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600 practices have withdrawn completely from NHS dentistry in ten years.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

@Lollygaggle you sound like you hate being a dentist, not just the money but the actual job? Is there an exodus from dentistry similar to that in doctors?
I know of several young people who went into medicine. A few years on only one remains, the rest have either quit and gone into different careers or left the UK to work abroad. My neice is in her second year and while she loves it the relentless travel as they get moved every few weeks plus 12 hour shifts, nights and lack of choice in when they take holidays is making her question it.

I loved being a dentist , I loved training young dentists (I no longer practice clinically due to illness but work in other ways in dentistry) but I qualified many years ago in a much less regulated , litigious and stressful environment when we could make a decent living doing interesting work that was decently renumerated on the NHS .

However since 1992 successive governments have gradually defunded NHS dentistry and the inception of no win no fee has made the general public increasingly litigious. The antagonistic and often unwarranted and disproportionate punishment of dentists by the General Dental Council has left many dentists , particularly younger ones , terrified.

Add to this the almost pathological hatred and personal abuse many dentists get from the Great British Public makes it very difficult to recommend the career to the very talented youngsters who are the only ones likely to get a place in dental school .

There is a massive exodus ,
dental nurses are leaving in droves , driven out by poor pay and onerous responsibilities coming from their requirements for registration

dental technicians driven out again by poor pay and, registration costs and responsibilities and cut price (and quality) competition from abroad

dental hygienists and therapists are relatively steady at the moment but as therapists are used more in private than NHS work this will change as much get caught up in NHS treadmills

dentists , particularly young ones , are leaving. Leaving to go abroad where conditions are so much better , no NHS treadmill , far fewer complaints, litigation and no fear of GDC .

older dentists are leaving worn out by all the above. Pre 2006 once you reached 55 you used to get seniority payments as recognition that the job took its toll physically etc and you could no longer work as fast as you used to. It was to protect your income, that was removed.

My colleagues in clinical practice in NHS are worn out by the excessive clinical and admin burden placed on them . They are sick of Porche and holiday snide remarks , particularly younger ones who find 50% of their earnings go in repaying student loans , registration, indemnity and CPD without even trying to cover cost of a cheap car and rent .

Ive had a great, rewarding career in dentistry . I loved the interactions with patients and colleagues and the life changing diagnoses and treatments I’ve provided . I would do it all again in a heart beat at the time I qualified. I would not contemplate it now as a new graduate . Maybe in a few years time when the NHS dentistry problem has been sorted one way or another and the toxic effects of providing dentistry for pennies and the value that puts on the highly skilled teams who provide it has gone .

Insurance for private dentistry.

That’s it. We need to all pay. The ‘free’ service for destitute people would be limited to extractions/treating infections.

Absolutely.
I pay private as no NHS but i struggle to pay it and already work full time plus an evening job twice a week to make ends meet.
Such a vast difference in costs NHS V private.

Train more dentists. That wold require allowing more universities to offer dentistry as a course. Like the BMA did for doctors, the BDA will resist this as it will dilute the value of a dentist and probably lead to them earning less money.

There are more dentists registered than there has ever been . There are also dental therapists being trained now to do some of the range of tasks a dentist does.

The problem is none of them want to work for NHS fees that don’t even cover the surgeries costs , let alone pay them anything. They can’t afford to lose money on treatments and be unable to afford to live and pay back the £100,000 debts the average new dental graduate will have built up.

Until what is paid covers both the the minimum £140 an hour to run one room and pay the clinician something you can train as many as you like they still can’t afford to do NHS treatment. In many cases they would lose less money giving a patient £20 to go elsewhere . Private dentistry has been subsidising NHS at most practices for years . https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

Thank you, this is interesting.

I think very little hard work is quite unfair. There is no way on earth you would get me to drill people's teeth and build the back up. It's not physical graft, but it is very skilled work.

I think loan forgiveness for NHS service is a very good idea. It would provide a constant supply of dentists, even if they did leave after ten years.

I think they should train some people to be able to do minor fillings and extractions. Leave those with the full dental training to complete exams and more complex dental work. Then treat these people a bit like when you go to get blood drawn.

You do realise the actual work involved with that root canal? It’s basically an operation in your mouth

How the bloody hell can every other European country manage to have affordable dentistry, subsidised by the state if necessary, and we can’t?

Our dental surgery does that - children see a dental technician for routine checkups. Same with the orthodontist- four technicians under one orthodontist.

Feel lucky to still have one. Our dentist is from Sierra Leone so sees the value in helping people rather than trying to extract as much cash as possible. Seems to still be doing ok, his car is nice anyway…

It must cost the NHS a lot when it goes wrong for people. Despite having a dentist, I got a bad abscess over Christmas one year so with mine being closed I ended up in A&E for example. It had spread so much my eye was closed so it was severe. They had to drain it and I’d also overdosed on paracetamol so needed treating for that. Imagining the thousands without a dentist must do things like that often.

