My Solution for NHS Dentistry

[Kendodd]

As I understand it dentists are all private businesses that do some or all NHS work. I think the NHS should set up its own dental practices employing dentists directly on a salary. A good salary with promotion opportunities.

They could buy old Debenhams/Woolworths/etc sites that are still sitting empty after many years (so should be cheap). Turn the upper floors into flats for the staff (low rent) and ground floors for treatment space. I know there are difficulties with these conversations but they're not insurmountable.

Parking may be an issue on site but city centres always have car parks nearby and are well served by public transport. This plan would also bring more life back to the high street.

This plan may take years to come to fruition, buying sites, converting them etc. This time could be used to massively expand training new dentists.

The biggest hurdle I could see in this plan is one the screams of 'no money' (so shortsighted) and dentists unions might block it.

I very much doubt dentist unions would block this, most dentists would love to take NHS patients if the government would simply pay a sustainable rate for the treatment of them. If the government/NHS wont pay the cost of treatment, how will you make them find the money to pay for the cost of treatment along with all other expenses of setting up and running the practice?

Or just pay a reasonable rate for the treatment?

Setting up and running a dental clinic is expensive. As others have said simply make the NHS contract fair so practices can afford to carry out NHS work. I'm an NHS dentist I've had money clawed back for not hitting my targets for the last 2 years. This is coming out of my pocket as I still need to pay my team and all the running costs.
I can't work harder I'm seeing people back to back all day the contract simply doesn't work.
When I qualified 60% of the population had dentures, now barely any of my patients have them. That's a lot of extra teeth to maintain. Gum disease is rife.

Dentistry in my career has become more complex, people's expectations and tendency to complain has increased. Offering me up to another £50 to see someone who needs multiple visits won't be financially viable.

I believe (could be wrong) that the current contract was introduced party because there were concerns (not without evidence) that dentists were doing unnecessary work on people's teeth as it was pay per filling. Ideally, dentists would hardly be doing any fillings because people looked after teeth better. This contract was to try to address that and move towards more preventive work and less corrective work. So essentially, if dentists take on a patient with rotten teeth, they will be loosing money.

If dentists are on a salary, this takes away any incentive (or suspicion) that they are doing unnecessary work. Downside for dentists is they don't get to be rich business owners. Please don't twist this to say I'm calling dentists greedy crooks though, I'm not.

I’ve never seen a poor dentist .. let’s face it, they aren’t going to do anything that threatens thier income.

For me .. free training for students, but tied into working 5 years in the NHS afterwards. Increase the number of students, get them fed into the pipeline when qualified, open more NHS clinics using these staff .. increase the number of NHS clinics, shift patients from private to state.

The problem is one of supply and demand. There is a shortage of dentists and so they can command very high salaries. The BDA has for years (like the BMA) ensured that dental training places are limited in number which means this situation will continue ad infinitum.

The solution is to increase the number of places at universities for dental students. But to do so the government will have to persuade the BDA to allow it which will mean some sort of massive pay increase for NHS work. Tony Blair discovered this when they increased the number of traiing place for doctors in the 2000s. The result of that was a renogitated contract for doctors which resulted in a massive pay rise.

Why would dentists want to live in flats above their workplace even if the rent was low.

@Kendodd with my dentist cynical thinking the contract was introduced to control the spending on NHS Dentistry. No-one could carry out NHS dentistry without having a contract which had it's value preset and the amount of dentistry set. Overtreatment would have been picked up as our activity was monitored at Eastbourne by the DPB.

There were PDS contracts which encouraged preventative care and improved oral health but these cost more money so were scrapped.

@ExtraOnions NHS dentistry is run incredibly efficiently and is cost effective. I can guarantee state run services would be way more expensive.

And why would they want to live cheek by jowl with their colleagues/employees, and vice versa. Sounds like a living nightmare.

Well it wouldn't be compulsory to live there. Cheap city centre accommodation might help recruit staff though.

I used to work in the dental industry. The majority of dentists I met wanted to do NHS work and often did so far longer than it was financially sensible for them, because they believed it was the right thing to do and felt a responsibility to their patients. Many of them were very reluctant to move to full time private work and only did so when they literally couldn't afford not to.

Do you know how expensive a dental surgery is? The chairs alone cost a fortune, all the equipment and in some cases lead lined walls to protect from x ray radiation. Old Woolworths would need full refurbs and refits and cost millions to do.

Has Brexit been a big issue in this? My kids NHS surgery hasn’t officially kicked them off the list but just cancels their check up every 6 months and re books for 6 months later. Last time I asked why & the receptionist said they’ve gone from 8 dentists to 1 in the practise. The only NHS orthodontist in the region has handed back the contract. Just wondering what has been the tipping point since Covid as feels that it’s a lot worse?

