Thursday 27 December 2012

Dr Tariq Drabu Dentist 15 Years at Langley Dental Practice

This January marks 15 years since I took over Langley Dental Practice. I remember it was 23 December 1997 when the sale of the practice to me was completed. I was very anxious and nervous being introduced to the existing staff. The previous owner David Brown had owned the practice since February 1965 which ironically was the month I was born. Taking over such a long established practice was a major change of culture for the team. At the time the practice was very small and cramped and had only two chairs for dental treatment and a patient base of around 1500. In 1998 I initially revamped both surgeries and installed brand-new equipment. My first day at work was 13 January 1998. My ambition was always to have a larger multi chair practice with brand-new modern facilities. In the year 2000 I purchased a large piece of land around the practice that was leasehold from the council. Over the next few years I fought very hard to try and raise funds and support from my local primary care trust in order to expand the practice. In 2004 planning permission was granted to expand the practice from 2 to 4 chairs. I will always be grateful for the support of local MP Jim Dobbin in regards to the planning application as well as the then minister of State at the Department of Health Rosie Winterton MP.
Although central funding never came through for the expansion of the practice, the primary care trust were very helpful and supportive during the rebuild period by allowing me to use nearby local premises while the practice was effectively demolished and rebuilt. I ended up taking a large bank loan in order to finance the expansion. When the practice reopened in October 2005 I was tremendously proud of the achievements of having a state-of-the-art and brand-new modern practice in the heart of Langley. From that initial patient base of 1500 back in 1998 we now have over 18000 patients on our computer list. Our premises are air-conditioned and fully compliant with the disability discrimination act. We were recently inspected by the independent watchdog the care quality commission (CQC) and we had a positive and very favourable report passing all that outcomes that were inspected in. In early 2011 we achieved BDA (British Dental Association) Good Practice status. This is an externally audited quality benchmark awarded to practices that meet certain very high standards set by our professional association.
As a local practitioner I joined the Bury and Rochdale local dental committee back in 1998. In 2003 I was made Chairman. I was Chairman for three years between 2003 and 2006 and during this time I helped try and steer dental practitioners in our area through the difficulties and stresses and trauma of the NHS dental contract of 2006. I was also during this time a member of the British Dental Association and was appointed to several national committees working with the Department of Health on the implementation of this contract. Although this particular contract was flawed we at the British Dental Association knew that from day one but I am still nevertheless proud of the work that I as part of that team did in trying to minimise the harm that it did not only to dental practices but also to the wider general public. The fact that the current government is now piloting a new prototype dental contract for introduction in the next few years shows that we at the BDA were right and the Department of Health at that time were wrong.
When I first took over the practice there was a team of four including two dentists. Now we have a team of 15 including five dentists three receptionists and two cadet dental nurses. I am passionate about staff training and development and I am delighted that we are able to make a contribution to the local employment economy in an area of high deprivation and social need.
The past 15 years have been the best of my professional life. I am proud of the achievements at Langley Dental Practice. I am excited and optimistic about the future.

Friday 21 December 2012

Tariq Drabu Personal Reflections on Mouth Cancer

The death of Larry Hagman who played J R Ewing in one of my all time favourite programmes Dallas from complications related to throat cancer last month, reminded me as a dentist how important it is to be vigilant about oral cancer.
Sometimes when I talk to patients they are not even aware that you can get cancer in your mouth. Here at Langley Dental Practice we make it a routine that at every regular check up of our patients we ask about and record smoking and alcohol habits which are known risk factors for mouth cancer. We also try and regularly offer preventative advice about smoking and alcohol. These are some of the frontline things that we as dentists can do in order to tackle the problem of mouth cancer. Also at every examination we do a thorough check not only of the teeth and gums but also of all the soft tissues of the mouth to detect any possible signs or warnings of mouth cancer. The majority of mouth cancer cases are linked to consumption of tobacco and alcohol. When we look at our patient population we are looking not just at cigarettes but also amongst our ethnic minority patients we are looking at issues such as habits of chewing tobacco, betel quid, gutkha and paan.
People ask me what the signs and symptoms of mouth cancer are. A white or red patch presenting in the mouth is one of the early signs of mouth cancer. Another sign is an ulcer in the mouth sometimes painful, sometimes painless that does not heal normally after a period of around 2 to 3 weeks. I would urge any patients with these type of symptoms to present themselves to a dentist in order to get themselves examined. It may be something it may be nothing.  'If in doubt get checked out' is the mantra. Most of the time it will be nothing and sometimes patients feel concerned that they have wasted our time. Nothing could be further from the truth. I would rather have a dozen concerned patients who think they may have something wrong with them but are actually okay, rather than missing the one patient who really does have mouth cancer. Because it is that one patient who really does matter and who really does need our help.
Cancer is a disease that affects us all directly or indirectly whether within our family circle or amongst friends it is a condition that has a profound impact upon all those who come across it. Our role as dental professionals is to firstly educate our patients to look out for the signs and symptoms of mouth cancer. We must also focus on the factors that cause mouth cancer such as smoking and alcohol and issue strong preventative advice to our patients to reduce smoking and alcohol consumption. Finally we must be vigilant at all times when we examine our patients and look out for the signs and symptoms of potential mouth cancers. We must work together with our patients to do whatever we can to fight this disease.

