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600 practices have withdrawn completely from NHS dentistry in ten years.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.

Judging from what I’ve seen both in person and on social media , very little of the dental tourism carried out in Turkey and other places can be deemed as clinically necessary.

In many decades of practice I have never placed cumulatively , on one patient , 28 crowns , let alone placed 28 crowns on a twenty or thirty something patient in one treatment .

Teeth were in such a poor state they needed implants. Constant issue with infection. I highlighted that aspect in response to a previous poster’s “well, duh” type comment.

Very often there is family pressure and unrealistic expectations of the job , pay , stress levels and conditions which is why most dental schools insist on work experience so they get a more realistic view of the intense pressures etc

We have a big problem in dentistry with burn out and particularly in younger colleagues . After investing years in studying and slogging through dental school many are disillusioned with the reality of practice but with the massive debts they’ve accrued can’t consider a change of career. Dentistry is widely considered one of the most stressful jobs combining micro surgery on conscious patients in a very small area , putting tremendous stress on the back , neck and rest of the body , whilst managing a team , admin and a business . Dental schools are now trying to assess resilience and ability to function under intense pressure as part of selection process.

It's the private practice bullshit. Both dentists and GPs argued for this at the inception of the NHS. They wanted to maintain it as contracted private practice. Doesn't work. Should be totally nationalised.

Clinics run by health authorities, dentists and their general staff directly employed by the NHS. Loan forgiveness after 10 years of employment in public NHS service. Nothing fancy, purely based on health.

Bizarrely, my adult daughter found she needed emergency dental treatment while living in Mexico. Better, cheaper and much less hassle than the UK. Ridiculous.

Further, energy single shred of evidence shows that insurance-based medical care is stupidly inefficient in economic terms, just look at medical care in the US. I do wish people would stop suggesting we should adopt such a deeply flawed system here.

My understanding is that dentists who only do private work for adults will offer NHS for children, so they, ie the dentists, can access the NHS pension scheme. Perhaps loopholes like that need closing or rearranging so that only significant and volume adult NHS dental work counts towards pension.

Clinics set up , equipped and run by the NHS have already been tried. It would require a massive increase in spending.

A course of treatment in a high street dentist costs , including patient charges , £39. That covers all the costs of equipping, running of the practice it gets no other money.

A course of treatment in a dental access centre costs £540. It is a more realistic view of what it costs to run a dental practice and explains why dentists need private treatment to subsidise the costs of running a practice.

When I qualified many years ago, there was a tiny percentage of dental treatment done privately , less than 5% and mostly in London.

Today around 69% of dentistry is private, because successive governments have systematically defunded NHS dentistry and without the cross subsidy from private treatment surgeries couldnt afford to keep the lights on https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

Missing legs because they had uncontrolled diabetes, and we don’t have diabetes clinics.

That’s what it’s like.

It is a bloody disgrace. My teeth are fucked. Haven’t had a dentist since Covid. Can’t afford one. I know I need work. Too terrified to find out the total cost.

It is embarrassing. Not just for me but the whole country. Most people’s teeth are awful. And the gov are like ooo britains the best. We look like we don’t even brush our teeth! Embarrassing. How do they expect anyone to take us seriously.

I don’t think anything the US does in terms of health should be adopted but there are plenty of other models in other countries which appear to work well. Healthcare is a mess but unfairly I don’t feel any of it, anything medical I really need followed up, I just use work related insurance and it’s no bother. I do have an NHS dentist (along with DH and my adult DCs) but when I had a molar pulled and could have lived with a gap, I could afford spending £5K on an implant because I didn’t want the gap. Healthy teeth should be basic healthcare, it’s terrible it’s such a mess.

In most areas child only contracts are not allowed.

It could be argued that by seeing children the subsidising of NHS patients by private work means that the money is directed towards the most vulnerable. Most NHS work will lose the practice money https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

Tbh I think the children thing is also a problem.
It makes a void.

I was a child on free with parents private dentist. At either 16 or 18 I can’t remember - I became ineligible. Right at the point I was moving out to uni. Obviously couldn’t find anywhere. Never had an nhs dentist since. Part of the reason my teeth are so fucked is lack of routine care in those earlier years.

