it and it makes it very competitive. I think what you’ve got to do, and I think there’s a lesson for this, and I think you probably guys would be on the same line anyways is that you don’t seek to compete, you just seek to stand out and be very, very clear about what it is you’re trying to achieve, why you’re trying to do it and how what you’re doing is a good way and is achieving results, because people will find whatever cause they want to support and the thing that when I was chief executive at Bridge2Aid, I would say be very clear with people.

Mark: I don’t expect everybody to support this charity. In fact, that’s not going to happen. But what we do want, you should find what you’re passionate about and then go for that 100%. If that’s Bridge2Aid, then great, but whatever it is that you do, make sure you’re doing something that that you feel you can make a contribution to.

Payman: Is there a marketing department and an operations department? For the record, I think Bridge2Aid’s marketing is excellent. If you said to me name, six dental charities I couldn’t. Bridge2Aid is the one I could think of. Is that you? Was that you or how does that work?

Mark: To start with, we did everything in the beginning. When things started, it was just Ian, Andy and then it was myself and my wife, Joe, together with them and a couple of Tanzanians and we did everything to start with, and it’s not to the point of a marketing department. Now there are people who have some responsibility for marketing, but we were very fortunate in that we managed to establish relationships with people in the industry who had skills that we could draw upon. To this day, Bridge2Aid has a creative group of different people from across the industry, in the sort of marketing and sales arenas that meet once a year and say, right, let’s throw some ideas around and then that means we can go in and implement them.

Prav: As somebody who has got a choice of six to seven charities to donate their pound to or whatever it is, there’s always that question on someone’s mind is, where’s my money going and how much of my pound goes to that end cause of either treating patients, educating people, whatever that end goal is. What was the case with Bridge2Aid? So would you be able to tell me for every pound that went into the business, what ended up and how you actually went around measuring that and being transparent about it?

Mark: I’m glad you asked this question because it’s one that comes up a lot and it’s one I feel really strongly on. I think that the difference between the commercial world and the charitable world is that the commercial world expects charities to do things that they would never sign up for. So, if I said to you tomorrow that you got turn off your sales and marketing budget, but you’ve got to sell more, then you’d be like, aye, what you’re talking about?

Mark: So there is this whole thing that a charity is going to make an investment in its marketing, and in its fundraising, what it does with that is it leverages the money that I give you. So for me, it’s not a case of, well so much a case of how much is going to the cause. Because that’s a little bit like asking my car, how much of my car is the parts and how much is the R&D and everything that went into it? It’s a similar sort of thing.

Mark: I can tell you how much the materials cost and how much it costs to run the car and all those sorts of things, but there’s a whole load of other things that are kind of involved. So I think question I would always ask is, if I’m giving you a pound and you choose to use that for fundraising, How much you’re going to turn it into? Because if you just turn it into another pound, then that’s rubbish.

Mark: You should be turning that into at least three or four pounds for every one that I give you, and if you decide, okay, I’m going to spend 20p of every pound on fundraising, but I’m going to turn that 20p into a pound or into two pounds, I’d be like, crack on, and that’s the creativity that I think charities have to be able to use, but that requires trust from their donors to say, do you know what, you know how to run a charity, I don’t, and I’m not going to use a simplistic a metric is how much do you spend on admin, whatever admin is. Is that paperclips or is it people who work in the office?

Prav: So I guess the way you’re, and I haven’t thought about it like that is that, if you’re using part of that budget, or that budget for fundraising, is actually the donation creates cash flow for you to multiply that cash flow to then…

Mark: You have to. If you didn’t use it for fundraising, if you said 100% goes to the cause, unless you’ve got a sugar daddy, who’s paying all your fundraising costs, or unless you’ve got a couple of hundred million quid stacked away that’s paying your operational costs, then that’s just not happening. I would question anybody that says that not over 90% of their money goes to the cause, because they’re doing something to dress up the figures. Ours is about 83, 84p in the pound, but that made things really, really tight. If a charity didn’t invest any of the money that it got in fundraising, it would die in about six months, because the cash would all dry up.

Prav: When you say like 83, 84p in the pound goes to the cause, are you talking maybe 50p of that goes towards fundraising, which generates more that allows you to make that 83, 84 overall figure?

Mark: No. 83, 84 would be going to the cause and then the other 16, 17p will be split about 8 or 9p to fundraising and the rest between the other things that we have to pay for.

Payman: Explain to us with the Bridge2Aid model, what was the way that it worked with regards to, we always hear about dentists going and firstly fundraising, climbing a mountain or rock bike rider and then secondly actually giving their own time. Talk us through what happens when they go and visit, for instance, a country like Tanzania.

Mark: Sure. So one of the things that Ian was very passionate about at the beginning was mobilising volunteers in a way that would make a long term difference. I think he’d spent a lot of time in the 90s when he was a young man, he turned grey a long time ago, but he spent a lot of his time travelling around doing short term dental visits, which were great for the time that he was there, but actually left very little behind, and would in some cases, demoralise the local workforce because you’ve got people that are, you’re going in and doing something but then you’re walking away and leaving a complete vacuum.

Mark: So one of the things that he was very passionate about Andy, his wife was very committed to as well was this whole thing of sustainability. So when we started the training programme, it actually morphed from, okay, let’s get some volunteers out to a conversation with the government to say, what can we do that will make the biggest difference to the healthcare system?

Mark: They were very clear that they had this cadre of workers, clinical officers, three years diploma training in medicine, that were based in the rural areas that had no dental training and yet, the majority of people that would come into a health centre were in dental pain of some kind of varying degrees. So they had a defunct training programme, which had been very successful. They couldn’t fund it, they couldn’t resource it.

Mark: So we put that together with all the volunteers that wanted to come and work with Bridge2Aid and said, well, what can we create from this? So with Ian’s dental expertise, my wife Joe’s expertise in training, she’s got a background as a nurse and my logistical kind of expertise, you put those three things together, what you ended up with was a two week intensive training programme in emergency dentistry for these rural medical workers where they would work one to one with a qualified dentist over a seven to nine day period.

Mark: On day one, the dentist was doing all their extractions because that’s all we were covering was just simple extractions. Then on day nine, the clinical officer was doing the extractions and the dentist was just supervising and watching. What that meant was that every dentists that came to work with us and every nurse that ever came to work with us, they might have seen four to 500 patients in the two weeks that they were with us, but the legacy of every trip was five or six people, each responsible for another ten thousand’s care, that are for the rest of their careers are able now to practise an emergency dental skill.

Mark: That’s a huge leverage of investment from the dentist and the nurses and from the organisation. Because I walked away from Bridge2Aid two years ago now, and in the time that I was there, we trained about 450 people, that’s access to emergency dentistry for about four and a half million people. Had I walked away from that at that point and just run short term training programmes, all that work would be done now, but those people that we trained when I was there and still treating and they’re still treating, they’re still treating, that’s what it’s about.

Mark: For me charity, in a development sense, it’s about outside of the world of emergency aid, it went in disasters, that’s a different shebang. We’ve got to be looking at how we can build the healthcare system, how we can build capacity into it, how we can serve the governments of countries overseas and help them to do things for their own people.

Payman: It’s interesting what you’re saying. I have a couple of questions really on that. Firstly, how easy is it to get access to the government of Tanzania? Are they all up for it straight away or is that not a easy thing?

Mark: It was in the early days, Ian did a lot of the groundwork and Ian, if you ever meet him is a very gregarious, charismatic kind of guy. He can kind of talk his way into anything, and thankfully out of most things as well as I’ve found, but yeah, he did a lot of the legwork and I think the big difference with Ian is different if you’re the UN or you’re a big international organisation, you’re walking into some of these government departments to get an audience but he was a nobody.

Mark: He wouldn’t mind me saying that. In the early days Bridge2Aid was a nothing but he went in with humility and a genuine desire to serve and said, what can we do? Got to know people. The Tanzanian culture is very much a relational culture. There is a hierarchy but it’s not transactional. You’ve got to be very, very relational in order to win people over and win people’s trust. It’s a form of socialist government.

Mark: So in some areas, there’s a natural distrust of foreigners that are coming in to save the world before next Tuesday. So he worked very hard on the relationships, built the trust and then we were able to then build on that over the next 10, 12 years. As the organisation grew, and we followed through on what we said we were going to do, then it became easier and now, we’ve got a couple of our patients, former health ministers, the current High Commissioner in London is one of the patrons. So we’ve got some fairly influential Tanzanians on the organisation now.

Payman: Did you ever think that it might make more sense to have people full time over there training these medical offices rather than getting dentists to come up all the way through or is it that dentists want to give their time and so that’s part of the whole business model?

Mark: Yeah. It was an interesting one we had to balance. In the early days there wasn’t a question of having people on the ground full time because we were still building the evidence base for it. During my time, couple years before I left, there came a point where in a strategic discussion with the government, we change to a two pronged approach, where we’ve been laying the foundations for what we call phase two, which is where rather than training dentists to clinical officer, we would train dentists to regional dental officer or district dental offices.

Mark: So you’re training qualified dentists to be trainers. It’s a train the trainer’s programme, which builds capacity for the long term, but the size of the country and the amount of resource that was available, we weren’t going to cover the whole country by doing train the trainer’s quickly enough without the other thing. The other thing we had to balance was the fact that and this comes down to funding, is that a lot of that funding came from dentists.

Mark: So we had to balance that need to keep people engaged with our commitment to sustainability, and that’s a difficult one to navigate but I think I was happy with the way that we navigated while I was there.

Prav: Was it quite easy to recruit volunteers, dentist because I can imagine certainly for a lot of clinicians, you’re giving up a sizable amount of revenue. I think probably the biggest cost to them is their time out of the clinic, and giving up that time is a big ask. I’m sure obviously there are lots of people out there who are willing to give back to the community. Did you have a recruitment process for that or were volunteers just knocking your door down, saying look, I just want to give back and how do I get involved?

Mark: Yeah, we had both of those things. We had people knocking on the door, but we had a very strict and stringent recruitment process. So everybody was interviewed. Everybody was properly prepared, vetted references, those sorts of things. Because as well as being qualified, academically and clinically to do it, we wanted people that we’re going to play nice with the other kids. So we had a fair amount of that.

Mark: You can imagine putting a team together that then goes to a developing country and has to land on the ground and has all of their buttons pushed. You need people that are fairly resilient or weren’t going to sort of cave under pressure.

Payman: So did you end up rejecting many people?

Mark: Not many, but we did do, ad there was a few, to my knowledge, there was a couple we didn’t ask back. We were pleased when they didn’t ask to come back, but the overwhelming majority were fantastic people and repeat offenders, as it were.

Prav: How do you test whether a candidate is good for coming out and delivering aid work? You say, obviously, you’d filter some people out and they need to be resilient because you’re going to push the buttons while they’re out there. Would you try and push the buttons over here?

Mark: No, it was a little bit more relaxed than that. So, the process now is different to when I was in, well, it was a long time since I’ve done any interviews. We interviewed people face to face and you’d get a sense for people. I think a lot of it was more what to look out for, or who to pair them with rather than this person can’t come. The ones that we did reject, it was very clear from the interview that this wasn’t going to work because they had a different agenda. I think that’s really the only thing where it was a big issue.

Prav: What are the agendas that people might go out there for?

Mark: A bit too, I’m going to do it my way. I do it like this in my clinic and that’s the way it’s going to be. We would gently push back and say, well, actually, there’s a protocol here, you’ll be expected to follow the protocol because you’re not just training one person, you’re training six people, and they’re going to go around each of the trainers over the time. If you’re telling them one thing, and you’re in and they’re being told something else by somebody else, that’s going to screw up the whole process. So if they’re not prepared to adhere to a protocol, then we would weed that out.

Prav: Playing devil’s advocate here. Do you think there are any people who want to go out there not to do good, but to look good?

Mark: Yes. I mean, the short answer the question is, yeah, but I think my hope would be that even If they came for those reasons, they’d go home very different anyway. I can only think of one or two people who came thinking this is the latest thing on my CV and went back and carried on being exactly the same out five, 600 volunteers probably that they’ve had now.

Mark: So, my hope would be that even if people did arrive a little bit full of themselves that you don’t have to do anything, because the experience will sort people out because everybody will reach their low point and everybody will reach their high point. We worked very closely with them in terms of the leadership teams and how we looked after people in the whole process to make sure that was all out worked and processed properly.

Prav: I guess you’re changing a high volume of number of lives, the easiest way for me to explain it, in comparison to what they’re doing back home, either in private or NHS practise, right?

Payman: How many teeth would they take out in a day?

Mark: Oh, not as many as you think because they were training. You’d be looking at Probably 20 to 30 patients a day. Again, sometimes as low as sort of 10, 12 because the priority is training. We might take 20, 30 minutes over one patient. What we would do in cases where I mean, one day, I think the record for the time that I was there was 400 people who turned up looking for treatment on one day, and in those situations, we would protect the training, but then the people that were supernumerary in terms of our clinical oversight, and the local government oversight would then set up a chair and we’d have extra equipment, where we could just bash through people and get them out of pain as quickly as possible.

Prav: How many dentists on a typical trip?

Mark: They might shoot me down. I think it was seven. So six training and one supervisor, site clinical lead, and four nurses. It’s been a while, I might get the numbers wrong. I’m sure I’ll get a phone call.

Prav: There or there about.

Mark: There or there about. Small teams. 11, 12 people, enough to fit in two Land Cruisers because you’re working in some pretty remote areas,

Prav: You’re looking at between that team, about 140 teeth a day?

Mark: Yeah.

Prav: Still quite a lot, isn’t it?

Payman: Working in the third world, there’s always going to be issues. Tell me about the worst clinical issue that came up. Anything. You’d imagine something’s going to happen, go wrong.

Mark: Yeah, we had instances where post extraction complications and nothing that wasn’t then dealt with that was pretty traumatic, and for the patient.

Payman: Bleeding.

Mark: Bleeding and then having to travel to access care. Thankfully, very, very, very rare. A number of cases where we’d get so far and then had to stop and then refer them so that patients then got a couple of days before they’re able to then get to a full blown clinic and have a surgical extraction. We were very, very careful to make sure that in the training, we taught limitations as well as skills. So to my knowledge, thankfully, nobody during the training has ever run into such a problem that we had a real big medical emergency.

Mark: We had a few medical emergencies, fainting often because people hadn’t eaten for a long time and then they’d get an anaesthetic and faint, but we carried crates of soda for that sort of thing and people usually tend to perk up. Because we’re not doing sort of general surgery, thankfully, we were able to control the environment as much as possible.

Payman: Then from the admin side, you had a couple of well publicised issues. Run us through those. Run us through your lowest moments. Perhaps this is the favourite, perhaps favourite part of the podcast.

Prav: [inaudible] get you to cry, buddy.

Mark: Never a dull moment. Never a dull moment. I think all sorts of things. I talk about the financial issue but we had people involved in car crashes on the way back from the airport and all sorts of stuff, planes not arriving, people getting sick sometimes because of poor choices they’d made. Other times just because they got sick, but we had a good infrastructure set up. The hardest one I think was the financial issue in 2013 into 2014, where we had a big grant cut, and at the same time, we had a fraud perpetrated on us in the bank.

Mark: The two of those added up to a shortfall of about $200,000 that we were looking for in our budget, having just ramped up for a big expansion in programmes. So we had to launch an urgent appeal to do that, which was start at 2014 for 50,000 pounds just to get us back on an even footing. We’d made cuts, we’d save money wherever we could, and I think that the challenge at a time was, can you talk about fraud because if you talk about fraud and charity in the same sentence, then people will get very, very scared.

Mark: There was a huge reputational risk with going public with that, but we all felt as a senior management team, it was really important to be completely honest with people. So we did, we wrote about both circumstances and the fraud was probably 10% of the deficit and the grant was 80% of it, but we felt it was important to do that and thankfully it paid off although there was a few nervous moments and sleepless nights over Christmas in 2013, I can tell you. It was-

Payman: Tell us about the first time you found out there was a shortfall in the bank account. I mean, exactly how did you find out and how did you feel?

Mark: Do , I would felt sick to my stomach because I knew that if it had happened, that was going two major consequences. One would be the actual loss of money, and the second one was going to be dealing with the whole process, because Tanzania’s set up from a legal standpoint and a policing standpoint is very different to the UK. In the UK if that happened, you could feel confident going into police interviews, and you could feel confident that the police were going to handle it.

Mark: We probably had less confidence given the circumstances and the amount of money that was involved. So that was the initial reaction. The only reason we found out was because the first fraud happened two days before we found out about the next one, they made another attempt and it was on the second attempt that it was uncovered. So there was a whole mix of, money’s gone missing, police are involved, all that sort of thing. It’s all that kind of crisis.

Prav: Were you more concerned over there than here because of corruption?

Mark: I think my major concern was, we’ve got to manage the process with the bank and we’ve got to manage the financial thing. The financial thing can wait a little while, although we’re going to have to deal with it quite quickly because it would leave a big hole in the cash flow, but it was more navigating the complexities and the subtleties. I think one of the things that I found when I used to come back from Tanzania to the UK was, there was a level of stress that you live under, when you’re an expat in a different culture that you don’t live under here and it’s almost like it lifts off.

Mark: It’s subconscious in many ways, but there’s a lot more going on behind your back than you realise and even what’s going on in front of your face you don’t truly understand. So, I think my friends that are fluent in the language, although we’ve got a reasonable grasp of Swahili, but my friends who are fluent in the language are much better.

Payman: Do you speak Swahili?

Prav: No. Just about say, hello mate. Jambo, habari gani?

Payman: Was there any idea that the bank would pay you? I mean, if it happened here, you’d imagine the bank would find the money for you somehow. Their error. Were you thinking that?

Mark: That was our argument. That was our argument. I can’t go into too much detail about it because we made agreements in closing the whole thing off, but from our point of view, it was a breach in protocol. From their point of view, there were things that shouldn’t have happened that did happen, which we disputed.

Payman: Did you change banks?

Mark: Yeah. Very quickly, very quickly and it worked out. The great thing was picking up the phones to friends in the UK after it happened, the people that have done work overseas were like, you can have all the due diligence and all the protocols in the world, and people will find a way through and they did. Then they close that loophole, and they’ll find another one.

Payman: I remember that time very well. I think it was interesting what you said. Bridge2Aid was doing really well. So you’d scaled up, but the nice thing is that Bridge2Aid was doing really well, so people really wanted to help at the time. It seemed personally, not for a minute that I think, look at this fraud or that’s something they’ve taken. I thought this is just, but then coming from a third world country, you can understand the way these things work, but people did then come up with money from the appeal which is lovely.

Mark: Yeah, it was great. It was one of those really bad things that turns into something really great and you move forward with a whole load more confidence. Although we still had a tough, tough period to navigate.

Payman: What’s it like living in?, you just alluded to it living in Tanzania. You’ve adopted three children you were telling us before. Do they go to regular school or do they go to English school and then what’s it like bringing them here after living there all that time?

Mark: So we were fortunate in that the city that we lived in, in Tanzania is the second city. So there’s an international school teaches British international curriculum. So they went to that school amongst probably a smattering of white kids and a bunch of Asian kids and a load of Tanzania kids. Then they came back to the UK and it’s the complete opposite, because obviously, there are very few ethnic minorities where we live.

Payman: How old were they when you adopted them? Were they babies?

Mark: Yeah, our youngest was six months when she came to us and the boys were both 18 months. So relatively young. We’ve got a friend, Amy who’s now based up in Bolton who started the home that they lived at while they were overseas and they all came from the same place. Fantastic woman, got her MBA now, started an orphanage, it is a baby home because it’s an interim care home for kids. Kids that are abandoned or lose parents in childbirth. One of the big problems in Tanzania is that because formula is so expensive, fathers can’t afford to raise kids if the mothers died in childbirth.

Mark: So they will take, Forever Angels is the name of the baby home, make a donation. It’s fantastic charity. They will take the baby in for two years, feed them look after them. Take regular visits from the family. They’ll do vocational training for families to help them to get jobs and get skills, and then at the end of that period, they’ll go back into the family and then they’ll carry on with their lives. For kids like ours who didn’t have anything To go back to, they will find them homes to go to, or push them up into the next sort of level. So they all came from there.

Prav: So what were the specific stories of your children? Had they mothers passed away in childbirth or different circumstances?

Mark: Yeah, different circumstances and hard to know, because there’s not very much information about it. In Tanzania when you adopt, you cannot adopt any child that has any living relatives, and so it has to be proven first that there’s no living relatives. So [inaudible] been through that process, which is why they could be adopted, but that’s the daily reality and as I say, Amy, who still runs the baby home, but she lives in the UK, would be fighting for and receiving kids on a daily basis. That’s the reality of life for most of the world, unfortunately.

Payman: When you were living there, what did you miss most about the UK outside the family and friends?

Mark: Paper.

Payman: The newspaper?

Mark: A newspaper, yeah. Real ale.

Prav: Was there no ale?

Payman: No, I guess not.

Mark: Fizzy lager. Fizzy lager.

Payman: Was there not an Irish Pub somewhere?

Mark: There was. So in Dar es Salaam, where Prav’s dad comes from, there is an Irish Pub.

Payman: There’s an Irish pub in every city in-

Mark: There’s an Irish Pub in every country in the world. So it was those sorts of things.

Payman: A paper and a beer. How about what’d you miss most about there now that you’re back?

Mark: Now that we’re back, there’s not an awful lot that I miss. I think I was ready to come back. 10 years living in country, another two sort of travelling backwards and forwards I was ready to move on. I think it’s different for my wife. I was face to face with the bureaucracy and the challenges of doing business every day and so I was ready to step away. The main thing I miss is people, friends that we made out there some of whom now I live in the UK, some live in different parts of the world, some still live there.

Payman: And the tomatoes. Do you know what I mean?

Mark: I tell you what, fresh fruit, fresh fruit. My kids, that’s the thing that they miss is the fresh fruit. So we would have mangoes and watermelon and pineapple all chopped up in the fridge the whole time. So miss those sorts of things. Yeah, for sure.

Prav: So the next step, there must have been some point when you decided to step away from Bridge2Aid. What was the factor that made you make that leap?

Mark: It’s interesting. I was listening, just after I made the decision to leave, I was listening to a podcast that Deborah Meaden did with a bunch of entrepreneurs and they were all saying that 10 to 12 years was the maximum, the top end in anything that they would do before they’d move on. Because at that point, you’ve kind of given everything you’ve got to give to it and I’d been in Bridge2Aid 10 years, seven years as CEO. So it was that point in time combined with, I worked myself almost to death in 2016.

Mark: We set up Bridge2Aid in Australia. So I was there and back two or three times for four or five days stints, at the same time flying backwards and forwards to Tanzania to look after the team. I got to the point where, it’s that perfect storm of you’re exhausted. You’ve reached the end of your tenure, somebody is trying to tell you something.

Prav: Did you think to yourself at this point, do you know what, I want to do my own thing now. It’s time for me to start my own business, be that entrepreneur and do your own thing basically. As a lot of us who own businesses, we have that turning point in our life and say, you know what, I want to be in control of my own destiny. Was there an element of that?

Mark: A little bit, and it’s interesting because the person that joined Bridge2Aid is very different the guy that left Bridge2Aid, like hugely different. The way that I developed as a leader, working alongside people like Ian, other mentors like Chris Barrow and other mates that have sort of shaped me, and I guess, given me the confidence to lead and I think that’s the key thing for everybody to understand is that, you don’t wait for people to give you permission to be a leader, you just find out who you are and what you care about, and let that be the driver for it rather than waiting for a door to open.

Mark: So I came out a very different sort of person and I’ve been in an organisation for 10 years. The responsibility of leading a large team, of having to raise 50, 60k a month, just to keep the doors open, I think you reach the point to say, okay, we’re going to cut it right back. What do I want to do? So the decision to leave was the first one. I didn’t know what I wanted to do when I left, but started looking for jobs and thought, no, I want to find something I want to do.

Prav: So you didn’t have a master plan in place?

Mark: No.

Prav: You didn’t think to yourself, okay, 12 months before I leave my job, this is what I want to do and start making a plan, set up my own coaching company, rock and roll.

Mark: Not at all. I never had a master plan.

Prav: So was the CSR Coach an accident? Did you happen to fall into it because of a few experiences and then thought, actually, do you know what, I’m pretty good at this.

Mark: Yeah, I think it was a combination thing. I think once you create the vacuum, once you create the space, things start to happen but a lot of people wait until, they want to wait until they’ve got the right idea before they step out. So I think, it was a happy set of circumstances that brought me to that point and thought, well, crap, I stepped out. What am I going to do now? I got three kids and a mortgage to pay, and we’ve always worked for charities. So we got no money, what are we going to do?

Mark: So then you start thinking about, is what I’m passionate about something that people will buy, and that takes a while because what you’re passionate about, you think people will buy, but they don’t but then you find one or two friends who are prepared to give you a go, like Colin Campbell and Joe [Bat] and other people like that, who say, yeah, come on, let’s do this. Then you shape it up and I think over the last, what is it, nearly 20 months, I guess since I left and started things up, there’s been a daily process of thinking how we’re going to make it work, but it’s very exciting at the same time, because I’m in my sweet spot and doing what I love to do.

Prav: I think one thing that you’ve just touched on that really resonates with me is that you’ve got to create the space to make it happen. So it’s a bit like, I’m part of a mastermind and a coaching group and one of the topics of discussion that I’ve had is, you want to work with a certain type of client, but say 30% of your client base is not a client base that you want to work with. How do you make that point, that switch when you say, I’m going to let go of the 30% so I can do that? If you never make that space, you can never make it happen and I guess, for you in your career, making that space, making that jump allows you that freedom to be able to drop into what you did.

Mark: Yeah, absolutely. Getting into Bridge2Aid was because something else got cancelled and getting into this was because, I feel like I need to make the change. No idea but, I’ll bet myself to find something to do that will be good.

Prav: Did you ever have any doubts about the CSR Coach? Did you ever think that, oh, crap, do you know what-

Payman: Every day, right?

Mark: I was going to say, tell me an entrepreneur that doesn’t go, blimey, I really hope this works.

Payman: Mark, the thing you should bear in mind, I don’t need to tell you, but three years, any endeavour, three years, who’s your ideal client? Are we looking at Henry Schein dental directory or are we looking at dentists down the road or both?

Mark: It’s a bit of both. The stuff that I do works for all businesses. If you’ve got a team, and you’ve got customers, then it works. It even works for, so my biggest client is a multi academy trust in London. So, they’re a charitable trust, but they’ve got to attract staff and they also have a strong set of values around who they want to be as an organisation, and they know that as a corporate entity, that has to be fleshed out somehow. So going back to the dental side of things, I work with dental manufacturers, and I also work with practises.

Mark: I guess, the ideal client isn’t a certain size, it’s more of an attitude and an aptitude for, the best people to work with other ones that go, do you know what, this is the right thing to do, but I know it’d be good for business as well. So I say to people, don’t do this, just because it’s the right thing because although it is, but actually, this is something you can really use as a tool to grow your business.

Mark: The caveat to that is if you’ve got a real dysfunctional team issues, then you need to deal with that, but this will really help with it. If you are struggling to stand out because you’re rubbish at what you do or your website’s rubbish or that your branding is not good, then this can’t turn that around, but in a world where everybody looks competent, otherwise they wouldn’t be in business, and where everybody’s got a good team package, what’s the secret sauce, what’s the differentiator both from a customer point of view and a team point of view, that helps you to bring the right people in and provides the energy in the business.

Mark: Oh, and it’s a great thing to do as well because you’ll go ahead and put your head on the pillow and think, yeah we did the right thing today. We’re doing it intentionally on a regular basis rather than every now and then.

Prav: So before we move on in this conversation, just as I did before I met you about an hour ago, what on earth is CSR? What does it stand for and because you described it quite clearly to me earlier, actually, what it means in real term words and before that it was just a three letter acronym that I didn’t really understand how it sort of expresses itself in your business, so to speak, and what it means. Would you mind just telling the audience what it is?

Mark: Yeah, sure. So when you asked me that question earlier, I said, well, you said, who would know what CSR means in the street? I said, well, probably pretty much nobody. A few people would know that it stands for corporate social responsibility, but if you said to them, you know how people now expect businesses to do good, how they want them to treat staff right and to have a team that’s motivated not just by money, but because they care about doing the right thing, and about how the business needs to care for the environment and not be just chucking loads of waste out and using up loads of electric needlessly, or driving really big thirsty cars the whole time, and how you want them to be a positive contribute to the local community.

Mark: When you put those three things together, and that’s corporate social responsibility. So as a business, as an organisation, we choose to make a commitment because of our values and those are unique to every business. Every business makes, because of their values, they make a commitment to doing the right thing for their people, to doing the right thing for the environment and to doing the right thing and being an active and positive contribute to their local community. All I do is take people’s aspirations and put them into a simple structured plan, train somebody how to run it, so that it adds value to the business year round and they can use that as a differentiator to help them to stand out and show that they’re one of the good guys, which everybody is pretty much.

Prav: Cool. So you provide the structure to help businesses be essentially good guys in terms of socially, environmentally, and I guess in terms of leadership as well, right?

Mark: Yeah. Because I think, two problems people face, they either don’t know what to do. So they’ve got this idea that we want to do the right thing. We’re not quite sure what that looks like or they’ve got a very clear idea of what it should be, but they struggle with structure and putting it into a plan and making it consistent. So they don’t have a staff meeting in six months and think, well, that thing we did for charity a few months ago, brilliant, why don’t we do more of that? Then it gets forgotten about for another six months. So it’s going to be part of the business plan, part of the management system. That’s from my experience, that’s what I bring in and help it to work in that way.

Payman: Well, it seems to me that when times are good, companies are up for this sort of thing, but when it’s recession, then they’re not particularly Looking at this sort of thing. Is that right? Does CSR suffer with that a lot?

Mark: I would say no, and the reason for that is that, at the front end, a lot of the stuff that I do with clients is cost neutral. So any client that I work with, I can guarantee that at the end of the process, 80 to 90% of what they’ll be doing, they’ll be doing the same things, but they’ll be doing in a very different way. So they’ll be leading differently, or they’ll be communicating differently, or they’ll have tweaked a few things, but at the outside, that is all based and founded on a purpose that they started in terms of going back to their values and what their commitments are.

Mark: There will be some small things on the edge, which will be around giving some money back because it’s important that businesses have skin in the game because it shows to the staff, we’re not just asking you to do a bake sale or to raise money, whatever and we’re not doing anything about it, but we are actually putting something into the process. I would say that that investment more than pays off, and some of the stats around engagement of teams that work in socially responsible businesses.

Mark: The stats from Gallup are that staff in socially responsible businesses are 67% more engaged than staff in non socially responsible businesses. So that means they’re much more switched on. Now, every engaged employee that you’ve got will generate 120% ROI on salary. If you’ve got somebody who’s disengaged or actively disengaged, they’re costing you money because they’re generating 60 to 80%.

Mark: So you take an average salary, a lower end salary is 20 grand a year. If that person’s disengaged, they’re generating 16k. If you can flip them to engaged, they’re generating 24k in the first year, multiplied by the number of staff that you’ve got and you can see that putting a few grand into a CSR programme and making it happen actually is going to pay off in the long run in all sorts of ways.

Payman: So whenever we’ve done any charity, call it charity work, apart from the good that the work itself has done, from a selfish perspective, definitely for me the effect it has on the team is the biggest issue. Not necessarily the “marketing message,” that did that but I don’t know. I’ve never really tried to measure that, but the effect it has on the team and what you said before about it can actually solve friction within the team. Because there’s something about management and workers that people think, they don’t care and somehow glues the team together.

Payman: Certainly what I’ve noticed a couple of times that we’ve done anything CSR related, and I never really thought of it that way. I never thought that that would happen. It’s an interesting point, isn’t it? It’s for the good of doing what you’re doing. There is, I’m sure some marketing in it, but this one, definitely I thought the most worthwhile thing from the company perspective was how the team come together for something like this.

Mark: What’s the sort of age range of your team?

Payman: 25 to 35, most of them.

Mark: So they’re in the sweet spot. Anybody under 35, the millennial generation, three quarters of them are looking for socially responsible employees to work for and if they’re employed by those people, there’ll be more engaged, they’ll give more to it, they’ll advocate for the business, they’ll produce more. So times have changed. It’s not the carrot and stick anymore, if you do well and you’ll get a reward. It’s like what are we all trying to achieve here, and people want to come to work in a place where they feel they’ve got a sense of purpose.

Mark: Although there’s a commercial purpose and that’s around excellence and doing the right thing for the customer and personal growth, you add a CSR element on the charitable side and it’s actually, as a business by doing business, we’re doing good because we are either generating funds that’s going into things or as a team, we did something nuts or we do something nuts on a regular basis. We have a lot of fun together, it builds collaboration and the whole team gets a buzz from that.

Payman: I know it’s different for every practise and depends on what they come to you with in the first instance, but run us through Dr. Prav and his team want to do something CSR related. They’re not sure, they want to kind of help the community, would be nice to help someone abroad as well. What’s the process? They get you in? Have a conversation?

Mark: Yeah, so we always start with values. So I’ll always talk to an owner or a senior management team and say, what is it you’re trying to achieve? What are your particular issues that you’ve got? What stage is your team at, what stage is the business at, what are you doing already?

Prav: I guess to a lot of people who are not well versed in business language or talk and you talk values, core values, what are your aims? What’s your vision-

Payman: Go on. Go on Dr. Prav, go on. What are you sort of do the thing, pretend to be that dentist?

Prav: So actually, you know what my values are is, I want to treat my patients in the best possible way. I want to deliver great dentistry and I want to make more money, do more high end dentistry and I want my team to be happy. In terms of vision and values this, that neither, I’m actually not sure what you’re talking about.

Mark: So in terms of vision, I’d probably ask you why you bought the practise in the first place. What was it that got you into dentistry? What was important about that? If we were to fast forward 10 years time apart from sitting on a beach, what does it look like? What does the practise look like in 10 years time?

Prav: So the reason I got into dentistry was it seemed like the right thing to do as an Asian. I was too clever to be an accountant and run a corner shop or drive a taxi. So I became a dentist and I finished my anatomy classes at the neck. So I decided dentistry and not medicine.

Prav: So about the practise to basically move on from being an associate and be the, I guess the controller of my own destiny but I ended up working a lot more hours probably earning less money and I’m at a space at the moment now where I just want to reduce my hours, spend more time with my family, but I want the business to run on its own two feet is my ideal and if I could wave that magic wand [inaudible] I would say and pluck up my dream scenario in 10 years time, I’d be working two days a week in the practise, working a day a week on the business and enjoying the rest of my time with my loved ones.

Mark: So it sounds like family and balance and work that’s fun, work that’s rewarding is really important to you. So we then look at okay, tell me about it when the business is running really, really well in terms of the team, in terms of how patients are being treated, what does it look like?

Prav: I’ll tell you what it looks like, everyone’s really happy. There’s no argument. There’s no bitching. There’s no he said that she said that. Everyone’s given that little bit more discretionary effort, going above the hundred percent and I don’t know quite what it is about that, but there’s times where that business is just ticking away and firing on all cylinders and there’s times, almost like the total opposite where things hit rock bottom, shit hits the fan and it’s just like, I don’t know why. So if I could have my business firing on all cylinders like a well oiled machine, and everyone was super happy all the time, I think I’d get to that position a lot quicker. Can you help me get there?

Mark: Well, I’ll tell you what, what you’re talking about is a cultural thing around expectation of performance but also tolerance of types of behaviour. So what we can certainly do when we look at the people aspect of CSI is look at how you’re leading, what expectation you’re setting for the team, how you’re rewarding people that behave in the way that you expect them to behave in, how you’re recognising those sorts of things. Sounds like there’s a lot around communication in there as well about do we know where we’re going, what we’re trying to achieve.

Mark: So in terms of that vision piece, the vision thing is no grander thing to say, well, how do people know what you want them to do unless you tell them what you’re trying to get to? So if you can tell them why you’re trying to get to, then people will engage and get behind it in their own way. There’s a whole piece around culture, there’s a whole piece around expected behaviour. We can shake that up with the community and charity side of things in terms of getting people involved in stuff and if you’ve got people that are aspiring leaders or could do better, we can give them some responsibility in that area before we test them on live stuff like running the finances.

Mark: So there’s all sorts of things we can do around that as well, and in terms of getting more high end patients in now you need to talk to somebody a specialist in dental marketing about that. What I can tell you is that consumers will come to you if they can see that you’re a good person to do business with and you’re a trustworthy person to do business with. They don’t just see that from your website and your testimonials.

Mark: That’s a big part of it but if you can show them that actually you’re rounded out as a person and as a business, then that will help to build trust and to help and to feel that they can to you for their dentistry.

Prav: Cool. I’m just going to step straight out of role play now and ask you a question that’s actually really current with me right now, and it’s a recruitment question. So I really love the fact that pretty much every one of my team members gives me what I consider to be discretionary effort and as a boss, and I’m being very sort of blunt here, I can expect 100% from my team. So I pay the money, I expect 100% and I can’t dictate or expect 110% for example. I get that every time though.

Prav: I get the 110%, I get my team members stay in after hours, never dictate it to them. I get my team members texting me, messaging me, emailing me at midnight, 11 o’clock caring about the business the way I do, sometimes more. How do you recruit for that?