Wednesday 19 December 2012

Dr Tariq Drabu Dentist Record Keeping

The Manchester Evening News reported on 7th December that a patient has been awarded £9000 by Manchester Dental Hospital following the extraction of a wrong tooth.

As dentists and responsible health professionals we must do whatever we can to minimise human error and mistakes when we treat patients. Good accurate record keeping is important. If a prestigious institution such as Manchester Dental Hospital can make mistakes then we as front line dental practitioners must be ever more vigilant.

As the lead clinician on the Heywood Middleton and Rochdale CATS service, an innovative scheme designed to deliver specialist dental services within a primary care environment I get referrals from all over the borough of Rochdale from colleagues asking me to undertake surgical procedures on their patients. I have noticed an increasing incidence of poor quality, and inaccurate referrals. Some of them are illegible, some have the wrong tooth to be extracted, say lower left instead of lower right. Often the medical history is incomplete. Many times pre-operative diagnostic tests such as x-rays of the tooth in question have not been done which sometimes makes me wonder how a referring dentist can have assessed the tooth as being suitable for surgery. On occasions up to 40% of the referrals that I receive are deficient in some way and have to be rejected and returned to the referring practitioner.

Here are some common tips guidance for accurate record keeping. 


Dental records must be easily legible if handwritten and they must be contemporaneous – i.e. written at the time not some hours or days later when one’s memory can cloud recollection of events.

Dental records must be of a consistent standard and must state facts and not opinion and must be accurate.

Paper records must be kept securely together and have the patient’s name and date of birth on each page.

Records must be arranged in chronological order – so one event logically follows another.

Records must be regularly audited and benchmarked against recognised national quality standards. I would recommend doing this every quarter.
Ultimately we are responsible for the care of a patient who is putting their trust in our hands. We must do whatever we can to earn and keep that trust. Good, accurate record keeping is an important step along this pathway of trust.

Tuesday 18 December 2012

Dr Tariq Drabu Dentists Must Carry Out Teeth Whitening

Last month Barrington Armstrong-Thorpe  was given a 16 month jail sentence by a judge at Chelmsford Crown Court for illegally selling teeth whitening products.