I remember doing a job lot on them about 25 years old. Cost nearly thousands to sort them out.

A decade on I need a similar amount of work done. Reckon it’s probably doubled in cost if people are saying a root canal is 1k!

Basically I am not saying they should get rid of free children. I think nhs should extend the age to 21. Hopefully gives people a chance to get a job, become sensible, get insurances. 19 year olds are not putting dental work as a top priority.

People who have more month than money can't just save up. People who already have dental problems can't get insurance until they're fixed.

I don't think NHS dentistry will ever come back in the way it once was.

Most people will need affordable dental insurance, and the government should focus on how to deliver that. There should be incentives for employers (particularly if low paid employees) to give employees insurance, and for self-employed people to take up insurance (by incentives I probably mean tax breaks). The government should also look at getting insurance plans for its own employees.

State money should be directed at those who genuinely can't get insurance or can't afford it, at children, and at those who have congenitally bad teeth or chronic dental problems, for whom insurance might be prohibitively expensive.

It'll be a brave government who grasp the nettle though, and there are so many other nettles to be grasped. So we'll probably drift further into a three tier system- those who have insurance or can comfortably afford private dentistry; those who have an NHS dentist or struggle to give themselves some private services; and those who can afford little to no dentistry at all.

Some dentists have child/exempt only contracts but for most they arent allowed to only offer NHS to children, it is a heavily regulated industry. The amount of work an NHS dentist does is fed back including the breakdown so if they arent seeing the appropriate number of adult patients, or if they are doing too many band 3 treatments on excempt adults for example they will be investigated. The practice has a contracted amount of work that they have to do, they cant just do a few quick children's check ups and fulfill their quota

What the practices usually do is offer free, not NHS subsidised, checkups to the children of private patients.

How do other nations keep basic dentistry affordable for everyone whilst also ensuring dental staff are fairly treated? Somewhere must surely be doing it right?

I had dental work done in Hungary and it was of excellent quality and much cheaper for me than UK, but for locals on local wages, it was probably little better than the UK situation in terms of affordability.

Also, is no one talking about the practices owned by private equity firms, whose sole reason for being is to extract maximum profit.

And are there lower cost models that would allow dentists to set up their own practices as a partner owned small business? I get that premises, insurance etc costs a lot - is mobile dentistry a thing and would that be cheaper to deliver?

Sorry I haven’t read the whole thread.

Only 19% of dental practices are owned by corporates and , as far as I know , none have ever made a profit on the dental side. The businesses are used more as a way of moving loans.

BUPA closed 85 practices, specsavers and boots withdrew from dentist and my dentist posted record losses this year.
When it costs over £140 an hour to run a room in a cheap area the total , including patient charge , of £39 per course of treatment paid looks more like the gross underfunding it is.

Most NHS treatment doesn’t even cover costs let alone pay the dentist. Private practice subsides it for most practices.

Mobile dentistry is hideously expensive , you have to have all the equipment , sterilisation etc but can see far fewer patients.

High street dentistry is as efficient as possible , owners do paperwork, maintenance, etc unpaid in evenings and weekends. What would you get for £39 from a garage or plumber? In the NHS this is what a dental practice gets to cover all costs, wages etc for one course of treatment for one patient.

I'm 56 and haven't been registered with an NHS dentist since turning 18. There are so few in our area and frankly the ones that are wouldn't be practices that I'd choose to attend. I pay £45 for an inspection every 9 to 12 months, and the last time I had x rays taken along with a scale and polish it was £85 total. So it works out at under £10 per month over that year.

I had a dental crisis two years ago and I went to the NHS dentist. It took some persistence to get an appointment and when I did and I went it was like a war zone. People yelling at the receptionist and the dentist himself looked like he had been dragged through a hedge backwards. His hair was sticking out in all directions and he seemed so stressed out. He almost threw me in the chair and was yelling at the hygienist for tools and I was out of there like a formula one car at a pit stop.

In the meantime I had decided to register at a private practice so went there for my next appointment. There were magazines and the dentist came down to the waiting room to bring me to his room. He chatted away. He looked like he had facials and he was beautifully dressed. Now if I was frazzled NHS dentist and I could stop being yelled at and having ninety seconds to do a check up then I would.

A Russian friend used to return to Moscow every year and would get her dental work done then. It sounded far superior to anything you’d get on the NHS, and was relatively cheap. The same goes for all medical treatment there, from what she has told me.

This makes sense. There are many, like me, who are lucky enough to have retained an NHS dentist for many years but could actually afford private. I could never get insurance as my teeth are a product of horrific 1960s dentistry (a whole other thread).

When I qualified many years ago, there was a tiny percentage of dental treatment done privately , less than 5% and mostly in London.

Pretty much what I said in my OP.
Vast numbers of the UK population can't afford private and can't access NHS.
There needs to be a middle ground.

So, most of the rest of Europe doesn't have subsidised dentistry for adults. You pay. But because everyone pays, it's cheaper, because private dentists aren't subsidising a state system. Unfortunately our NHS system for health and dentistry is no longer fit for purpose.

There is also another reason , dentistry in the U.K. is the most highly regulated in the world. Over 59 different bodies have the right to inspect dental practices .

All dental professionals including dental nurses and technicians have to be registered annually and have to carry out CPD (training) annually to remain on the register .

You are more likely to be sued in the U.K. than anywhere else in the world , including the US and more likely to be in front of the general dental council than any other profession and any where else in the world.

All of this has cost implications from the costs of regulation (just to have your sterilisers (autoclaves) serviced and inspected each year costs upwards of £1500 each and most practices have several and it’s a legal requirement , to the costs of registration and indemnity insurance .

This costs either do not exist or are far smaller elsewhere than in the U.K.

I have a nhs dentist - I pay band 1 which is twenty something pounds and she sees 6 patients an hour for band 1 check ups, sometimes more because families are booked into only a slightly longer slot. There’s the dentist and the practice nurse, 4 more dentists in the building and 2 receptionists. I’d love to know the full economics of the practice, on top of nhs work they have private clients on Saturday and a hygienist rents space. My back of an envelope calculation is that the room makes £150 an hour approx and that needs to fund a dentist (10 years qualified partner) dental nurse (say £25 an hour including ni, pension etc) 20% of the reception and building costs, insurance… I don’t think the dentist makes a big profit but I’m sure she is earning ok from nhs work, the big expenses are things like equipment but I know being an nhs practice they get help with capital costs

No there is no help with capital costs for dental practices. There is no help for any costs at all , everything from cost of buying, equipping practice , to running costs , materials, lab bills, wages, NI , pensions etc has to be paid out of that money that is earned from seeing people.

Add to that if a patient fails to turn up the fixed costs still have to be paid but with no income. 40% of all new NHS dental patients fail to turn up and most practices run at a rate of 10 to 20% of regular patients fail to turn up or give adaquate cancellation to book anyone else in .

Add to time in surgery all equipment and surgeries will be disinfected and sterilised inbetween every patient , paperwork filled out , x rays reported on , referrals done , medical histories checked , NHS paperwork done, audits done etc etc .

Realistically in a very busy , medium needs area with a very experienced dentist working full out , they might achieve 30 UDAS a day which is equivalent to 30 check ups or 6 to 7 lots of filling treatments (if they only need one filling . In a high needs area that figure will be much less as people come in needing multiple fillings , extractions , with many visits which earn the practice no money . This level of work is extremely draining and will result in burn out . You cannot keep up that pace of work year after year without the inevitable toll on back, neck, skin , mental health that comes from doing microsurgery on a conscious patient , in a tiny wet and difficult to access area , in very awkward positions for 8 plus hours a day as well as all the admin, paperwork and running a team and business .

Then take off holidays , training days (compulsory) , sick days .

Just to run one room in a cheap area , set up for NHS dentistry costs upwards of £140 an hour without dentist/hygienist/therapist being paid . Most NHS dentistry runs at a loss and is subsidised by private work. https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/