To think maybe they need to make NHS dentist places means tested?

[dameofdilemma]

Reading about the shortage of NHS places and having seen it in real life….is the Govt going to do anything at all about it?

I’m fortunate enough to be able to afford treatment as a private patient but what about those who can’t? Dp is registered as an NHS patient and is even thinking of giving up his place and registering privately (if he knew if would go to someone who needed it).

I’ve had two dentist appointments recently, both times while waiting, a string of people were coming in to ask about NHS places. The local FB pages are full of desperate posts as no one can find an NHS place. They’re facing long, long waits for treatment at hospitals.
Having had agonising tooth pain recently, its debilitating, it effected my ability to sleep, eat and work properly. This isn’t a ‘nice to have’ treatment, its essential.

So maybe the NHS places should be reserved for those on the lowest (or no) incomes? It can’t make any practical sense to offer places to higher earners, if places are so scarce, if all that happens is people are then having to rely on (already overloaded) hospitals or being unable to work etc.

I know we don’t want as two tier system or a shift to private healthcare etc but reading some of the stories of people unable to eat and passing out from dehydration, the status quo clearly isn’t working either.

This. Always the middle earners who end up disadvantaged, they will be the ones funding it through taxes and not receiving any benefit from tax payments.

As a dentist this is what I would do.

I think we will move to only children and exempt patients having NHS treatment. Exempt means on benefits which are means tested. This is happening anyway by stealth. The government needs to admit it.

Even more importantly, a core service. Pain relief, Exam, scale if clinically necessary, fillings, extractions, root fillings for teeth 6 and forward only, plastic dentures.
Complex treatment- 7 and 8 molar root treatment, crown and bridge, metal dentures to be private only.
This system would be greatly beneficial for patients because those who can’t afford it would be able to get out of pain and dentally fit.

People will get used to paying for dentistry like they pay for eye tests and glasses and will take out insurance.

The dentists who provide the NHS treatment need to be salaried and work in state run clinics (similar to community dental services).
UK graduates exempt from Uni fees for the last 2 years in return for a commitment to work in these clinics for a period of time after graduation.

This would also sort out 2 other problems:.

1. U.K. graduates have a fraction of the experience that the same graduates had 20 years ago. They can qualify having done 2 root treatments and no amalgams for example. Working for a few years in an NHS salaried service overseen by experienced dentists would give them a good grounding in the basics in an environment where they can try treatments out. These days we are so scared to try in case we fail and the patient complains. Patients don’t complain as much if it was free and it would be crown indemnity like hospitals.

The GDC standard for new graduates is “safe beginner”. 1 year of Foundation training doesn’t turn them into experienced practitioners ready to specialise in cosmetics but that’s what they all want to do! None of them want to be ground into the ground by an underfunded treadmill. These are the brightest and best of our A level students, all will have had 4 As.

. 2. Graduates would have less debt and less pressure to prioritise money over patient care.

I assumed this was about finding an nhs dentist. They are in such short supply now that even if you qualified for free treatment under these terms, you might not be able to find a dentist to actually treat you.
I took OPs post to be about that,

NHS dentistry is in a shocking state just now.

We have recently had a letter from our dentist to say they are going completely private and all NHS patients have been transferred to another dentist 15 miles away in village outside another own (and no direct bus service).

ds had problems this week and we called the "new" dental surgery to book an emergency appointment to be told, yes we are registered, but the only dentist there is retiring next week and they don't expect to have a new dentist until at least September so cannot take any appointments and they expect they will not be doing routine appointments until into next year so we are waiting for NHS24 to give us an appointment at a random dentist somewhere as well as waiting for a cancellation at a private dentist.

ds hasn't been able to see a dentist for over 2 years now.

Too late now but there should have been strict legislation in place so dentists couldn't do this. All private dentists should have had to maintain nhs places.

absolutely agree with this.

@Bickles that's really interesting and good to get a perspective from the inside. Very worrying that graduates have so little experience in things like amalgams.

I thought she was saying that there are no places because wealthier people are using NHS dentists. I don't think that is the issue, but that numbers of NHS dentists have fallen dramatically.

No! You get fuck all if you're working. One of my clients this week couldn't quite believe I've had to pay for my own childcare since Ds started at 9 months old, she thought it was completely funded. Indeed, it would have been if I hadn't bothered working. Why should I pay 3 x as much for care as someone who doesn't work! It's entirely unfair. Everyone should be able to get dental treatment on the NHS.

The thing is if we carry on as we are no one will get NHS. Dentists are handing back their contracts all over the country. The government promised 50 million in about February. Lovely- but it was to work emergencies only, evenings and weekends after an already full day and had to be used by 1st April. Funnily enough no one did it.
A core service for children and exempt (so people on an income so low they already need state help) is a good compromise IMO.

A good compromise for who?

Its not a good compromise for most of us who work and get no help anyway, and we are by no means well off.

Great if you don't work or can't work, not great if you put in 40 hours a week and all your other bills are up and you don't qualify for any extra help, is it?

Good grief, no!

My pensions take me a bit above the level where I qualify for pension credit, so I almost certainly wouldn't qualify for NHS treatment. No way would I be able to afford to pay for private dental treatment.

Having to pay for new glasses every other year is bad enough. Why you can't just get existing frames reglazed any more, I have no idea.

I guess a compromise to incentivise working in the NHS. I did it for years and it’s not fun. Working privately is much nicer. It’s hard work but it is Dentistry as we were taught to do it, not rushed and with good materials, labs and nurses. No one expects you to work for hours and hours for free. You get out of it what you put in. You sleep well at night knowing that you have looked after your patients well.
Anyway if you have a good NHS dentist then obviously the system is working?
if the system isn’t then what solution do you suggest if my idea (just my thoughts) is so rubbish? How will you do the maths?

