Compliance and Regulation: Disaster or Opportunity?

In the early 1980’s, I worked for a short time as a locum in a small Devon market town. The two-surgery practice had already been there for 40 years and the surgery I worked in had one of those dental units that you had to mount like a horse in order to drive it, with springs capable of catapulting you off the operating stool, while at the same time having your hair pulled out in clumps by a large rotating rubber band powering the (very) slow hand-piece.

The dentist I was locum’ing for wore a suit and tie at work and smoked in the surgery between every patient. He had his nurse “sterilise” the instruments in boiling water, (whilst his partner in the surgery next door had his instruments cleaned in ‘savlon’ and re-used his hypodermic needles). The two chair-side assistants in the practice mixed amalgam in vast quantities using a pestle and mortar, then squeezing the excess mercury out through the holes in a cotton gauze wrap which ran over their fingers… You get the picture! For the owners of this practice, getting an autoclave was a big deal and they questioned the need and the expense…

A little later in the 1980’s came Aids, and having to wear gloves. By this time, I was working as an associate with an enlightened Principal in Torquay, who allocated me one pair of gloves (very fancy Biogel D’s) in the morning and another pair in the afternoon which, after a couple of hours, became so sticky that I could pick up an instrument with the tip of my finger, great for placing veneers not much good for anything else. He questioned the need and the expense…

And then, the following twenty years has introduced us to: sterilizing hand-pieces, vaccinations, face masks, protective glasses, surface sprays, plastic disposables, zoned surgery areas, COSSH, tray systems, bagging instruments, amalgam separators, bio-film removal, disposable endodontic files, ultrasonic instrument cleaners, dishwashers, registration of dental care professionals, to name a few of the many recommendations that have fallen on the profession like confetti. And we questioned the need and the expense…

Towards the end of his reign, Tony Blair promised that everyone in the UK who wanted to, would have access to an NHS dentist (his successors have made this mostly happen) and he also promised he would regulate private dentistry. His legacy is that dentists have three rounds of heavy-duty regulation to deal with in the coming months, HTM01-05, The Care Quality Commisssion’s requirements and Revalidation.

Some of the dentists I meet are reacting in the way that people naturally do when they receive bad news, that is to journey through a sequence of emotions that begin with, denial, moves through anger, negotiation and depression and ends with acceptance.

So far I’ve seen:

Denial by some of our own clients in Scotland, who, when faced with the most recent regulatory demands tell me, ‘They will never get around to putting this into place’.

Angry dentists in South Wales who, like a striking workforce, hijacked a presentation I was giving on Marketing to voice their anger about the new decontamination requirements, demanding to see the scientific evidence behind the new compliance.

Negotiation, as several correspondents email Breathe to urge me to write to my MP/contact the Government to protest at the proposed new regulations. (see below).

I really hope the ‘depression’ stage won’t take us all too long and that we can hurry up and get on with ‘acceptance’ because, wait for it, I think that: HTM01-05, CQC Registration and Revalidation will create a whole ocean of opportunity for those willing to look for it! Now I don’t know whether there is sufficient science behind the new compliance and, frankly, I’m not that bothered. The bottom line is that it will raise the standard for everyone. Practice owners will, at last, start playing the game at the right level, and more principals will become serious about their business running proper, resourced, professional practices.

Of course, the coming regulations will change the face of high street dentistry, with many winners and many losers.

The losers may be:

  • Some Principals, who are forced to update their grotty, dingy premises and their poor facilities which represent years of under investment and profiteering. They’ll have to get rid of their in-surgery autoclaves, train and pay their staff properly and install computer systems (at last).
  • Some Associates, who may be asked to contribute towards the cost of new regulation by contributing higher percentages of their gross and/by paying a monthly ‘compliance tax’.
  • Some Hygienists, who will have to focus on their surgery occupancy (rather than face-book !!) as their Principals will no longer be able to afford to pay them a high salary to oversee an empty surgery. They may face a (welcome) change to associate-like performance-related pay.
  • Some Small Practices, whose compliance costs will increase their fixed costs and wipe out their profit.
  • Some Patients, who will be faced with higher private, pay as you go fees.