Mark: One of the things that I’ve found is that you can train skills, but you can’t recruit values. So if you’re going to recruit people that are going to do that sort of thing, you have to be able to identify what those values are and get those people in, and even if that means somebody less qualified than somebody else that’s a high flyer but won’t fit in the business and you’re very lucky, if that’s what you’ve got, then you’ve done a great job in building that.

Prav: I have and I feel very fortunate, but I would say you can’t teach the art of give a shit. You can teach everything else, right? What would you do to screen that in an interview?

Payman: Difficult one, isn’t it?

Prav: It’s one I struggle with all the, I am recruiting-

Payman: I think Prav, there’s a big part of your thing. You’re very happy to fire people too.

Prav: I wouldn’t say I’m happy to do it.

Payman: Not happy but-

Mark: You need to.

Prav: You fire fast, right? Definitely. Definitely, but never happy to.

Payman: I didn’t say, yeah. I did say but I didn’t mean that. I didn’t mean that.

Mark: If you’re a human being, then firing should always be hard because it has a consequence to that person, but we’ve all had to do it, and sometimes very early on, and it’s painful from all sorts of perspectives.

Prav: Taking food off someone’s table, and whatever all those other consequences are is really, really hard but then, as you said earlier, you’ve got that vision. You’ve got the rest of your team who are pushing in the same direction. It’s a responsibility to them.

Mark: Yeah, absolutely. Going back to your question, I’d probably tell me a story about, tell me about a time when that happened, get them to tell you about stuff that they’ve done. If they can’t think of anything, then that’s probably a good indicator.

Payman: Mark, do you think your time in the charity sector has prepared you well for what you’re doing now? So it’s clear that you’re obviously a leader, you’re obviously the kind of person you’ve managed big budgets, you’ve managed lots of people, you’ve talked to government, or do you think nothing prepares you for entrepreneurship?

Mark: Well, it’s interesting because I think, a few things happen. When I was with Bridge2Aid , it’s like you’re always reading in podcasts and blogs and those sorts of things. I seem to find myself on a lot of entrepreneurial type blogs because they tend to have the best tips. Very often I think you very much are an entrepreneur in the sort of charity that we were doing. It was a startup charity. It started with two people 15, 16 years ago. So you have to be able to think on your feet.

Mark: Cash flow is king. You can’t go to a bank and ask for another injection of funding, you’ve got to think on your feet in that way. So I think the charity was very helpful in that. I also think a lot of people that I met, a lot of people that I’ve worked with, during that time shaped my thinking, and got me ready. I think being prepared to grow as a person, had I not been prepared to grow during the time that I was chief exec, then no, I wouldn’t have been ready, but that’s not to say that I was ready when I started, but you’ve got all the tools in the box to use to build what it is that you need to build.

Mark: So I certainly feel like all the experiences I’ve had to date have got me into a position where I’m ready to take this challenge on. That’s not to say that it’s an easy one, but at least I know how I’m going to approach it and what I’m going to do, and it’s a lot of fun.

Payman: We’d like to wrap this conversation up with perhaps a favourite question.

Prav: Just before that. I just want to, there’s people out there, I am sure, like burning question on their mind. If I want to hire this guy, where do I find out about him, how much does it cost?

Mark: Okay. So to work with me, costs two and a half grand to get me in to do a two month intensive with you. That’s a couple of meetings. So I’m meeting with you as the principal with your senior management team. I’ll go away and put a plan together and then I’ll come back and I’ll meet with your team and get them overexcited about what it is you’re going to do together. Then once that’s done, I’ll then handhold whoever it is that you appoint to look after your charity work, your environmental work and your people stuff through the first month.

Mark: We then hand it on and then if you want to keep me on, which 90% of people do it, there’s something called the CSR Club, which is anything from 175 a month, starts at 79 a month for 10 months following that. So you’re looking at about 4k to get me in, all bells and whistles.

Prav: That’s for the year?

Mark: For the year.

Prav: And the club, is that a community of CSR devotees or whatever you want to call it?

Mark: Yeah, they’re busy people, so they don’t tend to hang out much but what I do is I check in them on a regular basis. So with my level one clients, I’m Zooming with them or calling them once a month and it’s not just a friendly chitchat. There’s a set of objectives that they’re supposed to have delivered. So what it means is that the principal can hand it on and sign up for the club and know that their CSR is going to get taken care of because I’m going to be watching and making sure that it’s all happening and supporting them. So that’s the way it works, and if you want to find out more than my website is marktopleyco.uk

Prav: Wicked. Thank you for that, and just onto my final question, Mark. So imagine it’s your last day on the planet, and your three children are all grown up, in their own lives, and they’re stood at the side of your bed. You can give them three bits of advice, life advice that they can take away from dad, what are they?

Mark: Three? Gosh. First one, I think would be, don’t let fear stop you doing anything, and never make a decision that’s based on fear. Always make a decision that’s based on hope. The second one would be, don’t worry. If it happens, it happens. You’ll deal with it. The third one would probably be, it’d be something about giving, that life’s not about taking. It’s about you get more out of life, through what you give to others, and that’s everything from me what you choose to do with your whole life to what you choose to do on the way back to the tube station, and that’s where the sweet spot of life really is about giving back to others.

Prav: Lovely, and just while we’re on that subject, I know that was my final question, but what do your kids want to do when they grow up? Any ideas?

Mark: Oh, who knows? My youngest wants to be a radio presenter. So one of my best mates is a presenter on local radio, BBC local radio down in the south. So we went in to see him over the Easter holidays, which saved my bacon because it was like what am I going to do these kids throughout the day. So we went in and they were on air and all that sort of thing, which is a lot of fun. So now he wants to be, his radio name is Bobby Strong on BBC Radio silent instead of Radio Solent.

Mark: So that’s what he’ll be doing. So he’ll do that. My oldest is a strong woman. She’s going to be awesome. She already is awesome. She’ll either be a chef or a lawyer and I don’t know which one I want more and I think my middle boy, Jack, I think he’s going to do something in sport. He’s only 11 but he’s already built like a [inaudible] and he’s great footballer. I think he’ll end up either playing football or he’ll end up on the sports science side of things as a physio. He’ll be keeping people healthy and keeping himself active.

Prav: Amazing. Mark, thank you so much for your time today-

Payman: Thank you so much Mark-

Mark: Yeah, it’s been great to be here.

Prav: It’s been absolutely really brilliant.

Payman: It really has. I think for me, not a dentist but definitely a dental leader. Definitely a dental leader.

Mark: Thank you very much.

Payman: Thank you so much.

Mark: Cheers guys.

Speaker 4: 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.

Prav: Thanks for listening guys. If you got this far, you must have listened to the whole thing and just a huge thank you both from me and Pay for actually sticking through and listening to what our guest has had to say because I’m assuming you got some value out of it.

Payman: If you did get some value out of it, think about subscribing, and if you would share this with a friend who you think might get some value out of it, too. Thank you so, so, so much for listening. Thanks.

Prav: And don’t forget our six star rating. Cheers.

Payman: When will we not, when should we do?

Bertie: June, definitely, that’s me, yeah.

Jason Smithson: It’s because the cogs are very big and turn very slowly. That’s the problem.

Bertie: Yeah.

Prav: Are you saying 1st of June as well, Jason?

Jason Smithson: Is 1st of June a Monday? If it were a Sunday, I would say no, I haven’t got a calendar at hand.

Intro Voice: 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.

Payman: As we enter week seven of the lockdown, many of us are looking at the virus, and we passed the peak in, at least, in metropolitan areas. I know there’s other parts of the country where they’re just going into that. But at the same time, we’re looking at the unlock. There’s patients with untold misery out there and there’s practises who are sitting on their hands. We’ve got dental professionals who can’t treat those patients while they clog up the one-on-one system and A&E. And so, we thought it would make sense to try and unlock this, and we’ve got three guests from the British Association of Private Dentistry which has recently been formed. So let’s welcome the guests. We’ve got Dominic O’hooley on the scientific community who’s done outstanding work looking at all the latest research.

Payman: And guys, before I go any further, I just want to thank the three of you and I know there’s a bigger team behind you guys for all the work you’re doing for the profession. Someone needs to stand up, step up, while we’ve got such a vacuum of advice coming from the top. We’ve got Jason Smithson who kind of started the BAPD with a few others with Zacky and with Neil and the others and has done stunning work on the political side and I think you guys are coming out with a bunch of recommendations for back to practise guidelines. And we’ve got Bertie Napier, who’s on the comm side and on the bunch of other sides of the BAPD, former president of the BACD as well. Lovely to have you all. So let’s start with Dom. Dom, where are we as far as you can see, we’ve got this aerosol issue which you put out your document on. Do you want to summarise what that document said and your thoughts going forward on what dentists should be doing next?

Dominic O’Hoole…: Happy to do that. Really just a little disclaimer to begin with, I’m just a dentist. Because I’m just a dentist, I’m able to look at all the research very carefully and one of my little things is that I am quite geeky with regards to that. So I have spent a lot of time collating and curating that research data together. And it’s provided me with the opportunity to formulate an opinion on this. And it’s not 100% clear, but we’re getting clearer that the two primary methods of transmission of the SARS-COV-2 virus are via droplet spread and something called ballistic droplet events. And the second one is by a surface spread through things called fomites.

Dominic O’Hoole…: And the issue with what we call dental aerosol generating procedures is a bit of a misnomer. And what we seem to be seeing with the literature now is that there is a consensus developing, the aerosol spread of SARS-COV-2 is not regarded as the primary vector of infection. And so, therefore we have to be very careful if we’re looking at a science based approach to going back to practise, that we don’t run down roads that are not going to lead us to a very effective way back. And we end up perhaps purchasing very expensive pieces of kit, that actually don’t provide us with any risk mitigation for our patients whatsoever and don’t provide our staff with any safety benefits either. So that’s really where I am at the moment with that.

Payman: Okay. Jason, you want to jump in?

Jason Smithson: And well I can just really only agree with Dominic and I think our main concern as a profession, certainly one of mine, is if we’re going to go back to restricted procedures, so we’re going to go back to aerosol producing or non-aerosol producing procedures without really any science base. And we have the other concern, if we go back to only completing non-aerosol producing procedures, what happens, as we discussed yesterday, what happens if the patient coughs? Which is as Dominic will probably confirm is a ballistic droplet event that non-aerosol producing procedures suddenly becomes potentially quite dangerous. Yeah, so that’s where we are.

Payman: Okay. So what I’m hearing you say is you don’t see a good margin of difference between a non-aerosol producing procedure and an aerosol producing procedure?

Jason Smithson: I don’t see any difference at all, but I think the first… I should really preface that by saying I think we should go back safely. So I think there are certain things we should be looking at and we’re currently, in the British Association of Private Dentistry, working on some forms of guidelines for that literally right now. But one of the things I strongly believe is that there doesn’t really seem to be much difference in risk between aerosol producing and non-aerosol producing, even though we’re going down that route quite seriously. So, that’s where we are with that. Dom, do you want to chip in on that? Because I think that will be valuable.

Dominic O’Hoole…: I’m just going to briefly chip in to just say that every time we… As I said in my paper, every time we breathe, we create a respiratory secretion aerosol. And so, there’s a bit of a false differential between aerosol generating procedures in dentistry and just being alive. And so, we’ve got to be very careful that we’re aware of the fact that when we use our humpies or our cavitron or the pieces of equipment in the dental surgery, they create clean wall on aerosols and these things are usually, it’s either clean sterilised water, or it’s an antimicrobial that’s used in those. And it’s only when it actually impacts into the oral commissure that you actually get what we call a mixed aerosol.

Dominic O’Hoole…: And there is real positive studies with regard to mixed dental aerosols. But what I would say is, I think Jason’s very correct in saying that I think it’s very wrong of us to have a red flag for dental aerosol generating procedures on one side and non-aerosol generating procedures on the other. I think what we’ve got to do is we’ve got to look at a risk mitigation approach to get back into practise with safety for our patients and staff at the heart of that. But at the same time keeping our eyes on the evidence all the time and not going down an emotive route. So anyway, that’s my kind of point where regards to that.

Jason Smithson: I would kind of add to that in a practical terms, what is the real difference in doing, for example, an extraction on a perhaps an older person with chest issues who may be coughing throughout the procedure in comparison, which is considered a non-aerosol generating procedure, in comparison to putting a rubber dam on and doing a small cavity or perhaps even a root canal access on a fit, healthy patient who is not coughing. And that would be considered to be an aerosol generating procedure. In my opinion as a dentist, I think my risk would be higher in the first approach rather than the second. And yet the guidelines are for us to do non-aerosol generating procedures.

Bertie: I think I’d like to support what Jason and what Dom are saying. And I think the first thing that resonated with me immediately with some of Dom’s work was, there’s a difference between an aerosol generating procedure or aerosol and droplets spread. These are two completely different things. And I think what’s tending to happen is this has all been lumped into one thing. And this is where the confusion is coming in for so many people. And we’ve also got to look at the history of dentistry as well. We’ve been faced with other epidemics in the past. We’ve had the SARS thing, I think it was 2003, we’ve had MERS previously and none of these things have we ever had where dental practise or the practise of dentistry has resulted in a massive or what we call a Super-spreader event.

Bertie: If we’ve read Dominic’s document, it’s got a very clear explanation of a Super-spreader event. And dentistry has never been that. So for people to come out and say that these aerosol generating procedures are, so, I think I’m going to use the words that have been used, dangerous without having any scientific backing to make that statement is a bit questionable.

Prav: I’ve got a question for you guys. Well, how do you think all of this media attention is going to impact the public perception of the safety of dentistry or how safe it is to walk into the practise? And I’ll just add to that, that I’ve seen and I think to share the video with you guys this morning, people have started to advertise their practises as the safest place to come in: “Look at the precautions we’re taking. Look at this air purification. Look at this space suit that I’m wearing.” And to me, that feels like you’re saying to the patient, “The dentist is an unsafe place to go, unless we’re kitted up like this.” My fear is that is we’re putting the news out there in the public that it’s an unsafe place to go.

Bertie: Which is a big problem. That is a big problem. I was on the phone with my son just a few minutes ago and these are his words exactly, “Come on dad, when you walk into a dental surgery, you probably know that it’s the cleanest place you’ve been in that day. If you’ve been in the supermarket, the tube, the train, on a bus, in a taxi, when you walk into the dentist surgery, that is probably the cleanest place you’ve been in that day.” And that says it.

Jason Smithson: I actually went on Friday evening out to get fish and chips for my kids, because they going crazy, they wanted take away food. And obviously, fish and chip shops have a health and safety regulations and actually CQC as well, which is one of our regulators, and standing outside the fish and chip shop at a two metre distance from all the other clients, I didn’t notice any masks on the people serving the fish and chips, I didn’t notice any gloves, I didn’t notice any significant wipe down of surfaces between people even though they are handing over money and putting their hands on the counter. And the fish and chip shop is open, providing a nice service and great but a non-essential service. Meanwhile we have, in my area people with fat faces, people with tooth ache, people with broken teeth and we have a very strong longterm record, I think since HIV, I think it’s fair to say, we’ve had a very good, strong longterm record for cleanliness and sterility in our surgeries and yet we are closed and patients are walking around in agony. Now, is that correct?

Dominic O’Hoole…: Can I just jump in that Prav, just to go back to your point, I think there’s two issues. I think Jason has very neatly summarised that, and I think so as Bertie. But what I’d say is I think that we had a little bit of a vacuum of leadership at the beginning of this. So unlike Wales and Scotland for example, we didn’t get really leadership from the top. This kind of vacuum created a situation where there was a real hunger for information happening and it wasn’t coming through. And I think the public were aware of that. And I think the second thing that happened is that when the urgent dental care centres opened, I think there was a second level of misspeaking information coming from the top with regards to the number of these urgent dental care centres and how many of them were actually ready to see patients.

Dominic O’Hoole…: And I think this fed into the general media worry regarding PPE. And it didn’t do the dental profession any favours at that time. Because I think that it tied in quite closely with the very many media reports we were seeing of patients who were having to do their own treatments, take their own teeth out and things like that. So from a dental profession point of view, I think that there was an issue with regard to how our leadership showed leadership with regards to this pandemic. Now I think going to your second point, I think if you look at what you were mentioning about potentially practises or corporates using a safety differential to kind of give themselves a commercial advantage over the other corporates or perhaps or the dental practises, well for me, I’m going to be quite open about this, I think that’s an example of naked profiteering.

Dominic O’Hoole…: And if it’s not science-based, I’m concerned about it very much. What I would say is that it’s perfectly reasonable for people to perhaps purchase things such as air purifiers, if they feel that that’s going to give the right message to their staff and it’s going to say to the staff, “Look, we’re willing to spend and invest in this kit. We know it hasn’t got a lot of evidence behind it. We’re going to invest it because we want you to feel safe to come back to work.” And I think that’s an entirely honourable way to go forward. But I think where it’s very different is if they start using these potential own evidence-based, pieces of kit to create this kind of safety focus that is not really true. And I think that’s not really what we should be doing as a profession. I think if patients go to a specific practise because they’ve got an app purifier, then I think we failed as a profession being true and honest to our patients.

Payman: Look, certainly I don’t think from a marketing perspective it makes much sense anyway. I think it makes you feel unsafe when you talk about this. But Dom, from your experience, from your research that you’ve done, what would you say is safe as far as equipment, air purification, high-volume suction, masks, what would you say, if you ruled the world, what would you say is the standard that we should be following?

Dominic O’Hoole…: I think if I ruled the world, we’d be in even worse situation than we are now. Well to be serious, I think if we got back to the premise that dentists, as Jason, and Bertie as well is, dentists have got a long history of being the experts of universal precautions. We’re absolutely au fait doing cross infection control extremely well. And we’re taught about at undergraduate level, and is then instilled in us as dental professionals going forward. So from my point of view, we are in a great position to be able to provide a safe environment for our patients. And that to me provides me with this troubling thought that we’ve been closed down. And yet as Jason said, so many others seem to be open where there is not the same level of regulatory control and we’ve got patients walking around with severe tooth ache and potentially very serious morbidity happening.

Dominic O’Hoole…: So go into your specific points. I think that if we look at what we always did first, so I think that the use of surgical masks which prevents a lot of wearer associated infection to patients because it’s a preventative measure in that way. The full face shield which prevents what we’ve talked about, the droplet ballistic events contacting the moist areas of the face, so your eyes, your nose and your mouth. The use of very careful and meticulous clean down between patients that we’re well aware and we use regularly already. These are the sort of areas where I think that we’ve already got an existing safety function for our practises. We use antimicrobials in many cases within our dental waterlines. Originally this was to reduce or remove biofilm within the waterlines. However, it seems logical to me for those antimicrobials to be used for a secondary function, which is to potentially reduce the viral load within patient’s mouth as well.