Quite a few years ago dental access centres were set up to cope with lack of dentists.
The centres were built and run centrally and dentists were employed.
Right now the average spent, per person treated per year , is around £30 to £40.
Then ,per person treated per course of treatment it cost £480 in an access centre.

This is because a surgery doing NHS dentistry is run incredibly efficiently, very often and min is done at weekends , lunch times, dentists often do their own repairs, decoration etc.
One room ,in a cheap area , doing NHS dentistry will cost £140 an hour to run. Dental inflation is running at 10 to 15% a year.

People have tried this and gone bust. We bussed in foreign dentists who could not believe what they were asked to do and left asap to go private or go home.

How much world class dentistry does £35 per person per year treated buy?

Dentistry was in crisis pre COVID.

The huge increase in dental costs , post COVID, the debt incurred to re equip surgeries and keep them going, staff near to retirement leaving burnt out and ill, the year on year decrease in earnings for the last ten years, the increasing abuse and violence from patients , stuck with an unworkable contract almost twenty years after it was deemed not fit for purpose , the increase in litigation and regulation has made dentistry a toxic profession in the UK.

Actually the BDA lobbied the government when there were not enough post grad places for new graduates a couple of years ago. A dentist has to complete foundation training post degree within 18 months of qualifying to work in the NHS and there were not enough places.
The BDA also lobbied in the 90s when dental schools were shut down because NHS modelling said there would be less need for dentists.
The BDA also lobbied when new foundation dentists could not stay on at practices because the health authorities would not pay for an expansion in contract to let the dentist stay on.
Unlike the medics the BDA has no power at all. If it did we would never be in this mess as we have been sounding alarm bells since the new contract in 2006

Dental earnings have gone down year on year for the last 10 years, at the same time new dentists are graduating with £80000 debt and older dentists are leaving worn out and ill .

When I qualified 60% of the population had dentures, now barely any of my patients have them
@MillyMollyMardy I had no idea that the population of denture wearers was ever this high 😲.
Would it be overstating things to say that this shift accounts for much of the crisis in dentistry, we just do not have the resources to do the work that needs to be done?

The only way forward would seem to be making it mandatory that we all take proper care of our teeth, and while I'm at it the same for our general health.
This of course is completely unenforceable😬

As a child in the 60s there was an NHS child dental service we all got sent to. As a teen I went to the local dental practice, which was NHS. I note it’s private now and had been since the 1990s.

NB dental check ups were free then as were eye tests

The current state of the NHS would put people off training if they knew they were tied to it for 5 years. I wouldn't have trained for that. Incidentally whilst the NHS paid my tuition fees I still needed a maintenance loan and took on extra expenses so I could work for free labour train for three years. I am still repaying that back.

A better solution would be to make the NHS a more appealing employer. Fair pay for NHS work, opportunities for development etc

@Gloriosaford it's not as simple as that more a storm of multiple factors as @Lollygaggle and others say.

Brexit didn't help but European colleagues were leaving before. The 2006 contract which was opposed by the BDA and declared unfit for purpose in 2008 by a parlimentary commitee is the predominant issue. The profession has been bolstered along by promises it woudl be changed but every attempt to change it has shown that it would all cost more money. Hence nothing changes.

So we're left with a contract that younger dentists with their massive debt (same as the medics) working in an intense and stressful enviroment ie treating often anxious people performing intricate and skilled work and also having to deal with the business side at the same time just don't want to do. I feel my peers 50+ have kept things going with a loyalty to the NHS but Covid was a shit show for dentistry and we are now burnt out and disillusioned. Thrown in lots of litigation, the GDC, cost of living crisis need I go on?

Thank you for taking the time to explain @MillyMollyMardy , I have long felt that dentists do a very difficult intricate and stressful job, I'm very sorry that things are so bad and I salute you all 🙏🏻💙

As a Hygienist I'd be happy to do NHS work if I was paid a decent wage. I wouldn't expect to earn as much as I do privately. But I think prevention and treatment of gum disease early would be very beneficial to the population.

However as it stands Hygienists cannot work directly for the NHS. And where they've changed some rules recently about dental therapists doing NHS work they don't get any of the "benefits" of NHS work like pension etc.

So yeah if the NHS would give me a salary and all the benefits that go with it I'd happily do it! Instead of being self employed with no holiday pay/ sick pay etc and if a patient cancels/ doesn't turn up/refuses to pay I earn nothing.

But I can guarantee you it won't happen.

And how do you suggest taking care of your teeth is made mandatory?

As a hygienist, could a patient just see you every six months and only see a dentist if you recommend it? Could an hygienist spot any potential oral health problems and just refer on? If someone looked after teeth well, with the help of a hygienist, would they need to see a dentist? Could more NHS hygienists reduce pressure?

feel sorry for the receptionists they are getting abuse daily because there are no dentists and they are in the dark too. They have no info to give. So please remember they are only doing a job over which they have no control.