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Dentists Who Invest

Podcast Episode

Dr James: 

Fans of the Dennis who Invest podcast. If you feel like there was one particular episode in the back catalog in the anthology of Dennis who Invest podcast episodes that really, really, really was massively valuable to you, feel free to share that with a fellow dental colleague who’s in a similar position, so their understanding of finance can be elevated and they can hit the next level of financial success in their life. Also, as well as that, if you could take two seconds to rate and review this podcast, it would mean the world. To me, what that would mean is that it drives this podcast further in terms of reach so that more dentists across the world can be able to benefit from the knowledge contained therein. Welcome.

Tony: 

Welcome to the Dennis who Invest podcast.

Dr James: 

Welcome back everybody to another episode of Dennis who Invest official podcast. Got a wonderful. We’re getting back into the swing today of regular podcasts with regular guests. Over Christmas time we had to make do with just me. I felt a little bit rude asking people, I must say, over Christmas. I’m sure they want it to be with their family and that’s why I’m extra appreciative to our guest today who’s donated some of his free time to come and talk to us. I’m sure you’ve all seen him on the group. He is well-knowing within the dental industry. He is someone who’s very well qualified to speak on lots of things I think will be of interest to the group. He is a specialist prosodontist. I’m right in saying that you run your own practice, you have a general background in investing and, last but not least, you’ve recently been re-elected to the primary executive committee of the BDA. So you speak up on behalf of us dentists. Rights to the BDA get stuff done. Somebody needs to do it, after all. His name is Tony Kilcoin. How are you, tony?

Tony: 

I’m very well, thank you. I do practice in Yorkshire, by the way, but I like to think of Yorkshire as the new London. As everyone did, the tier four Exodus up to Yorkshire.

Dr James: 

I’m a little bit out of touch. I think it’s still in tier three because I’m in Northern Ireland at the minute.

Tony: 

So that’s the interesting thing A lot of Yorkshire has stayed tier three, which is quite surprising, isn’t it?

Dr James: 

Why are they running back? I don’t understand.

Tony: 

Just the cases are still high, but they’ve stayed similar, so they haven’t worsened. So I think that’s why I mean ask us next week, and it could be different again.

Dr James: 

Sometimes it goes out the window in these tiers anyway, doesn’t it but three? I’m glad to hear that, because I have to fly back sometimes in and hope there’s not going to be an issue there, fingers crossed. When I was flying back over to Belfast not so long ago, it was mainly people from the Republic of Ireland on the flight, because they can’t fly from the UK, you know. So they’ve had to hijack our planes effectively. But yeah, you’ve got to do what you’ve got to do. They wanted to get back home to see their family, so I don’t really blame them too much. I hopefully don’t think there’s going to be an issue when I’m flying back, so we’ll have to see on that one. Anyway, have you had a nice Christmas, tony.

Tony: 

Yes, it’s been a very nice time. It was my birthday yesterday. Oh, 60. It’s one of those Sounds like such a big number, yet in my head I’m still 40, you know, which is still probably old to you, but nevertheless. I’m 60 is the new 40. That’s that’s. That’s what we’ve decided.

Dr James: 

Hey, you’re only as old as you feel. They say Tony. I’m about to hit 30 next year and that scares a life out of me, just to give you some context. But it’s all relative, isn’t it? It’s all relative, it is wonderful stuff. Yeah, happy belated birthday. As I say off camera, tony showed me this wonderful card that his family got him and this thing is it’s like an A5 page. It’s glossy. It’s got all these photos with Tony and his family on it. I hope I’m that much loved when I make it to 60. I’ll tell you what. You feel free to pop it up for the camera to those people who are watching the video.

Tony: 

All right, there you go. It’s not wonderful. I think that’s really nice. That’s really cool, my wife. My wife set up a Facebook group, in secret of course, and just said basically, when you’re with Tony, knows Tony, or whatever, let’s all just contribute past it. So some fun, some embarrassing, but you know, that’s what it’s about what are friends for.

Dr James: 

What are friends Absolutely? I was going to say something as well. Yes, off camera. Tony and I were saying as well that Tony obviously couldn’t celebrate his birthday as he traditionally would do, with a big party or a get together or anything like that. But you’ve had quite a few people come together. You had a big zoom call. The coronavirus pandemic has necessitated this, but we were just saying that there’s a gift in everything, which is quite a nice way of looking at it.

Tony: 

It was great, and I even had people chat to me from Australia and all over, which may not have easily happened otherwise. So every cloud has a silver lining. That’s the way we’re going to make a positive any situation.

Dr James: 

A bit of positivity. We’re in short supply of that, tony. I sense that me and you could probably not her all day. We have, of course, got some questions here that I’d like to ask you regarding your role and general investing. For anybody who doesn’t know you, who’s listening to this podcast and perhaps never seen you on any other dental groups beforehand, would you like to do a little bit of an intro about yourself, just in addition to what I was saying earlier?

Tony: 

Sure, I mean, it’s one of those things when I write my CV. Now it’s a bit like if you were selling your house and you were describing it, you know, with lovely views and extra rooms, and you think, wow, this sounds fantastic and it’s kind of like, yeah, but it’s still just your normal home. But you know, I qualified at Sheffield University in 1983, within two or three years I saw hairdressers for sale. I was looking for somewhere to live in the beautiful village of Howarth in Yorkshire. I thought, wow, that would make a fantastic practice. It’s on a main road, near a post office. Adopters, you know, ticked all the boxes that everyone said this is where you should look for location. And when I went home and looked to see how many dentists were in Howarth, it was zero. I couldn’t understand it because it was such a beautiful village but it like a dormitory village and of course people work somewhere else and so on. Anyway, long story short, I applied for planning permission. Soon as I did, several dentists tried to guzzump me, but in a higher offer than I did. Once they saw the public planning permission getting passed. So I ended up in a sort of Chinese bidding auction and ended up overpaying for the building, which I was very annoyed at as a young man at the time but needs must. So I converted it and I opened the doors and I think first day I had four patients and basically I’ve been there 35 years. So we bought next door and we’ve expanded and so on, but it’s now a totally. It’s gone from NHS to mixed to totally private, to mainly referral practice now and prosthodontics is a grand title but it just really means crowns, bridges, implants, rebuilding worn dentitions, the difficult stuff kind of nobody else can easily do in primary care and secondary care just simply can’t deal with all the referrals. So you know we can see them privately and sort them out and smooth any rough waters for people and so on. So that’s my clinical side. And then as I progressed, sort of getting involved with other dentists and groups and I was an examiner at the Royal College of Surgeons, then I actually got elected to the GDC and that was very interesting because they really need clinicians input there. I think we can all agree and I was on the main board and I did things like, you know, standards and education and policy advisory committees and stuff. In other words, even a lot of the standards we do today you. If you look at when the date was done, it goes back to 2013, which was the last year I was there, because after 10 years you have to leave. There’s a maximum amount of time. But the only unfortunate thing about the GDC is they gradually reduced, if you like, the input of dentists and clinicians into how the GDC runs, because they saw it as a conflict, when actually it’s an ideal opportunity to stay in touch with the very people who apply those standards. But, you know, not everyone saw it like that, so that’s where the tensions were there. But I found it a very interesting experience to see it on the other side and it’s allowed me to help many colleagues who find themselves in difficulties or challenging situations Because, let’s face it, most people just need a little extra help and advice and support. Really, dentistry can be very isolationist. And then, of course, yes, I stood for the BDA and I was elected four years ago to a UK seat and things were progressing quite well. But, as people will know from recent articles, there was unfortunately other things going on and I had to whistle blow about those and I resigned in June and I stood again and I made it very clear in my election statement why I was standing to fix the BDA, not break them, and they really do need that input. They really need to get back in touch with what members want and if you want me to do this, vote for me. And most people voted for me for that, because there was two UK seats and I got the highest number of votes for the UK peck seat and that officially starts on the 1st of January in the new year. So I hope even if there’s some bad feelings there at the BDA, because I’ve had to try and help them help themselves that they will be the adult professionals and look at how we can fix and improve things, because we really do need the profession to work together here and not become insular or self serving in any way. We’ve really got to look at what’s best for the profession and I think I’ve been so fortunate, having gone through the, the GDC route and helping colleagues and so on. You know that’s a big driver for me. I actually want to help colleagues. I’ve just celebrated my 60th birthday. I’d like to think when I do eventually ease out of dentistry, which my wife always says, yeah, that’ll be when you’re 80. But nevertheless, when I do eventually, you know, I would like to look back and think, yeah, there were tough times there, but we made some positive differences. And I know my colleagues on the front lines are so hardworking, so caring, so want to make positive differences, but there’s a lot of barriers in the way of that. So if I can help them, go around them or over them, that’s my number one goal really. So so that’s where I come from, that’s where I am now. I also run a foundation training scheme for young dentists. Now I’ve done that for 30 years. When I started I thought I’ll just do this for three years and see how it goes. But again, these are the future of dentistry and I love our young colleagues. They are getting less and less clinical experience. They have more and more challenges and, of course, they’re qualifying with a lot more debt and you know that’s a burden. I think my generation was very fortunate with. You know we had a little debt that we could work it off in a pub at weekends or whatever. So we have very little debt. I mean, these people are qualifying with 60, 70, 100 grand plus debts now and you know, starting in a profession in the middle of COVID, can you imagine where they’ve already got a lot less clinical experience from dental schools because they’re just not operating. So the challenges are huge. So, again, I see it as a privilege that I can help them at the beginning of their careers too, as best I can from an educational, supportive, mentoring, pastoral point of view. So I actually enjoy this. I am choosing to do this and I love the way my career has diversified as well, that I can do multiple things. The main thing I do most days of the week is working my practice, treating patients. I’m on the front lines too.