And the winners are likely to be:

  • Patients: new compliance will be another nail in the coffin for poor, shabby practices.
  • The Profession: collectively we will be viewed as doing the right thing for once…
  • Minimum wage staff: who will either shape up, get registered and get paid a proper salary for delivering a professional job, or leave.
  • Early adopters: Principals who can see the opportunities here in terms of their: Leadership and Professional Development, Practice Development, Growth and increased Profits, PR and Marketing opportunities and having a team work in an attractive, safe environment.

Some of the Corporates and a lot of our clients are getting on with their assessment and implementation of the new regulations NOW. So, how are you getting on? The Government is sending a very clear signal to the profession, to play the game at this new level, or leave.

What do you think? We’d love to hear (and publish) your views.

Please contact Ernie on 0845 299 7209 or if you would like to know more about Breathe Clinical Assessment Days or to book your place on our next Compliance Workshop

Compliance Workshop – Friday 1st October, London

We are running another Compliance Workshop day in London “Don’t Let Them Close You Down – Stay Ahead of The Game!” on Friday 1st October 2010.

The Tsunami of Change is about to sweep your business with requirements for revalidation, HTM01-05 and registration and compliance with the Care Quality Commission. Sign up for the following Breathe Business one-day event. You will leave the workshop with:

  • An awareness of the changes you will be required to make
  • The knowledge of how to implement the changes
  • How to engage your team in making the changes
  • How to turn compliance and regulation into an opportunity, not just a cost, and a chance to motivate and develop your team!

Please contact Ernie on 0845 299 7209 or to book your place.

Subject: Letter to Simon Hocken re Frustrated of Finchley!

June 29th 2010

Dear Simon


I am writing out of frustration! Many dentists are really unhappy about the HTM 0105 regulations, but as usual I find that dentists are very good at muttering to one another but not much good at communicating outside the profession. Dentists need to be more involved with government not just through the GDC or BDA but as a individuals who have a lot to say about the things that affect them and their patients.


To be frank just the name HTM 0105 is enough to put off anyone inside the profession. Now imagine coming in as a new minister and having to deal with it. I suggest that it is time for dentists to stop muttering and write using simple non-technical language and explain the problems with the legislation. There is a slight window of opportunity with the new government. Each dentist in England could write one letter to one MP and copy it to the relevant ministers. With 24,450* registered dentists in England that would make an impact!


Tony Kilcoyne’s fine review of the problems at <> which is well thought out and solid provides good information which could be used by dentists to write to their MP.


How many dentists knew there was Lord debate last week at which Lord Colwyn raised the matter of HTM 0105- how much support did individual dentists give him?



George Osborne has asked those involved in the public sector to give the government their views on how they think savings can be made. How many dentists have done this? It’s so easy



The Secretary of State for Health is Andrew Lansley CBE MP and the Minister of State for Health Simon Burns MP. To find an MP’s contact details



Please Dentists stop muttering do something.



Sara Pittack


Practice Manager


Hi Sara.

I agree with pretty much everything you say (although the old cynic in me says the Government will do what the Government will do!).

I believe there is plenty of opportunity for dentists. And, while everyone is busy complaining about these three, why not play the opportunity card and get ahead?

Do you mind if we publish your letter in our next ezine?

With All Good Wishes,



Hi Simon


Please do publish my email! But since the next day Nick Clegg made his Freedom announcement and I have also sent round the following to the partners here:


Nick Clegg announced the government wants to hear ideas for increasing Freedom.


There are 3 areas


  1. Restoring Civil Liberties
  2. Repealing Unnecessary Laws
  3. Cutting Business and 3rd Sector Regulations (focusing on those with less than 250 staff)


The more people that vote for an idea the more likely the Govt are to look at it again


If you are concerned that the HTM 01-05 does not protect your patients and places an unnecessary burden on you, please go to where I have set up an idea called:


Review HTM 01-05 Protecting Patients


Please VOTE today


Ask your staff to vote as well if they agree


Send this email to every dentist, every nurse, hygienist, therapist, practice manager and dental publication you know.


Every VOTE counts!


Thank you


Sara Pittack


Practice Manager

This entry was posted in News, Uncategorized. Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *