What's the answer to the loss of NHS dentistry in the UK

[Thottey]

600 practices have withdrawn completely from NHS dentistry in ten years.
My DC, both adults were told their dentist wasn't going to treat them any more unless they went private. They have registered as private patients elsewhere.
Private dentistry is hugely profitable but it used to be focused on cosmetic dentistry and serving the wealthy. Now their patients are from all walks of life.

NHS work doesn't pay and there needs to be an alternative.
Perhaps clinics where the dentists are directly employed by the NHS. Recruitment would be difficult at first but I think the vast majority of the population would abandon private dentists and use the NHS if they had chance. I'm aware there are a few of these already. The waiting list for the one in my area is four years.
So gradually the private firms would lose patients and there would be more dentists to recruit.

Insurance?
Or ask the dentists directly what they would suggest/recommend.

I think there are not enough Uni courses training dentists. My DD considered it initially and we looked into it and I was amazed at the limited number of Unis offering dentistry as a subject. Everybody in the country needs a dentist. I go to the dentist more often than the GP.

I think the provision of courses needs to expand. I also think the state should offer jobs to dentists on graduation, with a commitment to work in the NHS in return for a reduction in course fees.

What’s the answer? More government funding, in whatever form that takes. Personally I think the system needs a complete rethink. The gov will never fully fund what is required to provide a full service, so maybe put what money there is into giving basic treatment to put people out of pain where needed. Then provide free dentistry and preventative care and education for children? Ensure the next generation are taught to care for their teeth better, instead of being neglected by a system that doesn’t work.

The average cost , per course of treatment per patient , including patient payment in a high street practice is £39

The average cost per course of treatment per patient in a dental access centre is £540 . One has just been closed in the south west .

In the high street practice administration, repairs , meetings , maintainance is often done by practice owner , out of hours and unpaid . They are run utterly efficiently as there is no room for excess. Only 19% of practices are owned by corporates.

As the above figures graphically illustrate NHS dentistry is grossly underfunded. Most NHS treatments lose a practice money , the private side subsides the NHS https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

The answer is a massive increase in funding. How much work would a garage or a plumber do for £39? A cheap room in a cheap area providing dentistry will cost a minimum of £140 an hour to run . How far does £39 go towards this? A practice gets no other money to run, pay wages, train etc other than what it earns through fees.

Realistically after so many decades of defunding NHS dentistry no government is going to plot in the billions it would cost to rebuild it. Really using the funding to provide pain relief for all and basic dentistry for the most vulnerable/needy would be the best use of a tiny budget which will never provide a universal dental service for all.

I used to work for biggest dental provider in the UK and in honesty it just ain’t worth the clinicians time. Having to hit their UDAs etc. It’s also extremely difficult to get overseas clinicians in lots of more rural areas. If you’re moving from India you want to go to London or Manchester, not Lincolnshire.

There are more dentists registered than there have ever been. They just can’t work on the NHS for no money. Dentists are not employed , there are paid piecemeal per piece of work done. Often the fees don’t even cover costs and dentists would lose less money giving a patient £20 to seek treatment elsewhere .

Introduce licences for private dentists - restrict the number of licences issued and make them expensive. NHS dentists will be able to operate licence free, or at 50% of the licence fee if offering both NHS and private treatments. Not sure how it would be managed.

Basically the NHS needs to pay dentists properly for the work done.

That and I suggest we need to set up surgeries with Dentists employed by the NHS in some areas.

Dentists already pay GDC registration, indemnity, CPD costs to remain registered every year .

In addition private work subsidises NHS work , the pay for which often doesn’t even cover costs. Every dentist does private and NHS work because you cannot pay the bills to keep the lights on in the practice for what the NHS pays , let alone pay staff . The average cost , per course of treatment per patient , including patient payment in a high street practice is £39

As the above figures graphically illustrate NHS dentistry is grossly underfunded. Most NHS treatments lose a practice money , the private side subsides the NHS https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

The answer is a massive increase in funding. How much work would a garage or a plumber do for £39? A cheap room in a cheap area providing dentistry will cost a minimum of £140 an hour to run . How far does £39 go towards this? A practice gets no other money to run, pay wages, train etc other than what it earns through fees.

I think we would all be happier to pay if the prices were more reasonable, but I’ve paid £1000 for a root canal including cap

Everyone needs one so if they don’t have to do NHS dentistry and can charge more then that’s what they’ll do. I’ve never met a dentist who wasn’t very well off.

Already been done , with NHS paying all costs for a practice it cost £540 per patient treated per course of treatment. A true estimate of the extremely high costs of providing dentistry.

By comparison a course of treatment in a high street dentist , including patient payments , costs, in average £39 .

This demonstrates the gross underfunding of NHS dentistry.

Dentist qualifies with £100,000 debt . To qualify as a root canal specialist will have to pay the cost of training, circa £30,000 plus cost of equipment eg £20,000 for operating microscope, £90 per use of specialist cement, single use instruments etc.

The technician who makes your crown(cap) will have trained for five years and your crown will take hours of hand crafting to make .

A cheap room in a dental practice in a cheap area will cost upwards of £140 an hour to run. How many hours did the work take? All of this needs to be paid for .

This is a quote from a dental group posted today , many posters having the same problems

“Hi, have any other owners been at the point where there isn’t enough money to pay the bills?

How did you get out of this cycle of being chased for debt etc?

Currently stressing about not having enough money for payroll this month never mind anything else.”

personally speaking as a dentist of many decades NHS/private trainer etc I never made enough to pay higher rate tax .

My dentist in Wales have just stopped NHS patients ( I think the situation is even worse in wales) just grateful I’ve managed 63 yrs of NHS dental treatment.
Some of the children I have worked with have such poor teeth, never been taken to the dentist by their parents who probably don’t have a dentist themselves and seeing them in pain with toothache was so hard.
we did Design to smile where we sat with them to brush their teeth every day in school (not the nicest of jobs in school) sent home tooth brushes and tooth paste regularly with each child but even then I would be chasing parents down to get them to sign the consent forms!

I listened to a dentist on the news this morning who said that the NHS cost per procedure was too low and his private practice was subsidizing the NHS work.
I would like to see a breakdown of costs for an NHS procedure Vs a private one. For example a filling, to see an example of how much the materials actually cost and how much is being charged for labour in each case.
Without knowing what the comparison is, it's hard to tell if the NHS funding is mean or whether the dentist is coining it in for very little work.( Or excessive profits are going to the investers in big group practices)
All I know is that this seems to be the same as has happened with vets. As soon as insurance companies and corporate chains get involved, prices seem to rocket.

It costs , in a cheap area will cost, set up as cheaply as possible , a minimum of £140 an hour to run one room in a cheap practice . That’s without paying the dentist etc. Obviously costs in large cities will be higher , as will costs for rooms set up for more advanced dentistry as more equipment and better materials are used. Privately costs will run from £220 an hour per room . To train and equip a dentist for eg implants will cost a minimum of £300,000

The average cost of a course of treatment paid by the NHS including patient payments is £39 . How much work would a plumber or garage do for £39? That £39 pays for all expenses and wages etc .

Virtually all dentists now do some private work as that’s what keeps the lights on https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

Also , as far as I’m aware , nine of the dental corporates in the U.K. have ever made a profit , they are used as a method of raising loans https://www.cityam.com/mydentist-looks-to-india-for-new-recruits-as-loss-widens/

BUPA closed 85 practices a couple of years ago as they couldn’t make them viable.

Boots and specsavers had a go at corporate dentistry and closed because they couldn’t make a profit.

There is a saying in dentistry “it’s easy to make a small fortune in dentistry , you start with a large one……”

Hi, private dentist here! I worked NHS for 10 years and practically broke my back for an NHS contract that isn't fit for purpose. There were days where I didn't get paid for some patients, some where I lost money, I had to pay if I did too much work and pay if I didn't do enough of my target, patients walked in and yelled at me for the prices like the government isn't the one increasing them and pocketing the excess.
The crisis is a dastardly state of affairs but it isn't the dentists fault. The UDA system needs to be replaced and funding needs to increase in line with inflation - which, by the way, is what we dentists have been telling governments for years. Everything the government does in the meantime is just plastering cracks while the scaffolding breaks.
From what I know from fellow colleagues, if things go on the way they are, expect every NHS dentist you know to make the switch and NHS dentistry to drop off the face of the earth entirely. The government has expected NHS dentists to prop up the system at the expense of their own mental health while scapegoating them for all it's issues for far too long now.

There are practices where what they are paid for a proceedure is less than the patient charge (there is no more funding that has to cover all wages, expenses, training , equipment , materials etc). In effect the practice is acting like a tax collector.

It's sad because NHS denistry was bought in to help people look after their teeth at an affordable cost.

Will we just go back to people having bad teeth and lots of problems then?

I have seen a dentist open recently where you have to pay but your children are free!

I don't know what the answer is but you only have to look around to know there is a problem
In my whole life - and I'm not young - I've never seen so many people with missing teeth and obvious lack of dental care.

People get dental insurance. Look the NHS wasn’t made to support absolutely everything. People can save up and get a filling or a hygenist appointment. My husbands dental insurance is like £20 a month. The NHS has bigger fish to fry like cancer, people being housebound for years with pain…

It seems to me that there is NHS dentistry that pays bugger all and the private dentistry that can charge a fortune. Toothache is intolerable, that Marathon Man scene is so famous for a reason.

My old work colleague was married to a dentist, she was in her mid 20s and they had been dating since school. They were buying a second house and keeping their initial one to rent out. She said her husband did more NHS work than his friends so they weren’t as well off as them. My friend’s father is a dentist, he has passed hundreds of thousands of pounds down to his three children; the dentist family from at my DC’s school live in the million pound houses up the road. If that’s the kind of money private dentistry brings in, why would anyone do NHS work at a loss?

This ^