Dr James: 

Speaking of someone who, not so long ago, went through the whole FD process. So I qualified in 2016. So my FD year would have been 2016, 17. I actually felt that I just about got to that point where I felt competent enough to go and do dentistry independently, maybe in the last month or two. Now, maybe I’m a slow learner people might argue that maybe they might be wrong on that one, but what I’m saying is that, for the, my heart goes out to the FDs who are presently working, because they’ve had this huge compromise in terms of their clinical activity and I I presumed only that the umbilical cord is going to be cut at the same time in one year from when they started just as normal, or is that being extended? I don’t know much about it. Real quick, guys. I put together a special report for dentists entitled the seven cost and potentially disastrous mistakes that dentists make whenever it comes to their finances. Most of the time, dentists are going through these issues and they don’t even necessarily realise that they’re happening until they have their eyes opened, and that is the purpose of this report. You can go ahead and receive your free report by heading on over to wwwdentistuneinvestcom forward slash podcast report or, alternatively, you can download it using the link in the description. This report details the seven most common issues. However, most importantly, it also shows you how to fix them Really. Looking forward to hearing your thoughts.

Tony: 

Well, the answer is HEE, who you know run that in England, but there will be other. You know the other four countries operate similarly with their own boards. They are looking at this quite seriously. The problem is HEE have to, if you like, provide for any graduates that the dental schools produce. So it’s very much in the dental schools caught now, so to speak. So they will hopefully be telling us in January is the whole year going to graduate in June and July?

Dr James: 

From the, from the FD scheme, sorry. Or from the dental school no from the dental schools, right?

Tony: 

So if the dental schools say nobody’s graduating in summer, we’re going to give them extra clinical time. Obviously we have to move with that. If they say everyone’s graduating, then we have to both try to provide the schemes and try to compensate for any areas they need most helping. But we’ve only got a year to do it and we already feel like we’re doing miracles as it is. So you know, that’s where the strains are. No, but that’s where it is, isn’t it? And it’s the dental schools teaching them. They may say half the year is capable of graduating and has enough experience to benefit from foundation training. Half will be held back and there’ll be another. So there have to be a mid-year scheme as well. So the answer is it could be very disruptive. We’re going to adapt to whatever’s best for the students who will be graduating and so on, but we won’t know yet, for maybe another month or two, I see.

Dr James: 

No answers quite yet on that one. Fair enough, really Understandable, because I mean there’s no answers on the COVID pandemic just yet. We don’t even know the first thing, and fingers crossed. This vaccine works against the new strain? Sure, I’m sure it will. I’m an optimistic person. I also a question for another day and one that will not delve into too much on this one is how much are the government actually using this new strain to further their own agenda and maybe shift some of the blame from their mismanagement onto, perhaps, something that we don’t know? How much is actually contributing to the pandemic? That’s a conspiracy theory that is way off the mark of what we’re going to talk about today. Just an interesting one that I heard. I’m generally not a conspiracy theory person, but that one would add up quite a bit. Moving swiftly on, tony, I think it’s safe to say that in dentistry, if there is something to do, you’ve done it effectively. I want to know a little bit more about your role within the BDA, how you mentioned that you came to be involved in it. I’d like to know the specifics of that. Bringing your GDC knowledge to the BDA must be something that they’ll find very useful, and being a practitioner for as long as you have. What inspired that and how did you go about becoming part of the BDA?

Tony: 

Well, probably for a number of years I have been how shall I put it? A constructive critic of the BDA. It is, isn’t it? It’s like watching a football match. We can all sit there and say, oh, come on, bring this person on, do this differently, whatever. We can all be kind of armchair directors and I was making suggestions and doing other things and campaigning and so on, and more and more colleagues said Tony, why don’t you stand for the BDA? Put yourself up there. There is a democratic process that all the BDA members vote for who they want on their top board making strategic decisions for the BDA at all. That’s called PEC. So I thought about it and I thought, okay, I’ll put myself forward. I wrote what I felt the BDA could be doing different or better, and I joined the BDA, not because it was perfect, but because I felt I had something to contribute. Did the members want me there or not? And so, yeah, I won the seat basically the first time four years ago. So we went on and the general process is there’s about 15 of you on PEC and every year, five of you stand up for reelection. Of those five, one is a UK seat and four are local seats. Now, local might mean Wales or the Midlands or a large area like Yorkshire and so on, but to get elected to those seats you might only need 50 to 100 votes, whereas to get voted on to a UK four country seat then you need lots more votes, hundreds and hundreds of votes. So it has to be kind of a more of a consensus, if you like, decision. However, they’re all democratic and the reason it’s organized like that is because then you will have representatives from different parts of the country’s countries. You’ll have all four countries involved and there’s a number of UK seats three of them that anyone could stand for from any of four countries to. So the UK seats are kind of a free for all. So in this last one that I was elected to, for example, there’s 37 candidates for four local seats and two UK seats. Now there was only two UK seats because I had previously resigned in June and they’re freed at one of them, and they decided to wait and then put the elections together towards the end of the year because I guess it’s cheaper and easier to organize and that’s fair enough. I suppose you know that’s the decision. So there were two UK seats and they decided that this time. Whoever got the most votes would start again with three years and whoever got the second most votes would take over my previous 10 year, which had only been going six months. So, as they’re appointed in November, they would have two years and one month. So, if you like, whoever got the most votes got the full seat, whoever got the second most votes got the second UK seat and then all the local ones got their local votes and they were put in place. So I won the number one UK seat on the mandate of going in and helping the BDA to change its processes and improve itself and to address the points I’d raised. And I hope they will take that on board and not try and frustrate those members wishes, because ultimately that is what they voted for. It was very clear on my election statement. So that’s where I am now. So I do feel that I’m in a very interesting position of trying to help fix certain things in the BDA. There’s lots of good people in the BDA, there’s lots of good parts of the BDA, but a bit like cogs in a mechanism, if a few are out, then the whole thing starts to not work well and over the next six months, my goodness, we need the BDA to work well. It has got to be firing on all cylinders. It needs to be where everyone can have confidence trust that it can adapt, that it can not put some of these silly side issues, that it doesn’t end up dominating those and missing the other big issues, and that it’s got good governance that it can deal with these challenges that come up. Because if it can’t sort itself out internally, how can it possibly sort out the other big issues that are facing dentistry? And there are some big ones coming our way over the horizon, as we know. So my job is to go in there, help the BDA work with the BDA bit of give and take, bit of compromise, but try and actually get everyone to function well. I think my favourite word is optimally optimum. So optimum doesn’t mean some extreme here or there. It means coming together in the middle to work the best of that situation. So I hope the rest of the BDA will actually help that happen.

Dr James: 

You’ve been really open and honest about your analysis of things that perhaps aren’t really going to use your word optimally in the BDA, and I’ll thank you for that. What do you think those issues are? Now, I know that there’s obviously the C word, covid. Is it wholly that? Or are there other things as well in there that you’re thinking about addressing?

Tony: 

Do you mean for the profession, or do you mean issues that I’m still, if you like, addressing with them via an investigative process?

Dr James: 

I think it will be interesting to hear both, providing there’s not a list of length of your arm or anything like that. Yeah, let’s start off with the profession and we’ll see how we go.

Tony: 

Okay, Well for the profession. We’ve got huge challenges with COVID and those challenges affecting almost sort of different sectors within the profession in different ways. All difficult but in different ways. So, for example, we have our NHS colleagues who are self-employed but are individually contracting to the NHS and, in simple terms, the majority of those are practice owners. They have a practice NHS contract. They have to deliver the terms of that, otherwise there could be fines, penalties, clawbacks and so on. Within those practices you have various groups that are either self-employed such as associates and some DCPs and employed, and of course, if it gets squeezed from the top, then that squeeze comes down onto all the others. So we have the main contractual issues, the contractor issues and, in a way, the subcontractor issues within those, and they can all be different but still all affected. And then outside that we have people who are employed. We have private dentistry sector Now, perhaps in the past past that would have been less than a 1% consideration the unusual people who work on Harley Street and so on, but these days it’s rare to not come across a practice that’s at least doing some private to, in effect, either subsidise or prop up the NHS contracts that are usually not that well financed or it always ends up going right to the line on the 1st of April April to April year deadlines and of course there are some where they’ve managed to grow that significantly in their practices and that’s helped them to develop their practices and services to benefit all their patients and staff, and so on. So private is actually now a massive, massive supporter of societal dentistry, shall we call it, and in a way, in order to give proper consent and choices to the public, they need to know everything that is available private or NHS, if NHS options are there. So in monetary terms, I believe now more people spend on private dentistry than they do on the NHS, but in numerical terms more people are seen and treated on the NHS than privately. But the truth is there’s a range of practices that are mixed. It’s a mixed economy and the analogy I’ve often used for this is transport. So we have public buses, we have other public forms of transport, we have people who occasionally pay privately to have a taxi when the public system is either inadequate and not available or they need a more bespoke door-to-door service. And then there’s some people who go totally private and own their own car, and they pay extra for that, of course, but they have extra convenience. They choose who and where they go see and all the rest. So they have more control, if you like. But if you were transport minister, you’re not going to go. Oh well, we’re just going to look at buses and ignore taxis and cars and trains and whatever we’re going to say. Let’s see how we can make this all work together for the greater good. That is missing in dentistry.

