My Solution for NHS Dentistry

What you are describing is pretty much what dental therapists could do, and more. But they are not regularly used. (Although it's becoming more common). Therapists can do check ups, simple adult fillings and ALL children's dentistry including extractions of baby teeth. But as I pointed out earlier, they are not paid a decent wage for what they do. The NHS will expect them to do all that currently, but won't directly employ them. Most are self employed and earn way less than a dentist as the dentist takes a cut of what they get.

And yes in theory hygienists can also see a patient and refer if necessary. However there are issues with this (for both hygienists and therapists). If you start taking full responsibility for a patient you get more risks involved. You might miss something. The patient then might sue. If this risk increases our indemnity insurance will go much higher (we currently pay much less than dentists). So if this increases hugely then we would want more pay which is more equal to a dentist. There is a reason dentists train for 5 years and hygienists/therapists for 3. They have more responsibility and pay higher fees once qualified.
Also currently most hygienists have 30 mins appointments on average. (Some can be 45-60 in high end places). If hygienists are expected to then do full check ups and referrals the appointment times would need to increase. Meaning seeing less patients in a day and earning less for the practice.
The last issue is people don't listen. I have told many patients they need to see a dentist as half their tooth has fallen off. They come in 6 months later still the same. Then 6 months later its disintegrated and beyond repair. So I would worry about who has responsibility for that should the patient complain. I always write in the notes what I've told the patient, but they could still claim I didn't.

The NhS is trying to create a service where a practice will be mostly staffed by dental therapists and with a dentist to do the more advanced treatments.

However at the moment there are problems with therapists being able to open courses of treatment as they are not allowed to hold contracts.

The other big problem is pay . A hygienist has fewer outgoings than a dentist , smaller student debt, a lot less for indemnity and registration , and a far lower risk of litigation and being sued. However in my local area where they tried to replace dentists with therapists in this way the problem was therapists wanted to be paid a decent rate according to their skills which was actually more than the dentists were earning.

To put this into context I stopped most of my NHS commitment (other than vulnerable groups) in 2006 (new contract) because as a highly experienced dentist I was earning less than my newly qualified dental therapist .

Without large, significant reinvestment or large rescaling of what NHS dentistry can and can't provide we are looking at a lost service.

So NHS dentistry which provides the

• buildings in which to practice dentistry
• sufficient support staff to enable appointments to be organised
• A fair pay for dentists directly employed by the NHS?
• training more dentists probably to cover the excessive numbers of people who don't have one and to provide for future need.
• affordable dentistry for all.

How many dentists per 10,000 population do we need?

And then do the same for GPs.

So NHS General Practice which provides the

• buildings in which to have a general practice
• sufficient support staff to enable appointments to be organised
• A fair pay for GPs directly employed by the NHS?
• training more GPs probably to cover the excessive numbers of people who don't have one and to provide for future need.
• affordable health care for all.

How many GPs per 10,000 population do we need?

Quick and simple, but only a partial solution:

There are 43,000 dentists registered in the UK. The fee for registration is £621 per year. Add a government levy to the registration of (let's say) £2,400 to raise £103m. Use this to increase the payments to dentists for NHS treatments.

feel sorry for the receptionists they are getting abuse daily because there are no dentists and they are in the dark too. They have no info to give. So please remember they are only doing a job over which they have no control.

And how do you suggest taking care of your teeth is made mandatory?

As a Hygienist I'd be happy to do NHS work if I was paid a decent wage. I wouldn't expect to earn as much as I do privately. But I think prevention and treatment of gum disease early would be very beneficial to the population.

However as it stands Hygienists cannot work directly for the NHS. And where they've changed some rules recently about dental therapists doing NHS work they don't get any of the "benefits" of NHS work like pension etc.

So yeah if the NHS would give me a salary and all the benefits that go with it I'd happily do it! Instead of being self employed with no holiday pay/ sick pay etc and if a patient cancels/ doesn't turn up/refuses to pay I earn nothing.

But I can guarantee you it won't happen.

Thank you for taking the time to explain @MillyMollyMardy , I have long felt that dentists do a very difficult intricate and stressful job, I'm very sorry that things are so bad and I salute you all 🙏🏻💙

@Gloriosaford it's not as simple as that more a storm of multiple factors as @Lollygaggle and others say.

Brexit didn't help but European colleagues were leaving before. The 2006 contract which was opposed by the BDA and declared unfit for purpose in 2008 by a parlimentary commitee is the predominant issue. The profession has been bolstered along by promises it woudl be changed but every attempt to change it has shown that it would all cost more money. Hence nothing changes.

So we're left with a contract that younger dentists with their massive debt (same as the medics) working in an intense and stressful enviroment ie treating often anxious people performing intricate and skilled work and also having to deal with the business side at the same time just don't want to do. I feel my peers 50+ have kept things going with a loyalty to the NHS but Covid was a shit show for dentistry and we are now burnt out and disillusioned. Thrown in lots of litigation, the GDC, cost of living crisis need I go on?