We are living in austere times and many people are looking at ways of maximising or supplementing their income. It is easy to go on to the internet where you can find lots of companies offering franchise opportunities for teeth whitening or sales opportunities for teeth whitening products and on the surface this can seem like a perfectly legitimate way of making extra money. In the case of Mr Armstrong-Thorpe he had been selling products since 2005 online with concentrations of peroxide that were 100 times the legal limit. It appears that he was doing this through several online outlets. As far back as 2007 he was warned by Bath Trading Standards the whitener he was selling was illegal. He appears to ignore these warnings and in 2009 was contacted by Essex Trading Standards. Despite receiving a caution from Essex Trading Standards he still carried on trading. I am therefore pleased that the law has finally caught up with him although it has taken five long years to come to a conclusion.
There has been a lot of guidance recently about teeth whitening which should hopefully give some clarity around the whole situation. Firstly the General Dental Council (GDC), the organisation which regulates dental professionals and is responsible for protecting the UK public clearly states that applying materials to teeth and carrying out procedures that are supposed to improve the appearance of teeth and also giving clinical advice about these matters is actually the practice of dentistry. The GDC state that this should only be undertaken by dentists or dental hygienists/therapists working to a dentist's prescription. I support the GDC in its view that the carrying out of dentistry by individuals not registered with them is a criminal offence. This is not about dentists having a monopoly it is about the protection of the public.
The most recent important piece of legislation from the government is the Cosmetic Product (Safety) (Amendment) Regulations 2012. This came into force on 31st October 2012. From 31 October 2012 the government has basically fallen into line with a directive issued by the EU. This means that:
1.    Products containing more than 0.1% hydrogen peroxide cannot be provided direct to the consumers or public.
2.    Products containing between 0.1% and 6% hydrogen peroxide can only be sold to dental practitioners.
3.    These products can only be made available to patients following an examination - by  definition that would be a clinical procedure which would have to be undertaken by a dentist. The first session of whitening treatment should be provided by a dentist, or by a hygienist or therapist under supervision of a dentist after which they can be provided to the patient to complete the cycle of use.
4.    Products containing between 0.1% and 6% hydrogen peroxide should not be used on under 18s.
5.    Products containing over 6% hydrogen peroxide are illegal to use.
Some dentists as an alternative to hydrogen peroxide are using carbamide peroxide and 6% hydrogen peroxide equates to just over 16% of carbamide peroxide.
Many so-called teeth whitening clinics are using products such as chlorine dioxide and sodium perborate. These are not appropriate products for teeth whitening and have strong and serious question marks around safety attached to them. So with so-called teeth whitening clinics, what we are effectively talking about a group of people who are not only illegally practising dentistry, but also selling products that are dangerous for health to a public that is unsuspecting and is looking for what they think is a cheap bargain. Why on earth would people want to compromise their health in this way by using organisations and companies that are providing an service that does not fall within any recognised framework of regulation or scrutiny?
The so-called cosmetic teeth whitening companies try and put forward the myth of greedy dentists ripping off the public claiming that we want to charge anything between £350 and £700 for whitening. Here at Langley Dental Practice we start our teeth whitening prices at just £199 for both upper and lower teeth and this includes a full detailed consultation with an experienced British educated, qualified and trained dentist, somebody who is skilled in the art and science of looking after your teeth - not a "cosmetic technician" or "beauty therapist" or even worse somebody working out of the back of a van who comes to your home.
I welcome the fact that there is now greater clarity around the issue of teeth whitening and also that illegal teeth whiteners are now being prosecuted. Everybody is looking for value for money these days but why put a price on your health and take unnecessary risks?


Sunday 16 December 2012

Dr Tariq Drabu Dentist Reflects on the Affairs of 2012

2012 has been a year of strong landmarks and great strides forward in terms of the practice its staff and its achievements. This has been our best year ever in terms of progress and advancement.
Back in January of this year we received our renewal notification for the British Dental Association Good Practice Scheme which was valid for another 12 months. This scheme is an external quality benchmark given to practices which meet a high level of accreditation and standards and is externally audited and verified. Following on from this external audit and verification we were thrilled with our Care Quality Commission (CQC) inspection which was conducted in October 2012. We came out of that with a very positive report and all our staff worked very hard to ensure that we passed. Special mention to Sharon Daly our cross infection lead and Kristy Miller our Senior Receptionist who even came in on their holidays to get the paperwork in order.
On a personal level I was absolutely thrilled and delighted in August to be appointed as a staff specialist in oral surgery at the brand-new state-of-the-art UCLAN dental clinic in Preston.The clinic has four general dental surgeries; an oral surgery suite (two surgeries and recovery room) and a 10-chair training suite and will be fully equipped to meet both treatment and teaching requirements. UCLAN is believed to be one of the few universities in the country, other than specialist dedicated medical centres, to have such facilities on site.
In the same month the dental CATS services celebrated its eight year milestone. This service delivers specialist minor oral surgery care to patients away from a hospital setting and within a primary care practice environment. It has resulted in shorter waiting times for patients higher quality treatment and a more patient friendly experience. It has also proved to be cost-effective saying the taxpayer and the NHS considerable sums of money. Overall I am immensely proud to have been involved in setting up a scheme that I believe is high quality, patient centred and above all value for money.
In terms of staff training and development the practice has again taken strides by recruiting and training two cadet dental nurses one who is currently now in full-time employment with the practice. We are always excited to be at the forefront of training and development of new staff.
In autumn of this year two new websites were launched relating to Langley Dental Practice. The first of these was my own personal website and the second one was the relaunch of the Langley Dental Practice website We decided to increase our Internet presence and the launch of these two websites has directed a lot of traffic our way. In conjunction with this we have also launched the Dr Tariq Drabu affair and media department specifically to increase our visibility and profile and attract new clients. This department has already delivered some excellent results in terms of new leads and new patients coming to the practice due to our increased visibility online. Also in the autumn of this year we launched our new private fees and offered these to our patients. We have had a steady increase in uptake and we will be able to look at stronger generated revenues at the end of this financial year.
2012 has been outstanding progress for Langley Dental Practice. We have seen this in terms of increased revenue increased patient numbers and increased new patient leads. This is against a background of economic uncertainty and difficulty so we are immensely proud to have done so well. I would like to take this opportunity to thank all my wonderful staff and all our patients. We look forward to an outstanding 2013.