Dr James: 

Interesting. Yeah, I’d agree.

Tony: 

That is missing in dentistry. And all these things are happening kind of separately and therefore haphazardly, and occasionally they bash into each other. Occasionally they conflict. Occasionally they work just perfect together not often, but dentists are good at making something good out of something imperfect. But too often it’s a versus thing and sometimes it’s portrayed as NHS versus private, as if private’s bad or private versus NHS, as if that is bad, and actually it’s a mixed economy, a bit like transport. You need everything to be working my favourite word again optimally together to get the best result for all of society. And so that’s a big challenge for the BDA, because I have other colleagues who work in hospital or employed, who are specialists, work in the community. There’s all kinds of other sectors in dentistry that gets forgotten, and the BDA ideally, optimally, really has to be that umbrella that can go across both and say hey, we’re going to stop thinking in terms of conflict, we’re going to stop thinking in terms of favouring one that ends up disadvantage in another sector. We’re going to think in terms of win, win, win, and and, and, not versus, versus, versus. Because I think the BDA has got stuck in this almost self-conflict. Really. Some people criticise them for supporting the NHS too much. Some criticise them for not promoting private side enough. Some criticise them for this, that and the other. Some criticise them for not supporting associates enough because they’re too owner biased and the associates are getting downtrodden and treated unfairly and the COVID payments are all getting passed on and so on, and yet the majority of practices are actually being very good, very fair, very supportive. But the BDA is the ideal place to sort out these internal conflicts. So, if you like, actually have a policy of care for itself, because unless it can do that, it can’t really go to government and suggest to government how they should run dental services if they can’t run themselves where they’re seen as equal, fair, supportive, constructive to all the different sectors. It has to kind of be not just the arbiter but the actually. It has to walk that walk. And it’s a difficult walk to do because as dentists we’ll all think, oh well, how does this affect me right now? And we need to also just broaden our mind a little and say, actually, what is for the greater good? And let’s think win, win, win. Because ultimately what COVID has shown is with reduced provision of dental care, they’ve missed us more, they’ve needed us more and now the demanding is back and perhaps they’re valuing us more in terms of what we offer to society. And this is almost a perfect platform now, in the next three to four months going forward, to show society how we can benefit them in prevention, dental health and we know dental disease also has a knock on effect to general medical health as well. So we have a real opportunity here to show our value and be valued by government regulators, mps, society generally, to be valued in all the different sectors that we work in, and that’s the NHS and private principal owners and associates, corporates and individual owners, employed and self-employed. We have a great opportunity here to start thinking and and and working together, because together we are very powerful indeed. If we can start supporting each other in just instead of instinctively just thinking how does this affect me right now? We will make great progress as a profession and all the other. When people look at other unions, other working groups, how do they manage to succeed in things? What they do is they put minor differences aside and they work together for the greater good, because they know then everyone benefits and the public benefit too, and that’s why we’re professionals. So that is the main hurdle we have to get over. Easy for me to describe James, but it is hard to do. We need a majority to want to do this, and sometimes people have said to me well, how bad does it have to get, tony, before we, as colleagues, start looking to be inclusive and working constructively together rather than be divisive and kind of self-serving and self-protective, which is a natural human instinct, let’s be honest. It’s a natural human instinct, but as professionals, we have to stand back and say no, we’ve got to look at the bigger picture.

Dr James: 

A lot of the time. I often think to myself if we don’t have each other’s backs as dentists, then who has our backs? You know, and that’s the way.

Tony: 

That is a very good point. I mean, if we, who’s going to care about us if we don’t care about ourselves?

Dr James: 

Because we’ve got all these things harrying us. You know media don’t do us any favours Some of the public. There’s this narrative about the rich, wealthy dentist who’s only out for himself. You know, and honestly, from what I’ve seen hand on my heart, that could not be further from the truth. For the vast majority of dentists they’re kind people who just want to help, but people don’t see it that way. That’s the problem. What you said there sounds incredible. And where there’s a will there’s a way, and 100%, there’s 100% room for improvement in cohesion between us dentists. You’ve just spoke about the issues affecting us as dentists and then I sensed you wanted to touch on as well issues within the BDA that you were hoping to improve on, make more optimal.

Tony: 

So there’s yeah, there’s a lot of good parts in the BDA, but there’s some lack of transparency, there’s some lack of good governance, there’s some lack of actually a bit of a disconnect with our frontline members and concerns in the profession. And you know, I was always told don’t put down to conspiracy what can be explained by incompetence. And, of course, people here in BDA will maybe take personal offence, isn’t it? It’s like an institutionalised form of it. It’s sometimes, you know, when people are put in a different environment, it takes on a behaviour of in of itself that is perhaps not as conducive or not as connected to those on the front lines and their immediate concerns. And so that is what I want to try and help and improve and fix. And, yes, there’s some temporary inconvenience necessary to actually get a better outcome. That’s my goal to fix it, not break it, I think what you said is reasonable.

Dr James: 

Alex Ferguson’s book, the One on Leadership, it’s when you blame the team as a collective, then they all put their socks up. Blaming individuals is something that’s a little bit different and a little bit more something that you aim to avoid. So, yeah, you’ve identified that. You know you’re someone who’s going to work under the BDA. You’re qualified to say that you’re under this banner as well, so you’re able to say it. So I think that’s completely reasonable. To be honest with you, when, well recently in dentistry, there’s been a few feathers ruffled, shall we say, about this 45% UDA ruling, where do you see the BDA? How do you see the BDA approaching that? Is that something that they’ve maybe accepted as a little bit of? I mean, let’s be honest, I think a lot of people feel like the NHS was very generous when they paid all of our contracts up front or how it was at the very start Maybe not everyone, but some people Do you? Is there a perception that, maybe that this is reasonable for the governing body I don’t know who decides these things specifically, but let’s say the NHS that is reasonable for them to push us a little bit in return, or is this something that you’re actively fighting against. I was just curious.

Tony: 

