Tariq Drabu Dentist Affairs Concerning Mouth Cancer 2013

Last week North West dentist  Ian Hughes was acquitted in the High Court in London by a judge of negligently failing to spot a patient’s life-threatening oral cancer.

The circumstances surrounding this case were really unfortunate. The dentist concerned was cleared of any negligent behaviour. Nevertheless mouth cancer is a disease that has increased by around 50% over the last 10 years. Over the next 10 years around 60,000 people will be diagnosed with this disease. Without early detection around half of these people will die. By 2030 the it is estimated that almost half a million people worldwide will die from mouth 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. We at Langley Dental Practice support the line that says 'If in doubt get checked out.' 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.

Tariq Drabu Affairs at the CQC Must Sharpen Up

The Care Quality Commission (CQC) to sharpen its focus, redefine its role and win the confidence of the public. This follows the highly critical report published recently by the all party House of Commons Health Select Committee. The report, released on 9th January which was widely reported in the UK press and television media.

Among its key findings as widely reported in the media was the concern that the CQC needs to have an idea of what its core purpose is if it to inspire public confidence. I echo the findings of the health select committee. The CQC was founded in 2008 and even now some five years later many health professionals do not have a clue as to what it is there for. The CQC began registering dental practices two years ago. At that time, the vast majority of the dental profession questioned the need for CQC registration when we as dental professionals were already registered with organisations such as the General Dental Council and we were already being inspected on a regular basis by our local primary care trusts. Many dentists were furious and appalled at the level of ignorance of some of the inspectors when they finally came round to inspect. Some inspectors asked dentists as their opening question is how they physically restrained and held down their patients. For many dentists a CQC inspection was just simply a box ticking exercises to show the policies and procedures were in place. It never got to the root cause as to whether practice was providing a good quality of service and care to its patients. These experiences and findings were echoed by the Health Select Committee which said "The CQC's primary focus should be to ensure that the public has confidence that its inspections provide an assurance of acceptable standards in care and patient safety. We do not believe that the CQC has yet succeeded in this objective."

As dentists we feel that we were used as experimental guinea pigs in advance of the real big agenda which is the registration and inspection of GP practices. This is echoed in the findings of the committee report which states "Looking ahead to the challenge of GP registration the committee will examine carefully in 2013 the extent to which the CQC has learnt from its experience of dental registration and is able to deliver a streamlined process that limits the burdens placed upon GPs." This seems to imply that a lot of burden and stress was placed upon dentists during the registration and inspection processes. To use dentists in this manner is very unfair.

What struck me about our inspection process in October 2012 was that there was no real clinical input. What I mean by that is there was not a doctor or dentist or another healthcare professional who was actually coming to do the inspection. Some of the inspectors came from a social care background; the inspector who came to inspect our practice was from a pharmaceutical industry background. The health select committee found that although clinical expertise is available to the CQC, almost nine out of ten inspections carried out did not have a clinical expert input. That is a shocking statistic.

In 2011 Langley Dental Practice achieved the BDA Good Practice Scheme award. This is an externally validated quality benchmark which assesses and measures quality in dental practices. We were also subject to a CQC inspection in October 2012 which came forward with a very positive outcome. At the moment we are reapplying to be a training practice within the North West Deanery and will therefore be inspected by the deanery within the coming few weeks to assess our suitability. We welcome this level of scrutiny as it keeps our practice sharp and focused in order to deliver high-quality patient care.

My action plan for the CQC would be:

1. Clearly define its role with respect to public safety.
2. Set itself some achievable objectives over the next 18 months with respect to its key stakeholders - namely the public and the organisations that it regulates.
3. Review it's performance against those objectives with an independent assessor.

The CQC must define its role more clearly to have any credibility with the public. It must take on board the findings of the health select committee. It has already lost one chair and its current chief executive has stepped down early. This indicates a loss of confidence and lack of leadership at the top of the organisation. If this were a company in the private sector it would have collapsed by now. The CQC needs to get its act together sharpen its focus, redefine its role and come up with a system of inspection and regulation that really does focus upon quality and gains public trust.

Tariq Drabu Looks to 2013

2012 was an exceptional year for us. In January 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. We are currently applying again to be a training practice in the dental foundation training scheme in the North West deanery. This will again require an inspection from two of the training program directors next month. So all the time our practice is continually alert in order to be prepared and ready for inspections and quality audits at any time from whatever source.

On a personal level I was absolutely thrilled and delighted in August 2012 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. I have been at the UCLAN dental clinic for 4 months now and am enjoying every week that I work there as it brings new challenges. Last week was my first opportunity to meet my first group of postgraduate students and I was delighted at what a keen and energetic cohort they were.  The vision of teaching and training that UCLAN has is outstanding and I am sure that 2013 will see the teaching program go from strength to strength. We are already looking at a variety of short courses as well as the formal masters and postgraduate taught programs.

In terms of Dental CATS 2013 sees the abolition of local primary care trusts in April. I have always enjoyed tremendous support and backing from Heywood Middleton and Rochdale primary care trust and I look forward to working with the successor body to continue to help to deliver high-quality specialist dental services in our locality.

After a great 2012 we are looking to 2013 as a year of progress and consolidation for Langley Dental Practice. Exciting times and new challenges lie ahead and we look forward to meeting them.