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.

Quick and simple, but only a partial solution:

There are 43,000 dentists registered in the UK. The fee for registration is £621 per year. Add a government levy to the registration of (let's say) £2,400 to raise £103m. Use this to increase the payments to dentists for NHS treatments.

So NHS dentistry which provides the

• buildings in which to practice dentistry
• sufficient support staff to enable appointments to be organised
• A fair pay for dentists directly employed by the NHS?
• training more dentists probably to cover the excessive numbers of people who don't have one and to provide for future need.
• affordable dentistry for all.

How many dentists per 10,000 population do we need?

And then do the same for GPs.

So NHS General Practice which provides the

• buildings in which to have a general practice
• sufficient support staff to enable appointments to be organised
• A fair pay for GPs directly employed by the NHS?
• training more GPs probably to cover the excessive numbers of people who don't have one and to provide for future need.
• affordable health care for all.

How many GPs per 10,000 population do we need?

The NhS is trying to create a service where a practice will be mostly staffed by dental therapists and with a dentist to do the more advanced treatments.

However at the moment there are problems with therapists being able to open courses of treatment as they are not allowed to hold contracts.

The other big problem is pay . A hygienist has fewer outgoings than a dentist , smaller student debt, a lot less for indemnity and registration , and a far lower risk of litigation and being sued. However in my local area where they tried to replace dentists with therapists in this way the problem was therapists wanted to be paid a decent rate according to their skills which was actually more than the dentists were earning.

To put this into context I stopped most of my NHS commitment (other than vulnerable groups) in 2006 (new contract) because as a highly experienced dentist I was earning less than my newly qualified dental therapist .

Without large, significant reinvestment or large rescaling of what NHS dentistry can and can't provide we are looking at a lost service.

What you are describing is pretty much what dental therapists could do, and more. But they are not regularly used. (Although it's becoming more common). Therapists can do check ups, simple adult fillings and ALL children's dentistry including extractions of baby teeth. But as I pointed out earlier, they are not paid a decent wage for what they do. The NHS will expect them to do all that currently, but won't directly employ them. Most are self employed and earn way less than a dentist as the dentist takes a cut of what they get.

And yes in theory hygienists can also see a patient and refer if necessary. However there are issues with this (for both hygienists and therapists). If you start taking full responsibility for a patient you get more risks involved. You might miss something. The patient then might sue. If this risk increases our indemnity insurance will go much higher (we currently pay much less than dentists). So if this increases hugely then we would want more pay which is more equal to a dentist. There is a reason dentists train for 5 years and hygienists/therapists for 3. They have more responsibility and pay higher fees once qualified.
Also currently most hygienists have 30 mins appointments on average. (Some can be 45-60 in high end places). If hygienists are expected to then do full check ups and referrals the appointment times would need to increase. Meaning seeing less patients in a day and earning less for the practice.
The last issue is people don't listen. I have told many patients they need to see a dentist as half their tooth has fallen off. They come in 6 months later still the same. Then 6 months later its disintegrated and beyond repair. So I would worry about who has responsibility for that should the patient complain. I always write in the notes what I've told the patient, but they could still claim I didn't.

Dentists, hygiensts, therapists and nurses all pay the GDC levy annually are you suggesting we pay more levy to fund NHS dentistry?

It's not just a case of people taking care of their teeth.

Some people just have crappy teeth.

My siblings and I were all taught the importance of looking after our teeth, brushing them properly, not many sweets. Regular private dental appointments from the age of 5. We all needed fillings in our baby teeth. My grown up teeth are just falling apart - I don't eat many sweet things, I visit the dentist regularly, my last hygienist appointment she basically told me I don't need to be there as my teeth are so clean. Same with my siblings.

I had a boyfriend who would only brush his teeth once a day, in the morning. He'd never had a filling. No-one else in his family had.

I love the naivety of this post

dentists also pay £5000 to &20,000 per year indemnity (malpractice insurance) , cost of continuing professional development , sick pay , holiday pay , locum cover insurance, sickness insurance etc etc.

Again to put into context 84% of NHS dentist have had to pay back money because they cannot hit the targets set. Your suggestion , at average UDA values(Units of dental activity ) would mean a dentist would have to see an additional 225 patients or work an additional 70 days to pay this.

As things stand the average dentist works January to April to pay their personal professional expenses before they earn any money themselves.m

Surely we need to train lots more dentists, so the BDA need to take their fingers out and stop restricting how many places there are.

And pay more for NHS work.

Denplan is like £18 pcm. It's nothing. All but the absolute poorest should suck it up and pay. Kids should be free.

But the NHs does none of this in dentistry . The buildings, staff, support staff are all paid for by what the dentists earn in seeing someone.

In the NHS the average spent , per patient treated per year is around £35 .

In the salaried service where dentists are employed and everything paid for by NHS the cost of a course of treatment is around £450.

When you don't have people self employed and when you don't have people who do a lot of unpaid work to keep a practice running the true cost of dentistry is exposed.

@Lollygaggle and what do they do in GP practices?

Heavens, please no more centralisation. Just renegotiate the contract so that dentists can afford to do NHS work.