So I suppose there’s two aspects to this. Really, this 20% UDA activity seemed like a reasonable thing and of course, they didn’t just say 20%, they said a minimum of 20%. If you can do more, do more. However, it’s not a target, it’s a minimum, and you are still expected to treat as many people as you can. Given how slowed down things were in COVID, given how there was extended fallow times, given how people were told to only come if it was urgent or an emergency or routine, things were kind of defaulted. And what we know is that UDAs are a terrible measure of anything that’s patient-centered. They don’t measure time, they don’t measure quality, they don’t measure need, they don’t measure what’s delivered. They do measure two things in a gross kind of way. They measure roughly the volume of people who come through and they measure roughly the amount of NHS patient charge revenue collected. That is it. But guess what government is very interested in the number of bodies that go through and how much patient charge revenue can they collect to offset their overall budgetary costs? And nowhere else in the NHS do you go and you pay hundreds of pounds for a course of treatment again and potentially again, and potentially again. Nowhere it’s a fixed prescription charge of hundreds of pounds. And for a lot of people who are technically not exempt, they’re still relatively poor and they simply just don’t have that spare money in their pockets. And they will then compromise on their level of care. They’ll choose not to have laboratory work and just have that tooth that should be crowned, filled yet again. They’ll choose to have a tooth out instead of having it root canaled and have a crown on it. They’ll choose to just not have dentures or other things and have a reduced quality of life, and so on and so on. So the NHS, when politicians say it should be free of source, regardless of income, based on need and available to all, you kind of go accept dentistry, accept dentistry, accept dentistry, accept dentistry. And you do get to the point where you think UDAs and the way things are described is just not accurate to the public and that creates a tension in and of itself. But UDAs do not measure how much time you spend with patients and at 20% most practices manage. Some still didn’t, some had staff off. Ill isolated Practices were closed for weeks. Triaging and treating a toothache can take hours because sometimes you can’t tell which tooth it is. You have to try something first, get them back and so on. You can’t measure that by a unit of dental activity. So the 20% was just an arbitrary thing. But most practices managed to suddenly jump to 45% when, okay, the follow time has reduced somewhat because of new possible mitigations and so on, but you’re still having to triage. Covid is still out there, people aren’t vaccinated and it still takes time. But the problem with the 45% target is it’s very punitive. Now you don’t meet that, you start to lose a lot of funding and get a lot of clawbacks. That could be devastating to a practice where there’s four, five, six dentists that work there, dcp support staff and so on, and so the only way they can meet a 45% UDA target in many ways is to stop seeing urgent cases, stop seeing toothaches and start seeing routine checkups and things that generate UDAs, because the criteria is UDA-led, it’s not patient care-led, it’s not doing what’s best for patient-led. They can go look at appointment books and check that, but people are spending all the time doing what they should be doing on the NHS but they’re not doing that. So it’s an arbitrary figure and the BDA being crystal clear this has been imposed. It has not been with their agreement. They certainly don’t agree with it and they certainly see a lot of problems. And I know the GDPC chair and so on, which is another committee of the BDA that tends to do the direct negotiations, at the General Dental Practitioners Committee they will be negotiating and trying to get government to change its mind on this, but it’s an uphill struggle. And, to be fair, I don’t think it was the office of the CDO, I don’t think it was all the people we usually speak to. This gets pushed up to NHSC and the higher people in charge and it’s probably, frankly, a treasury decision. The treasury said not make them jump high for 45% and if they don’t make it we’ll get clawback, some money, won’t that be great for us? And you just start thinking, whoa, this is not patient-centered and this is certainly not COVID. I was gonna say COVID, friendly COVID, considerate in the great limitations a lot of practices have. Now, of course, in private practice, you do 45%, you get paid 45%. You do 25%, you get paid 25%. You can’t work, you get nothing. So private practice, in comparison, is a lot less well looked after. However, even in private practice, we can look at this and say, well, that’s just dumb, because it’s not easily achievable. It’s an arbitrary target. And why are you measuring things with UDAs? Anyway, nobody in private practice has gone. Hey, these UDAs are a great idea. Why don’t we adopt private practice? Because it’s a dumb idea. We look at time and care and overhead and, yes, a small profit. Every business has to make a profit to reinvest in itself and keep going. There’s nothing wrong with ethically earned profits and of course, private practice doesn’t do that system. So we’re talking about mainly England and Wales, I know, in the UDA system, but UDAs are wholly inappropriate. We’ve been campaigning, and so has the BDA, for years to get rid of them because they’re inappropriate, and even Parliament’s own Health Select Committee have said UDAs are wholly inappropriate and must change. But they haven’t been changed and that’s the flaw. So yes, it’s not good.

Dr James: 

So long story short, this is something that the BDA will be actively fighting against.

Tony: 

Actively fighting. Now there’s supposed to be a parliamentary debate, but for dentistry I think on the 7th of January, and these issues will be raised. But I believe because of COVID, a new London tier four restrictions and things, there might be an increase in the recess, just like there might be some schools told to not come back for a week or two, so that might get pushed on a bit further into the debate. As we speak, james, you can see the little face, but there is a debate about this and I know the BDA myself. I’m writing a telegraph letter and I will ask colleagues to sign it. Other people are doing initiatives as well. We’re all just gonna say look, mps, everyone, please go to this debate, take part, listen to what’s happening to dentistry. This is not good, it’s not fair, it’s not proportionate and the private sector needs help as well, because they’ve been valiantly dealing with a lot of extra toothaches and problems that, frankly, the NHS system simply can’t cope with. So again, this is my optimum situation, again together for society. We are sorting this out. Just like on Christmas Day, all the taxes and stuff were taking people wherever they needed. Even if they needed to get to A&E, they were there when the public transport wasn’t, couldn’t do it. So this is how you get things to work together for the greater public good, and we have to change that mindset that it isn’t versus it’s not. Instead of it’s not one benefits at the demise of the other, it’s that both are providing an important service in synergy to society. So it’s NHS and private together helping the public get through this, and we need the politicians to appreciate that.

Dr James: 

I like that, I really like that. How do you see that proceeding, then? Or are you able to say at this point and when I say so specifically, the thing I was interested in knowing about how, with regards to how it might be proceeding is the 45% ruling. Is there any signals that they’ve been giving off at this point that might lead you to suggest that they’ll push that even higher? Maybe it might be 50%, 60%, or can you even say anything at this point? Or is that too far off or you’re not on your point.

Tony: 

Well, I would say we just start to speculate a little here because obviously nobody knows what might happen there. But the 45% is just for this last quarter in the financial year, so January, february and March, and it will be compared to its equivalent either for the existing year or quarter of that or the previous years for those months. But of course those months were affected by COVID and you were seeing the full range of normal patients which you need to do to achieve such targets. And they will say, yeah, but we’ve reduced it by 45%. I just think that number’s the wrong number and in fact it’s the punitive effect. They are actually in danger of pretty much destroying the provision of NHS dentistry going forward and they have to be aware of that. And I think the public and politicians have to be made aware now, because there is a 36% level below the 45%. So if you get 40% or 38% you will then get a proportionate reduction in your contract, but as soon as it hits below 36% it drops off a cliff.

Dr James: 

I mean, I must be honest, anecdotally, from other practice owners that I’ve spoken to have said that they want to get out of the NHS now. So punitive punitive from the point of view that you’re punishing the dental practices and punitive from the point of view that you may even be sabotaging yourself because people seek to no longer associate with you because of these measures, because of the clawback that you might have. And maybe they’re looking at private and they’re saying actually this is a lot less stress. We know roughly more likely, what we’re going to turn over. We can just put our prices up as a fair if we wish.

Tony: 

And, yeah, self-sabotage, perhaps you might even argue Well, again, we’re down to never put down to conspiracy. What can be explained by incompetence?

Dr James: 

I like that We’ll leave it at that.

Tony: 

Oh no, you want to say more, go on, I’m not always going to say more, but sometimes you do wonder how much repeated errors can be made before it’s a deliberate pattern. And you see, this is the thing you know once might be accidental, two is a coincidence. Three things you’re starting to form a pattern of behaviour there that is not easily excusable. So of course I do feel there is a way to look at activity constructively in the NHS. That is again my favourite word optimum. That’s good for the patients, good for public need, supports the practices through this difficult time and reduces any abuse either way. But high UDA targets are not the way and that is what’s going to cause a lot of issues.

Dr James: 

How do you foresee a new NHS contract panning out in April? Speaking of March and April, Well, who knows what?

Tony: 

Again speculation I was just curious on your thought oh, speculation, I mean will it just be a variation of UDAs? Will it be? I mean, the BDA have always been in the past keen to get rid of UDAs. The pilots have shown that UDAs don’t work very well. The more computation that there is, the more stable a practice base can be and the more it can meet the individual needs of that local practices population really. And some of that might be more children and prevention. It might be outreaching the schools, who knows? Once you’ve got a capitation, you’ve got a steady fund with which the practice can flexibly apply it to patient need. So we do just need a whole different contract. Somebody else it might be. Yeah, we’re in such a poor area of high need and we don’t get people regularly attending because they’re missing appointments all the time. They need a really good two-fake emergency service and they might totally buy it. But you’re going to meet the needs of those different areas Somewhere else. Just need basic exams, support, perio and the more advanced stuff. Perhaps there’s no money left or they can do some. But the practice with under-capitation can have that flexibility and, through good examinations of the patients, can base it on the need of those local populations. Again, we come back to being patient-focused, patient-centred. Not bad targets, not bad systems and certainly not bad governance. So we really have to get a handle on this. And UDAs, we know, fail in all those respects. They’re not patient-centred, they’re not based on care or quality and they’re certainly not individually flexible enough for different regions’ needs, and so it does need another looking at. So when you say what’s going to be the new contract, I think there’s still this tension here of the government-likeing targets or maybe the treasury-likeing targets, for the reasons I’ve already mentioned. It’s a crude measure of access, it’s a crude measure of collecting patient payments, that’s it. Otherwise, it’s a disaster. And every practice from April to April is on tender hooks. It doesn’t know whether it’s going to meet the targets or not. Will it face a big clawback? And if it does, it then has to go back to wallets associates and say, hey, you have to do your share of this now. And suddenly it all becomes very negative and insecure. And how do you plan forward for that? How do you do forward investment in your practice? How do you improve services, environment? How do you keep up with new technology? And you don’t even know that you’re going to get the same funding next year? How do you plan? It’s crazy. So it’s not good for patients or the profession.

Dr James: 

It’s really throwing the fox in the rabbits, has this poor COVID business. And when there’s another expression, when the tide goes out, the cracks show on the ship. I suppose might be apt as well. Do you think we spoke a lot about NHS? Do you think that we actually slightly touched upon this earlier? Do you think that private dentistry is being forgotten a little bit, maybe by the government, maybe by the BDA?

Tony: 

Again, conspiracy, incompetence or ignorance, I don’t know. But for a long time the private sector has been growing.

Dr James: 

No doubt about it.

