NHS dentist referring to private

[CJM2010]

Hi, yesterday my 12 year old DD was sent home from school suffering with terrible tooth ache. We are registered with an NHS dentist and I managed to get an urgent appointment. After examining and xraying her teeth the dentist explained that it was something she had never seen before and that she would need specialist treatment. She referred her to a private dentist and advised that the treatment should cost around £900. We are waiting for the private dentist to call and luckily in the mean time through pain management my daughter does not seem to be in as much pain, although still in clear pain. AIBU to expect the NHS to resolve this? We pay our taxes and are lucky to be registered to an NHS dentist, but as soon as it becomes ‘specialist’ we are turfed out of the system and expected to pay for it ourselves?

Unfortunately under the current NHS contract dentists are limited as to what they can do. When this happened to me I asked for a referral to the Eastman Dental Hospital in London who did all the work for free.

Search up your local dental hospital. They should work on DD for free. I am surprised the dentist didn't refer you there! Maybe you are too far away from one?

Why didn't they refer to an NHS dental hospital?

Thanks for the advice. I’m now trying to speak to the dentist about a dental hospital referral. Much appreciated

This seems to be happening to so many people I’ve spoken to, and not just for highly unusual work. IDK if it’s just that nhs dentists can’t afford to do the work, but it seems a bit dodgy to me.

In theory there are NHS dental specialists that a practice can refer to . For children the sorts of problems where you might need a specialist are for certain types of root treatment where eg the root of the tooth is unusually formed (dens in dente on a front tooth is an example) or where there has been trauma and specialist equipment is needed.
The problem becomes then that in many areas either such specialists don't exist on the NHS (endodontists) or the waiting lists are closed or waiting lists are years long.
Many dental hospitals eg Peninsula have closed waiting lists and those that are accepting people for treatment will be selective and only accept those with easy treatment that is suitable for students and even then the waiting lists are very long.
In other words , depending on what the problem is and the area you are in , there may well be nowhere to refer your daughter or waiting lists will be very very long.

The problem is a dentist is much more likely to be sued in the U.K. than anywhere else in the world. Techniques, equipment etc have come on in leaps and bounds.

The situation then occurs that if something looks a bit challenging , in the past many dentists would have a go and , as a consequence , become more skilled. Today as dentistry becomes more and more defensive because of litigation there is absolutely no incentive to "have a go" at anything that looks a bit complicated as the pay out , if it goes wrong , is normally for private corrective treatment even is treatment was on NHS. Hence there are strong reasons to refer anything that looks a bit complicated (tooth, person,medical history ) to a specialist .

To put it into context a course of treatment that includes root treatment often loses money for a dentist providing it on the NHS. If it fails and complexity means it should have been referred (and this will be a private referral as NHS endodontists are rarer than unicorns) the payout could run into thousands.

The further complication is that in eg root treatment however well it is done , and even in specialist hands , success is not guaranteed and for complex teeth rates can be lower than 50% . So a dentist can , in good faith , do a good job on a root treatment , which subsequently fails through no fault of the dentists, but because they did not refer to a specialist will still have to pay out.

Hello, sorry to hear your DC is in pain. We have been in a similar situation. DD (at the time was 14) had moderately rare issue that was finally diagnosed with an X-ray during a private appointment. We opted for NHS treatment as it was estimated it was going to cost around £2000. It has taken 2.5 years for her to reach the top of the waiting list, and the wait has meant that some of her adult teeth cannot be salvaged (earlier treatment with a brace might have saved them). It'll be another 2 years at least for the Orthodontic work to correct the surgery. There are definitely worse health issues, but in hindsight, I wish I'd started her treatment earlier and privately. It was just it was going to be so expensive! It's best to treat dental problems quickly though, I think, if you can afford to.

This happened to me. The nhs option was to remove the tooth. I ended up paying around 1k privately and it's been fine since (this was over a decade ago). They are very limited as to what they can offer on the nhs with dentistry. I'm afraid it might be a case of sucking it up and paying it.

I would just like to rant that the surgeries need to take down all the posters that tell you, " Did you know children can be treated for free on the NHS?" or however it is they phrase it, because it is a fib. Dentists don't get paid for NHS work past a certain point, which has led to a major problem organising treatment for so many patients.

They are not allowed to. There are certain posters /information that you have to have up to pass CQC /HIW inspection. One of these is posters about costs for NHS dental treatment.

Oh I didn't know that - cheers. Dentists clearly in an awful position. The whole thing needs proper debate and the powers that be need to make a decision to either properly fund childrens' NHS dentistry or admit that they can't/don't want to.

The government will never admit it. They twist the statistics so it suits their purposes

With the new rise in NHS prices thousands of dentists will be paying the government for treating patients because what they get in fees will be less than the NHS patient payment. These and all dentists doing NHS treatment are , in effect , government tax collectors.

My neighbour is an elderly bloke (looks about 65 to me but my dad though 60 max, don't want to ask), new to the area, can't afford private and the dentists in this village and the town 20 odd miles away are only taking on private plus they're chocka for appointments too so he's not made an appointment and considering pulling out a tooth.

Also noticed the majority of dentists in our village and neighbouring town are in converted terraced houses.

To clarify the minimum NHS UDA value is £23 . So a dentist on this doing a check up will get £23.80 patient charge and will pay the government back 80p ,band two will repay £3.80 , band three £9.60 . It's the logical consequence of the gradual cutting the lifeblood of NHS dentistry.

https://bda.org/news-centre/latest-news-articles/Pages/nhs-dentistry-new-plans-will-not-bring-real-reform.aspx

Because , unlike gps , dentists have to pay every running cost and purchase of buildings etc out of what they get paid for treatment.
It is prohibitively expensive to build a purpose built building , and NHS dentistry is already over the precipice .
The cheapest places to buy and run are surgeries that are already set up or converting existing buildings . There is no money for the swish gp style health centre.
A few years ago the practice I was in was offered space in the new gp health centre that had been built. Just to move our equipment and buy new what could not be moved was over £100,000 . More than that the rent they wanted to charge would have taken the entire amount of two dentists earnings on the NHS . We couldn't even think about it.

@Lollygaggle how depressing! :(
I always wondered about that. The dentist I go to is on a busy road, parking for maybe one one car and nestled between houses. They also often try to sell me botox while I'm there.

Can’t link at the moment cos my internet is shit but Bupa have announced this morning that they are closing or merging 85 practices all with NHS contracts

This is absolutely no surprise.
The government announced NHS patient charge rises which mean for some dentists they will be refunding the government of every NHS patient they see .

The BDA and dentists have been warning for years that the cuts in finances for the services are unsustainable and if you look at the finances of the big corporate dental chains none make a profit, especially those that mainly rely on NHS work.

Here's link with list of practices affected https://www.theguardian.com/society/2023/mar/29/bupa-dental-care-to-cut-85-practices-amid-uk-dentist-shortage

I don't get what you point is here? My dad was an nhs dentist for his entire career before he retired and he purchased a terraced house for his surgery? There was nothing nefarious about this?

Thanks @Lollygaggle