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.

Yet the Government just found £20bn in tax cuts, with further £6bn for more cuts in the Spring budget.

So no, i do not hold "there is a finite amount of money available"

Its all down to political choices.

But even if you want tax cuts before healthcare, what is the sense in cutting dental services just for the very same people to turn up in AE/Hospital/give up work because they have terrible teeth, it costs us far more in the end.

@Depresseddentist yep. Decades!! I was a dental nurse back in the early 90s. (How am I EVEN this old?!!) The boss turned 100% private while leaving the associates taking the NhS patients. Not very long afterwards the whole practice went private.

And now with a different hat on I wouldn't take on the debt and stress of any dentist for the pay on the table. (I'm in IT)

Bless you guys

I wonder if some of the issue is like the doctors - that the professional organizations set low limits on the number of people who can train?

It would be interesting to see how many people registered to an NHS dentist could afford to go private. When my son started nursery (£1900 per month) one of the first things we did when going back to work was cut back and reduce our phone contracts to sim only. Food budget is £150 a month. Never have a penny left at the end of the month at the moment (sometimes a bit overdrawn) would like another child so cant see us having much spare money for the next few years. Our private dental plan for the family is £52 a month. There are many out there who could afford this if forgoing newer phones, subscriptions, no holiday, nails, hair appointments and the like, leaving the NHS for those who truly need it. Mum paid for my hair cut for my birthday present last year. Of course not everyone can cut back but many could re prioritise their finances. We are so used to getting treatment for free that a lot of people think it is a right. Unfortunately the NHS was not built for the size of our ageing population and the extensive treatments it now offers compared to the past. Thanks to all those in the NHS who work hard and look after people. I just don’t think it’s sustainable unfortunately unless we go into a semi-privatised system.

I take your point and a majority can afford a modest monthly fee if they prioritize it, or to pay some extra tax.

..but as @Chocolatebuttonns says, those low monthly fee private insurances don’t cover much if you need treatment, and the costs quickly spiral beyond the levels of affordability.

No , the BDA campaigned against closure of dental schools , campaigned against loss of training places for post grad dentists to work on the NHS , campaigned against loss of contracts to allow new dentists to stay on in practices they trained in.

The governments of the day decided the NHS would not need as many dentists . BDA and dentists campaigned against but no one listened to us.

Voterrs are very concerned currently about lack of access to dentistry. Now would be a good time for a petition to get it debated in Parliament. And to encourage opposition parties to commit to funding NHS dentistry in their election manifestos.

It has been debated in Parliament only a few weeks ago. There has also been a select committee hearing a few months ago https://committees.parliament.uk/work/7140/nhs-dentistry/
https://hansard.parliament.uk/commons/2024-01-09/debates/21A6D6D0-27DD-4AD6-BA98-6176B0864827/NHSDentistry

There has been talk since 2008 when the dental contract (brought in by labour) was deemed not fit for purpose.

Dentistry is similarly bad in Scotland (SNP led) and Wales (labour led).

The problem is dentistry was only ever funded for very simple treatment for 50% of the population.

Dentistry has moved on but for decades the funding hasn't. For years dentists have accepted a decrease in pay year on year until they can no longer prop up the health service because it's go private or go bankrupt.

Yes it would. Unfortunately The reality is that any real change would take 10 years!!

@Tatumm The majority could afford if they had a honest look at their finances and it is something I prioritise over other things. I genuinely can’t wait for the day I can get my nails professionally done again or buy take away coffee when out for a walk but it’s not something I can afford right now. For £50 it’s two check ups and two hygienes a year each. Private treatment can be costly but some things you can then be referred to hospital for. Otherwise you would have to pay off a treatment plan - again in many cases if someone is paying £30-£40 for a dental treatment plan or £30 for other things (non-essentials) it depends where someone’s priorities lie. The orthodontic and implant work I need will be around £6,500 but I’ll have to wait a bit for now until I’m in the right financial position. My partner recently had treatment and the cost was £700 and he’s on a plan for £50 a month until paid off.

Exactly
I think the fact that health services in this country have been free for so long, have essentially devalued the service.