Monday 10 December 2012

Dr Tariq Drabu and Langley Dental Practice Apply to Join Second Wave of NHS Dental Pilots

Following the announcement in October 2012 from the Department of Health in England that more new practices are going to be added to the current dental pilots that are testing out new ways of working, Langley Dental Practice has applied to be a second wave pilot practice. From April 2013, around 25 extra pilot sites are to be added to the existing 70 dental practices that have been trialing new ways of delivering NHS dentistry. It is hoped that these new extra sites will help fine tune different parts of a proposed new dental contract that will see dentists paid for the number of patients they care for and the health results they produce rather than, as they are now, simply the number of courses of treatment they perform.

It is now 10 years since the Options for Change report was published by the Department of Health. That report proposed a new NHS dental service for England and contained radical changes and recommendations, designed to provide a first class NHS dental service, responsive to local needs. That report recommended introducing pilots to test new ways of working and many dentists put themselves forward to trial these. Regrettably the Department of Health never waited for the results of those pilots and trials but instead forced through a new NHS dental contract that was imposed on the profession back in 2006. That NHS contract, which is still current, was hailed by the Department of Health as having a focus on prevention but instead it has put dentists on a target driven treadmill based on courses of treatment. The NHS contract is seen as a failure by the dental profession, by patients and probably by the Department of Health who have acknowledged that it does not explicitly reward quality or prevention. That is why in 2009, just 3 years after the contract was introduced, the Department commissioned another review of NHS dentistry in England led by Professor Jimmy Steele from Newcastle University. The Steele review suggests putting new pilot schemes in place before rolling out any new contract based on registration, capitation and quality.

Ten years ago in 2002 Langley Dental Practice put itself forward as a pilot site to test some of the ideas in the Options for Change document. We wanted to be at the forefront of change and innovation. The oral surgery CATS service which delivers minor oral surgery procedures in a clinic based primary-care environment was one of the fruits of that pilot. However many of the other positive findings from many pilots up and down the country were never taken forward. Having looked at the current situation I feel that the time is right again to try and be at the forefront of delivering change, innovation and a better dental service to our patients. We need to correct the errors of the 2006 NHS dental contract – hence why we have applied.

Any proposed NHS new dental contract must deliver quality for patients and value for the taxpayer. It needs to be properly tested and piloted to make sure that it is robust and sound. We need to make sure that the errors of the past are not repeated. Langley Dental Practice wants to remain at the forefront of change and innovation in delivering NHS dental care, so we have put ourselves forward to trial this new prototype dental contract in a second wave pilot. We will find out later this month whether we have been successful and look forward to learning the results and being given the chance to improve services for our patients.

Tuesday 4 December 2012

Tariq Drabu Dentist Affairs Around Direct Access

Should the public be able to access dental care directly without having to see a dentist first? The General Dental Council (GDC) are consulting about this on their website and this consultation closes on 31.12.12.

