Tackling the not-so-quiet elephant in the room – NHS Dentistry

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  Posted by: Dental Design      4th April 2018

The NHS has certainly taken some heat recently for its inability to meet the substantial demands placed upon it. Many are quick to point out what’s not working but fewer seem prepared to work together to find solutions. One thing we can surely all agree upon is there is no quick fix for the wider NHS and, more specifically, NHS dentistry will only deliver some of its former achievements if the profession and the government work together.

The first step in such a situation is to identify the key problems – I don’t want to dwell on them but it’s necessary to establish what needs to be addressed.

Aneurin Bevan’s 1948 core principles for a health service meeting the needs of everyone, free at the point of delivery and based on clinical need, not ability to pay, have remained at the heart of the wider NHS for 70 years. Patient charges were introduced to NHS dentistry after THREE years but still successive governments and politicians continue to quote the NHS mantra of ‘free at the point of delivery’. I am certainly not advocating a ‘free for everyone’ dental service – far from it – but the increase in patient charges continues to out-pace the rise in NHS contract values, meaning that some practices receive less for a UDA than the patient is paying. Based on current projections, it is estimated that by 2022/2024, nearly every fee-paying patient in the UK will be charged 100% of the UDA value paid to the practice.

The second fundamental issue is the complete lack of definition as to what constitutes NHS treatment. When we moved from a defined (albeit long) list of treatment to the current UDA banded system in 2006, dentists had their ability to state what items of treatment are or are not available to patients severely curtailed. Even the GDC includes a section in ‘Standards’ relating to NHS treatment (Standards 1.7.2-1.7.4). Ironically, the lack of clarity stifles our ability to deliver the best dental care to patients. This is especially true when private options might afford the best outcomes, but there is an expectation to deliver, often financially unviable, NHS treatment because of some nebulous requirement to do so. It can be very difficult for dentists to evidence why they did or did not perform certain items of treatment on the NHS when challenged, and they must walk the semantic tightrope of compliance while trying to avoid breaching guidance that is open to fluid interpretation.

Finally, the long awaited reformed contract is a source of anguish for many. The structure of any future contract is still very much up in the air as the profession can’t agree on the best format. While 100% capitation would be the utopia for some, I doubt any government – even one led by Mr Corbyn – would agree to pay for this. We therefore need to find a balance that will enable us to put our patients first, while still running viable businesses.

Clearly, any solutions to these problems will be fairly complex, but there are ways of moving forward. Initially, we need some honesty and clarity. We all know that the NHS could not fund treatment for every single person in the UK, if they were to all suddenly attend our practices. Perhaps it would make more sense for the NHS to offer a core service that simply gets people out of pain, provides limited defined treatment and ensures that they have treatment to restore dignity. Any further, more complex treatment, especially for fee paying patients, would be performed privately – like when flying with a budget airline and you’re given the choice of just the flight and hand luggage, or if you want to upgrade and add food and checked-in bags. Without such radical thought in NHS dentistry, and indeed the NHS as a whole, we could see further deterioration of a once great service – a service that could remain true to some of its core values if it stopped trying to pretend everything can be provided for everyone.

This greater integration between private and NHS dentistry could lend itself to a more flexible system that enables dentists to deliver the best care for their patients. It would ensure access to basic care for the entire population, free the profession from the current constraints and confusions, and allow more targeted delivery of the NHS budget to those with high needs. The profession desperately needs a defined NHS dental service that patients would also understand.

As the saying goes, “The definition of insanity is doing the same thing over and over again and expecting different results”. We cannot keep going the way we are and expect everything to just sort itself out. The profession’s leaders must stand up for what we need in order to provide care that is in our patients’ best interests.

If NHS dentistry is to survive, it requires a complete restructure that really does promote preventive care and gives the dental team the flexibility they need to deliver this. Changes to the current system could be introduced tomorrow helping to deliver care to the high-needs patients who are often ‘frozen out’ by the rigid UDA system. You cannot prevent what is already diseased, and any reformed contract must reward prevention but also remunerate treatment for the extensive dental disease that is sadly so prevalent in 21st century Britain.


The views expressed in this and similar columns by individual ADG members are intended to stimulate constructive debate about current issues in dentistry. Thoughts are the authors’ own and not necessarily those of the ADG.


For more information about the ADG visit www.dentalgroups.co.uk



Ian Gordon is a partner of Alpha Dental Studio, a member of the Association of Dental Groups (ADG)


NB to editor, this line must be included in published version:


The views expressed in this and similar columns by individual ADG members are intended to stimulate constructive debate about current issues in dentistry. Thoughts are the authors’ own and not necessarily those of the ADG.


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