Basically I had a raft of emails earlier in the year from Infection control at my PCT saying they were coming to audit our readiness for HTM01-05.

What with me being big on common courtesy and all that old fashioned stuff, and also undergoing a decontamination room refit I told them that I would allow them access when the new facility was up and running.

This wasnt acceptable to them initially, and they wanted to come when we had a temporary facility in place. So I categorically refused them access to the practice until after the install. I discussed it with some knowledgeable people, and they agreed with me.

The visit was cancelled until this week when our facility was fully running.

At this point a little background is necessary to perhaps explain my stance with the PCT. Back in 2004 a senior dental member of the PCT stood in my surgery and stated that if I went private  he would see that a dental access centre staffed with an imported workforce would open next to me and shut me down. I have never seen my associate so angry (I was speechless which is rare) and thought there was going to be bloodshed. So I have an attitude of absolute and utter distrust stemming from this. Prior to this I was going to work within the new system, but this persons attitude singularly changed my mind for ever. I have also had my contract breached on 2 occasions by the PCT when they have stopped payments without asking permission or issuing breach notices. They have apologised on both occasions and rectified matters.

So, If anyone from the PCT is to have a professional relationship with me then they HAVE to earn my respect from the beginning.

I spoke to Infection control, and explained that I would allow an inital visit informally on the following terms.

There was to be no HTM01-05 Audit performed by them. They have until December to check I comply, so we will arrange a time when that will occur. I have already done it and they were free to look at my results. I would not participate in a tickbox exercise just so they could say they’ve done my audit.
There would be 1 1/2hr for the visit over lunchtime (not the 3hrs I was told the visit would take) as I will not cancel patients for this, and it would be informal at this stage.
No patients would be allowed to be observed – they are private adults and therefore I will not allow their confidentiality to be breached.
At this visit it was not their place to criticise or suggest any issues. They were there to observe only. Until I have trust in their knowledge and authority, nothing they suggest will be acted upon.
I would not allow them to place my pregnant practice manager under any stress or interview/question her without my presence – she is a very consciencious worker but a worrier, gives 110%, has an amazing eye for detail, but at that point was struggling with the succession planning, and I was worried about her.

(I may appear arrogant to some taking this stance, but I have had so many issues to deal with I now let them know exactly what kind of situation they are going to experience, and agree it beforehand.)

This was all agreed and witnessed by my PM, and they also suggested that the Dental Advisor attend too, to which I was more than happy to agree as it was someone I have enormous respect for.

So we had the visit Wednesday lunchtime 12.40. Straight into my surgery with the PM in tow (she was happy to take her lunch a bit later). I reiterated my stance that anything suggested would not in any way shape of form be acted upon.

Within the first 5 minute we had an argument about handwashing, and that I was wrong to classify the paper towels I dried my hands on as clinical waste. Look, if something’s touched human skin, body tissue and is in a clinical zone, then I reckon I want to treat it as clinical waste. Better safe than sorry. And the Dental Advisor was happy with this protocol too.

We then had a tissue rolled up and wiping the skirting boards, picture frames and door frames, whilst I was having a friendly discussion with the Dental Advisor. I should have called a halt at this point, but thought I’ve nothing to hide so let it carry on.

On to the Decontamination room, and further issues were pointed out by Infection Control, discussed (nearly arguing), and when we referred to HTM01-05 found I was right (the Dental Advisor agreed with me). And apparently we are not allowed a fridge in the room even on the clean side, or storage for any materials. I’ve yet to find this in HTM but if its there I will.

But the bit that made me incandescent was yet to come. We all went downstairs to finish off, and to check the OPT room. Infection Control  then asked to see the various policies (which had already been seen upstairs) and some waste consignment notes. At this point my PM said she’d go through them up in my surgery as it would only take a few minutes, and then she’d get some lunch. This was about 1.40pm.

I had patient at 2pm and after chatting happily and informally with the Dental Advisor we went up to see if they had finished at 2pm. They were still looking at the bits and bobs of paperwork so I suggested they went in the staff room for 5mins.

My 2pm pt was for 1hr. I surfaced after 3pm to be confronted by a stressed PM who basically had a go at me for dropping her in it. They had only just left! Every document under the sun had been asked for, the audit had been done behind my back, and the PM had had to run up and downstairs constantly to fetch the documents (she’s pregnant don’t forget!), but some were not to hand as she is working on the succession training for our acting PM and they were on a different computer. Apparently there were some ‘that’ll be a no then’ comments made. So by now I’ve got a stressed knackered hungry Pregnant PM through no fault of my own, who’s not had a break for god knows how long. Incidentally, None of this stress was from the dental advisor, just Infection control.

Basically the very things I had stipulated were not to happen had, and that my reasons for the distrust had again been confirmed. Not only that, there was a definite lack of pragmatism being employed with HTM0105, and potentially a lack of understanding of the document itself.

I wasn’t able to speak to the person concerned, straight to voicemail.

I followed it up with a very strongly worded email demanding action by noon the following day. The action was to be an apology for this breach of trust, the return of the audit for destruction, and an apology to my PM (she is too polite in these situations to have called a halt for some sustenance!). I then stipulated that there would be no access allowed ever again to anyone from the PCT in a professional capacity other than the Dental advisor who came.

A worried Dental contract manager rang at 8.45 saying it wasn’t her dept, but she would try to sort something out. No response at all then from the PCT. Until another email by me at 11.15 reminding them they had 45 minutes left to respond.

11.58 – Phone call from a senior department assistant director who had apparently been unceremoniously dragged out of a meeting to ring. We agreed to talk today at 1pm.

And todays phone conversion was with someone I can have respect for at the PCT. The matter is still under investigation, and I am happy not to make a formal complaint.I Did however give them a few more home truths about HTM, dentistry in general, and we had a good bit of banter and a laugh. We have now both an image of Prions flying around the decontamination room like performing fleas, jumping 6ft from clean to dirty, cupboard to cupboard with lives and families all of their own.

So alls well again.

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