The current state of the NHS would put people off training if they knew they were tied to it for 5 years. I wouldn't have trained for that. Incidentally whilst the NHS paid my tuition fees I still needed a maintenance loan and took on extra expenses so I could work for free labour train for three years. I am still repaying that back.

A better solution would be to make the NHS a more appealing employer. Fair pay for NHS work, opportunities for development etc

As a child in the 60s there was an NHS child dental service we all got sent to. As a teen I went to the local dental practice, which was NHS. I note it’s private now and had been since the 1990s.

NB dental check ups were free then as were eye tests

When I qualified 60% of the population had dentures, now barely any of my patients have them
@MillyMollyMardy I had no idea that the population of denture wearers was ever this high 😲.
Would it be overstating things to say that this shift accounts for much of the crisis in dentistry, we just do not have the resources to do the work that needs to be done?

The only way forward would seem to be making it mandatory that we all take proper care of our teeth, and while I'm at it the same for our general health.
This of course is completely unenforceable😬

Actually the BDA lobbied the government when there were not enough post grad places for new graduates a couple of years ago. A dentist has to complete foundation training post degree within 18 months of qualifying to work in the NHS and there were not enough places.
The BDA also lobbied in the 90s when dental schools were shut down because NHS modelling said there would be less need for dentists.
The BDA also lobbied when new foundation dentists could not stay on at practices because the health authorities would not pay for an expansion in contract to let the dentist stay on.
Unlike the medics the BDA has no power at all. If it did we would never be in this mess as we have been sounding alarm bells since the new contract in 2006

Dental earnings have gone down year on year for the last 10 years, at the same time new dentists are graduating with £80000 debt and older dentists are leaving worn out and ill .

Dentistry was in crisis pre COVID.

The huge increase in dental costs , post COVID, the debt incurred to re equip surgeries and keep them going, staff near to retirement leaving burnt out and ill, the year on year decrease in earnings for the last ten years, the increasing abuse and violence from patients , stuck with an unworkable contract almost twenty years after it was deemed not fit for purpose , the increase in litigation and regulation has made dentistry a toxic profession in the UK.

Quite a few years ago dental access centres were set up to cope with lack of dentists.
The centres were built and run centrally and dentists were employed.
Right now the average spent, per person treated per year , is around £30 to £40.
Then ,per person treated per course of treatment it cost £480 in an access centre.

This is because a surgery doing NHS dentistry is run incredibly efficiently, very often and min is done at weekends , lunch times, dentists often do their own repairs, decoration etc.
One room ,in a cheap area , doing NHS dentistry will cost £140 an hour to run. Dental inflation is running at 10 to 15% a year.

People have tried this and gone bust. We bussed in foreign dentists who could not believe what they were asked to do and left asap to go private or go home.

How much world class dentistry does £35 per person per year treated buy?

Has Brexit been a big issue in this? My kids NHS surgery hasn’t officially kicked them off the list but just cancels their check up every 6 months and re books for 6 months later. Last time I asked why & the receptionist said they’ve gone from 8 dentists to 1 in the practise. The only NHS orthodontist in the region has handed back the contract. Just wondering what has been the tipping point since Covid as feels that it’s a lot worse?

Do you know how expensive a dental surgery is? The chairs alone cost a fortune, all the equipment and in some cases lead lined walls to protect from x ray radiation. Old Woolworths would need full refurbs and refits and cost millions to do.

I used to work in the dental industry. The majority of dentists I met wanted to do NHS work and often did so far longer than it was financially sensible for them, because they believed it was the right thing to do and felt a responsibility to their patients. Many of them were very reluctant to move to full time private work and only did so when they literally couldn't afford not to.

And why would they want to live cheek by jowl with their colleagues/employees, and vice versa. Sounds like a living nightmare.

@Kendodd with my dentist cynical thinking the contract was introduced to control the spending on NHS Dentistry. No-one could carry out NHS dentistry without having a contract which had it's value preset and the amount of dentistry set. Overtreatment would have been picked up as our activity was monitored at Eastbourne by the DPB.

There were PDS contracts which encouraged preventative care and improved oral health but these cost more money so were scrapped.

@ExtraOnions NHS dentistry is run incredibly efficiently and is cost effective. I can guarantee state run services would be way more expensive.

Why would dentists want to live in flats above their workplace even if the rent was low.

The problem is one of supply and demand. There is a shortage of dentists and so they can command very high salaries. The BDA has for years (like the BMA) ensured that dental training places are limited in number which means this situation will continue ad infinitum.

The solution is to increase the number of places at universities for dental students. But to do so the government will have to persuade the BDA to allow it which will mean some sort of massive pay increase for NHS work. Tony Blair discovered this when they increased the number of traiing place for doctors in the 2000s. The result of that was a renogitated contract for doctors which resulted in a massive pay rise.

I’ve never seen a poor dentist .. let’s face it, they aren’t going to do anything that threatens thier income.

For me .. free training for students, but tied into working 5 years in the NHS afterwards. Increase the number of students, get them fed into the pipeline when qualified, open more NHS clinics using these staff .. increase the number of NHS clinics, shift patients from private to state.