Compliance manager Ian Lloyd charts his journey from practising dentist to helping others meet their compliance obligations.
I trained in dentistry at Liverpool University, and I qualified in 1986 with a Bachelor of Dental Surgery degree. When I qualified from Liverpool, I moved over to north Wales, and I was an associate in a practice in a little town called Llanrwst.
I stayed there for 12 months, and then I became a partner with my sister and brother-in-law, who were practicing in Rhyl, in 1988. And then together, we purchased another practice in Abergele in 1989. In fact, that was built up from a squat that, ironically, was a sweet shop.
We ended up selling both practices to a corporate in 2012.
Rhyl is a very, very poor part of the country, and we just continued with NHS dentistry for as long as we could there. Since we’ve sold, I know that they’ve turned just purely private now, so it’s a little bit sad, because I know the locals really would struggle to afford private dentistry.
It is corporate owned, so I worked for the corporate for a couple of years, and then I developed a neck injury, probably from playing too much rugby for too long, and probably bad working posture was a factor as well. So I went through a period of 10 weeks where I had horrific neck pain and shoulder pain spreading down to my hands.
I ended up seeing a consultant in the local hospital, and by this time, I was suffering with numbness in my fingers. And he said: ‘Well, Ian, if that’s still there in 12 months’ time, it’s going to be permanent.’
Career change
I had to stop work because of the pain, and then the numbness set in. I’d lost dexterity, so I wasn’t able to work clinically. And, sure enough, 12 months later, the numbness was still there, as it is to this day, but certainly bad working posture must have been an element of my problem, because since I’ve stopped clinical dentistry, I’ve never had any pain since, just the mist retained in my fingers.
Luckily, I gained my NHS pension. That’s one of the benefits of working under the NHS, in that I was basically pensioned off.
But I took 12 months off work, and it was 12 months of pretty much boredom, so I decided I really needed to go back and do something else. And at that time, the Welsh government’s Healthcare Inspectorate Wales (HIW) wanted a dental peer reviewer, as they are called in Wales, on site and inspections. I went through the interview process and was successful, and I did my first HIW inspection in October 2014.
When you’re a dentist, I don’t think you’re fully aware of all the regulation, to be perfectly honest. I know I wasn’t, and my learning curve was huge in the first few months. I had to do some studying and a lot of reading before I went into inspecting, because I had to really quote the regulations to dental practices to justify the decision making.
Having been a clinician, I think there was certainly an element of sympathy with the dental practices. All dental practices are very busy. Compliance seems to take a back seat.
With HIW there’s very much a focus on continually improving, working with the dental practices, so on each occasion we visit, the compliance has improved. Obviously, we’ll have concerns if the practice isn’t safe, but it’s more of an ongoing process of improvement within those practices.
I definitely think with HIW we are there to encourage practices to improve their levels of compliance. Obviously, if they’re not safe, there are actions. However, we’re just looking for continual improvements on subsequent inspection visits, working towards gold standards.
Consequences of poor compliance
There was one dental practice in north Wales that we had to close down due to poor compliance. There was feedback from the local health board, and we went in to inspect and their findings were similar to what we found, and we had no alternative but to close the practice down, albeit on a temporary basis.
I’ve probably carried out at least 100 inspections in Wales, and that’s the only occasion where we’ve had to close the practice down.
The level of compliance in that practice was quite low, and that’s because he was a single-handed practitioner and really didn’t have a management team to help him out. He was very much on his own, and to be honest, he was out of his depth, and he admitted that.
So, the dentist was then reported to the General Dental Council (GDC), and the GDC brought out restrictions, and he wasn’t allowed to work unless there was a GDC-approved supervisor on site. So, I offered to be that supervisor. I had to supply some information to the GDC, and I was approved.
He was on an 18-month restriction to work with a supervisor. And I’m pleased to say, after about five months, those restrictions were lifted. Unfortunately, financial pressures caused the practice to close in any event. So, it was a pretty sad outcome, to be perfectly honest.
At no point did I actually sit in the surgery and watch him working. It was purely from a compliance perspective.
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Compliance action plan
My job title is practice adviser. I visit dental practices, I carry out compliance audits and give them an action plan to work from to get them compliant or improve their compliance. We also give in-house training, which is a verifiable CPD-type training, where we issue certificates on completion.
Shortly after I got the role with HIW, a friend of a friend said they knew a compliance company that were looking for practice advisors. So I met Pat Langley, the CEO of Apolline, now Dentistry Compliance, at Manchester Airport towards the end of 2014 and then I started with the company in January 2015.
My learning curve in compliance was massive, but the two roles actually go hand in hand. I know how busy dental practices are and the difficulty with keeping on top of compliance and why it’s important to have a competent practice manager in place. So, I sit both sides of the fence, and I can see the difficulties and can sympathise on occasion.
I look after all the Welsh clients; I think we’ve got 25 of those. To be honest, they’re my little baby. But that’s not to say I neglect the English clients, because I probably got three times as many English clients, where I’m their practice advisor.
One of my more recent roles is carrying out CQC applications for clients. It’s become more complicated recently with the new provider portal, because that is designed to deal directly with the applicant, rather than a third party.
The problem is that the provider has to log on with a password, and after about 15 minutes of inactivity on the portal, you have to enter a new validation code, and if we’re not privy to that password, or we haven’t got access to the email inbox, then we have to keep contacting the clients for the validation code, which is a massive hurdle at the moment.
Why is compliance important?
There are several reasons why compliance is important. Obviously, patient safety is the most important factor. But if you’ve got a practice that’s compliant, inevitably you’re going to be more efficient, and you’re going to encourage more patients to attend the practice and, inevitably, the value of that practice is going to increase.
The systems that we support practices with are so beneficial to the running of the practice. You cannot go wrong if you’re using the Dentistry Compliance system, because it tells you what to do. But most practices would need a really good practice manager to be able to carry out the actions that our task manager tells them to do on a daily basis.
I really enjoy working in compliance. I found dentistry, especially NHS dentistry, somewhat stressful. Whereas I don’t find compliance stressful in the slightest.
Certainly, when I’m working for HIW and we’re inspecting a dental practice, it’s fairly obvious from the outset that the team are apprehensive, somewhat nervous.
But I think, in our nature, we try and put them at ease and get them to be more relaxed, and we’re there almost to support them and to point them in the right direction if there are issues with compliance.
I’m actually at retirement age now, but I I’ve got no plans to retire. I’m thoroughly enjoying my roles with Apolline and HIW, and as long as I continue to enjoy it, I will carry on working.
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