Up until a few years ago the practice of dentistry was restricted to a small group, namely those doctors and dentists that were registered with the relevant regulatory bodies. Therefore it was limited and restricted as to who could practice dentistry; this was backed up by legal sanction if a non-registrant was found to be practising. In 2006 registration became compulsory for a further group of practising colleagues namely  dental nurses, dental technicians, orthodontic therapists and clinical dental technicians - known as dental care professionals (DCPs). Therefore since 2006 the practice of dentistry has been redefined as being performed by these particular groups. However each group has its own parameters as to what it can and cannot do in terms of the practice of dentistry and that is known as the 'scope of practice.' It is also a requirement in almost every case for a patient to see a dentist in the first instance and for the dental care professional to be working under the prescription of a dentist. So for example a dental hygienist will administer gum treatment to a patient on the prescription of a dentist as part of an overall treatment plan. Pretty much the only exception to this protocol is for the construction of complete dentures by a clinical dental technician.
Direct Access means that any member of the general public will have access to any member of the dental team without first referring to a dentist. This was one of the recommendations of a report to dentistry by the Office of Fair Trading. Although I support quite a lot of what was written in that report it was noted by many in the dental profession that the report was very one sided and made very far reaching conclusions on the basis of some very flimsy statistical evidence particularly by extrapolating data. These far-reaching conclusions were then pounced upon by the media as the headlines and much of what is positive in the report about dentists and dentistry was overlooked. However whether we like it or not the OFT report is supported by the government and therefore it is very likely that direct access will become the norm in future. Therefore I guess the question that we all have to ask ourselves will be 'does seeing a dentist in the first instance increase the protection of the public or is it actually a restriction of practice?' If you read the dental press you will see that the GDC is seen in a very poor light by the majority of dentists who are at best suspicious of its motives and actions. It has also been recently criticised by  the healthcare watchdog the CHRE.
Notwithstanding the shortcomings at the GDC, I support and would urge every member of the dental community to step forward and contribute their opinions regarding direct access. These potential changes will be the biggest shakeup to dentistry that I have ever known in my professional life time. There would be some parallels with the American model of service delivery where dental nurses are given extended roles and duties in support of the dentist. Here at Langley Dental Practice many of our dental nurses already have extended duties qualifications, in that they can take impressions on patients, they can apply fluoride and they can take x-rays. I am a passionate believer in the dental profession having a voice in its own future affairs and will be contributing to the consultation and would encourage all dental professionals to do the same.
I believe in developing every member of the dental team to their full potential and for career development in dentistry to be seen in the context of a process of lifelong learning and improvement. Affairs and concerns around direct access represent the most important changes to dentistry since 1948 and the founding of the NHS. Apathy and disinterest are not options. The consultation closes on 31 December 2012 and I would encourage every interested member of the dental community to contribute their opinions and take our profession forward into the 21st century.

Saturday 1 December 2012

Tariq Drabu Affair and Media Department Update

I am writing to report on the latest progress of the Tariq Drabu affair and media department. I am very pleased with the work that the Tariq Drabu affair and media department has done to date.
The Tariq Drabu affair and media department is led by a small dedicated team consisting of myself, Tariq Drabu, Matthew Hodkinson the clinical director of the Langley Dental Group and Kristy Miller the senior receptionist. It has been set up with the aim of increasing revenue streams and increasing the number of new patients being referred to the practice and also a widening of the referral base for specialist dental. With the advent of inspections from the regulator, the Care Quality Commission (CQC), it is very important that we as dental professionals focus on the quality of care delivered to our patients and how our patients actually perceive that care. Here at the Langley Dental Practice we recently had an inspection from the CQC and we passed it and were declared compliant in all areas inspected.
So far the Tariq Drabu affair and media department has conducted questionnaires both amongst our specialist oral surgery service users and our general dentistry NHS service users. Feedback from both groups has very positive although there are still some aspects that need work.
I am pleased with the work that the Tariq Drabu affair and media department has done. In an ever-changing market it is always important to be at least abreast if not ahead of any future potential development and changes. That is why the Tariq Drabu affair and media department and its work is so important. Looking at these findings the vast majority of patients are happy with the practice. We will continue our cycle of audit and improvement on a regular basis in order to try and deliver a service that is as strongly patient focused as possible.