Dominic O’Hoole…: I think it’s interesting to look for us, and we are looking at this at the moment, to be looking at preoperative mouth rinses, to think about another way of reducing that viral load within the mouth. And it’s a simple, safe and effective way to make a material difference to the risk to our patients in our practises. And I think that when you start looking at really, really less evidence-based things such as floor standing air purification systems, wall mounted ones, or the ceiling mounted ones, I think the real issue there is twofold.

Dominic O’Hoole…: I think one issue is that they are not evidence-based and they’re absolutely very, very poor and limited amount of evidence that’s available doesn’t support the use. And then secondly, that they’ve become an extremely commercially sensitive product that appears to be pushed to people who are in a position where they feel they want to get back to work. So there’s an almost a mass hysteria going on. “We’ve got to go back to work. We need to do this. We need to do that. We need to buy this.” And the problem with doing that is, that if it isn’t evidence-based, we’re actually spending money on things that are not going to make a material difference whatsoever to our patients.

Jason Smithson: Yeah. The other thing Dom is perhaps the rubber dam, which is the other big aspect. The use of rubber dam reduces obviously ballistic droplets if the patient were to cough whilst you’re working. So all of those things really, I think that Dom’s mentioned, barring the pretreatment mouth rinse, we’ve pretty much been doing anyway, we all been wearing a mask, most of us wear a visor, we all cleaned down between our patients and ideally, you should be using rubber dam. So it’s not like you’re going to have to rip your surgery apart and put big glass shields at the reception and put huge air purifiers everywhere, and this and the other. The fact is we’ve already been working to a very, very high standard as dentists anyway. And that’s actually interesting enough, that’s actually been reflected in the research shows that the transmission rates to dentists over the last two to three months have been very, very low. In fact, no difference from the general population.

Payman: Globally as well, that’s what-

Jason Smithson: Globally. Yeah.

Payman: What would you suggest regarding virus in the air, how long does it stay there? How much of it gets there? and high volume suction is used, what percentage of it is taken out?

Dominic O’Hoole…: This is very interesting. I think without going into too much detail, if we look at actually the virus measure in aerosol first. So if we’re looking at trying to measure SARS-COV-2, in aerosol, there is a recent study that came from two hospitals in Wuhan, which looked to collecting a proxy measure of the virus within, it ended up being two specific areas of the hospital. One was patient toilets, and the second area was areas where soiled PPA was removed or doffed. And what they did there, is they actually were able to measure viral RNA and they admitted in the paper there’s an issue with that.

Dominic O’Hoole…: The issue is that viral RNA doesn’t tell you if it’s effective virus or not. It just tells you that it’s either dead, demoted or potentially live virus there at some point. So the second issue that was there is that, one of the most heavily measured areas was the patient’s toilets, and it seems that something called faecal airialization which is where your toilet flush. I know this is a bit disgusting, but this is another way that we can actually obscure SARS-COV-2 enter aerosol is through toilet flushing.

Dominic O’Hoole…: So there’s a lot of problems with that paper and I don’t think that it provides really anything like weighty evidence to suggest a change in the consensus that we’re looking at primarily droplet and surface primary spread. So thinking about your point there Payman, regarding aspirators. I think what’s interesting there is that it’s very clear that high volume aspiration, just from a visual point of view, takes away the vast majority of the aerosol that’s generate as you do in your procedures.

Dominic O’Hoole…: If you tie that in with what Jason mentioned, that using rubber dam where possible, obviously you can’t do that if you’re doing-

Jason Smithson: Scaling.

Dominic O’Hoole…: … scaling and things like that. In a way you can use it. But at the same time if you use a really efficient, high volume aspiration and if you’re making ensure that your nurse is trained in forehand dentistry so that she can provide you with optimum aspiration, then it’s a very effective method of reducing the aerosol generated by your dental procedure. And you can see that on your face mask. Just a simple measure look at your face mask if it’s been done properly and it remains very clean. So with regard to formalise measuring of that, I don’t think there’s been any studies that have shown a percentage of their aerosol is taken away by high volume aspiration. But it seems to be a large, large majority of it.

Payman: Well I think that then works into the N95, the FFP2, FFP3 story. Once you layer the reduction that you get from rubber dam and high volume aspiration, layer on to that the small percentage difference between these masks, the differences we’re talking about between surgical masks and the top mask might be a 1% difference at the most. And you were making-

Jason Smithson: I can tell you exactly what it is in a moment.

Payman: Oh go ahead.

Jason Smithson: Give me a moment,

Payman: But Dom made a very excellent point when I spoke to him, that the FFP3 mask is an uncomfortable thing. We’ve been advised to wear it all day. And inevitably as dentists, we know inevitably you’re going to touch that thing, particularly when it’s uncomfortable. And so any marginal gain you would have got from that mask is immediately lost because you touch it so much. So the idea that keeping a mask on between two patients just seems ridiculous anyway to us because we’re so used to changing things. But what it says to me is possibly a surgical mask is safer than FFP3 mask because of these nuances.

Jason Smithson: The differences 0.4% before we go forward.

Dominic O’Hoole…: I think one of the issues is that when FFP3 masks were used in COVID wards with patients who’ve all got COVID-19, there was a recommendation made for various reasons that they shouldn’t be changing those FFP3 masks all the time, they should be wearing them. And part of that, possibly was due to a lack of PPE. But there was a very good reason for it as well insofar as you can’t really infect people who were already infected. But when you come to dentistry, the vast majority of our patients are actually noninfected. There will be a subset of patients who’ve got subclinical or asymptomatic infection, but most of them won’t. And that suggests that after every single patient we need to change the FFP3 mask. And that gives you an issue with regards to the actual practicality of that measure in the longer term.

Dominic O’Hoole…: The other thing with FFP3 masks particularly, is that the tight fitting nature of the mask means that… Studies have shown you actually tend to adjust the mask more often and bring… You actually put your hands onto the mask a lot and they’ve noticed areas of former generation around the handle of the mandible with these masks. And the other thing they’ve noticed for certain people, is that they actually end up with a form of bad sores on the face from wearing these masks. They get surgical sores around where the mask fits. So for various reasons, I think that if you can actually avoid moving down this route towards this really, really uncomfortable type of mask, then we should do so if all possible.

Prav: Just a question that’s not COVID related but related to dentists working in close proximity of the mouth, precovid, influenza, is there any evidence to suggest that the infection rate to dentists without wearing a shield and cracking on is normal and the rate of infection with influenza is actually higher amongst dentists because you’re in and out of people’s mouth all day, every day, some of them are probably coughing, You’ve got these ballistic events, you do an AGP all day long, surely the infection rate amongst dentists with influenza, you’d expect it to be a lot higher, right?

Jason Smithson: Well Andre Haigh actually did the research on COVID with the same model so it’s probably more useful. I think Dom can probably fill you in on that because he has a co-author.

Dominic O’Hoole…: Well I can. With regards to COVID, it’s clear there isn’t an increased infection rate if you use the proxy outcome of a self-diagnosed infection because what we weren’t able to do, was actually use formalised testing. But if we go back to your point Prav, with regard to influenza, there are no studies that suggest an increased infection rate in dentists worldwide for influenza and that can be for many reasons. I think one of them is that our existing crossing function control measures are adequate. For a well recognised respiratory pathogen, they work well. I think the second reason is that there is some argument that we are quite a essentially healthy population base and that we may due to micro exposures to all these different pathogens every hour of our working lives.

Dominic O’Hoole…: We might have actually primed our innate immunity in some way to be actually almost like we’ve got super human… not super human immunity, but we’ve got really well functioning immunity. That in another way, what we do for a living is actually possibly protected us slightly. When you look at studies of dentists, they seem to be healthy individuals who unfortunately we find that they’ve got a lot of orthopaedic problems from being bent over patients looking like prawns. I think there’s something about slight increase in kidney disorders. And there’s also unfortunately very, very sadly, there’s a high rate of suicide in dentist, but there’s absolutely no evidence whatsoever of an increased risk of infective disease, of any type in dentists.

Payman: What do you attribute the fact that… I’m not sure you know better than me, but the fact that ENT surgeons do seem to catch coronavirus now?

Dominic O’Hoole…: I think that’s very interesting and it’s a really important point. I think the first thing to say is that these were very early in the coronavirus pandemic, that there were reports of excess infectivity among ENT surgeons and ophthalmologists as well actually, and these were what we’d call anecdotal reports at that time. So there was no very, very detailed specific study that was double blind and randomised that showed that there was an actually increased risk in those surgical subgroups. Because people have tended to adopt different precautions since that, we don’t really have any further evidence since those early reports. I think the second thing to be aware of, and this is, again, entirely anecdotal, is that we’ve got to ask ourselves, are they always using there PPEs effectively as dentists are? And were they doing that before this crisis? And I wouldn’t like to allude negatively in any way, but I would say that there are some anecdotal reports that they use of masks and eye protection among those groups for routine procedures, where as not as widespread as it is in dentistry.

Payman: I think you’re right. I mean after I spoke to you on this subject, I spoke to an ophthalmologist about it and he said, “Look, we only have two states, totally a septic or dirty and there isn’t a one in between.” And what he said to me was in the consultations and he said it for EMT as well, outside of operations, they never wear a mask. So they’re doing a consult, they’re right close up. He mentioned something about tidal breathing. You were saying as well that the volume you speak at all of these stuff actually affects the amount of virus coming out of you. But it’s a very interesting point because, yeah, we seem to, Because of our history, we have a mask on at all times and in hospitals, Dominic O’Hooley was making a point. If you visit the hospital, you can see this cross infection breaches happening just at every point. It’s very interesting. So now going forward, with all of this evidence you guys are producing this document what else would the document comprise of? Are you looking at other countries? Are you looking at other professions?

Jason Smithson: We’ve looked at other countries fairly comprehensively, but we’ve written a report, which, well, we’re just editing it right now, aren’t we Bertie?

Bertie: Yes.

Jason Smithson: it’s very close actually. Should I say it will be out tomorrow? Is that too much? Maybe Thursday.

Bertie: Thursday for sure.

Jason Smithson: Yeah, we’ll see. But it compares and contrasts what’s going on in other countries with what’s going on in the UK. I’ve just read it this morning for the third time. And what strikes me is the countries that have done well and are currently getting back to work. A good example would be Australia. You would see a very, very coordinated approach and a very organised approach to managing the disease. For example, in Australia the government was advised very strongly by the ADA, the Australian Dental Association, and all of the correct evidence and the pathways back to work, the various levels of getting back to work were all displayed on the ADA website. So that means that the dentists in Australia had the ability to get the correct information from one site rather than running around like headless chickens looking at things on Facebook, which is perhaps not the best way to do things.

Jason Smithson: And that’s very similar in New Zealand. Canada is slightly different, they went state by state, but they also had very coordinated ability through their state websites or through their province websites. And I think I’m correct in saying Denmark was pretty much the same. Is that right Bertie?

Bertie: Yup.

Jason Smithson: Yeah. So yeah, the paper will be out quite soon but it’s quite interesting.

Prav: Just in terms of going back to dentistry based on what you guys have said today, we should be going back when we go back I’ll be able to do AGP from day one. Am I hearing that correctly with the right precautions?

Dominic O’Hoole…: You are from my point of view.

Jason Smithson: Yeah. There are some small differences we’ll have to make, but I’m not seeing a vast difference in dental practise. Maybe for some people, but not a vast difference in past good practise. Let’s say that.

Dominic O’Hoole…: The other thing to say there I think is really important is that the absolute key to this is very effective patient pre-screening. And I think that’s going to tie in with an enhanced and improved testing policy UK-wide. I think understanding the parameters of what level of asymptomatic people we’ve got in the population and what level of people have the infection and what their immunity is. And whether we go forward with formalised immunity, passports and that kind of thing. I think it’s dependent on further scientific knowledge on the levels and the efficacy of immunity anyway. And also there’s some other aspects with regard to personal freedoms and things like that. But for me, I think patient pre-screening is an absolute key. And then looking at patient throughput into and out of the practise.

Dominic O’Hoole…: And I think we can make subtle modifications to that to avoid our waiting rooms being full of patients sitting two foot away from each other, chatting into each other’s faces and potentially things such as perhaps putting screens, partial screens between reception and other areas, and looking at trying to avoid contact transactions. So therefore, using money free and contactless payments as much as possible to try and limit the amount of surface contact that we’re having with things such as cash machines and card readers, and pens and things like that. So there’s a lot of things we can do to adopt that best practise. Well, the bottom line from my point of view, and this is my opinion, is that there is nothing where we can not think about, as a profession, that should stop us going back to a full range of dental procedures when we go back.

Prav: Who decides how we go back in what capacity when we can and can’t do AGP? Is that down to the CDO? Is that down to dentists and individual practitioners discretion? Have you guys got the answers to that or do we just simply don’t know?

Jason Smithson: I think Bertie can answer that, I think.

Bertie: Look, we’ve been told by the CDO that she doesn’t speak for private dentistry. The reality is that whatever she says, we are expected to comply with because if you listen to our defence organisations, they’ve made it pretty clear that if we don’t follow CDO guidelines, we need to have a very good reason as to why we haven’t done that. And I think the danger is, this is the only danger, and it’s not to do with dentistry being dangerous, the danger is that if somebody contracts COVID-19 somewhere else, and they’ve been to the dentist, this is what the defence organisations are pointing at and saying, “Oh, it’ll be difficult to defend or it’s going to create a case that wasn’t even there.” Yeah. We know the cases, the cases are not good, but just going back to who’s making the decisions in the end.

Bertie: What this whole thing has highlighted for us is there’s a massive void in representation of all of dentistry at the highest level. So we’ve got a big representation for NHS dentistry which is the CDO. We’ve got the BDA doing its best to represent dentists, but when it comes to the whole profession being represented, especially a strong voice for private dentistry, which has got a massive contribution to primary dental care, we simply don’t have a voice. So the decision is going to be made by others on our behalf, but we are doing our level best to change that. And that’s part of what the BAPD is about. Is to make sure that that change actually happens.

Bertie: I don’t believe that we would be in the situation we’re in now if there was a stronger representation for private dentistry in the first instance. I do think things have gone wrong. It’s not about pointing fingers, but we cannot let this carry on. So we are doing our best to try and have input at the highest levels possible. I think you’ve heard from Dom’s contribution to this conversation today, that there are people out there who are doing well, who are wet finger dentists who are really, really good at looking at the research and applying these things. Yeah. The decision. Yup. Somebody else is probably going to make the decision, but we’re doing our best to influence that decision now.

Payman: It’s high time, we had a BAPD even without coronavirus. But it’s accelerated it now. And that’s a good thing in a way for private dentistry. But how did you guys achieve so quickly? With regards to parliament, all those MPS signing the letters? What did you do differently?

Jason Smithson: I think it was way to numbers. I think everybody in the group, and by the group, I don’t mean the committee, I mean the whole group, the whole 8,000 members, PUT their shoulder to the wheel, they signed all the petitions. We released, I don’t know how many petitions, perhaps six. They all signed those. They, hopefully all wrote to their MPS. I can’t remember how many DMs I used to get up to in the morning saying, often a hundred, “I’ve written to my MP.” And all that pressure.

Jason Smithson: It was not us as a committee that did this, it was us as a committee that facilitated it, yes. But it was pure way of numbers of members. And I don’t think that’s been done before. Not only was it members who were dentists, it was members who were dental technicians, dental hygienists, therapists, nurses, practise managers, and even patients. That’s what made the difference, I think.

Dominic O’Hoole…: And just to say if we… The fact that it happened so quickly, the fact that within a couple of weeks of starting with over 6,000 members and it just showed you that that massive appetite was there among this big population of private dental professionals that they wanted this voice, they wanted this conduit to be able to speak to people who actually make the decisions. And just briefly going back to that, if we talk about the CDO in England for example, we’ve got to remember, she’s actually been seconded as a deputy commander for PPE procurement. So she’s actually been taken almost out of her role in some ways. There’s a lot of the day-to-day running is done by her deputy. And then we’re starting to hear now that despite initial perceptions, that it wasn’t input from SAGE, which is the government committee that was shrouded in secrecy for a while.

Dominic O’Hoole…: It’s now clear that they do actually facilitate dental specific guidance through the department of health, through NHS in England, to the office of the CDO. And one of my specific concerns here is that there appears to be no dental specific representation on SAGE or its subcommittees whatsoever. Now I can’t be 100% clear about that because despite them yesterday releasing all the member lists, there were certain members decided to remain anonymous. So we haven’t got all the members and then there’s a potential, some theoretical chance that the ones who remained anonymous were dentists or dental professors, or the rest of it. But it seems unlikely to me, and I think that that’s at the heart of this whole thing is that we need somebody, we need people who know about the day-to-day running of dentistry to be providing the centralised advice that we can then get and input into to allow us to go back to doing what we do best. It’s as simple as that.

Payman: Yeah. In some countries, dentists are considered key workers. Over here we… if you look at the Irish exit plan, it looks like… To me it would look like, with the current situation here, we would be coming out at the same time as hairdressers and phase four or phase five tattoo artists. How do we change the agenda over here to make them just like key workers? Why would you… Jason, you travel the world, as far as the respect for dentistry, do you see us as the poor cousin in that sense?

Jason Smithson: To be honest, I don’t have an answer for that. The reality is, in many countries dentistry is seen as a branch of medicine, which is an in a sense essential service. It was not so many years ago in Italy you had to train for medicine and then did dentistry as a sub specialty. And certainly in the UK, Royal College level, for example, dentistry’s still part of the Royal College of Surgeons, et cetera, et cetera. So I really, really can’t give you an answer as to why we are considered separately, and no detriment to hairdressers or anything like that. But we are a subspecialty of medicine and we should be considered so. As to why we’re not, I don’t know,

Payman: But what do we do from the sort of agenda perspective to try and put us up in this… I think in these sort of times, it’s actually a good opportunity to affect that. So is there something we can do now?

Jason Smithson: As a group or our association?

Payman: Well, as a profession. My inkling of it is it’ll take a problem like someone has to die of tooth ache… Something-

Jason Smithson: Well, somebody nearly did, didn’t they? In Exeter quite early on. Somebody was in intensive care in Exter after a dental infection so somebody nearly did. I honestly can’t answer that question. Bertie, do you have any thoughts?

Bertie: I’ll be very honest. For me, that was one of the most shocking things when I came over. Because I graduated in South Africa and worked there for a while, and the level at which dentists are treated as part of the healthcare team was a bit of a shock. Because we were almost at the same level as the milkman, the dentist man, the whatever. It was just so… I sort of looked at it and I thought, “Well, if you treat people at that level and then you hold them to such high standards such as the GDC holds us to, there’s a massive disparity in what’s going on here.” I don’t know how we’re going to solve this. You hear the CDO saying things like, “We’re putting dentistry back in the mother.” I think she meant the mouth back in the body. Yeah. How do we go about it? I actually don’t have an answer. It’s a bit of a situation we’re in actually.