It exactly what's wrong with any privatisation.

If someone can work privately and have more control over their hours and client list, why wouldnt they? The only real barrier to full time private is having enough clients, hence many doing the mixed model. But once you bring in dental plans and insurance, it further undermines the need for the NHS contracts.

The solution for people is wrapping dental care fully into the NHS and, IMO, there shouldn't be a charge to access it for anyone- noone pays for the GP, so they shouldn't pay for a dentist.

Obviously that solves access but comes back to funding, for which I think the Gov need a huge wake up call about funding certain services but that's a different topic.

Cynically, I think lack of funding is why we're going around the Merry Go Round again with this devolving to councils idea from Andy B - the idea sounds nice: give local areas control of local services. In reality, hardly any central funding will be ring fenced, so anything that can be deemed non-essential funding, like making the place look nice, environment or transport will be eaten up with ever growing social care costs. Which will be further propped up by deals for agreeing housing sites in exchange for yet more primary schools rather than healthxare services (if you've ever seen a huge new build area go up, you'll be familiar with this sweetener whereby housing developers agree to build something for the local community and its always a bloody primary school).

In no planet is the right answer to bring dentistry back into the NHS. Once again - look at European peers and how they run their dentistry and healthcare for answers.

I think that we are at the point where NHS dentistry doesn’t exist. It should exist for all children under the age of 18 and all adults in receipt of the state pension. Plus all adults in receipt of the enhanced PIP.

Anyone else will have to take out insurance.

This is what happens in the area in which I live. 14 years ago when we moved to our large town (60,000 people), there was only one dentist taking on NHS children in the area. Not one for miles and miles was taking on adults. So we signed up with the one dentist that would see our two DC under the NHS. DH and I then took out monthly Denplan insurance. We are still with him, loyally so.

And if you can’t afford the insurance? No treatment. Until the inevitable emergency treatment at a dental hospital miles away.

I think it’s going to have to be normalise having dental insurance, larger employers should offer affordable dental insurance schemes, my work offers this already.
My dental practice also offers an insurance scheme with 2 free checkups a year etc.
I think if people think it’s normal to have dental insurance most people in employment will do it.
NHS emergency drop in clinics for everyone else, or pay for one off treatments.
I think dentistry including orthodontics for under 18s should be free with private practices being able to claim back from the NHS.

I haven’t had an NHS dentist for years now, we just pay privately. Luckily I have good teeth! Kids checkups are £20 each at my practice so no excuse really, most families can budget for that 1-2 times a year.

Dental therapists are trained to do this , except they can only remove baby teeth not adult teeth. They can open courses of treatment on the NHS and refer back to dentist for more advanced work.

They are used in NHS and private practices except it still doesn’t stop the problem that what is paid on the NHS doesn’t even cover practice expenses , let alone pay a clinician .

It doesn’t . In most areas dentistry is not part of state provision , or is aimed at vulnerable groups.

Dental insurance is compulsory in many countries and dental tourism is common. Eg many people in Ireland travel to Northern Ireland for cheaper dentistry etc

It doesn’t matter if your student loan is paid off if the fees for NHS treatment don’t pay enough to pay practice expenses , let alone have enough left over to pay the dentist. https://www.bda.org/media-centre/nhs-dentistry-treasury-now-no1-roadblock-to-saving-service/

Private work subsidises NHS . Without it the derisory amount paid won’t even keep the lights on in the practice . £39 per patient per course of treatment , on average, including patient payments . How much would you get from a plumber or garage for £39? That has to pay for everything including building, materials, lab fees , equipment, wages etc. There is no other money.

The number one reason for dentists to retire early is back and neck problems , caused by doing hour after hour of microsurgery in a very small area , on a conscious patient , in very awkward positions.

Dentists hit peak earnings around 40s as they become more experienced and faster. Their earnings decline in 50s as their physical limitations start to affect speed and hours they can work. The NHS used to allot seniority payments because it caused a substantial drop in earnings .

My dental practice has been private since the 1990s, although they provide NHS treatment for children & ds1 has continued as an NHS patient, but they will only see him every two years.

From what I recall from the news of the time - lots of dentists became private in the 90s - dentistry was never properly integrated into the NHS. Dentists were paid for work done, not a salary. Although it was intended to be universally free, it proved so expensive that charges were introduced in the 50s and have continued ever since.

Not sure what the answer is really. Children should definitely receive free treatment though imo.

A dentist is not a GP. A dentist will do many procedures at their practice where the equivalent would be referred to secondary care by a GP.

As with “free” childcare hours, if the government underpays providers for the work, providers will need to find other ways to cover costs.