Tony: 

I mean, like I said to some colleagues, have you thought about setting up a private squat? 10 years ago They’d be like, oh no chance, can’t be done, impossible, maybe in some areas around London. Or they just have this perception of, oh yeah, if there’s a lot of money somewhere maybe. But actually now the prices of NHS perhaps has been so high, the punitive contracts being so tight and the insecurity around the NHS, which has not done itself any favours, a lot of people are thinking, yes, it’s hard in the first few years, but you actually have something you’ve built, you’ve started, you’ve created the environment you wish that will attract patients. And there are private plans you can pay on capitation. It can be very affordable. Now you can provide the routine period, restorations and checkups and prevention for children very easily and very affordably for a lot of the public and suddenly it’s viable. Suddenly you can put together a business plan. You find the right premises, the right area and get a good team together you can stand out. So now I know many associates are thinking that might be the route I go down. And then who’s gonna buy the NHS dental practices? Will it just be the corporates hoovering everything up? Will it be just being a sort of mini corporates of 10, 20, 50 practices together in groups and branded, so we might just have lots of little niche private practices providing for what I would call good routine family dentistry and not just the cosmetic and the aligner braces and the more shall we say optional dentistry, but more sexual dentistry, but done very patient focused. So I can see that happening and I can see a lot more practices developing the private side and becoming much more mixed. And it could well be that, if you like, the private business element is the bigger element, even though the bigger numbers are seen on the NHS. And so gradually I think there is a trend of private being unappreciated. It’s been slowly growing. The public are far more accepting of it. It’s not seen as, oh, that’s exceptional or weird. They may not like it because the politicians have promised everything free on the NHS to everyone, which is fine. When you see your medical GP doesn’t really apply to a dental GDP at all in anything like the same sense. So it means two very different things and so private really is almost a natural progression. But again, I would like the government to not be ignorant of that and look at how, instead of conflicting, it actually works more in synergy for the greater societal good.

Dr James: 

The part I find interesting about what you just said is even hard. Now. I’ve had a very small window into dentistry compared to you, because I have, of course, only been a dentist for four years. Within that window, I’ve always sort of perceived it as, yes, we have the NHS, yes, we have private, but they very much kind of compliment each other almost, and you’ve just told me that even 10 years ago, aside from these incredibly affluent areas, that this was something almost unheard of or it was very difficult to find a private practice. So, yeah, I can 100% vouch for that shift, because to me it’s always just felt like there are these two things that compliment each other and they’ve always been there. And will that mismatch or will that those percentages, in terms of how much interest they garner or how much foot traffic they get from patients, will continue to shift? It sounds like it, particularly if we’re just going to see NHS dentistry the quality of dentistry you can do continue to go down, the more patients have to pay as a proportion of their UDAs go up, which seems to be happening too, and now, well, who knows what’s gonna happen, just as you say, in April time. So, yeah, I was just, I was interested, as I say, because I always thought that there, it was always there, or it was always consistently like that. But yeah, there you go, interesting one for me and anybody who’s listening as well, I suppose, who’s maybe qualified around about the same time as me. On the topic of NHS versus private good time to buy a practice in NHS, good time to buy a practice in private? What are your thoughts?

Tony: 

Well, I know a lot of colleagues who, having sold practices last year or the year before, feel like they’ve won the lottery. Ha, ha ha ha ha.

Dr James: 

Yeah. Yeah, I know what you mean. They don’t have all this headache about PPE and regulation and all of this. So fair play, fair play.

Tony: 

You know, the value of the practices increased greatly. They maybe had two or three people competing in an auction for it. They probably got higher than the average true market value, shall we say. Because of that They’ve banked that whilst COVID has sort of helped maybe the NHS side for the person who’s bought it, as you say, they just don’t have one tenth of the grief and hassle that they would have had as owners had they continued. So in a sense talk about perfect timing. But we’ve seen a lot of people kind of accidentally fall into that, I think for the last four years or so. A lot of people have felt that prices are, shall we say, near a peak, if not at a peak, in various cycles and that’s for all kinds of reasons. And so, you know, one has to ask can that continue really? And I suspect it’ll always be a viable business? But if you were a young person, would you invest your money in a mixed practice or a totally NHS practice? Mixed? And certainly the mixed is showing the private potential and further conversion. But it’s also got a foot in both camps. So whilst going through difficult COVID times, there might be some supportive funding that they can at least depend on in the short term, that as a long term thing. What is the trend? And the trend is simple NHS funding for dentistry is capped. It’s like that. It stays the same. Now, every year, you’re overhead, you’re wages, technology renewal, reinvestments. That’s going to cost more money. Where’s that more money going to come from? Not the NHS, because it’s like that.

Dr James: 

For anybody who can’t see, because they’re listening on podcast, Tony is moving his hand in a horizontal tangent across the screen, so he means it is level.

Tony: 

Yes, that total national funding stays the same. That’s why they like the UDA system. There’s a maximum number of UDAs. It will cost this much. There’ll be a 1.8% 2% annual uplift. It stays the same. Dental inflation is not 1.8% or 2% or 3%. It’s near a double figures. And if you want new technology, scanners, improving things, renewal of equipment in your dental practice, these are very high cost items. So where’s that extra money coming from? And again, the numbers don’t lie. It can only come from growing the private side On average on a national scale. That’s the only place it can come from. So it’s inevitable that the increase will have to come from the private side. That is where it’s going and it will be more patient focused because of it. I personally don’t agree. I just think, wow, look at all the billions they’ve just spent in COVID on all sorts of things wasted PPE. Who knows what? If they had doubled the NHS budget from 3 billion to 6 billion, everyone could have fully comprehensive dentistry free, like senior medical GP, just by doubling the dental budget, and it would have gone from 3 billion a year to 6 billion a year. They’re not even noticing numbers like this and they’re spending hundreds of billions extra dealing and wasting it, sometimes on various COVID initiatives or other things or just debt interest. So, going from 3 billion to 6 billion, they could have had a fantastic dental service if that was their focus. Is it their focus? And you’ve got to say, well, in the bigger NHS budget of things going from 3 to 6 billion, everyone could work in it handsomely, give great service and everyone could access it, like your medical GP, totally free. You don’t even have any patient charges and it funds all the laboratory side and everything. No, they won’t do it. In fact, they’re constantly looking at how they can squeeze and turn the screw down more. And you’ve got to say, therefore, the only growth area in dentistry, the only progressive area in dentistry, is private and the NHS will just keep looking for efficiencies. But you can only take so much fruit off a tree before you’re down to the bare branches.

Dr James: 

Do you know? We had Andrew Apton of Frank Taylor Associates on one of the previous podcasts I don’t know if you saw it, perhaps, tony, I haven’t seen that one, but I’ve heard of it Interesting. He says that buying a practice, demand for buying a practice has never been higher since he’s worked there at the moment. So that’s two things. First of all, he said it’s mainly private One because, within the scope of private obviously means that you can have a subscription service, which is really really, really nice way of supporting your cash flow. And number two, he said that because there’s so many of these people looking to buy realistically, what’s the likelihood that this buying pressure can increase any further? And therefore, if that’s not a sign that we perhaps in a bubble on that one, I don’t know then I don’t know what else is. So something that you may like to consider if you’re going down this route sometime in the near future. Did you have something else that you wanted to say on that as well?

Tony: 

No, just again. That’s the future growth area and I think a lot of people are. Yes, there’s high demand and that drives up prices when there’s a limited supply. That’s just the law of the markets, isn’t it? That will always happen. But the reason people are wanting to buy practices is to get more control of their destiny. So unless they bid for an NHS contract that in effect they get without paying the real goodwill value, then they will be looking at private conversions or perhaps opening another practice that does more private and so on in an area. But they’re looking to take control of their destiny. It’s a 20-year investment and you’ve got to say, in 20 years, those that are 100% NHS, 90% NHS are you going to be 100% NHS and 90% NHS in 10 years time or 20 years time? Almost certainly not. Almost, certainly not. Now, never say never. The government may change its mind and realise oh, the value of dentistry to society’s oral health and general medical well-being makes it a priority. We’re going to reinvest for all those failed years we haven’t done so and give it extra investment. But without that it’s static, it’s a flat lining, and unless you’re going to resuscitate it, then you have to look at alternatives, and so I think most practice owners understand they’ve got to diversify, they’ve got to do more private to support the NHS side and whilst they’re getting some temporary help during the COVID challenging year or two after that, what next? What next? And that’s the question they have to ask themselves, and they have to be prepared for several alternatives and ride that storm Diverse vacation is key and similarly, this is why the theme of this page and this podcast is investing, of course.

Dr James: 

Similarly, this is another reason why people who are financial buffs suggest it to you, and it’s interesting to see the parallel even in dentistry. I think it’s just a general sort of nice theme to live your life along the lines of you’re more resilient when you’re diversified, aren’t you? We have to address this. While we’re on this podcast, Tony, Some there are whispers and murmurs on occasion within the dental community that the GDC are sometimes suboptimal, shall we say, in looking after dentists’ wishes or maybe necessarily prioritizing those or seeing them from our point of view. Naturally, I would expect the BDA to speak up on our behalf on this one. There’s a general undercurrent of this from some individuals. How do you foresee yourself pursuing this over the next year, coming years, during your tenure on your BDA PEC?

