NHS Dentistry takes the piss

[gobbin]

AIBU to wonder why the Receptionist at my dental surgery gets pissy when I haven’t been for 2.5 years (because my teeth aren’t giving me any bother, I just thought I’d have a check up) and arsily suggests that ‘I’ll have to ask the dentist if he’s prepared to put you back on his books’.

Fuck me, my hospital consultant only sees me once a year for my well-managed, life-threatening chronic illness, my tits and fanny get seen every 3 years...what the fuck is so different about teeth that the dentist NEEDS to see a patient every six months. Apart from the kerching they get from the NHS, that is. Christ, if we all went to the GP every six months for a check up the system would be beyond breaking point.

But I DO want to use it. Regularly. Just not as often as they think I should, which is far too frequent in my opinion, compared to other NHS services. Every two years would be fine, with no urgent issues.

Makes sense to me. Any business/service that benefits financially from your patronage wants you to go as often as they can get you to go.

Your local takeaway would far prefer you to go every Friday evening, but they won't decline your custom if you turn up once a year. I know it's not the same thing, but the principle is similar.

Advice used to always be to replace mattresses every 10-15 years. Now, with many years of advancements and improvements in mattress design and technology, it's every 8 years. Whichever place it is in the adverts shows that they write the year you buy it on a label, so if you bought one on New Year's Eve, you'd effectively have an ever-present nag that you 'must' replace it after 7 years, even if you were only ever going to use it occasionally in a guest bedroom.

Maybe, if your GP were personally paid a fee every time you went for a check-up, you might find that they would 'recommended' much shorter intervals than they currently do. I don't know. Logic dictates that, if an annual check is great, then a 6-monthly one must be even better and a quarterly one must be even better still. Having one every day would surely be the very best option for reducing your risks of poor health, but who would ever suggest that as a reasonable use of everybody's time and resources?

I don't know if it's always (or ever) true, but I've read reports of US doctors demanding all manner of 'essential' routine tests and procedures at low-risk births (which, of course, are not 'free' in the way that NHS births are), all of which add to the bill being run up by the patient/their health insurance company, many of which would never be considered in circumstances where the inflated cost could not be passed straight on to a third party.

Come on, they dig 500 year old skeletons up that still have some teeth.

One of the few advantages of being dead is that you no longer have to worry about tooth rot or gum disease!

Additionally, 500 years ago, people didn't live as long. Teeth only needed to last until you were 30-something (if that)!

Just not as often as they think I should, which is far too frequent in my opinion, compared to other NHS services.

Are all services directly comparable? I assume someone somewhere has done research on the optimal time between check-ups to pick up any problematic changes without them becoming major, untreatable problems. I can easily imagine that problematic cells in the cervix may develop at a different rate than a dental cavity, so different times between check ups for different parts of the body seems quite reasonable.

Having said that, it also wouldn't surprise me if guidelines are based on research from decades ago, and haven't necessarily been updated to reflect the current rates of incidence and prevalence of tooth problems.

In any case, we are all different, so whether it's eyes, teeth, cervices or any other part of the body, some people could go decades without there ever being the slightest issue, and others will need further investigation and treatment every time, so the ideal time between appointments will not be best for many individuals.

I don't know if it's always (or ever) true, but I've read reports of US doctors demanding all manner of 'essential' routine tests and procedures at low-risk births (which, of course, are not 'free' in the way that NHS births are), all of which add to the bill being run up by the patient/their health insurance company, many of which would never be considered in circumstances where the inflated cost could not be passed straight on to a third party.

I used to work in medical insurance. The US hospitals would do all manner of unnecessary tests for financial gain.
Once we were handed a bill for the equivalent of £8,000 on tests due to abdominal pain. The diagnosis (which, in the UK, would have been worked out with common sense and conservative 'watch and wait' treatment)... Trapped wind!

My dad is an nhs patient with the dentist. He went for a scale and polish. He was charged £10 and he saw the form the dentist sends off. They charged the government £115 for the remainder of the fee!!

I can't believe anyone could get worked up about a free dental check up, I mean come on!

It may be free for you luv, but some people work for a living, and have to PAY for their dental check ups (AND treatment.)

Some people have certain circumstances and/or are in receipt of certain benefits and don't have to pay. Some people are minted, so the cost doesn't actually register to them as actual money. It's the people in the middle, deemed not to need government assistance but nevertheless on very low incomes, who will often struggle.

Prescriptions are another blatantly unfair scenario. Only about 10% of adults in England have to pay - for everybody else in the UK, they're free.

Some people (like me) with chronic life-threatening illnesses get ALL of their prescriptions free (even if it's for a fungal toenail or something) whereas some people with other chronic life-threatening illnesses, such as asthma, have to pay for them (especially considering that blue inhalers cost pennies to buy, but have to be prescribed).

The fact that such a thing as prepayment 'subscriptions' exist for people regularly needing a number of items seems to me to just rub salt in the wound.

I may be wrong, but I believe that one factor in the other three Home Nations' decisions to give everybody free prescriptions (apart from maybe compassionate and humane grounds) was the sheer cost of administering the minority of paid-for prescriptions - and policing false claims for free eligibility - as opposed to a blanket policy of free for everybody who needs them.

I think at some level people subconsciously assume that the premises, equipment and staff are already covered by the NHS in the same way that a hospital clinic is, and that the 20 pound is going straight to the dentist's pocket .
In reality it is going towards rent/mortgage, bills, paying off the chair and equipment that cost hundreds of thousands, wages for dentist, nurse, receptionist to book your appointment/ remind you / check you in/ process your payment.
Then there's the cost of disposables (2-3 pairs of gloves, bib , covers on tray, headrest, light handles, all this for each patient even if only a 5min appointment) plus time & disposables to sterilise all the instruments,and get you in and out of the surgery.
I would expect most check-ups be close to break-even actually.