No, I think the answer is for the govt to make NHS dentistry financially viable for dentists. Which could be done if they made the super-rich be taxed on UK income revenues in the UK instead of hiding their vast incomes in tax havens .

Ok, seems you all disagree - what’s the alternative?

Currently lots of people, regardless of how much NI they’ve paid, can’t access an NHS dentist. The current system isn’t working.

Lots of middle earners (who lots of posters flag would be disadvantaged by means testing) are also presumably currently impacted by the lack of NHS places. I live in an area with lots of dentists within a 3 mile radius - there’s still a shortage of NHS places.

Do we need more funding for NHS denstistry presumably? Or more dedicated NHS dentists working from hospitals?

Whatever the solution is, it will take time to implement and in the meantime lots of people can’t afford dental care while others, who could afford private dental care, have NHS care. Is there an interim solution? What’s the long term impact of people not being able to access entry level dental care. - is it a greater financial burden on the NHS in the long run?

In theory I agree, the NHS should be accessible for all and I do get that earners on the fringes of the bands lose out. But pretty soon there will be no NHS places for anyone at all.

@BicklesI think that’s a good plan. Working in NHS practice dentistry currently is soul destroying, I moved into community services and much prefer it. I have much more time and actually feel like I’m doing a good job, rather than being incredibly stressed and like it was a ‘business’ (and treated as such by patients and practice owners alike). It feels like proper healthcare again.

Where does all our tax go!?

It seems a bit silly to tax people for a service they won't be allowed to use. With the NHS, you pay in, but it means you (and everyone else) can use it. This way would mean you pay in but also have to pay private if you earn over a certain amount? Unless I'm missing something.

The people with lots of money probably go private anyway, so I wonder if this will just affect people that are earning just above an average amount and make them worse off as a result.

I'm all for free healthcare and dentistry, but I just think everyone should be able to use it.

I have denplan. Mentioning it because some people haven't heard of it and it might be helpful

Yes I pay but it's a LOT cheaper - mine is £27pm. It covers 2 x check ups and 2 x hygienist appointments per year, and pretty much everything else excluding lab costs (fillings etc)

Yes denplan is a good system and I think lots of the NHS who convert will use it.
The amount you pay depends on how good your teeth are so if you have nice teeth it could be £10 per month but if you have heavily restored teeth and gum disease plus poor oral hygiene it could be £50 per month.

'Lakeylady Why you can't just get existing frames reglazed any more, I have no idea.

You can and I've done it numerous times ; just ask! You're the customer. The optician serves you.

Just 6 months ago I was about to get a favourite old frame ( holding my old-prescription varifocals) reglazed again as prescription reading glasses ( by Boots, and they had agreed to do it) but then I spotted an irresistible new frame that was a perfect fit for me, and had that instead.

I have a great dentist but I was a nervous patient so they put me on denplan rather than me try to find an NHS one. I actually do a 40 mile round trip to him

Middle earning household here, fuck that. Not paying tax to fund healthcare I won't then have access to. DH and I could and would reduce our incomes and thus the tax we pay, in this situation. Agree the current system is fucked and would have no objection to paying more tax to adequately fund it.

I have a dental plan ( IOW I get all my dental work done promptly with the latest equipment and fantastic service) for £35 a month .

Lots of people on very modest incomes pay far more than that for their smart phone, takeaway, TV services cigarettes.

Just a question of priorities.

Absolutely not.

Middle earning household, kids with NHS dentist and I transferred into private today.

Total cost for preliminary works £982 (some of which is fixing the NHS dentists fuck ups) and it's not entirely down to my previous bad oral hygiene either so that really hurts.

My friends, who are also middle earners, can't afford that cause of childcare costs etc.

Why should it always be the middle earners who get shafted?

Unfortunately NHS dentistry has been severely underfunded for years.
The government don't want to admit that, with ambulances queuing outside hospitals and poor secondary care funding, dentistry just isn't top of their list of things to sort out.

They don't address it, possibly because they want the public to think it's all down to the 'greedy dentists' leaving the NHS but it's actually due to lack of funding and poor remuneration.

I agree with the above posters, children and exempt patients (those on benefits) on the NHS is probably the way it'll go.

Too late now but there should have been strict legislation in place so dentists couldn't do this. All private dentists should have had to maintain nhs places.

The problem is that this is what the government wanted, not the dentists. My understanding is that the money allocated to dental practices with NHS contracts has stagnated over the past decade whilst costs have gone up, meaning that doing NHS dentistry went from just about profitable, to breaking even, to a massive loss-maker which created unviable practices to an extent that even doing lots of private work as well couldn't compensate for. Additionally the NHS heavily penalised dental practices for doing too much/too little NHS work per year etc. I think the final straw was covid - practices had to suddenly close, with very little financial support, and then reopen. Dentistry was/is a very dangerous job covid-wise as dentists and their nurses are basically working in a saliva-aerosol created by the procedures. The price of medical equipment such as gloves and PPE skyrocketed, and practices could only see a few people a day as they needed to leave time to remove the saliva aerosol from the room. Trust me, it's not that all dentists suddenly realised that private work makes more money - they've been limping along in a hostile and punitive system for years. All we can really do is not vote Tory.

what we need to do is scrap the system Tony Blair instigated, which caused a lot of dentists to quit NHS dentistry then, the government were told 2 years later it wasn’t working,but unfortunately they and subsequent other governments haven’t changed it and it still doesn’t work.
A £50 million investment sounds a lot but in reality it doesn’t buy everyone in the country a toothbrush. As @Bickles said you could only get that funding if you were willing to see patients outside normal practice hours…… we’re already exhausted and yet if we ever complain we’re seen as being greedy