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 honestly believe NHS dentistry as a service is finished. Let’s face it - it’s increasingly expensive and complex , the govt is unwilling / unable to finance it properly and dentists are losing out financially. Labour have no answers either - it’s all tinkering .
Instead of letting NHS dentistry die slowly - which is what is happening, the Govt should be transitioning us to an insurance model, with different levels of cover and co-pays and with underwritten safeguards or guarantees for the poorest.

£20bn is a large sum but consider the NHS as a whole costs £180 billion a year. 20 would make a difference but not enough to revolutionise it. The cuts aren’t actually going ahead anyway as we can’t afford it (no surprise there!).

I wonder what percentage of patients actually do have to pay anything though? I googled and 89% of prescriptions are 'free' in England. Don’t know how many NHS dental visits are free.

A GP friend of mine thinks all medical appointments should have
a fee (to book) and all prescriptions should have a fee to collect. Very low,
about £1 but with no exemptions. She thinks this would improve attendance rates
and time waisters. Maybe. Maybe people will think its ok not to go though
because they've paid for the appointment. Also, 2024 in Britain, some people
really don't even have £1.

@Tatumm only 40% of patients in the NHS are eligible to pay for prescription yet 89% of scripts are free. This is the problem people want a world class service at rock bottom prices

Except.
Those 40% of patients are going to be the elderly, the chronically
sick and children. The same people who are exempt. These groups use the vast
majority of healthcare in any system, paid or 'free'.

The NHS was introduced in 1948
In 1950, the labour government realised this was all going to be much more expensive than they first thought, so introduced prescription charges and charges for dental work
Where we are now is the logical conclusion - and the result of children having access to processed foods, refined sugars, and an inability to clean their teeth

*sorry 60%

I started anyonther thread recently asking the question 'would it be cheaper long term for the public purse to give all school children, free, really good quality, healthy school meals'. The MN view was mostly 'we can't afford it' and 'free choice on what we feed children'.

My GP friend also thinks its immoral to vaccinate/ anti biotic very elderly people living in distress and pain to try to keep them alive (and suffering) for as long as possible. She is also against assisted dying. She just thinks we shouldn't try to extend as long as possible very poor quality life, we should let nature take its course. A huge amount of NHS money is spend doing this. I was shocked when she first said this, I agree with her now.

When I qualified 60% of the population had dentures, now barely any of my patients have them

That's possibly because they're so expensive, not because people don't need them!

@Kendodd other way round 40% of the population have to pay yet they only get 11% of prescriptions.

DH had a filling he paid £144 + £90 for the appointment £234. On the other hand NHS cost is only £70 which is meant to be 80% of the cost of treatment. Meaning an NHS filling "costs" £87.50 no wonder dentists won't do NHS work. If you want NHS dentistry the 40% paying prescriptions are going to have to fund that for everyone.

Actually the NHS charge is less than some practices earn on a band two treatment as it depends on practice UDA value (units of dental acitivity ) ie every practice gets a different amount. In our area the average UDA value is around £27 so a band two treatment would get a massive £3.60 ish extra. Band 1 is one UDA , band 2 three , band 3 twelve.

This band two payment will cover the initial check up, x rays , unlimited number of fillings, extractions , root treatments and scale and polish if clinically necessary . So the dental practice may , literally , recieve a few pounds per treatment done .

In 1972 44% of the Scottish population over 15 had no natural teeth.
In 2015 only 6% had no natural teeth

The statistics show in the U.K. as a whole people are keeping their teeth longer.

Here's the U.K. picture from a quote

Over the last 40 years standards of adult oral health have improved dramatically. While just 22% of people in England aged 65 and over retained some of their natural teeth in 1978, by 2009 this had increased to 85% of 65–74 year olds and 67% of those aged 75 and over**. However, this also creates new challenges for dentists, as many older people now require ongoing maintenance of heavily restored teeth.

All the suggestions I see for improving medical/dental services are piecemeal: they focus on one aspect and ignore others. While the supply of qualified and motivated healthcare professionals needs to be maintained and probably increased, it is also essential to put much more effort into effective public health measures to reduce the very heavy burden of avoidable illness. But this will require curtailing the marketing activities of the industries that promote ill-health (fast-food, snack foods, soft drinks, alcohol, gambling, etc.). The marketing budget of the junk-food industry is many thousand times bigger than the budgets for publicising public health campaigns, personal & social education, supporting victims, etc. There absolutely must be restrictions on advertising, sponsorship, etc., but I don't believe any mainstream political party will ever accept this.

Out of interest the health secretary is married to the managing director of British sugar . https://www.bbc.co.uk/news/uk-england-lincolnshire-67448520

Older people are more likely to vote conservative, therefore they have to be kept alive for as long as possible 😶

Well that’s the biggest joke I’ve I’ve ever heard!

The post is about Dentistry, you don;'t think £20bn would fix it?

The BDA say 500m would resolve the current contract under payment issues.

The tax cuts have already happened, implemented in January, so the money was found and we "apparently" can afford it.

Reality is its GE year and the electorate has to be bribed.....

TBF we've had access to refined foods and sugars for at least 60 years, the difference was, when i was kid scoffing fruit gums and black jacks, i had twice yearly dental check ups.

My DD is in her 20s, she has never had access to an NHS dentist, we ve had to pay for all her dental check ups, technically, she could still be on a waiting list she first went on over 20 years ago.

I had pretty much the opposite. I'm in my 50s. I grew up having sweets everyday, processed food every night. No tooth brushing, terrible toothache, all my baby teeth removed and every back tooth filled before I was 14. Crooked teeth, no corrective treatment. I did have easy access to an NHS dentist though (my family only went if in pain though).

My own children are just on the cusp of adulthood. They have had a much better diet growing up than I had. No sweets before they started school and a rare treat afterwards. Much less processed food. None of them have had any fillings and two of them have had orthodontic treatment. They used to have an NHS dentist who went private about four years ago so after that we paid.

@Kendodd My mum was a nurse and pretty hot on this sort of thing, we always had to drink water after sweets but even so, ive a mouth full of amalgam.

But as with yours, the Huge difference between mine and my DD's childhood was dental access and i very much limited her sweet intake, she has had one small filling in her first 24 years.

I never really warmed to Wes Streeting but his plan on Dentistry seems really good.

Just found this in todays Guardian:

https://www.theguardian.com/society/2024/feb/08/number-of-children-having-rotten-teeth-extracted-in-english-hospitals-rises-17

This isn’t surprising. There’s absolutely no dental education out there and hasn’t been for decades.
I volunteer and talk to my local primary schools about dental health, I offer for parents to be present, but sadly as it’s during school hours( even though I give up my paid time) very few attend. Official school dental visits were abandoned decades ago
The government just don’t care
Theres only noise now because there’s an election imminent and it’s reaching crisis point. If the election was two years away, it would be swept under the carpet

One think I did learn until my 40s was about snacks. I seems three/episodes of eating/ drinking (other than water) is much better for the teeth, even if its crap than the almost constant nibbling we have now (dentists?) One thing I really don't like it break time tuck in schools. It's completely unnecessary and bad for both the waistline and teeth. Hunger is treated as some sort of medical emergency these days when for the vast majority of adults and children it should be just a normal rhythm of the day.