Back in March Mick Armstrong was elected to serve as chair of the British Dental Association’s (BDA) Principal Executive Committee (PEC), a job which the BDA described in its press release as the ‘leader of dentists in the UK.’
That’s quite a job description. At the British Dental Conference and Exhibition, Mick gave his first public address in his new role proclaiming that the profession was under attack and vowing to vanquish the double standards that batter dentistry. That’s quite a speech. But who is Mick Armstrong?
A plain- peaking Yorkshireman, Mick cuts quite an imposing figure. He has a great physical presence, whether chairing the Local Dental Committees’ Conference, or making his inaugural speech at the British Dental Conference. But speaking one-toone, and hearing him talk fondly of his early days as a dentist, I was impressed by his love for the profession, and encouraged by his hopes for the future.
Mick entered dentistry almost by accident (his initial vocation was to be a vet) but after qualifying from Newcastle Dental School, he has never regretted his decision. “In 1985, I qualified and entered a wellrespected profession. Dentistry was a job for life, and there were plenty of opportunities for career progression. Working as a dentist meant you were well-paid and had autonomy: you could be your own man, so it was very appealing.”
Given that explanation, it is perhaps easy to see why Mick feels the profession is being challenged. A new contract in the pipeline, increased regulation, changing market pressures and a shift in the public’s attitudes towards the professions have transformed a dentist’s working life: the prospects for those about to qualify from dental school are quite different to those he enjoyed. The challenges posed by change were instrumental to Mick joining the BDA.
“I remember being dragged along to the BDA as an associate, when there were contract problems in 1990/1992. I listened, and went away thinking that the BDA seemed to be the ones that might be able to do something. “Working in practice you become very insular at times. Then, when something changes – for you or your practice conditions – that often forces you out of your comfort zone. For me the crunch came when my associate terms were changed – who did I get advice from? The BDA.”
Simply being a member of the BDA wasn’t enough. After continued encouragement from peers, Mick began his political climb.
“Initially I decided to join the local dental committee (LDC). I enjoyed having the opportunity of engaging with other dentists from various parts of the country, and somebody suggested that I might make a good chair of LDC conference. I was elected to that position. During that time I’d also been elevated to the BDA’s Rep Body. It was great sitting on the Rep Body, and the very intense meetings that we had on those Saturdays. I enjoyed the craic and eventually decided to go for a more advanced position to influence things even more.
“I’d had encouragement from many colleagues. People said, ‘You’re the sort of man that we need there.’ I was elected because I want to maintain the principles on which I became involved with the BDA, which involve standing up against the political or regulatory environment in which we operate.”
When speaking of the BDA’ principles, Mick repeatedly references the importance of promoting evidence-based patient care and highlighting the impact of oral health inequalities. He was keen to stress that the BDA does not just exist for dentists or the dental profession, but also to improve people’s oral health.
“That’s why we all go into dentistry in the first place, and my job, as I see it, is to get the organisation to help with the best delivery of that. That involves keeping us happy, and keeping the patient happy. If you do those two things, you’ve got an excellent workforce and a workable oral health strategy.”
The subject of the workforce led to direct access, and Mick was keen to stress that the BDA as an organisation was never against the idea in principle. As a journalist who received press releases before and after the decision was announced, I felt as if the BDA was in the ‘no’ camp. I asked Mick if there was a danger of the BDA being seen as a protectionist association.
“We’ve been working with DCPs, therapists, hygienists, for many years and we want to promote skill mix, but we thought the way the GDC implemented direct access was a bit hasty. There were a lot of loose ends that should have been ironed out beforehand, but working with therapists or hygienists is part of parcel today of what makes a good dental team. If you look at the portraits of dentists that feature in the BDA’s museum down through the ages, many of them evoke a protectionist era, but I think most dentists now realise the value of skill mix and embrace that. Those barriers have broken down.”
In Mick’s speech at this British Dental Conference and Exhibition, he spoke of dentistry being under attack, but the BDA itself is also facing criticism. One of the reasons for this was the new tiered membership and the financial problems which followed.
“The BDA continually reviews our services and takes on board what members tell us because it is democratic organisation.We also observed that a very small number of members wanted a huge amount of help and a lot of people didn’t seem to need much help at all. To fund the overall needs of the BDA, the membership fee had to keep increasing, and I think it got to a stage where some people just said no. We also recognised that the level of support dentists need often changes over time so we looked at different ways to provide a flexible, affordable membership that reflects those needs.