Tony: 

Well, there’s no doubt about it, the GDC is usually up there in the top three or four issues, be it NHS or indemnity, or lawyers, or the GDC or whatever. It’s up there in the high concern area and it’s because and the BDA has raised these concerns many times, as have other bodies it’s because the GDC has, I think, lost its focus on its way a little bit. Let’s be clear the GDC is there to protect the public. That’s its number one goal to act in the public interest first and foremost. Not to act in our interests as a profession, but to act in the public interest. Where I feel it then completely loses way is that it’s got locked in this versus thing and it thinks oh, we can show we’re standing up for the public more by being harder on dental professionals, by being more strict in our fitness to practice, by punishing them higher for smaller and smaller things, many things, actually, that should never get to the GDC. But our local resolution or local governance or NHS system issues Loads of stuff should not get to the GDC. Now, when I was on the GDC, we set up a private complaints board, and it was because nobody else did, and we set it up with the point of view of being resolution-based and when I look at the statistics of that, it’s almost fine. It was one of the great successes ever because, a it had an external advisory board looking over it, of which I was part, and B if a complaint came in that couldn’t be resolved with the practice, it went to the certain complaints system and it tried to resolve it between both parties. And its average resolution time guess how long its average resolution time was, from receiving a complaint from a patient about a practitioner or a practice to sorting it out to the satisfaction of both the patient and the practitioner.

Dr James: 

I’m gonna guess it’s exceedingly short. I am not too familiar with how long they typically take, but I would expect to take months.

Tony: 

Well, a fitness to practice case can take 18 months.

Dr James: 

Wow, okay. Well, based on that, I think we’d be happy with six, one third of that.

Tony: 

Yeah, and this is a problem with fitness to practice cases when they go through the formal GDC process is there are long, laborious, legalistic, stressful process. Even if you’re totally innocent, even if it was a misunderstanding, you will feel like you’ve been cut through the mill. It’s like a punishment in and of itself. So the alternative for things that didn’t need to go that way went this way. The average was nine days. Wow, from beginning to end. Wow, nine days. And it’s interesting, we did satisfaction surveys and it was something like over two thirds of the practitioners were very happy with the process, even when decisions went against them, because it got resolved and it’s no longer hanging over anyone and everyone can move on with their lives and it’s sorted and people learn lessons from it. That’s real life. We weren’t happy with that. So we carried on looking at how we could prove the process more and by the time I left after 10 years, we got it down to just over six days average. That’s good. Well, it did overrun just into the second week and that’s because we would have a neutral person mediating between the two, listening to both sides, seeing, understanding, explaining and finding out what was the best resolution to that. Occasionally, some of the matters that went there was so serious they had to be referred on to fitness to practice, but 99% of them were resolvable to the satisfaction of both. Now, to me, that is acting in the public interest. That is, helping someone who had a dissatisfaction to get it sorted in the quickest, most positive way, and so it’s not hanging over everyone, and I think about a third of the decisions were actually in the professionals favor as well, because it was just a misunderstanding or whatever. The patient had perhaps I don’t know been using obscene language at the desk and that’s why things couldn’t progress, and so on. These things happen though, don’t they? They happen. They probably happen more in COVID because people are getting more frustrated. So all I’m saying is there’s a way to do things that is constructive, not destructive, and I think for too long the GDC got stuck in destructive mode and somehow saw that as but this is how we demonstrate, by being harsh on the profession, that we’re doing our job and being in the public interest. No one could ever say, oh, we’re not, for we’re for the professionals too much, because there’s dentists on the GDC board. So I think they got stuck in that mode when actually it’s about protecting everyone and being fair and having a good system of justice and be seen to be doing it and, frankly, to do it in a timely manner, because anyone’s going to be peed off having a case heard a year later or 18 months because it’s just dragged on too long, so everybody’s unhappy. At that stage there is no useful resolution, whatever the outcome. So I think that’s where the GDC can radically change how it does its public interest role, because actually the best protection the public have is our professionalism and if they can actually protect us, empower us, enable us to sort things out directly, be fair, transparent and in a timely manner, that is in the public interest. And if they can get to that stage a lot of the criticism of the GDC will fall away. Because it’s mainly on the disciplinary fitness to practice side, which when I was on the GDC I was not involved with. There’s like a Chinese wall with that so you can’t influence it. I was on the kind of other side of the wall, helping to write standards and looking at education undergraduate and postgraduate, looking at different policies and creating them with a committee to present to the rest of the GDC for approval. So I was more on this kind of creative professionalism side, but nevertheless, when seeing what’s happening on the FTP side, that was bringing the rest of the GDC into disrepute and really that’s where they are making some progress now. They have shortened times. They are sending more cases back, say, to the NHS, where the GDC sometimes uses a dumping ground for what are person-to-person conflicts. I mean, even now, I think 9% or 10% of all FTP cases are what they call blue on blue Densis versus dentist colleague against colleague, which is terrible, isn’t it? So we really need to sort ourselves out and again, start thinking more constructively and have better local resolution systems. These things shouldn’t be going to the GDC most of the time. I think they’re starting to realise that, but they also feel stuck in the but we have to demonstrate that we’re not being nice to dentist by being harsh to them. I think they’re still too stuck in that mode and it’s all about fairness, justice. A lot of colleagues actually need help and support. They don’t need some terrible sanction or to be struck off or whatever. 99% just need help and support. Yes, there’s some really bad apples in the profession and in fact, as dentists we’d probably be harsher than the GDC ever would to the really, really nasty ones, but they are genuinely few and far between. A lot of good, innocent people just get chewed up by the process and end up being resentful after it, because it’s not something anyone can forget and we’ve got to make the process better, fairer, and that is in the public interest.

Dr James: 

I really hope you make some headway on that one hand on my heart, and I’m sure a lot of people who are listening will feel the same.

Tony: 

So, yeah, it’s a wonderful endeavour, and I think that you’ve probably pretty well encapsulated how a lot of dentists feel there, sure, and I think, ultimately, the GDC does want to be a good regulator and there’s no reason why it cannot get there, but it has to do it with the profession, because we want what’s best for the public and patients too. Good stuff.

Dr James: 

Tony, this podcast, as we’ve mentioned earlier, it is on the theme of investing. I understand that you do a little bit of investing yourself. Can you just explain what it is that you enjoy about investing or why you prefer to do your own?

Tony: 

Yeah, it’s interesting, isn’t it? Because I think if anyone’s ever in the fortunate position of having a little bit extra cash and it’s sat there in the bank and you’re thinking great, in the current account it might be getting whatever 0.1% or less Interest is so big these days, isn’t it? Yeah, it is Okay, you can fish around for little deals and oh, you might get several percent in this one, but it will usually limit the amount and there’ll be little traps to bounce it out. So that’s just short time things. So you do like well, on those times you might be in the luxury position of having some extra cash to have it work a bit harder for you. So how do you invest it? And, generally speaking, the better returns are usually from something that involves more risk than having it in your bank account, for example, or even just sat at home stuffed under mattress or whatever people do these days. But so how do you make it work best for yourself? And it’s interesting when we’ve mentioned that I run a foundation training scheme for you in dentists. They have a lot of debt and so on, and we do actually run courses. We bring in independent financial advisors, accountants and so on to give them a little insight into how business and interest and managing money works. Because, guess what, that’s not really taught dental school and these days they’re starting with, you know, 50, 100 grand debts and they’re going to have other expenses going forward. So you know, whilst this is just you know my observations and opinion. Get your own financial advice, as usual from professionals. But just watching what they say to FDs and the general tone of the advice is that if you have any spare money, the best return you can get is to reduce first of all your debt burden and look at what is charging you the highest interest rates. And that’s usually things like, you know, short-term loans, credit cards, that kind of thing. And, interestingly, they don’t always advise them to pay back extra on their student loan. They have to pay a minimum amount, because that’s the deal with the student loan, but they don’t always say, yes, go pay that more, because you can kind of part that to the side. It will, you know, gain interest, but look at other things to pay off first. And then the next thing they will often point out is well, a lot of dentists, you know maybe it’s the stress of the job or whatever they like to buy themselves a nice car, and the trouble with a car is, as we all know, the nicer it is, the pricier, the more flashy it is. To show off to your friends, maybe. Or take some pictures for Instagram. You know, the calculations are there, aren’t they? They just are. Who doesn’t like to show off a little bit and so. But the trouble with investing in a car is it devalues quite quickly, so you’d certainly look at it as a minus percent investment, and he’s that wise to do with spare cash. So really starting with an old banger or having a cheaper form of transport and then using that money to either reduce your debt burden or then investing something that’s going to pay you back more.