Thanks @Lollygaggle I did not know that. I know that there have been restrictions on training places from other professional bodies such as doctors and psychologists, just wondered if the dentists were the same.

Do you think the entry requirements are too high for training places? Or has it a result of such limited training places?

The problem is that there is not the infrastructure. It's not just the increase in size and facilities of dental schools , the recruitment of academic and clinical staff, it's also having the NHS practices and staff willing to train the new dentists once they graduate.

To work on the NHS you have to do foundation training , at a practice doing NHS dentistry , for a year. The amount of people willing to become educational supervisors in a practice is dropping off a cliff because the pay is rubbish, the responsibility immense , the requirements in terms of time and training is large and mostly unpaid and newly qualified dentists are needing more and more support which is difficult to prioritise when you have your own patients to see and a living to earn as well as teach .

The number of practices carrying out NHS dentistry with enough surgeries and personnel willing to do training is dwindling year on year.

Moving on to DFT 1 and 2 which is further training in hospital and community settings again there is the problem of clinical teaching staff, places , equipment and space .

Dentistry has been so underfunded for so many years it's coming to a crunch that the older generation who would normally be the teachers, mentors, educational supervisors are retiring due to burn out . They've had enough and there's no one to replace them.

Finally for years there has not been the funding for a dentist to stay on at the practice that trained them , hence a revolving door of newly qualified dentists each year with patients seeing a different dentist every year .

How many empty Woolworths/Debenhams units do you think there are in your imaginary world where every lives in or close to a city center?

Who is paying for this we already have a massive deficit we are passing onto our kids for what? Say you add 1% to everyone tax to fund it who is going to agree to that when you can get implants in turkey for 3.2k

I think we need to be realistic about what NHs dentistry provides (pain relief and antibiotics) vs what we pay for

I work for a University supervising/ training dental students.
We are always understaffed, always advertising but working for the Uni is hard work and not very well paid. I earn double in a day in practice (privately- I wouldn’t touch NHS any more!) than I do in a day for Uni. I enjoy it so do I a day a week.
Where are you going to find the Clinical teachers to train all these new dentists?

We ve just had £20bn of tax cuts.

There was no reason to increases taxes

Increase the fees you get?

The fees are set centrally by the government and most Universities charge the highest rate.

Another dentist saying it’s absolutely a joke. I’ve done 23 years NHS work and am converting to private right now. My husband and I have run our practice for 15 years; he has done more and more private work to subsidise the practice, I do admin all hours and he is in doing diy in the weekends. We are tired and fed up and burnt out. Especially since covid while earning 48% less over the last ten years. I am very sorry for my patients that cannot afford it and we will try to keep the nhs side running while we can get younger dentists to work in it but they do not want it either. NHS dentistry is dead in the water.

I support dentists, I'm so sorry that you are being treated like this, and after all you have given in training effort & dedication. Are there other countries that we can look to for better systems?

I do wonder if all aspects of healthcare are essentially bottomless pits?
Free treatment will tend to slightly disincentive people from (not all people, and I'm speaking in very broad terms here) from being as conscientious as they might with their health. BUT we do need everyone to have access to healthcare. The inevitable perverse incentives are very tricky to navigate😐

Good luck with your private conversion. Just hand the contract back, it will be the best move you ever make. I moved to a private practice 8 years ago and I love it. I don’t think there could be a better time for it.

1% of tax to fund NHS dentistry? It wouldn’t cost that much. Remember we are not talking about funding a completely free service. Most NHS patients pay a contribution for their check ups and treatments, only those on the lowest incomes don’t. It is still necessary to pay privately for some treatments.

https://www.nhs.uk/nhs-services/dentists/dental-costs/how-much-will-i-pay-for-nhs-dental-treatment/

The problem is that it probably would. Dental technology is moving forwards so fast. In my practice I have 3D printers, digital scanners, the ability to provide immediate replacement teeth for emergencies should I need to( privately of course, as this level of care simply isn’t even considered on the nhs!). So why, should I as a professional be forced to provide compromised care, which is what the government is basically offering. They are asking us to provide the most basic of care, in the shortest amount of time for a pittance.
If we truly costed up what each patient would need, I don’t believe the government would pay( they won’t pay for basic crowns at the back now!)