Payman: Sometimes you see journalists hassling politicians during that afternoon briefing thing. One side of you says, “Yeah, you should hold them to account.” Because there’s been a lot of lack of transparency, some incompetence of course. It’s a new situation, it’s a difficult situation. And so should we just be leaving people to it or should we be holding their feet to the fire? And my feeling on it is just like, coronavirus was a great time to accelerate the BAPD, coronavirus is a great time to examine the GDC’s role, examine this problem that we’re talking about right now. And it shouldn’t even be a question of elevating or reducing. But my feeling on it is dentists should be allowed to go back to work. Those who don’t want to don’t have to.

Jason Smithson: I think we’re picking up traction in the media as well certainly Yu Chana gave a very good interview on Sky News this morning. Some of you may have seen that. And the message was very, very different. And I thought it was a very respectful interview and very constructive.

Bertie: Yeah. She’s very good actually. Yeah. And the interview was very good as well.

Dominic O’Hoole…: I think it is a golden opportunity in this awful crisis. It’s a golden opportunity for dentists to come together like never before. I think that many of us share the perception that we have a very heavy touch regulator. And I think that we want to reconfigure regulation so that it’s got the right touch. And I think that happens as part of this overall process of rebirth of dentistry in the UK. And I think that the regulators should be thinking, “We are being looked at now.” That’s a perfectly reasonable thing for us to do because I think that the first contacts we had from the GDC after this COVID crisis started, was a little missive telling us that they were… Just not to worry about them because they were all working from home.

Dominic O’Hoole…: And from my point of view, partially set the precedent that, “I’m sorry, you’re not really speaking for the profession.” And that could very well say, “Well yes, but why the regulators and why not really.” You know but, no, it doesn’t work like that. I think one of the things I’ll be looking for is a GDC that’s by dentists for dentists. So that wet finger dentists are integral and central to the regulatory process for dentists in the U.K. And I’ll leave it at that.

Jason Smithson: I think I would add to that for the dental profession, not just for dentists but everybody within the dental profession, because I think everybody’s in the same boat. There are enough or more dental nurses with issues. Were you? I didn’t notice

Bertie: I’m proud of your Dom, I like the way you put that.

Dominic O’Hoole…: Thank you.

Bertie: Especially that… And I agree with you about the first missive we received from the GDC, it was all about them. It had nothing to do with the profession, with protecting patients, with looking after the people that regulate it was, “We’re working safely from home.” It may not have been what they intended, but that’s certainly what came across to us.

Dominic O’Hoole…: Absolutely.

Prav: Just going back to the media. And stuff that’s been out to the media the various dentists have been interviewed. Some have said things that are so negative about the profession and alluded to the fact that it’s a little bit dangerous to step into a dental practise. Now they are going to be dentists who are probably watching this who may get invited to speak to the media and I’ve never sat up in front of the media, had a camera in my face and all the pressure of that and within 30 seconds had to say anything you can slip up. Now I guess what I’m asking you guys is if somebody does get invited to speak to the press about COVID and dentistry, what sort of message should they be putting out there? And what tone of voice should they be speaking? And if you were to advise them or brief them five minutes before they goon in front of the camera.

Jason Smithson: My first message would be if you’re not confident to speak in front of the media and give the message that you’ve clearly thought out in your own head some hours before or even some days before and prepared carefully because this is an important issue, then perhaps you shouldn’t be speaking to the media and perhaps you should contact somebody who is confident to speak to the media. That will be my first message because it can be very alarming for dentists and patients. Bertie.

Bertie: Yeah, I agree. I think you’ve got to be prepared and Prav you’re right, the pressure is probably… It’s unbelievable. Again, you might prepare in your mind exactly what you want to say, and even they might even give you the questions ahead of time, but sometimes they’ll phrase something slightly differently which can throw you. But Jason is right, you need to prepare yourself. You need to be really well prepared. And don’t wait until you maybe get a call to do something or say something. Prepare yourself well ahead of time as to what you would say. You’re watching other people saying things and you may be thinking, “Oh shouldn’t have said that.” How would you have responded in that situation? So take great, great care and sometimes as much as we all would like our little 15 seconds of fame, if the right thing to do, might be to pass it onto someone who’s going to do a really good job with it.

Prav: I think that’s probably the best advice, because I think especially a lot of dentists feel a little bit… Get this celebrity type persona on them and think, “Wow, I’ve been invited by the press, this is my 15 seconds of fame” or whatever it is. Get a bit star struck and whatnot. And I think that’s right, Is that if you’re not confident at doing it, especially during these times, probably the best advice is don’t do it, pass it on.

Jason Smithson: It could. It could even be something as basic as a patient calling you for some advice. It doesn’t even have to be the media, but you have to give the correct evidence-base message and not spread alarm. That’s the important thing.

Payman: One thing I would say guys is that a week ago, the evidence-based… Now Dominic has found, wasn’t there and

Dominic O’Hoole…: I just like to say that I think that… Just alluding to what both Bertie and Jason said, I think that it’s very easy to go rogue when you’re in front of the camera. Very easy for the rabbits in the headlights. You’re brain disconnects from your mouth and you basically say somethings that you’d never possibly say if you’d actually had the opportunity to reflect beforehand, and you say things that are inappropriate. And I feel great empathy with individuals where that has happened, I really do. What I would say though is that I think sometimes it’s important, with hindsight, that you’re then able to put your hand up and apologise in a very, very non-ambiguous way. When you see that you have actually created a damaging perception within the profession and within patients. And I think that that’s something that I would have liked to have seen in certain cases that I’m thinking about at the moment.

Payman: Going forward guys, what are the silver linings of the situation? We were discussing more use of rubber dam for instance.

Bertie: I think it’s brilliant. I think we where patients that had a resistance to rubber dam in the past. It’s always easier when you say, “Well, the guidelines say that this is what we should be doing.” And I think it takes away the excuse from a lot of dentists as well that the patients don’t like that kind of thing. So we know that that’s one of the things we’ve recommended. I think our defence organisations would love it if we used rubber dam on most of our procedures where we are actually doing treatment. And this is an opportunity for us to introduce this into our practises and just start using it as a normal part of what we do.

Payman: Jason, do you agree?

Dominic O’Hoole…: I would agree with that.

Jason Smithson: I’d agree entirely with that, Dom.

Dominic O’Hoole…: I was just going to say that the innovation that we’re seeing as well. So for example, something as simple as being able to innovate and get a really effective facial that works well with prismatic loops, how fantastic is that? We went from a situation where people were trying to lodge the old face shield in front of the loops with it sticking out of four or five degree angle and providing no benefit for anybody. So a situation now where you can get certain brands of face shield, I mean Oregon’s a good example where it’s incredibly comfortable to wear and yet you can weigh your 4.5 mark loops and forget that you’ve got the face shield on, how fantastic is that?

Dominic O’Hoole…: This crisis has brought the best of British engineer and excellence into play. And as a profession we’re really designing things that are fantastic. We can see that with 3D printing as well. The 3D printing technology that’s allowed wider bar aspirators attachments that can go on our existing aspirate attempts thing that just people think laterally and we come together and we do something that works super well. And it’s this rapid prototyping thing. We’ve got a crisis so we’re not going to mess about, let’s get it done.

Jason Smithson: It’s very British.

Bertie: I think if we look at it… I’m part of a group called the IDDA International Digital Dental Association or Academy rather. And when you look at the reaction that these guys have had on an international cooperation that’s actually gone on between dentists to try to find solutions, innovative solutions to a number of things. And you think, “Wow, if we were this quick with so many other things, how much more can we actually achieve?” And I think it has been really great in pulling people together. So that’s another silver lining on what’s happened with this.

Payman: Prav, what do you say?

Prav: For me, I think it’s been the digital communication between dentists and patients and we’ve broken down lots of barriers. So I’ve noticed now in my practise as we started doing live video triaged consultations and then we’re having conversations with our teams where we say, “Hold on a minute we’d usually get this patient here to have a chat about their treatment plan, we could just do it over a video at their convenience in an evening or whatever.” So I think the thing about doing this sort of stuff, a lot of people find talking to a camera uncomfortable. But I think Zoom and stuff like that has just broken those barriers down with the kids doing fitness classes over Zoom, talking to their families, communicating with their grandparents. So now suggesting to a patient, “Well, let’s do a video consultation or a video call and save an appointment,” I think those barriers have been broken down and I think that’s a big silver lining that’s come out with this.

Payman: I think Jason, you’ve had some successful webinars going on. Do we perceive now that the dental population is going to come in more educated than before?

Jason Smithson: Well, it’s encouraging to see that people have spent their spare time, firstly doing dental education, which is great and, but also maybe connecting with their families, doing a bit more exercise and maybe sitting back and, myself included in this, and looking at actually what you were doing with your life precovid. Perhaps it wasn’t quite the right direction, certainly for me it wasn’t. And there is-

Payman: Finding a more balanced perspective

Jason Smithson: Absolutely. I was looking at, I’ve spent so much more time with my… I’ve spent all my time with my family, which has been amazing. And how we can work forward in the future to maybe do that. Obviously I won’t be able to spend 24/7 with my family, but more time with my family. How I could take more exercise. And I’m sure everybody else is in much the same boat, not only dental education, but all facets of your life really.

Prav: Jason do you think online education is here to stay? Would that be part of your ongoing curriculum considering]-

Jason Smithson: It certainly is for us. Yeah. I think the convenience for dentists of… Well let’s say this, the normal format for most whatever educational programming in whatever sphere is, you sit and listen to a lecture and then sometimes you do a bit of hands on. I think I would hate to see conferences go, to be honest, because I think that has a huge social aspect. It’s not only the conference and the learning, it’s the lunch and it’s the party afterwards. And even if there’s not a party, there’s going for a beer or whatever with the people afterwards, and it’s social interaction. I’d hate to think we were all sat in our little boxes looking at our screens. That would just be weird.

Jason Smithson: But I think you can certainly dynamize your education business by perhaps doing quite a bit of it online and then either the hands on courses are shorter which impacts overheads and makes it cheaper for people or you do more hands on in the same amount of time rather than doing the education, so I think there’s quite a lot to be said for that. So yeah, that’s kind of where we are. But yeah, I’d still like to see a big congresses going. I think it’s very social.

Payman: I’m going to ask the three guests, what’s your estimate of when are you going to get back into your surgery date? When are you going-

Jason Smithson: 9:00 AM at…

Payman: When’s going to do hands on course and when’s the next time we’re going to be able to hug each other again?

Jason Smithson: Oh, I’m not sure I want to hug you at all, Payman.

Payman: Dom, go ahead. What do you think?

Dominic O’Hoole…: Well I think that I’d like to think that by June we’ll have a phaser turn into general practise.

Payman: 1st of June?

Bertie: I agree with them. I think I’d really like to see us by beginning of June that we are… Actually, I’m of the opinion that by the middle of next week we should be able to start seeing emergency patients-

Payman: When will we is the question.

Bertie: Pardon?

Payman: When will we not, when should we?

Bertie: June. Definitely. That’s me. Yeah.

Jason Smithson: Because the cogs are very big and turn very slowly. That’s the problem.

Payman: Are you saying 1st of June as well, Jason?

Jason Smithson: Is 1st of June a Monday? If it were a Sunday, I would say no. I haven’t got a calendar at hand. So I would say early June. I would hope

Payman: How long before we can do hands on courses?

Jason Smithson: Well I have a council call scheduled for mid June and I have up to now no intention of cancelling it because my feeling is if the government stance is if hotels are opening and the course is being run in a hotel, why would you not do a hands on if somebody is sitting in a restaurant, why would you not do hands on it with correct social distancing?

Bertie: And with people who know what to do.

Jason Smithson: Yeah, exactly.

Payman: Providing PPE masks at the hands on.

Jason Smithson: No. But we will be providing rubber dam.

Payman: So do we have to wait for a vaccine before we can hug again?

Dominic O’Hoole…: No, I don’t think so. I think that that’s a false premise. I think that it depends a little bit on the testing with regards to the massive subset of the population who may have had asymptomatic infection. So studies are very variable on this at the moment. Anything from between 15% and 80% of the study cohort had had an asymptomatic infection. So I wouldn’t like to predict what the actual answer to that is, but there seems to be a consensus developing that it can be an excessive 50% so you can tap find that you’ve got many, many factors of times higher number of people in the population that had this infection than the ones that are reported. I think that creates a background kind of hard immunity situation. I think the second thing is, we have to be a little bit more logical and a little bit more calm about what kind of immunity we’re going to get.

Dominic O’Hoole…: Even if we find that the immunity does weigh in after a year or so, that doesn’t mean that we’re going to get a second COVID-19 infection with the same level of morbidity that we got the first time. A lot of scientific evidence suggests now that even if we did have that situation, that the second time we get the infection it’d be very, very different, sub-clinical almost. And so, I think we’ve got to inject a little bit of optimism into the situation at the moment. I’m very optimistic about it. I think as a civilization, as the human race, we are incredibly resilient people and I think that we will, we will achieve an outcome. There is some of the darkest moments we’ve seen in recent weeks we could never have imagined. But I’m very optimistic.

Payman: I think after the 1914 to ’18 war, then the pandemic in ’18 to ’20 was it, and then the roaring 20s after that. So back then without any of the stuff that we’ve got and then the great depression after that. So yeah, I think there is cause for optimism. Hopefully our businesses can survive this. I want to thank you guys. I think on Friday we’re having a panel of one dentist from each country to see what each of the other countries are like and what those dentists are going to actually say in practise about what their life is like, what the government’s doing, and bearing in mind the different positions of the virus and there’s different times. But I really want to publicly thank you guys for giving so much to the profession.

Prav: Thank you guys, so much.

Payman: All right guys. Thank you so, so much.

Prav: Thank you guys. Thanks a lot.

Outro Voice: 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.

Prav: Are we all done?

Jason Smithson: It seems so. That went quite well actually. Are you’re happy?

Dominic O’Hoole…: Bloody hell

Jason Smithson: Go on, Dom. Go on.

Bertie: You know you want to.

Jason Smithson: Not one bleep, amazing.

Dominic O’Hoole…: The bloody fagots were chewing me balls all the way

Payman: I’ll stick that in the outtakes, Dom. We’re still recording mate.

Dominic O’Hoole…: Don’t mind I’ve got no shame.

Prav: So Pay, tell me how has lockdown been for you, Enlighten at home, things like that? Well, obviously we went through the mass panic, the hysteria, not knowing what to do and how things would settle down. Just talk me through the stages that you’ve been up to now, and obviously we’re going to be moving on to the interview where hopefully we’re going to get some of the answers of maybe what we should be doing and what the new normal will be in dentistry, buddy.

Payman: So look, for me, the first couple of weeks were kind of rabbit in headlights is the way I would describe it. So I didn’t know what to do and think. And at the same time I quite enjoyed being at home with the family. I’m enjoying being home with family right now, to tell you the truth. I think my life and your life are a bit different to most dentists lives. They have to be there at 9:00 AM. I know you get up at 4:00 AM anyway, but I was feeling guilty, Prav. I was feeling guilty that I didn’t have solutions to the problems that we were having. And it started off with the team at Enlighten. We met together and said, “Look, sales are going to go to zero.” I think we kind of anticipated that a week or 10 days before the actual lockdown was actually put in place and the team were already working from home before lockdown started, but how are we going to fund it all? The furlough scheme came in place, helped us a little bit.

Payman: Currently we’ve got four people not furloughed, four people sort of running the life support of the business, and we’re considering how to unfurlough people a week at a time going forward. But what’s made me feel a lot better now is I’m kind of being kinder to myself and not feeling guilty on this subject. And as soon as I started feeling that way, I started to find some solutions. And I think for us, as a company where all of our customers are dentists, of course a lot of our customers are patients as well, but actually it’s a B2B2C business, it’s become clear that the health of the dental practise as a business is number one, and only when the dental practise is a viable business will they even consider cosmetic treatments.

Payman: And so we’re planning now how do we help our users, our regional centres get out of lockdown in a sort of obviously safe way, and that’s something we’re going to be discussing later, but in a way that the business is viable. And after that I think we’re going to see another month lag between practises actually opening and practises actually thinking about looking at our products. Although I think, lucky for us, bleaching is non-AGP, and my thesis on it in the end is that non-AGP treatments like bleaching, aligners, facial aesthetics are actually going to be the things that save practises from a financial standpoint. What about you, bud? You’ve partnered in what, six dental practises?

Prav: Yeah. But before we talk about the practises, bud, what you just said there, I remember speaking to you when you’d just come out of … and you had the conversation with your team, and you’d said to them, “Look, this is what’s going to happen.” And they all turned around to you and said, “Thank you,” right. And it was pre-furlough. You said to me you were going to reduce their wages, right?

Payman: Yeah.

Prav: And a lot of their friends and colleagues had been fired, laid off, whatever, right. And I remember you building up to that conversation. You were saying it’s such an emotional time. And for me, mate, it was the day that Boris Johnson made that statement, okay. I remember Bob, my copywriter, senior copywriter, knocks on my door and he goes, “Prav, there’s just been a statement. They recommend we work from home.” So I called everyone over and I said, “Listen guys, this is what we are going to do. Pack your computers up. Today’s our last day here. And we may not come back for three months, four months, six months, whatever it is, but I guarantee you, whatever happens from this point onwards, you will not need to worry about your salaries.” And for them, it was huge, right. For them, it was enormous. And for me, okay, it’s remortgage my house, take some cash out of the business, and they’re the team who got us where we were today, and they’re the team that’s going to help us grow in the future, right. So I felt I owed it to them.

Prav: In a similar way, Enlighten is a family. Every time I visit your office, it’s a family. It’s not a corporate business. You know what I mean? It’s a fun place to be and everyone feels like they’re at home. And so that’s what happened in the agency. And then look, moving forward to the practise, a week or two later, we’re having these conversations and then doing cashflow forecasts. Who do we furlough? Who do we keep on for normal tasks? And then having that conversation. I was trying to get through my head that people who have been furloughed, sit at home, do nothing, get paid 80%. People who are not being furloughed, getting paid 100% but working their socks off, yeah. I had to get my head around that. [crosstalk 00:05:44]. It’s hard to compete with that, right. But at the same time you’ve got to be grateful and thankful that we have government support. Yeah. I mean we can all sit here and pick holes in it.