“We did a lot of modelling before the launch, got in-depth feedback from members, and came up with three tiers of membership that we thought would be fair to members. For the first time the system has an in-built flexibility should a dentist’s circumstances change. It’s true that we didn’t get the outcome we expected initially – it takes time for a major change to settle down – but we are turning it around.”
I asked Mick directly if he was confident about the finances. Without hesitating he replied yes: the association will continue to meet the needs of its members. But does the financial situation weaken the BDA’s position at all?
“We have more than 20,000 and the membership is continually going up – it is a significant number. We would like it to be more, but it is a very credible number. It’s useful when we are going in to bat against the powers that be.” I don’t doubt Mick’s sincerity, and his confidence should give reassurance about the continued existence of the BDA. I did have to ask whether the problems encountered have affected the BDA’s reputation and the perception of its ability to represent the profession.
“I think some criticism has become more vocal but I don’t think the volume of criticism - the numbers of those criticising what we do - is any different really. I think there is immense frustration out there that we can’t deliver a better working environment and conditions for our members, but in the vast majority of cases – and certainly in the NHS – it’s not within our remit to write the contract ourselves. That said, if we can’t change something we’ll do everything we can to mitigate the pain. We have to work in conjunction with the government. That’s what we are trying to do in piloting the new contractual arrangements.”
The financial problems faced are clearly an unwanted distraction from the important task at hand for Mick. The same can also be said of the gossip surrounding the personal lives of some on the PEC.
“Private lives are private lives: they shouldn’t, and didn’t, impact on the board room. The gossip may be out there, but it has had no bearing on the internal workings of the PEC. Anyone who has ever worked in a collective decision-making situation will know that sometimes changes in the hierarchy are needed in the interestsof the business. That applies to the BDA just as much as anywhere else."
I was expecting a polite “no comment” on the subject, but that isn’t Mick’s way. He met the subject head-on, in his usual no-nonsense style. For an interviewer, this is fantastic, but does it lend itself to the role of chair? Mick explained: “I try to moderate my language and use words that are perhaps not as direct as I normally would use, but it’s a skill you learn through life. You start off being all fire and brimstone and you find out when that is effective, and you learn when it is best to be more diplomatic.
“There are a lot of big personalities in PEC but that doesn’t faze me at all. I’d rather have a meeting where people are espousing their views than sitting there and saying nothing. You tell me what you think and we’ll distill it down to something reasonable.
“To get a consensus is really important and the majority hold sway in my view. I am a democrat! If something I think is not carrying sway with the PEC – they’ll let me know and we’ll alter our direction, it’s not a problem.” The entire profession will be looking to see how successful Mick is as chair of PEC, but the general consensus is that Mick’s appointment as a positive move, and that the PEC now has a spokesman who isn’t scared to tell it how it is and is prepared to put his point across bluntly.
“It’s a fine line isn’t it? The BDA has been saddled with the ‘broadly welcome’ catchword for a long time. I don’t broadly welcome anything though – apart from maybe Christmas cards! I think there are times when you have to say no, and say no firmly. If someone is talking nonsense and you need to get your point across, then plain speaking works. Speaking about dentistry being under attack, that just reflects how we feel. I am a wetfingered dentist, and I see new directives landing on the practice desk every day and I think ‘Crikey, what’s all this about?’ because what I actually do day-to-day hasn’t changed an awful lot. It just seems to have been caught up in political dogma, and bureaucracy, and that is not right – that can’t possibly improve patient care.” It’s clear from just a short conversation with Mick that he feels there is much work to be done in his new role and that he is relishing the challenge. What would he like to achieve during his time as chair and how will he judge whether or not he has been a success?
“I would like to grow the BDA to be the loudest and strongest voice in UK dentistry. I aim to deliver better working conditions, better pay, a better working environment and better services for patients. So it’s vital to have a bigger union to protect the interests of dentists and patients alike. I would like to leave the BDA stronger in terms of numbers, more respected by its members and those in power who shape the dental environment. I want UK dentists to be more respected internationally. I want them to be able to enjoy their dentistry again.”
It may sound like a bold ambition. But one man called Armstrong was the first man to walk on the surface of the Moon. That was pretty ambitious, too.