The BDA have absolutely no power at all, but even if they had they have never lobbied to restrict dental places, in fact when dental schools were shut in the 90s and early 2000s because the NHS predicted we would need less dentists the BDA campaigned against the closures.

when the government restricted Foundation training places meaning less dentists could do NHS work the BDA campaigned against this.

When local health boards restricted funding so post foundation dentists could not stay in practices because there was no NHS funding for them the BDA campaigned against this. No one was listening.

This crisis has been decades in the making , dentists and the BDA have been shouting in the wilderness for years .

GP practices have training funded , support staff funded , computer and IT funded , buildings funded , equipment funded . They have ,essentially , capitation for patients as well as KPI (key performance indicator) funding .

A dentist only earns money when they have someone in the chair. If a patient doesn't turn up (40% of new patient NHs dental appointments are missed ) the dental practice has lost money.

I met with local optometrists, pharmacists and Gps recently where we discussed how each is funded and the ins and outs. I am saddened to report they all thought the dental contract was worse than their own and the pharmacy and optometry set ups are pretty dire.

I've given talks to local gps in which I start asking them how much they think a dental practice is funded and how much it costs to provide eg a set of dentures.

None of them got any answers right , they thought we were funded in a similar way to them and they are struggling.

Universally they could not believe how we are expected to fund a practice on NHS fees and how many NHS treatments actually cost the practice (dentist) money.

It came to a head when we had to resuscitate a person on the street and the ambulance took our defib with them because the gp practice hadn't got one. They were astonished we had to pay for the cost of a new defibrillator ourselves , approximately 100 patients worth of treatment on the NHS .

Is that true?

I ve had extensive work at a Dental School, almost all the students were overseas, i was treated by East Europeans, Indians and the final work was done by a Russian but they were all supervised by UK dentists who made sure they did a good job, this mentoring was done FOC.

We have more dentists than ever in the UK but they pretty much all do private only.

A dentist was on Sky saying he did treatment inc root canal and crown for an NHS patient and the lab costs alone were £600, he got £320 from the NHS.

I can see the attraction of @Kendodd idea but it would require billions of investment which of course we have got..... Hunt just did £20bn in tax cuts, that for the average worker wouldn't pay for 1 filling, clean and an x-ray.

Maybe a solution is for the patient to fully pay for the treatment they need. There then to be a system where there is an agreement between the government and the patient. So the government repays the patient directly. That way, the patients are directly responsible for recovering their costs/ proving to the government they are responsible for their own health etc…..
Maybe the government will go for that suggestion.
I think not….. I suspect patients wouldn’t like it either, but just a thought……

The patient already does that, in fact in many practices the patient contribution is more than the practice gets for the proceedure so the practice ends up giving money back and acting as an unofficial tax collector.

The problem is NHS rates are just not economically viable , many proceedures cost more than what the NHS pays.

They all do private work only because it pays more. Private patients tend to pay a lot more than the NHS pays.

As with any job, if there is a shortage of people trained to do it, then those people will only do the most lucrative work. If there are more dentists then of course some will continue to do private work only but others will do NHS work to make a living.

I think some countries, Germany maybe, even on the state plan, which is subsidized but not free, and definitely on insurance plans, gives discounts or free treatment for keeping your teeth healthy.

Dentistry should be free for children and those in very low incomes the rest of us really should look after our teeth properly and have insurance plans, which is normal in the rest of Europe.

Most dentists who have NHS practices do private work to keep the practice open. You cannot keep a practice going on what the NHS pays and private work subsidises the NHS.

In a cheap area a practice doing mostly NHS work will need £140 per hour per room to keep going. An experienced dentist in a low needs area on a good day can do 30 UDAs a day (thirty units of dental activity ) , of course not when sick or compulsory training or on holiday but that bill still needs to be paid.

Let's say a UDA pays £28 (some will be more some less ) that's £840 a day working very hard . The costs of running that surgery are £1120 . Do you see the problem?

Running a private practice will cost a lot more as more expensive materials, equipment are used and alot more time is taken.

Without increased funding the priority has to be under 18s, care for children and adults with SNs and help for those on low incomes. No political party is brave enough to declare it though, hence the official we are investing xbillion despite withdrawing ringfencing on dental budget and a big chunk of that money comes direct from the patient and the practice is expected to carry out work for nothing on some patients with poor oral health.

We need to realise we can no longer provide a comprehensive National Health Dental service and make brave decisions.

In my area a three year old with decayed teeth needing a general anaesthetic , even though they may be in a lot of pain, will be waiting two years to have the teeth out.

Almost 50% of children in my area have decay by the time they are five .

And yet........ almost 50% of the children's dental spend is spent on orthodontics (braces) . This is even after rationing via the IOTN (index of treatment needs).

The sad fact is over 90% of dental treatment is entirely preventable , early intervention sets good habits for life .

At the other end of the scale the elderly and particularly those in homes are largely left without care as post 2006 contract dentists could no longer do home visits and the community dental service is overwhelmed and underfunded .

Dental care professionals other than dentists currently pay £96 and I am not suggesting a levy on this.