Prav: So there was all the shock, the rabbit in the headlights, the massive loss of income, yeah. And then everything settles, three or four days pass, and I say to myself, “This is actually pretty good.” Falling in love with my family again, spending times with my girls. My youngest has a nap at one o’clock. I’ll go to her bedroom at two o’clock and she’s drenched in sweat, yeah. She’s been sleeping. And she wraps her arms around me and falls asleep again on my shoulder. Never experienced that before, ever. And if it wasn’t for COVID, I wouldn’t have done. So there’s so many little micro moments like that that I am grateful for and thankful for. And for me, got myself into a routine. I don’t wake up at 4:00 anymore. Wake up at 6:00. It’s a respectable time, yeah. Get in the gym. I’ve got dedicated time with my family. I’m in the office. We’re busier than ever, and the team are collaborating together.

Prav: At the same time, on the practise side of the business, there’s lots of battles and things that we’re struggling with, and some of them is when we go back, how we will go back, in what capacity we will go back. What about all those patients who’ve paid for half of their treatments and need finishing off with AGP? Yeah. And we’re booking patients in now for say mid May, and now ringing them up and moving them on until June, and we may need to move them on until July. And there’s that whole admin process, and those systems, and process, and protocols, and at the same time we’re still carrying on with marketing, so we’re putting content out there. It’s more education. It’s less offer based. It’s more about connecting video consultations, and just making sure that people out there who want our services tomorrow, I want to develop rapport with them today. I want to make a connection with them today, yeah. I don’t want to sell to them.

Payman: Yeah. In marketing speak it would be work on brand now. It’d be marketing rather than sales now.

Prav: And it’s not a traditional advert. It’s not, “Roll up. Roll up. Get your £1,000 off this in free whitening, this, that, and the other.” The message is more along the lines of, “Hey guys, as dental professionals, we’re locked in our homes. Unfortunately we’re not in a position to see you face to face. And you’re spending more time at home as well. Let’s connect. Have a video call. We think it’s a good idea. Why don’t we just … Why don’t we just allow you to learn about how we work, what we do and how we can help? And then in the future you might want to come in for a full mouth checkup.” The message is that simple, okay. And what’s really surprising is that there are lots of patients who are unaware that dental practises are closed. They’re definitely not scared of walking into a dental practise, and they want to rock and roll with treatment straight away. Even though we know we can’t fulfil that.

Payman: The thing is, dude, your practises are so content heavy that if I am a member of the public doing some research into implants, aligners, whitening, whatever it is, your practises seem to come up. And of course that’s because of all the marketing bits you’ve put in place before. So what I think is your practises are funnelling in the demand for that, and that’s why they’re such successful practises. But going forward, as doors open, as the unlock happens, will lots of patients, the majority of patients feel comfortable coming in? And the conversations I’m having with non-dentists is, “How do you feel about going to the dentist?” And without fail, most of them say they’d be nervous about going to the dentist. When I ask them why they don’t mention AGP. It’s not on their radar.

Prav: They don’t know what it is.

Payman: Yeah. Although, a couple of TV appearances later, they might be, but what they’re saying is just close proximity to another human. Because with social distancing, we’re getting used to just crossing the road when someone’s walking this way and so on.

Prav: Do you know where the first time social distancing impacted me?

Payman: No.

Prav: Very first time it hit home for me what it was. I walked into your office.

Payman: Oh, that time.

Prav: Held my arms out, yeah. Because you’re a hugger, right. Okay. We normally give each other a big hug, yeah. And I held out, and you looked at me like, “No.” I was like, “For real?” And you were like, “Prav, I don’t think you realise how serious is this, buddy.”

Payman: I had relations come in from Iran, and obviously Iran was ahead of the curve because of the disease, and over there they were doing the elbow and the foot things. So that’s why. I’d seen them.

Prav: So that happened. The morning after I went to have coffee with my buddy Danny Watson, yeah. And so we had coffee in Starbucks the morning after, in Manchester. And I looked at him, he looked at me and goes, “Are we going to hug or what?” He said, “Yeah, fuck it,” yeah. And we gave a hug, right. And that was it. And at that time, I don’t think it had sunk in how serious everything was in the whole social distancing thing, right. But very rapidly it did scale up. So with patients now, with what’s in the press, with the governmental recommendations, I think you’re probably right, the general public confidence of stepping in anywhere where it’s not a utter necessity, for example a supermarket or something like that, is going to be-

Payman: Yeah, I think that’s one of the main challenges for the profession as a whole, because I was on a BDIA call and they were saying in Holland dental practises are now seen as vectors of disease. People feel like you go to dentists if you have to, but actually you wouldn’t go at all because that’s where you catch COVID. And we’ve got to avoid that scenario in the UK, otherwise we’ll get put back another few months. But the problem we’ve got is there seems to be a vacuum of advice, a vacuum of regulations. We don’t even know where to look. I mean, is it The Chief Dental Officer? Is it the GDC?

Prav: Definitely not Facebook, mate.

Payman: Exactly. Is it CQC? Is it looking at other countries? We’ve spoken, both of us, to colleagues in Germany and Sweden, where Germany is doing so well on the Coronavirus and the dentists never closed. And in fact in some of these countries they don’t even see the electric handpiece, electric motor handpiece as a aerosol generating procedure. And so I think we thought the best thing to do was to get some experts on, and see from their position where we are, and try and unpack. Okay, it’s a new virus. It’s a new situation. It’s a once in a hundred year situation. So we’re not expecting all the answers right now. But when the answers come, where are they going to come from? Will it be CDO, GDC, or CQC? And what will they rely on? Will they rely on evidence? Will they rely on scare mongering? What will they rely on? Will they look at the far East where they’ve had SARS and MERS before? And that’s really the question for me. Who are we waiting for? Is it regulatory or is it advisory?

Prav: And speaking to a lot of dentists now, and key concerns in my own practises as well is it all revolves around this huge amount of uncertainty. A lot of scaremongering, a lot of, I feel personally, unnecessary panic buying, right. Masks in volumes, yeah. Air filtration technology. Fogging machines. Extra oral suction machines, yeah.

Payman: I think they’re a good idea, but, but keep going.

Prav: But whether it’s a good idea or not, we’ve got no guidance at the moment, right. So average practise goes out, blows 10 grand on all this stuff. Guidance comes out and goes, “Listen, just stick a visor on, make sure you follow these cleaning protocols, and you’re good to go.” So then what happens? Does that end up becoming a USP in a private practise? “Hey, I’ve got an air filtration system.”

Payman: I think that would be a shame if that happens, in my opinion. I saw a webinar with Miguel Stanley, and he said patients are going to seek out safe dentists, but I think it would be a shame if the communications message was, “Look at our practise, we’re safe,” because I don’t think overall that’ll work. That itself will go in the heads of the patient as practises are unsafe.

Prav: Unsafe. You’re not going to win that war, right.

Payman: Yeah. For me. I think that’s the case. I can’t be sure exactly how it will pan out, but the best thing for me would be if there was some basic guidelines that everyone had to stick to that work-

Prav: They’re discretionary extras.

Payman: Exactly. Nice to haves. But then I don’t think it’s wise to market my practise is safer than the practise down the road because I think that makes you look unsafe by itself. [crosstalk] were Dominic’s, I thought. Dominic’s piece that he wrote about aerosol, Dominic O’Hooley, and Tony Kilcoyne wrote a lovely piece 10 years ago. I don’t know if you read that. Did you read that?

Prav: I haven’t read that.

Payman: 10 years ago he wrote a piece about, “Look, why do we only clean the surgery? Why don’t we clean the waiting room? Why don’t we clean doorhandles? Why are there toys everywhere with cross infection on those?” Some simple basics.

Prav: Yeah. I read Dominic’s, and it really sort of got me thinking.

Payman: He does. Brilliant writer.

Prav: Because do you know what? When you consider all the hysteria on Facebook, the panic buying, the what ifs, the buts, the SOPs, all this, right. And then you look at the science, and I’m a scientist at heart. So you look at the science, you look at the evidence, and I reached out to Dominic and actually said thank you because I think he’s done something really good for the community in spending the time. He’s definitely got something up here, and the energy to be able to dig into this research and then put it down in a way that’s very easy for all of us to digest, right.

Payman: Well, one word of caution, Prav, though. It’s been banded about quite a lot, there is no evidence to suggest, yeah. Under normal circumstances that would mean something, but in this situation, I think we do need to be aware that it’s so new that there isn’t much research, and just because there is no evidence doesn’t necessarily mean it’s not true yet.

Prav: I get that. And no evidence doesn’t mean that hey, we’re totally safe, right. But if I’m looking at things from a very, very simplistic perspective, right, and scientific, but not super scientific, right. And say right, okay. There’s some water firing down these lines and it’s got hypochlorous in it. And it hits the mouth, and then some of it bounces back out, and 99% of it goes down a massive vacuum cleaner, and 1% of it comes out as an aerosol. And it’s incredibly dilute, yeah. I think everything that we do involves taking a risk, mate. Walking out your front door, getting on a bike, jumping in your car. And I think we need some guidance on what that risk versus benefit things should be, okay. Because there becomes a point where you’ve got diminishing returns, yeah.

Prav: You can add on layers and layers and layers and layers of protection, and then the decontam room, the fogging, the this, the that, 20 minutes between, 30 minutes I’ve heard, between patients. What’s the implications on patients actually getting healthy mouths again? What’s the financial impact on the businesses? Let’s not skirt around the financial issues, right. We can always say, “Oh yeah, dentists agreed,” and all the rest of it, but we’ve got businesses to run, okay.

Payman: Yeah, I mean it sounds like 30% are in trouble.

Prav: We’ve got jobs to maintain, okay. And people’s livelihoods, and putting food on the table for our team members, yeah. And so we do have to look at the commercial side of things. All this extra PPE, laser protection, I think it adds time, it adds expense. Who’s going to pay for this? Is it going to be the government? Are we going to do it? Are the associates going to pay for it? Are the principals going to pay for it? This has got to come from somewhere, right. I really, really hope that the three guys who we’ve got on today have the answers to the key questions, which are who’s going to make that decision for us? What does comeback mean? Yeah. In what capacity? And when will it all end? Are we going to be in a position where this is the new normal, or is it a new temporary normal and then we go back to normal?

Payman: Yeah. I think [inaudible] the latter, I think the latter. We won’t know for sure. It’s going to be phased. The guys we’ve got on, they’ve got years of experience, both in the research side and what I would term as the corridors of power. Maybe they’ll shed light on it. We’ve got to be aware though, dude, it’s once every hundred years. So no-one’s been in this particular situation before. We did have SARS, we did have MERS, we did have HIV. So I’m looking forward to it.

Prav: Absolutely. Let me ask you one final question, mate. Obviously your wife’s a dentist. How does she feel about going back to work?

Payman: My wife’s a at risk dentist, so it’s a layered thing, but she’s quite relaxed about it, strangely enough. Quite relaxed about it. I think she’s thinking … She works at Bupa. I think she’s thinking that Bupa will take care of it. But-

Payman: … but we’ll take care of it, but it’s one of those things. Your brother’s a dentist.

Prav: Yeah.

Payman: Your brother’s a dentist. So, this affects everyone. The thing about it is even if you are not a dentist, even if you’re not in contact with people, you’ve got a grandparent and on the global perspective, if any good comes out of this, there might be some feeling of whatever’s happening in a rich country, we’ve got to look up for the poor countries too because infected people will be infected people. For me, if we’re really zooming out, it’s a disgrace that there’s bio weapons labs, what’s that about? Is it ever going to make sense to attack another country with a germ warfare? If it does make sense that’s not a future I want to be part of that would be great. Just like some of the other silver linings, that the environment is cleaning up.

Prav: Amazing, yeah. Yeah.

Payman: I think tele dentistry, virtual …

Prav: Consultations.

Payman: Virtual consultations should be something that continued forever because why not? Why shouldn’t someone triage that patient before they come in and you book them a 40 minute appointment, really it should have been 10 minutes or whatever it is. For me, and I want to put this to the guests as well, the NHS, the way it was, 40 patients a day, is it possible to clean up between 40 patients a day properly? And then is it possible to treat those patients with work that’s going to last and isn’t going to come back and haunt the NHS again? For me it would be nice if, if that volume dentistry again, Miguel talks about slow dentistry, but we’ve all known about it. If anyone’s ever been exposed to NHS dentistry, they know about it. It would be good if after this there’d be some sort of impetus to improve the NHS, put more money in, or call it a core service and people save up for their teeth. Yeah, that’s the one thing I’m going to ask them.

Prav: Cool. Let’s get the boys on.

Payman: Let’s get it on.

Intro Voice: 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.

Payman: Welcome guys to the first of the Dental Leader’s Bulletin. This little meeting that we’ve organised today is to look at the situation that we’re in right now and to try and put some light on, some of the unknowns that the profession is going through right now. I mean obviously with the new virus, it’s difficult to get the full story, but we’ve got a panel of experts with us. We’ll start with Professor Nairn Wilson, who’s served as the Dean of both Manchester and the Kings Dental Schools. He served as the president of the GDC, the BDA, developed visible light curing. We could keep going, but right now prof, you’re actually founding the College of General Dentistry soon to be hopefully the Royal College of General Dentistry.

Nairn Wilson: Absolutely right, and I’m here today as capacity as chair of the college, thank you.

Payman: Perfect. We’ve got Tony Kilcoyne who has served in many roles. He’s served on the GDC twice. He served at the BDA. He’s currently serving at the BDA. He’s been trainer of the FD, he’s the director of training of FDs for over 30 years now and has been an examiner at the Royal College of Surgeons. Although Tony’s speaking independently today as one of us, one of the front line. Nice to have you, Tony.

Anthony Kilcoyn…: Thank you.

Payman: And we’ve got professor Mike Lewis who’s professor of oral medicine at Cardiff, past Dean of Cardiff and has served as the president of the British Society of Oral medicine, president of the British Society of Oral and Dental Research, currently on at Cardiff Dental School. Is that right, Mike?

Mike Lewis: Yeah, yeah. I’m sorry, you broke up a little bit there, but yeah, Cardiff Dental School, professor of oral medicine.

Payman: So I think we want to unpack the situation a little bit and I think the first thing we want to start with is we know that the exit out of lockdown is going to be phased. That’s one thing we know. What should those phases look like and who makes the decisions. Let’s start with what those phases should look like. Should we start with Nairn, Professor Wilson?

Nairn Wilson: Well I think as you’ve indicated, I think it’s got to be phased, I think has got to carry the confidence of the public, the patients we treat. They don’t want a run of … As hospitals and GPS are saying, people frightened to go and speak to them. We’ve got to bring them back and gain their confidence, in the different levels of phase that we move in, we’ve got to be a safe environment for all the members of the dental team within the practises. They’ve got to feel safe coming to work, et cetera. But of course we’ve got to be safe, our colleagues who are in practise have got to be safe for the sake of themselves and their own families and so on. So I think safety, trust and an evidence-based approach to getting back to it, I think is what we’ve got to do.

Nairn Wilson: I think it will be step by step. Clearly we’ll have priorities of extending emergency dental care services so people don’t have to travel big distances to dental care centres, et cetera. Then rolling that out as a system of priorities, maybe kids, elderly people, et cetera, et cetera. That sort of approach very much I think is the sort of thing that we’re going to hear of how the country’s going to get out of lockdown. I think it will mirror that a little bit, but it will be prioritised in my view in moving forward. I don’t know what the other folks think.

Payman: Tony, what do you think?

Anthony Kilcoyn…: It’s interesting isn’t it? Because I think there is two aspects to this. There’s very much the psychological aspect. You want the confidence of the public. Even our teams going back are going to be a little bit unsure and of course then on a individual patient dentist relationship, coupled with we have a mountain of pent up dental need. Bear in mind now, we’re entering the second month of basically loads of people having dental problems not being attended to. The three As approach. I mean come on, it’s a bit desperate isn’t it, really? Because dentistry nine times out of 10 or more, needs an actual direct intervention to improve matters. That is the nature of our job. It’s very hands-on. So we’ve been putting things off with painkillers, advice, antibiotics, but those problems haven’t gone away. There’ll be very few things that will have been fixed by any of that. So there’s actually a tsunami of need.

Anthony Kilcoyn…: So the idea of a phase back fits in nicely with the psychology of it. Let’s dip our toes in the water. Oh great. We didn’t all fall off our perches straight away. Let’s do a bit more expansive scope. Oh great, we all survive that. Then psychologically we can get back to almost normal operative dentistry because let’s face it, without high speeds and ultrasonics and all the rest, we’re not actually doing more than 50% of the routine dentistry and the substitutes for it aren’t that great. It’s a bit like the triple A approach is not a great substitute for dentistry generally. So I think the phases are more psychological than what the science would say because if you put certain risk reduction approaches in place, and I think the history has shown that dentistry is actually a relatively low risk environment.

Anthony Kilcoyn…: If you put certain risk reduction processes in place, I personally don’t see why and the evidence base is just generally weak is our problem, but I personally don’t see why we can’t make those phases go a little bit more rapidly than some of the reports I’ve been hearing generally of, we won’t be back to normal dentistry by the end of the year. I’m sat here thinking, well why not? What’s the evidence for not doing that? But I think there are some psychological barriers to overcome first. We will have to look at how we do risk assessments and how we chase some approaches. Not because dentistry is dangerous, but because psychologically the general population, we’re in unprecedented times. We’ve had a lockdown in society. I don’t remember that happening in my working lifetime of over 35 years.

Anthony Kilcoyn…: So this is being taken seriously. We have to be seen to be taking it seriously. So I think the phase in is more psychological steps than it actually is, well the evidence says that’s all it’s safe to do because I don’t think the evidence says much at all.

Payman: Do you think it’s going to be emergencies only or none GP only?

Anthony Kilcoyn…: People are going to argue about where are the lines drawn. I would argue that you have to look at the risk assessment and probably look at it from three points of view. Your staff, first of all, I mean some of those might already be suffering or having infections, who’s able to work who isn’t, who’s recovered and already relatively immune to the disease. That could change the way we approach how we treat patients. So we have to actually assess, literally risk assess, what are staff are like, what’s our environment like, and what’s the patient attitude like?

Anthony Kilcoyn…: I know some areas you could say, “Yeah we’re doing everything,” and there’d be a queue out the door. You could just say, “We’re seeing emergencies.” There’s still going to be a queue out the door because we have this pent up need that’s there. So I think almost just logistically as well, you’re going to have to look at how about pent up need can best be managed because it will have to be managed, where … It’s a bit like the R number in reverse. We need to get through more than one patient to fix them before another patient gets worse. We need to get two in before one gets worse so that gradually, we start reducing this mountain of built-up dental need. Because for a while we’ve been saying dental disease affects your general health too and if people are walking around with more infections and all those toxins going into their own systems and so on, that’s not good for their general health either. So for society, we’ve had to make this work.