Dr James: 

I must say this is something that frustrates me a little bit about the representation that investing gets sometimes, because people they think that it inherently has to be something that’s very, very risky, whereas a good component of it is just saving some money in the first place. To hedge yourself things that you don’t necessarily have to spend your money on, and I would. I haven’t met anybody yet, I’ll say this who doesn’t suffer from lifestyle creep to a degree, and it’s something that you have to almost go out of your way to target it and foresee it in yourself, and I’m getting a lot better at it. I’m getting a lot better at it. But we all know how it is. We earn a little bit of money for the first time we go out. It’s not, you know, kind of rubbish wine anymore. It’s really nice merlot. You know what I mean. And, yeah, it might be a little bit better from the point of view of your headaches, a little better in the morning, but you know what. You can overdo it as well if you’re not careful, and it’s something that I’m actively watching. I’d like to see that message promoted a lot more, because I think it’s safer and it’s so much worthwhile, so worthwhile for people to hear.

Tony: 

Sure. So obviously everyone’s going to be in different situations at different stages in their life and career and so on. But if you do have some extra cash, what can you best do with it? And I think there’s two things you could do. Professionally. You can invest it in yourself, first of all. Now, that might not just mean nicer clothes and you know whatever designer labels, and again, that’s all fine, everyone has to treat themselves occasionally. But why not go on some courses, get more skilled, offer more treatments to your patients that actually, professionally, then will give you more income, give you more job satisfaction, actually, and then allow you to progress professionally and afford other things. The other thing you can invest it in is perhaps your own house or property and from I don’t know a tax or investment or, if you like, useful point of view. That’s something to take seriously. Now, if you’re going to move around a lot, yes, you’re probably better renting and so on, because the costs of buying and selling a house, unless things are moving in a boom situation going upwards, you know the costs involved. If you haven’t noticed those auction programs where they go buy a property, do it up and they go oh, the profit before taxes and solicitors fees and stamp duty and all that and all that and again, yeah, that’s going to make a huge dent in those profits. So you know the frequency with which you do that is a big issue too. But generally if you’re buying your home, then that’s somewhere where you’re going to live. You’re going to get, if you like, secondary value out of it and it’s a long-term investment. You can get a 20, 25, even 30-year mortgage and you might be smart there’s different. You know mortgages out there get advice, of course, but one of the best things I ever did early on was get an offset mortgage. And they do still exist. And that’s where it’s kind of linked to your current accounts and any positive monies that are left in there actually comes off your mortgage charge that month and you can either leave that in and pay your normal mortgage or you can pay less mortgage that month. But I guarantee you will end up paying a higher mortgage percentage rate than you would if sat there just in a deposit account or a current account. So by having that linked in an offset mortgage arrangement, then your money is working for you. For example, you might get paid, you know, a certain day of the month and it has a peak in for a few days Because interest is worked out daily across the month. You then have some of your extra money when it does peak or occur, working for you to reduce your mortgage interest rate. Now you have the value of that up over the next one, two, five, 10 years. It’s a no-brainer really. So you know there are accounts like that out there and you can look at doing that. Now I would normally say you can’t go wrong buying houses, but the only house I’ve bought and sold I lost money on.

Dr James: 

I see Now, it was a happy ending to this.

Tony: 

But at the time of the crisis and now I’m going back to early 90s, I think England, the UK, had just fallen out of the ERN. The ERN interest rates went to 15%. One five percent, yeah. Now those of you who have got mortgages, you will know what that means. But if you’re paying, say, a 5% mortgage at the moment, whatever you’re paying per month when the interest rate goes up to 15%, that’s not just another 10%, it actually trebles your mortgage payment, because most of the mortgage payment is the interest repayment. So 5% to 15%, that trebles your monthly payment, yikes. So, yeah, yeah, and it’s sweating time and of course, there was a general economy sweating time as well. So I’m trying to sell a house. All this happens and I can’t remember. I think I originally bought the house at 75,000. I ended up selling it at 59,990.

Dr James: 

Ah, it sounds like misfortune on the timing, I suppose. Well, there’s a happy ending here, oh yes, of course I forgot about that point, yeah.

Tony: 

Because I didn’t sell the house just to be homeless. I was moving into another one and looking around for ages and there were some lovely detached houses in the countryside. I just couldn’t afford. Even if it was like, okay, I’ll put 100% of my wages into the mortgage and I’ll go work somewhere else at weekends or not, I just couldn’t do it. When this happened, my house came down in price dramatically by that amount. But bigger houses just couldn’t sell at all Because no one could get the mortgage. And at 15% you now treble them up. So that price came down and down, and down and the difference between the two reduced. Oh, I see, I see to then allow me to springboard onto that, so I’ll have so minor a loss. The dramatic reduction in the price of the bigger house made it viable for me as a mortgage. Now it was still a big gamble Looking back. It was like when you’re in the middle of this and you can’t see the outcome, when you’re in the middle of a storm, you can’t see the outside of it or it ending. If this last I think I calculated I can do this for three months then I’m stuffed. I see it was sweating time but fortunately it crept down 12, 10, 9, 8, 7. And started, I think it settled at 5% or 6% interest rates. But it took three months to get there. But this is when the houses were exchanged. So I sold mine at a loss. Can you imagine selling a house and the mortgage, people saying, and you’re still always, oh, my goodness, yeah, oh. But I got the other house a dramatic, like a third reduction. That would not have happened in any of the circumstances. That allowed me to leap. And I’ve been in that house since and the mortgage is coming close to being paid off and so on, and in those frightening times it was probably both. I don’t know if it’s the dumbest, almost courageous thing I’ve ever done.

Dr James: 

There’s a blurred line between those two things sometimes isn’t there, but this was our home we were talking about.

Tony: 

And it was Looking back now. Yes, it was a great home. All as well as it ends well, I suppose, but I don’t think houses are a good investment. Yeah, Maybe not advisable to everybody but all as well as it ends well, should we say.

Dr James: 

Oh, absolutely.

Tony: 

I mean no more dead vise, but the advice was, this could be an opportunity because you would never in normal circumstances afford this house and because it’s your home and so on. And then you bring up your family in it and so on. And so, yes, now I can look back and go. It was the right thing to do. If it had all gone well, I would have been in a good position, but it was the right thing to do. If it had all gone wrong, I guess they’d repossess the house and that bees and stuff. So, yeah, then you’d be homeless and rent in somewhere, but you still have your job to still be earning. But yes, there was a gamble and you always have to look at what is the worst-case scenario. Can I survive this? And I still did that calculation and, yes, we could survive it. We won’t want to be in that position but, yes, we could survive it. But this was your home and you still have to look back at it and say what do I do with this Two or three grand spare cash? And, of course, back to the course with the FDs. They tell you about ISIS, they tell you about tax-efficient packaging and so on. So there are lots of things you can do to make that money work for you. But as you move on in life you saw celebrating my 60th birthday At the other end of the extreme then you’ve got various pension rappers that can use and you can use a sip and then within that sip you can then buy and sell shares, investments and so on, and then any money you may call lose is relatively tax-free. Any money whilst it’s in the sip, anything that you put into your pension fund is tax deductible from your normal earnings. So you can time certain years to help you if you’ve got surpluses and so on. So you know that’s another vehicle as well. And again, you get financial advice on how to operate. So if you enjoy a bit of selling and trading and so on, you can even just have a small sip. I’m not saying you have to put everything in there and you can just use it as your little trading envelope, if you like, as a particular package there, because you always have to be aware of even when you make profits. You know there’s capital gains, there’s taxes and other fees and so on, and then you know how can you withdraw that in a tax-efficient way later on in life and so on. So, depending on your own circumstances, get advice what’s best to do when so you can invest in yourself, you can invest in your home, you can invest in other things land, property, commodities, whatever just big companies out there Deraseh, coca-cola you know Warren Buffet, that’s one of his favorite companies. You know he’s invested in that company for the last 30, 40 years, but he takes a long-term view. And then of course, you’ve got day trading where just the price moving up and down in a day but that’s too scary for me. I think you really have to know what you’re doing there. Most of the people I talk to who invest, james, they tend to know two or three companies or two or three investments really well and almost specializing in those. I don’t know. If you come across people who do these other things which you know, it’s fascinating. I suppose you know about dentistry, so you know I can get how, if you know a sector really well, you can see trends come in and going.

Dr James: 

I read a book on spread betting very recently. The guy who spread bets very successful wrote a book on it One of the few ISA millionaires. So he’s managed to turn his yeah, he’s managed to turn his 20K limits per year ISA. Now God knows how long he’s been investing it into a million. Apparently, there’s only 200 of these in the UK. So I, like thinking, knows what he’s talking about. He was saying that he’s created all of this just by knowing 15 companies inside. That’s all he does. There’s only so much. There’s a myriad of companies out there. I think I said countries earlier. I meant to say companies. My bad Might work, maybe. Where were we? So yes, there’s a myriad of companies out there. There’s only so big, so much information your brain can hold. So that was his technique. So it kind of touched upon what you were saying earlier. I just wanted to throw in there as well that Tony and I are on the topic of IFAs. We are, of course, not IFAs, but we are people who maybe have a little bit of investing experience and we know that for our circumstances these things may work. For you personally, you might just want to explore this, educate yourself, learn. All I do know is. There’s a lot of ways that we can potentially be savvy that are worth looking into. The other thing that I was going to say just to throw on top of that as well interestingly, tony told me off-camera that he accepts Bitcoin as a payment in his practice, which I thought was really cool. Was that something? You’ve had an interest in, crypto then? Or did you just think to yourself do you know what? I want? A bit of Bitcoin. I want. This is the way the world’s moving. I want a piece of the action. How did that happen?