I can easily imagine that problematic cells in the cervix may develop at a different rate than a dental cavity

I'm not a medical professional, so am very prepared to be gainsaid, but AFAIA, once any cells start to become cancerous, they don't tend to hang about in multiplying and metastacising.

On the other hand, dental cavities aren't usually life-threatening and rarely go completely unnoticed or unsuspected by the sufferer.

I think at some level people subconsciously assume that the premises, equipment and staff are already covered by the NHS in the same way that a hospital clinic is, and that the 20 pound is going straight to the dentist's pocket.
In reality it is going towards rent/mortgage, bills, paying off the chair and equipment that cost hundreds of thousands, wages for dentist, nurse, receptionist to book your appointment/ remind you / check you in/ process your payment.

I think many people will appreciate that a dental business has overheads like any business - but we're constantly being told of vast numbers of people who can't find an available NHS dentist. If the individual practices were not restricted on the numbers of people they could have on their books, what difference would it make to them if they have four separate patients over two years rather than one person four times?

With respect, I don't believe that many of them are only just breaking even - if that were the case whilst there's clearly a huge demand for dentists, why would any of them decide to take on NHS work in the first place?

My apologies, I just re-read your post and you were only referring to check-ups when it comes to breaking even - not all treatment.

If that's the case, though, it's a sad state of affairs if they can only make a living as a direct result of discovering problems and thus, financially speaking, their ultimate incentive would not be to promote continued health and prevention of problems.

Tbh after my mum died of mouth cancer i would recommend going every 6 months as they are trained to spot this....and gum disease.
I am a hypocrit of course as i never go! Ignore snotty receptionists.

WeBuilt,I agree it is a sad state of affairs
This is one of the many reasons I (and many of the colleagues I qualified with) no longer see NHS patients.
This was not what we intended when we started out in our careers, but the funding model is broken, unless you are in a low-overheads part of the country, or fudge the rules, unfortunately.

@malificent7

I'm really sorry to hear that. Of course it's not just painful-but-otherwise-non-dangerous problems that dentists discover and treat.

I think that (most) dentists do a great job and I've no beef with them at all; but mouth cancers are (I believe) much less common than breast or cervical cancers, so why, as the OP has mentioned, is there a stated/implicit need to have mouth/teeth check-ups much more frequently than breast and gynae check-ups?

@MargaretRiver

It is indeed shoddy that, with the noblest of intentions, so many of your profession are effectively forced into abandoning the NHS in order to make ends meet.

I've never understood why almost all potential health conditions and issues are covered by the NHS (some of which could arguably be considered of lower urgency/priority) - but teeth and eyes are nominally subsidised but largely left to be run by independents as businesses.

I agree that the frequency of appointments should not be one-size-fits all.
If we are monitoring early reversible disease they should be more frequent and if everything has been stable for a while, less frequent.

But the fault for the inflexible system lies in the NHS funding model, not in the individual dentists struggling to continue to provide NHS services

I understood that the 6 monthly recommendation was for children only. Adults are now recommended 12 monthly checkups unless they have specific issues.
But I am one of those people who treat the dentist like my GP. I don't go unless I've got a problem. I'm prepared to pay for private, as I'm aware an NHS dentist will kick me off their books. It has saved me money doing it this way.

But I am one of those people who treat the dentist like my GP. I don't go unless I've got a problem. I'm prepared to pay for private, as I'm aware an NHS dentist will kick me off their books. It has saved me money doing it this way.

I'm exactly the same. I see no need to visit the dentist as frequently as they recommend, so I only go when something is wrong. The last time was 4 years ago for a filling (the only one i've ever had to have)

Dentist works differently to the doctors. You don't get 6 monthly checks at the GP. It's just different. You should look after your oral health. YABU

I'm having a similar issue at then moment. Just had to cancel my 2nd appointment as work keeps moving around. I asked if I could delay booking another one until things had settled down and was told if I don't turn up then they'd deregister me. I said ok, do that and I'll re-register in future with another dentist. Then told that actually they had spaces open so they wouldn't deregister me until they had people who would fill me space but they're still going to keep calling me and sending letters threatening to re-register me until I book an appointment

We are still having to pay our dental fees! And more often than private patients too, coz they are not forced to attend every 26 weeks. hmm

I visit my private dentist every six months and I can promise you it’s far more than the £22 NHS check up fee!

I was going to say that NHS dentists are paid on a unit system and this is fully explained in a previous post. In some cases, NHS dentists end up earning more than private dentists.

I did briefly switch to a NHS dentist who decided immediately I needed five fillings (private dentist never said this and I’d seen him recently). I had these five, very small fillings done, in pain as she didn’t give the local anaesthetic a chance to kick in. I didn’t go back after this as I just can’t trust that they did these fillings in my best interests.

So I pay more because I trust my dentist, I’ve been going to him since a child, and I’ve never had a painful experience with him.

Oh, and I didn’t see a dentist for a few years and my private dentist very nearly made me re-register with them, which would cost a small fortune in xrays etc. Thankfully they let me off!

They are free to the child. The dentist gets paid to do it They get about 6 pounds for a child's exam.

I've never understood why almost all potential health conditions and issues are covered by the NHS (some of which could arguably be considered of lower urgency/priority) - but teeth and eyes are nominally subsidised but largely left to be run by independents as businesses.

This explains why:

www.nationalarchives.gov.uk/cabinetpapers/alevelstudies/management-1950.htm

I've been told, by more than one dentist, that given the condition of my teeth, that a 12 month check up is all that is necessary. Will my current dentist have it? No. I'm in the chair for less than a minute.