Prav: One of the questions on my mind that I, being a practise owner as well as speaking to a lot of practise owners and the uncertainty about not only when do we go back but Payman, you mentioned this phased approach and let’s just stick to say phase one. What does that look like? Because some practises are putting together SOPs that involve fogging the surgery, cleaning it down, 20 minutes decontamination, patient waiting in the car park, et cetera, et cetera, and there’s a complete lack of guidance or certainty in terms of what’s the right thing to do, a lot of confusion people putting together these SOPs and as a practise owner, part of me’s thinking, how are you going to get through the NHS waiting list if you’re mopping down for 20 minutes in between patients? Who’s going to be the person who actually decides this is the protocol? Or is that going to be at our discretion as practise owners or is there going to be a minimum guideline set? What is that? Who will decide? Will it be different for NHS or private?

Prav: Quite a few questions there that have stemmed off phase one but I think when I’m speaking to practise owners and my principles, it’s this uncertainty of phase one, what is it? Prof Lewis, you mentioned that … the air filtration systems, for example. Will that be mandatory in practise or will it be a nice to have, for example?

Mike Lewis: Right. Yeah, and I think you know, I agree with Tony and what Tony was saying. I mean, I think underlying this we have to get dentistry back on the road. I think we are all striving to get that. It’s frustrating me with my patients here that these clinics are all closed. But to do it in a way that we’re comfortable, we feel safe, our staff feel safe and the patients feel safe, again as Tony said, I think you have to accept that dentistry really is got the rough end of the stick here because of the aerosol generation and the fact that COVID is in saliva. If you generate a saliva, there is no doubt we haven’t measured loads yet, but it has been shown that it’s in saliva. So for non-aerosol generating procedures, that’s what I’m doing here at the moment.

Mike Lewis: I spent a day yesterday, I saw about 20 patients yesterday with toothaches that needed … perhaps they needed some extractions. I saw an urgent suspected cancer that needed a biopsy done. I did that biopsy with just routine mask, visor without, FFP3 regulations and I had no problem with that. We’re washing down the units in the same way as we would as every day, pre-COVID. So I think for certainly for the non …. Phase one would certainly be let’s get back, non-aerosol generating procedures. Let’s get the patients back in. If we do say that … I think the air clean systems aren’t going to be the way forward. I remember and Nairn will certainly remember, we used to clean our instruments between patients in a hot water bath at the end of the comms clinic in dental school and then we got these things called autoclaves and then we actually started wearing gloves.

Mike Lewis: I mean that was a miraculous … I remember all the things. It’s all about, “We’ve got to wear gloves and do we wear the same gloves all the time?” And then of course, prions popped along a now we’ve got to have washer/disinfectors. I mean this is just the next stage, that the issue of viruses in saliva, it’s not been before. Herpes simplex has been documented at spreading from saliva into nurse’s eyes and hepatitis B can be spread from saliva into the eye as well. So the aerosol issue has to be addressed and I think we can reassure ourselves and address it with high volume aspiration. The video clips that were shown on the television didn’t really quite explain what happened but there were two there and one of them was with the use of high-speed volume aspiration dramatically reduces the aerosol, it’s taking it down 99%. then if you had an air clean system in the surgery as well, that will take the rest out. These air clean systems are very effective.

Mike Lewis: Whilst we did the research 10 years ago, we were looking at bacterial spread, the filters that can be put in these air clean systems, will take COVID out and all sorts of other things that we may be worried about, particles in the environment. Because the latest research from two weeks ago where they were looking aerosol generation, the virus will float around in the room for about three hours. But if you’ve got an air cleaning system, it’ll take that right down.

Mike Lewis: So we, I think as dentists, would be more confident where we’ve got this environment. The support staff would be more confident and then hopefully the patients will be more confident. That is the realistic way of getting dentistry back on the road because we’ve got to do it. I’m frustrated here. We have a dental school sat empty and I feel for … The final year students fortunately have done most of their practical work, but the ones that are coming in for fourth year into final year, we’ve got postgraduate students paying large sums to be learning dentistry, hands-on techniques. They’ve paid us money, we’re not delivering it. It’s an awful situation but I think with common sense and us all working together, then we’ll beat this.

Nairn Wilson: One of the things, I know I’m not personally involved, but standing back and looking at it. I think one of the great sadnesses to me is that the current system has not taken opportunity of all that dentistry could offer. For example, why aren’t dentist practises being used for virus testing centres? 20 odd thousand around the country, good access and local communities. Get dentists, well-trained health care professionals who know about infection control. Give something dentists to do, give them some money coming into the practises and if then, through using those practises as testing centres, A, the dental team are tested maybe once a week. I know it’s not every day, but at least once a week and the patients who come for testing, you know that if they’ve got a problem that they need to be [inaudible 00:18:05]. You’re saying, “Well, you’ve got a negative test, we could see you, we can do something. I’m negative, you’re negative. We could start.”

Nairn Wilson: To me, a way of kick-starting dentistry back in would be let’s use dentistry. People have heard me lecture in the past, heard me say, why aren’t dentists use for things like winter flu vaccination and so on. We are properly trained healthcare professionals better us than the army doing this testing. These poor guys in the army that are recruited into this, they don’t know one end of a swab from another, sort of thing. We [inaudible] and our healthcare professionals taking these samples at back of a throat, I think we might be quite good at that. That might’ve been a way in.

Mike Lewis: Can I just come and say Nairn, I think that is absolutely fantastic because I don’t know if you saw on the news last night they were talking about the self home kits and they show the person where they’re supposed to stick the swab. We know where to stick our swabs. There is no doubt about that and I think this suggestion is fantastic.

Nairn Wilson: It’s going back to what Tony was saying, what I was saying about building that, getting that relationship back with the patients, trust. “I came to you, you’re the guy, or person, lady who tested me, kindly just down the street. You reassured me I don’t have the disease, et cetera.” That’s breaking that psychological link again and getting them back in a practise and building that trust and giving everybody trust. We’re only treating people who have tested negative in the last three, four or five days or whatever and we’re all tested negative and wouldn’t that be good that if we’re helping to pick up people who are carriers who’ve got the disease and of course in the process, as Tony was saying, our link with general health and so on, we’re going to say, “How are you?”

Nairn Wilson: These people aren’t going to their doctors about heart attacks, strokes, cancers, lumps and bumps. A good dentist with good communication. “How are you doing Mrs. Smith?” Or, “Well I’ve been a bit anxious the last week or two. I’m breathless, I’ve had chest pain.” We could pick that up and get these people back to hospitals and so on. We’re good at it and we’re not being used and I think it’s a great shame that dentists and the facilities and the potential is there. It’s just not in the minds of the folks that are firefighting this terrible situation the country finds herself in. I wish somebody would wake up and say, “Here’s a wonderful resource. Let’s use it.”

Payman: Nairn, you’ve been in the corridors of power. Who makes these decisions?

Nairn Wilson: Well, as you see, it’s the advisors to the government to et cetera, but with no disrespect, they’re all medics and so on. We’re probably just not in their thinking. We’re not on their radars.

Nairn Wilson: And we’re probably just not in their thinking. We’re not on their radar screen. They don’t appreciate… And even, again with no disrespect to them, some very senior people in medicine, who think that dentists are just filling and taking teeth out, don’t really appreciate that the extent of our training and appreciation of human disease and looking at people holistically.

Nairn Wilson: And it is sad in this day and age that there is this lack of appreciation of what we can contribute, as Tony was saying, to general health and wellbeing. And this, to me, is an example that we could do this and we could make a huge contribution. They’re very much in the thinking of the College of General Dentistry of getting this brick in this dome. We are part of healthcare system in the UK. We are important.

Nairn Wilson: And other issues are missing at the minute. I know it’s the immediate topic today, but why aren’t people being encouraged to brush their teeth and use mouthwash before they go out in the street? Possibly more important than some face covering, or equally because there’s not much evidence, we keep getting told that it’s not much a benefit. Maybe brushing your teeth and using a mouthwash before you go to the supermarket, or whatever.

Mike Lewis: If I can come in there, the ITV have just asked me to put out a press release following on from what I was saying on the TV early in the week. There is no doubt I have a mantra. Wash your hands, clean your teeth. And the basis behind that is that there is no doubt that from the work that we did here and published in Critical Care about four years ago, we were looking at oral hygiene in relation to ventilator patients.

Mike Lewis: And we demonstrated without any doubt that if you go into… Say you’re COVID, you go in and you have to have a ventilator, your chances of coming out of there alive will be related to your oral hygiene. Now that’s on the basis of going in and of course maintaining oral hygiene when you’re ventilated is difficult. And we did studies using brushes and swabs, and everything.

Mike Lewis: I don’t want to complicate it too much about that, but there’s the benefits of good oral hygiene at this stage. If you were unfortunate enough to get COVID-19 and then be unfortunate enough to require ventilation, the better that your oral hygiene when you go into there, the greater the likelihood of coming out and there is no doubt about that. We publish these papers three or four years ago on a molecular basis.

Mike Lewis: What I do agree with you right now is that if it’s a great opportunity to get people brushing their mouth. And I said the four… You’re all in lockdown. The four most important minutes of your day today are two minutes brushing your teeth this morning and two minutes brushing your teeth this evening. And when I said that on the TV, the newsreader actually laughed a little bit, because it’s true.

Mike Lewis: That should be the message out there. The foremost important, because not only is that going to be good at hopefully preventing if you are unfortunate to become COVID-19 positive, but it’s going to get people brushing their teeth anyway. And for the benefits of the dental need out there, that we’ve been trying to get them to brush their teeth for two minutes twice a day for, I don’t know, as long as all of us have been in the profession and it doesn’t work.

Mike Lewis: This message out there is brush your teeth. We are now in a fantastic opportunity. Now there’s a little bit of evidence that Martin Addy I understand published in the BDJ, had a letter in the BDJ two issues ago. And I think the press have picked up on that and they’re going to interview him this weekend about some of the active ingredients in toothpastes, because some of the components of toothpastes actually have… They’re the same as they are in hand sanitizers.

Mike Lewis: Now if you teach it… And the way I teach virology is you imagine it as a little scotch egg and the scotch egg is… The COVID-19 is the egg inside. It’s an RNA virus. The crumbling coating on the outside will determine which cells that virus gets in. Now in COVID-19 it’s cells in your lungs. So, it allows it to get into the lung. If you disrupt that coating, it can’t get into the lung. It cannot get in.

Mike Lewis: So, anything within… If there’s saliva in the mouth or the throat, brushing is good, but also using a toothbrush, or some of them. The Listerine mouthwashes, the essential oil mouthwashes, povidone-iodine. Chlorhexadine not so much, because it only has an anti-adherence effect, but I have to pick up on what you said there and the ITV are coming back to me. They’re doing some national meeting at the moment. They’re going to ring me back later today, but I’m hoping that the dental profession out there is… And I’ve altered my email signature. Wash your hands, brush your teeth.

Nairn Wilson: Sorry, very quickly. I’ll come and… We haven’t heard from Tony. He’s being uncharacteristically quiet there. But a little bit of dental history, they say it’s nothing new and our medical colleagues… Again, notice, right? The same problem there. In the first world war where they had to operate on people with ether and its inhalation. If, as was very common, they had trench mouth, i.e. acute ulcerative gingivitis, or whatever its new term these days. I do get confused.

Nairn Wilson: The perio people keep changing the terminology, but it was well known then that given your mouth’s such a bad condition, if we give you an anaesthetic, it’ll probably kill you. So, maybe we’ll operate without the anaesthetic and you might survive. Now that was in the first world war. Same message, yeah? And our medical colleagues who given a hundred years that this sort of stuff has been appreciated, it hasn’t twigged on them. And when they’re giving all… Mike is saying they’re showing all these pictures of people coughing and sneezing and so on. Where’s it coming from? At least half of it’s coming out at the mouth, yeah?

Narin Wilson: Tony, what’s your experience? Okay, we’re saying central government medics don’t appreciate where we’re at, but once it filters down to dentistry, is it the chief dental office, is it the GDC, is it CQC? Who’s going to regulate, or is it down to the professionalism of the dentists themselves going forward?

Anthony Kilcoyn…: I think my other two colleagues on this forum today have made an excellent point that generally dentistry is being undervalued and it’s probably due to a lack of wider knowledge. Even in our medical colleagues, but also regulators, politicians, the people with power. They really can only relate to their own personal experience of dentistry. When I speak to them, lobby them, as do many of my other colleagues, they’ll often quickly refer to their personal experience with their dentist.

Anthony Kilcoyn…: So, that’s very important. Don’t get me wrong. That is very important, but their relative breadth and depth of knowledge of dentistry is not good, and that’s being subtle. Unless it becomes a news story, or a disaster, or a problem, and then they look at it and it becomes an irritation and an annoyance. And for so long I feel like we’ve been the Cinderella of all the health care sector. I think the only other healthcare sector that’s probably treated even worse than us is mental health. Well, after that it’s us. It’s dentistry.

Anthony Kilcoyn…: We’re highly skilled, we’re highly trained, we do five years at university, and all the other additional skills. Narin said the point of we have a bigger role to play in society as diagnosticians and interpreting the results and doing it well. We’ve got a big role in improving oral health to improve general health, and we can monitor and interpret that.

Anthony Kilcoyn…: We do medical histories on everyone all the time. Our quality of PPE and routinely changing things between patients. I don’t know about you guys, but I laugh sometimes when the show a TV clip of the medics struggling and they almost need that second person to remind them what to do in more order, because they’re doing something out of the ordinary. We’re looking and thinking, “Well, it’s obvious how to put a mask on and take it off, and not touch the front and not contaminate it.”

Anthony Kilcoyn…: We do this between every single patient. That’s our normal. We are very good at this and that’s I think is actually what has protected us for so long. But the appreciation of what we can do and what we do for society is very poor in many levels of politics, regulation and even in all these advisory bodies at the moment. Going into SAGE, how many dentally qualified people are on SAGE? NERVTAG, who then feed into that, and then when they do all that evidence about PPE and saying, “Oh, you can wear the mask for a full session.”

Anthony Kilcoyn…: We’re all scratching our heads thinking, “Well, hang on a minute. That’s even worse than what we were doing before. We were changing everything between patients.” And I drill down all their evidences and papers, and there’s about 19 papers. They’ve lumped us in with all the medics again, but there’s only two specific papers there that are dentally related.

Anthony Kilcoyn…: And one’s from 2011 and one’s from 2006, and you sat there thinking, “Oh, my God, they’re talking about this wonderful NERVTAG panel they’re feeding into SAGE, they’re feeding into COBRA, they’re feeding into the politicians.” And you sat there thinking, “Basically they’re using two out of date references that sort of semi-related to dentistry and they have no idea what’s happening on the front lines.”

Anthony Kilcoyn…: You ask the CQC who is the best healthcare performer of all the healthcare sectors that they regulate, who’s the best? Number one by a mile: dentistry. In fact, they were surprised that why is dentistry been added to our list to inspect? When they went around the practises and saw what happened, and saw how intrinsically patient centred we are, they were scratching their heads thinking, “Why have we got dentistry?”

Anthony Kilcoyn…: We’re in the top 90 odd percent performers. We’re so good. They’re actually saying on average we only need to visit you once every 10 years. Everywhere else, the hospitals, or the medical clinics, they’re in the 80%. They’re struggling. The poor care homes at the moment, they’re far higher risk and don’t have the same cross infection control and what I would call a closed circuit environment that we control so well, and have been patient focused for decades.

Anthony Kilcoyn…: This is not new to us. This is our bread and butter. And we are very, very not just unappreciated, but nobody realises actually just what high standards we have routinely. So, this is when people talk about after lockdown and going back, and so on. I don’t think we’re a million miles away at all. I think medicine might be. I think the way we visit people in hospitals and wards, and the free flow of vectors with different patients and hospital acquired infections.

Anthony Kilcoyn…: Somewhere between 4000 and 8000 people die a year from a hospital acquired infection. They went in with something and ended up catching something else and it killed them. So, we just don’t have that in dentistry, because we’re so well controlled. It’s our closed environment. Okay, patients are there for a relatively short time and they’re not residential overnight, but we’re already in tight control of that. So, when Mike says stuff about the aerosols and so on and reducing it, we’ve been using high volume suction for a long time.

Anthony Kilcoyn…: In fact, as I go around and inspect practises, we’re all supposed to have extractor fans in the room. Now it goes through different phases of how important that is, but even health and safety executive will tell you that there’s a minimum of air change that has to happen every hour. But if you look at the latest guidance coming out about these high filtration units now, they’re talking about if you have six room changes of air in an hour, then you need to leave an hour between patients to be a hundred percent sure there’s no aerosol there.

Anthony Kilcoyn…: But if you have 12 changes in hour, you can leave 30 minutes. And, of course, everyone’s going, “Well, I don’t know what my fan does.” So, I had to go back and look at mine. Mine does 15 an hour, but that’s the 12 inch Xpelair super duper one, because I remember putting it in and thinking, “Well, if you’re cutting up through all through my glass, we might as well pay another 50 quid and have the better fan on, because I’m doing it once kind of thing.”

Anthony Kilcoyn…: So, who knows? So, of course, we need some at near the mouth and so on, but what I’m saying is we already have a lot of these risk reduction ideas in place. We might have to enhance in some way. We certainly are going to have to screen the patients better. We can’t have 40 people a day just coming and filling up the waiting rooms and being too close to each other at this time. So, we are going to have to streamline that, but I think with a few sensible risk reduction approaches and the phased approach, not because we’re high risk but because psychologically we just need to reassure patients first, nobody dies. Right, we can step up a gear and so on.

Mike Lewis: Right, can I just come in on that just to support Tony completely on that. Firstly with regard to washing your hands, PPE, et cetera. When we did infection control audits across this site, that’s not just the dental hospitals, but it’s the University Hospital of Wales, the biggest hospital in Wales. Dentistry always came out on top. Our house was in order. We were always up there in the high 90% for adherence to the hand washing and an appropriate PPE. So, tick that.

Mike Lewis: I can give you examples of that in a large hospital setting. Also with the air clean systems, I was actually… I unfortunately couldn’t go and look up the value, because I had to go and see a patient, but I’m glad you reminded me it’s six air changes per hour. But in fact some of the ones I was looking at earlier today will do 20 air changes per hour, which is even better than your 15. And I think with that type of volume air clean, that’s the what we can say to people, “Look, we’re doing this. It’s safe to come into this environment.” I can’t agree with you more.

Nairn Wilson: How do we get out of this? Become part of the agenda and to get our message across. And disappointing if our CDOs are not part of the core team, or they’re saying these things and they’re not being listened to. I’m sure people have said these things to our chief dental officers and so on. And I feel sorry for them if they’re not being listened to, or I feel…

Nairn Wilson: Goodness what goes on? You have a chief dental officer, you ought to listen to them, yeah? If they’re not being listened to, that’s a real problem. I think one of the things that has to come out of this at the end of the day, other than getting dentistry up and running, and go back and say, “I think a great way to get it will be to be testing centres and get recognised through that.”