Tony: 

Well, I didn’t mention it in my CV, but I am interested in new technology blockchain, which is the technology, of course, behind all crypto, but it is actually a functional technology and combining that with artificial intelligence, I think those two together are going to actually transform the way we do things in the future.

Dr James: 

I actually know people might be listening. They might say I’m biased because I do own crypto about half my savings are in crypto but I actually, honestly, I challenge anybody to read about what blockchain is, what it can do and how it can effectively remove the need for any third party in any transaction, and when you read about that, you can actually defy anybody to think that it won’t change the world. And I don’t care about companies, unless you can ban the internet. A country can’t ban it because it is the internet. That’s just what it is essentially. So, yeah, as I say, I might be slightly partisan when I say that, but it really is. It’s interesting when you say that, tony, because that’s how I feel about it too when I started learning about it.

Tony: 

I think because of Bitcoin, it’s had various press and so on. People confuse Bitcoin with blockchain, and I’ll discuss Bitcoin specifically in a moment. But with blockchain it works, and especially Bitcoin works with the DLT Distributed Ledger Technology. What it basically means is it’s out there in the public. You and I can go, if we can be bothered to download every Bitcoin transaction there’s ever been in about 20, 30 gigabytes, I think. But you can do it and you can actually. It’s actually transparent and public. So it’s like if I give James a fiver, it will actually say, well, this has come from Tony Kilcoin’s wallet. And then if James gives it to somebody else, and then all that happens is everybody else looks at the fiver and goes, yeah, we can track that fiver, that’s the original fiver, that’s real, that’s genuine. This transaction is verified and hundreds, thousands, millions can verify that. So it becomes self-governing, in a way, and everyone has an interest in doing it correctly, because if they don’t, then everyone’s Bitcoin becomes worthless. But in order to pass it from me to James, to whoever, it has to go through certain calculations and changes which are then added on to show it’s gone to another wallet or destination. So that’s a very short version. Go, Google it, look it up, read it. It’s very interesting how blockchain works. I went to a blockchain summit whilst you could a year ago, last summer, did you as well? Yeah, it was out of lived here. And who did I speak to there? The Bank of England, who are researching this and already using it, because blockchain can be used for contracts, transactions analysis and so on. I spoke to Merck, who I think it’s Merck, I forget how you pronounce it. Basically, they’re a big cargo company. They transport something like a fifth of the world’s cargo around the world. They already use blockchain to track every container in every port, in every ship around the world. So these things aren’t theoretical, they’re being used.

Dr James: 

I believe I know the crypto that that company use. It’s called VET value exchange token. Okay, and the interesting thing about that is I don’t want to get too much into the technology or anybody who’s listening what happens is you create a product in a factory. You have a QR code on it, you scan the QR code, you upload it onto the blockchain. Then this box can go anywhere in the world, and people can corroborate where this box came from by checking the blockchain. Okay, and this deals with so many issues within supply chains, because you can just who’s to say that I can’t make something in India and then claim it’s from China and sell it under the pretense that it’s something from China. No one knows. I can just stick a label on the box. What if I hire a company to do it? What is the validity that they’ll be able to definitely confirm this. It’s really interesting. So that’s that is something I’ve heard of, and I actually think I know the crypto specifically that they’re using to do that. How interesting is that, though? What a great idea.

Tony: 

Yeah, so your key word there was validity, you know, and it allows you to look at the due provenance of where things have come from and gone to, so you can be assured this genuinely happened. And that can be contracts, it can be money, it can be lots of things, tracking stuff and so on. So it is the future for sure.

Dr James: 

I believe, is it Venezuela. They have a massive problem with hyperinflation out there and they’ve got the digital peso already in Venezuela, so it’s basically their currency, but online and confirmed by blockchain. China are a big fan of it too. Digital yuan and sounds like the Bank of England are getting in on the act, which is something I’ve learned.

Tony: 

They’re all looking at it. Now Every country can’t not look at it. It’s more, how do they use it and apply it in a business sense as well as a monetary sense. So things are definitely going to change that way. The minister was there for IT and so on from the government and they were looking. They’re already using it for things and they’re looking at using it for medical records and I was there to look at what dental applications might be there and so on. And if you start combining it with things like artificial intelligence that can read radiographs and give you consistent results and so on, and you can blockchain it and provenance and pass it on, and then people can keep their own records, you can keep their records. It can allow you just certain access for dentists to medical records or A&E or for other things and so on. So you start combining, you start layering these technologies on top of each other and it’s just going to transform the way we’re going to well, just behave. It’s like you know, when the internet came, it just changed how you did things. This blockchain is just going to change how you do things. You don’t have to know all the technicalities, it’s just very, very reliable, transparent and useful and it’s been tested so much, because if you can test it with money like Bitcoin, how many people would try to defraud it, break it, you know, or they can’t. They can’t, and they can’t because it’s so open, transparent and obvious what you’re doing. Where people can lose money is if your wallet that you keep it in isn’t secure or isn’t well looked after, or what you can get hacked. You can lose it empty, give you passwords, someone, whatever, so, but you could say that about a wallet full of money, you know. So you do have to take certain precautions, of course. But yeah, I got into just some Bitcoin because patients, younger patients were like oh yeah, we deal with Bitcoin for this, that and the other, and you take Bitcoin, I’m like what? And I look into how you might do it, and so you know, just through the practice we’ve set up, you know, an account, an exchange and so on, and then people could just pay into the practice wallet and then that goes into the exchange and then I can either decide to accumulate or, you know, to sell some or whatever. Now you take a risk if you wait, because the price can go up and down. At the moment, the price has gone bonkers and I sold, I think, a couple of Bitcoin off whenever it was. In fact, I put a screenshot up because it went up to about £10,000. And I thought oh, wow, that’s trebled. How can I not sell Profits, profits, profits, profits, profits? And what I’ve found over 60 years is and I’ve made losses, don’t get me wrong is I’ve held onto things too long and you always think you almost sort of reset it in your mind oh, it’s here now, so now it won’t go down from here, it will only go up. It isn’t, it’s a roller coaster up and down. You know, this is just how things go through cycles, and the hard bit is knowing, because usually, if you’re trying to buy low, you’re buying. When confidence is low, other people are selling, and so you know when do you do that, and you know the old adages don’t chase some at down. But when it’s levelled a bit or creeps up a bit, that might be the time you decide, depending what it is. But when do you sell? When it goes up, then Bitcoin. I’ve been watching the pattern for the last year or two and it would get near $10,000 or whatever, and then come down again, and of course then when it went up to about £13,000,. I thought, well, I haven’t been here for ages and that was about the plot of this is a good time to sell. So I put in the sell order and it didn’t even sell for about three, four hours or something, until then it started to creep up and it still came down below and I thought, oh, aren’t I clever, I’ve sold at peak. And then about two weeks later it just went yeah, and it’s built at spins. So there’s a part of you that thinks, oh, what an idiot, I sold too early but at the same time I did lock in the profits. You know, and you’ve got to beware greed, greed, you know. It is. As much as you try and be objective, the emotions are high and I think if you’ve made a good profit on something, so at least lock some of it in is wise. Well, you’ve just described investing.

Dr James: 

You’ve just described investing in a nutshell there, haven’t you? And yeah, how many times we tend to beat ourselves up. We almost strive for perfection in investing. It’s not about perfection, it’s just about being profitable. And those are very in the pursuit of perfection, you can wind up being unprofitable, and I’ve certainly had that happen to me as well before. It’s almost like a change in mindset to allow yourself to become successful, Tony, I sense we could do this all day.

Tony: 

I think what we’re going to have to do is continue this conversation over a beer at some point I’m very gorgeous that I’ve taken about an hour and a half of your time.

Dr James: 

This has all been excellent. I think people are going to be really interested to hear this podcast. If anybody hasn’t heard of the group, it’s called Dentist who Invest Community Group for Dentist who Enjoy Trading. Look it up on Facebook if it sounds like your thing. Just all about promoting a healthy mentality on long term investing and being safe and being savvy with your money. Tony, I’m going to let you get off. No, I just want to say thank you so much for me and thank you so much for everybody who will be listening to this. Honestly, I thought that was a brilliant podcast. I really enjoyed doing that and I actually learned a lot myself. Thanks for coming along.

Tony: 

Not my pleasure and you know we’re all learning. I’m 60, but I still want to stop learning. And the more you know, the more you realize there is to know. So look, good luck everyone. Be careful, get advice, listen to people like James and other people, and, you know, look at your own circumstances, but don’t risk everything. And, you know, just be wise.

Dr James: 

The more you learn, the more you earn. Thank you so much, Tony. I’m going to let you get off now. Thank you.

Tony: 

Thanks everyone.

Dr James: 

Bye, bye, well being and investing knowledge. Looking forward to seeing you on there.