Nairn Wilson: We must address this once and for all, and be part of the healthcare agenda in this country and indeed internationally. As and when the next crisis, whatever it is and what shape it takes, whether it’s AIDS, respiratory, something else, we’re not the forgotten tribe of well-trained healthcare professionals who comply, who are good at this stuff, and can really make a difference and make a major contribution.

Nairn Wilson: We’re currently just forgotten, or we’re not on somebody’s radar screen. And that’s really, really sad. And one of the things I would like to do again with my new college is that very much a part of the agenda. Dentistry has never had its own independent college, let alone our own college. Maybe we’re not being heard because maybe the secretary of state says, “Get all the presidents of all colleges in here.”

Nairn Wilson: We’re not there, because we don’t have a college, let alone our own college. So, we’ve got to take all action we can to be at the right place and be at these high level meetings. So, the voice can say, “Hey, dentistry could really help here. We can do something.” And you could keep these dentists and their dental teams employed in the process, not run the risk of them all disappearing and going bust. And no dental service as and when we do get back to business. It’s sounds a no brainer to me.

Mike Lewis: That very point. When I was Dean of the Dental Faculty at the Royal College of Physicians and Surgeons in Glasgow, when I was chair of joint faculty meetings, I tried to get representation for dentistry from one of us from the four colleges onto the academy and medical and they said no. And what happened was one of the medical presidents or surgical presidents represented us, but I thought dentistry should have… And I fought and I did the battle for a year and I gave up.

Anthony Kilcoyn…: I think both guys have made great points. We need to raise dentistry’s profile. I suppose if there is a silver lining to this cloud, what I have noticed is a quite positive side effect is that it’s unified dentists and dentistry with a common sense of purpose. We’re all struggling in different ways. We’re all quite keen to get back to help patients.

Anthony Kilcoyn…: We’re all thinking in the same direction and we’re all feeling a little bit under utilised and unappreciated at the moment. There’s examples of colleagues now setting up urgent dental care centres. They’re buying their own PPE, they’re bringing in all these extra risk reduction things. There’s almost zero support coming in from the system and they’re the only ones who are trying to look after this tsunami of acute need patients at the moment. And it’s just totally inadequate.

Anthony Kilcoyn…: So, in a way by allowing a phase one in a bit perhaps earlier than they might have been thinking about, it would actually be a dual benefit. It would take some pressure out of the central system. Let’s be honest, by the time they get around to planning something that actually works, most practises could be looking after at least that level of acute care themselves, be doing it safely and well, following certain protocols, and doing risk reduction assessments.

Anthony Kilcoyn…: And, yeah, we can’t see 40 patients a day like that. We’re going to have to slow it down and have no more than one person in the waiting room and family members can sit in the car, or however we manage that. There’ll be ways of doing it. They’re going to be some people we’re still going to have to do an AGP on now. Now it might be we’re allowed to do one of those a day and they’re the last patient of the day. Whatever. There are ways to risk reduce, to risk mitigate, and to do it effectively and safely.

Anthony Kilcoyn…: And there’s certainly a big desire now in our profession to just… We’re doers, aren’t we? We want to crack on and get this solved. We don’t want bureaucratic barriers stopping us from providing the care we know we can do safely.

Prav: Tony, you mentioned about cracking on and doing and all the rest of it, and funnily enough I got off the phone with a colleague of mine who’s a dentist in Sweden this morning. And he’s a personal friend as well and I just said, “Listen, mate, what’s going on out there? How has dentistry changed?” And he said, “We’re operating at approximately 30% to 40% of our previous rate.”

Anthony Kilcoyn…: Yeah.

Prav: “We’re being sensible. We’re wearing visors. We didn’t wear visors before. There’s gaps between patients. We’re doing AGP and I am looking after my existing patients. I’m not taking on new business. I’m not advertising. I’m not doing any of that, but we are just being sensible about it.” Same story in Germany, same story in Finland I hear.

Prav: Do you think we should have taken that approach, or do you think the approach of completely closing down in line with letting the peak come and go and isolate was the right thing to do, or should have we been following our colleagues in Europe?

Anthony Kilcoyn…: Sure. I would just say one word of caution.

Prav: Yeah.

Anthony Kilcoyn…: If I look at it, I’m sure like my fellow two colleagues, we have lots of friends and connections.

Prav: Yeah.

Anthony Kilcoyn…: And academic…

Anthony Kilcoyn…: We have lots of friends and connections, academic as well as frontline level dentistry, and in the medical and especially virology, immunological… So it’s really interesting, isn’t it, just to compare-

Prav: Of course it is.

Anthony Kilcoyn…: … what a country’s done, different systems, how they’ve approached it. Do you know what? They’ve nearly all done it differently. They’ve been at different phases, with different problems at different times. We can pluck out the dental bits but we do have to be careful to see how has Sweden done that in the context of how they manage the general population, and that’s why it is a bit different.

Anthony Kilcoyn…: So I’ll give you one example of mine: Thailand. So I was there in January, speaking at a massive dental conference. It was like a joint conference between Thailand and Germany. It was just packed. Thousands of people, over a week. Of course, I’m arriving at the airport thinking, “Oh, why are they doing the thermal checks on the temperature as people arrive?” It is that part of the world where about 20% of the people walk around wearing masks anyway.

Anthony Kilcoyn…: It’s really interesting how they behave and interact. Very polite, lovely people. They always find it a bit strange when I put my hand out to handshake because it’s a nice, respectful bow, at a respectable distance. So they kind of respect personal space. There’s none of this hugging or French kissing on both cheeks, or whatever. Suddenly, as a lookback exercise now, I’m thinking, “Wow. They were already intrinsically safe in many ways that they behaved.”

Anthony Kilcoyn…: They’re not more high tech than us, although it has advanced a lot as a country, but I would say, probably because they’ve had experience of bird flus and swine flus and they’re in that Asian region where there’ve been many epidemics and pandemics before, they were far more prepared. They’re a far more compliant general population. Again, like us, they adhere to cross-infection control as dentists very well. But the first thing they did was, they had the sterilisation arches. So whenever you went to a shopping mall or anything like that, you had to walk through an arch and it would just spray a mist on you, which was antiviral or whatever. But everyone just cooperated with that. They’ve had a lockdown of sorts but it’s been a mild one, but what they haven’t done is the widespread testing in the population and so on. I think probably just because of costs and so on. But they took early preventive measures.

Anthony Kilcoyn…: Now, their dentists, they’ve stopped for a while and they’re starting again. They stopped for a while and they’re starting again. But do you know what the total number of deaths was? And I’m about a week and a half out. The total number of deaths from coronavirus in Thailand: 41.

Prav: Wow.

Anthony Kilcoyn…: We were getting more an hour last week, of deaths.

Mike Lewis: Also, in South Korea, I was in South Korea a couple of years ago, and South Korea, I think their death toll is less than 40.

Anthony Kilcoyn…: Yeah. It’s incredible, isn’t it?

Mike Lewis: It’s similar behaviour.

Anthony Kilcoyn…: So the bigger picture is important. We pluck out the dental picture, which is actually very encouraging because, as you know, there’s been studies in Wuhan. They’ve even looked at the dentists who worked all the way through there and whilst there’s some casualties, it’s no worse than the general population. So it’s more likely that it happened out of dentistry than within.

Anthony Kilcoyn…: So there’s some hope that what we do is intrinsically protective but, again, I think we have these physiological barriers to overcome here, both for our own worry and our team’s concern, as well as the public. So I think it will be a turn the taps on, dip your toe in the waters, get a little confidence with that and you move forward from there.

Narin Wilson: Yeah. Our position in the U.K. is that we’re not integrated into general healthcare. Part of the issues in Thailand and Germany and Sweden, all these countries that we’ve mentioned, and many other countries around the world, dentistry is much greatly… much more value put on it and it is seen as an integral part of the healthcare system, and these people are very much part of it, not as an add-on as we often feel in this country.

Narin Wilson: One of the things I felt I failed to do in my career is to do this, to achieve it, and there’s all sorts of examples, issues about general anaesthesia and this and other, and various things. You go to government briefings and stuff and they produce stuff and you had to stand up and say, “When you talk about medicine, do you include dentistry or not?” Isn’t that sad, that we had to ask, “Does this apply to dentistry too?” Of course it ought to be because we’re meaning it to involve nurses, pharmacists, this, that and the other, but we weren’t sure whether it meant dentistry as well.

Narin Wilson: I think one of the things we must learn from this and take forward is we’ve got to address this, and we’ve got to put that one to bed and catch up with the rest of the world, that do value good oral healthcare and dentistry and appreciate it more than it has done so in this country.

Narin Wilson: But coming back, I very much hope that a way can be found to get us moving again. I totally agree with Tony. It’s a bit like the tsunami that cancer care and hip surgeons are going to have once they get started again. We’ve got the same problem. I agree entirely with it, and the sooner we get started and we can find a way to get in and use our expertise and our resources. It’s a wonderful geographic distribution of well-trained healthcare professionals, and here we are sitting frustrated.

Payman: What about going forward, the psychological part of it that we’re talking about? Firstly, for dentists and teams, will they feel confident going back, as far as safety? And then, secondly, patients. Even when, let’s say, the regulators or whatever decide that we can open, what can we do to encourage patients to come in? To the approach of, in the media, is it right to talk about aerosols in the media or isn’t it? This influence that you’re talking about, Prof. Wilson, do we get influence by politics or do we get that influence by media, or is it a combination? What are your thoughts on the psychological side?

Narin Wilson: I think you’ve got to fire on all fronts: media, politicians, et cetera, and do it in a meaningful way, not get angry and aggressive because that never helps. Gently reminding people, “Hey, we’re here. We can really help. We can do things,” et cetera. It won’t be the regulator. It’s impressing departments of health, Public Health England, NHS England, the Chief Medical Officer and the Chief Dental Officer to think afresh and to stand back and say we must embrace this, all aspects of dentistry. Not just the NHS, the whole of dentistry, including private dentists as well. If you said to a private dentist, “Will you help? You can make a difference,”… of course a bit of funding to cover costs, et cetera… I bet you they’d all say, “Of course I’ll do it.”

Payman: Yeah, of course they will.

Narin Wilson: We’re a very professional group of people. As Tony said, just give us a chance. If we’re given the chance, I think we’ll get the route in to getting back, and getting back and established. I think a lot of the psychology, if we embraced by the system and they talked to us in the way that they talk about nursing and pharmacy and so on, then I think that would have a great transformation in the public perception of dentists as well. If we were seen to be part of the family, I think that would make our lives a lot easier. I think part of it is that we’ve, historically, not been included. I think getting around that psychological stuff, if we were integrated and we were talked about as if we were part of the healthcare family, I think a lot of these issues would disappear or be a hell of a lot easier to deal with than they are as at present.

Prav: I know we’re running short on time and something that’s very high on the agenda that I mentioned earlier on is what is this new SOPO protocol going to look like when we come back to dentistry. Let’s say when we come back to AGP dentistry, for example. I think if anyone can answer this question you guys can, having the research background that you have.

Prav: The key things that have been brought up in conversation after conversation is PPE and the level of it. Obviously, high volume aspiration. Fogging. Hyperchlorus in the lines. Clean air technology. And then another hood of suction that sits above the patient that sucks some air out. So it’s almost like some practises are going like absolutely ninja on this, right? I’m looking at this and thinking, “How is this sustainable?” And if

Anthony Kilcoyn…: It sounds like we’re going on stage of Britain’s Got Talent and the fog clears and the dentist appears in full PPE from head to toe with the patient in the chair!

Prav: Absolutely. And gives

Anthony Kilcoyn…: Look. I’m on many forums and still Zoom, and meet with many dentists up and down the country. Because there isn’t this guidance that’s clear for all of us, we’re all making up our own and chucking it into the pot, and it’s just chaos, and that’s worrying.

Anthony Kilcoyn…: Cut a long story short because I realise we’re running out of time. The best one I’ve seen so far, and I hope Mike Lewis agrees with me, is the Welsh SOP. They released it only just a week ago, so it’s one of the most modern ones as well. I would still pick faults at it and adjust things in it but if you’re going to score something nine out of 10, it would be that. So I think that’s a good basis for the other CDOs to look at that and adapt it, and then just modernise it again in another week or so because it will be two weeks out of date by then.

Anthony Kilcoyn…: We’ve got through April. We’ve got through the peak risk to the general NHS system. I’m kind of half pleased we’re not hearing much about Nightingale and the ExCel Centre because it’s not getting used. Apparently the Birmingham one’s totally unused. So we’ve now got excess capacity with the ventilators and the ICUs and so on.

Anthony Kilcoyn…: So the general burden on the NHS, yeah, it’s still big, we still need to applaud them every Thursday night at eight o’clock, but it’s not what it was and now, this is 1st of May, I think we can start looking forward instead of backwards and start planning it. But you’re right, we need something to say, “Look, this is the start. Use this as an example.” But it’s a continual process. We’ll all have to adapt it in risk assessing our own environments.

Prav: Tony, are you a practise owner?

Anthony Kilcoyn…: Yes.

Prav: So what would your SOP be going back, and obviously I don’t

Anthony Kilcoyn…: Well, I can tell you mine.

Anthony Kilcoyn…: We’ll be here all day. So I’ve already been

Payman: I’m sure you wrote an article 10 years ago about this.

Anthony Kilcoyn…: Yeah, I did. I wrote an article 10 years ago almost predicting this, I would be wiping door handles down and so on. So those are our protocols. I’m hardly going to have to do… I will have to do some things but I’m not going to have to change much. I think there’ll be a lot more prescreening before people come down, and so on. Mine is a private practise. So I have more time per patient and I don’t have 10, 15 people sat in the waiting room all the time. So actually it lends itself to this.

Anthony Kilcoyn…: So I think NHS systems are going to have to change and start looking at units of dental time and making it practical and work, and that’s a subject for a whole other seminar I’m afraid. The private practise will have to adapt but it isn’t going to have to adapt that much. It isn’t going to have to adapt that much because it’s already kind of units of dental time focused. Dentistry is very good at finding solutions to problems. That’s what we do, that’s our day job. So someone needs to just bring this together and give us the starting point. Let us go, and we’ll evolve quite quickly.

Prav: Am I right in assuming that NHS and private dentistry will be measured by the same yardstick, so the same standards will apply? Because, from my understanding, I might be incorrect here, the CDO is the voice for NHS dentistry. It that right?

Narin Wilson: No.

Prav: Oh, is that not right?

Narin Wilson: The role of the all the CDOs is very careful, it’s overall responsibility for the oral healthcare of the nation. They have a focus on NHS understandably, because that’s the government funded side of it, but the role is to advise ministers and so on on the oral healthcare of the nation. Yeah?

Prav: Yeah.

Narin Wilson: We, as a profession, should work… and I keep thinking it’s so unfortunate that we have this division because most practises are mixed economy anyway, and that’s another thing I would like to see getting rid of. This is the nature of the beast. Very few people can survive on NHS only. Hardly the entity of an NHS practise because most practise has got an element of private, they’re all mixed economy, and there’s relatively few absolutely purely private that don’t do anything in the NHS. So we should, again, try and get away from this. We’re dentistry and we’re dental practises, and of course we’re there to serve patients first and foremost. We do it in subtly different ways.

Narin Wilson: If I come back on the guidance, it will never be specific for everybody because all the practise and configurations and the nature of them, the age of the building, quality of the ventilation, all the rest of it, as with anything, the guidance will be a bit generic and it requires our professionalism again to apply the rules and make them work in all of these different environments, that you feel safe, your staff and your dental team feel safe, and your patients are going to feel safe about coming into it.

Payman: When we talk about going back to normal, one thing I wouldn’t want to go back to normal is the volumes of patients the NHS dentists are seeing because if you look at… they’re seeing 30 to 40 patients a day. If you look at a five minute clean up in between those, it’s impossible to see 30 or 40 patients a day. So the clean up must be one minute, and one minute’s not enough to clean the surgery pre-COVID.

Payman: So if something can come out of all of this, perhaps it’s that the NHS has to change, and maybe that means people have to start saving for their dentistry, which hasn’t been in the culture here as it has been in lots of other countries. But we do need to pull out some silver linings from this cloud, and I think that will be one of them, that the NHS finally changes and either becomes a core service or more money goes into it, God forbid! But somehow I don’t think that’s going to happen. But who’s going to pay for it?

Anthony Kilcoyn…: I would just say, that’s been an ongoing issue since UDAs came in in 2006. Target-based healthcare-

Narin Wilson: Even before then though.

Anthony Kilcoyn…: … has been recognised as not good anyway. So maybe this will be the catalyst that finally drives some change. Instead of having pilot after pilot after pilot and kicking the can down the road, maybe finally someone will go, “You know what? Let’s grasp this nettle. Let’s make something fit for purpose.”

Narin Wilson: I couldn’t agree more, Tony. No disrespect, something like the Jimmy Steele report, lots of great stuff in it, still relevant, but that’s now… how old is that? 12, 13, 14 years, and the world has changed in that time, let alone through this episode, and we can’t be building a system on a report that’s that old, and through this.

Narin Wilson: I couldn’t agree more that, again, a fresh approach, a fresh look at this, the feasibility of quick turnaround, high volume patients, et cetera, it’s not going to work. In a new world and the new norm, there is a need, and a realisation that… and your pragmatism about what money can be afforded for oral healthcare and how do we spend that best. If, in the grand scale of things, as is common in most countries, total spend on health, that you can afford 2%, 3%, or something, of the total spend relative to cancer and all the other things you do, and that’s about what the level is, what can we do with that money and use it to best possible advantage to achieve something that we can all be proud about, and we can all sign up to and move on.

Narin Wilson: Yes, I think if there’s a silver lining, it should precipitate a fresh look and a fresh consideration of we need oral healthcare, it’s important to general health, let’s do it in a way that can be a good use of money and can be most effective, and we can all feel very proud about it and get on with it.

Mike Lewis: Just have to say I absolutely, totally agree. Gentleman, I am going to have to go in five minutes because I’ve got a patient to see in the emergency clinic. I’ve found this last hour fantastic. It’s a great opportunity to have discussed this problem from the various angles that we’re coming from. I thoroughly enjoyed it, and I hope that anyone that watches this comes out with… gets the impression that we are all trying to work to the common good to get our profession back on the road and in the best possible shape.

Anthony Kilcoyn…: I agree.

Prav: Thank you so much.

Mike Lewis: Thank you.

Payman: Thank you. Maybe we’ll reconvene in a month and see where we are.

Mike Lewis: Indeed, indeed. On PPE.

Payman: Thanks a lot, guys. Thank you so much for taking the time. I know you’re all busy.

Anthony Kilcoyn…: Thank you.

Mike Lewis: Thank you very much. See you, guys.

Mike Lewis: Bye, everybody.

Anthony Kilcoyn…: Cheers.

Outro Voice: 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.