Dentist cancelled because of maternity exemption

[Acc0untant]

This isn't a huge deal in the grand scheme of things but I feel a bit put out regardless.

My dentist has cancelled my appointment next month and when I queried why the receptionist told me that they aren't seeing any patients who are exempt at the minute. In my case I have a maternity exemption certificate (runs out in March). She said it's because they aren't receiving any NHS funding for it at the minute.

The point of the maternity exemption is that due to pregnancy you can have additional things needing work (pregnant gingivitis etc) and you aren't unfairly penalised by having to visit often. In this case they're saying I can't be seen until I start paying the NHS prices again in April.

Not going to pull the discrimination card (although being told I can't use their services until I no longer have an exemption due to pregnancy certainly feels like it) but would like to hear the thoughts of others on this too!

OP had a check up 5 months ago. Their next check up was booked for next month but has been cancelled. They were offered an NHS appointment after 1st April when new funding year starts but their exemption runs out before then so they want to be seen before then .

In short OP is going to have to wait 6 to 8 weeks after their routine check up was scheduled and this is why posters want to complain to virtually everyone in charge because the practice has rescheduled ,by a few weeks , a patient who was only seen 5 months ago , because they will not get paid for the work but will still have to pay expenses.

And here is from a dentist who is in this situation

“Seeking Advice: NHS UDA Contract Challenges

Our practice recently took over an NHS contract xxxxxxxx xx . After implementing changes, we successfully hit our UDA target by the first week of January 2025 and now have no UDAs remaining. Since September 2024, we kept ICB commissioners informed of our run rate, knowing we would likely hit our target by January. They encouraged us to maintain our pace and assured us they would confirm if additional NHS funding would be made available.

Last week, we were told no extra funding would be provided. Despite repeated requests for guidance on managing existing and future NHS appointments (including emergencies), we received no response. As a result, we stopped scheduling NHS appointments until April 2025 when funding renews.

Today, we were informed of complaints about not seeing NHS emergency patients and that an “investigation” is being raised—despite the commissioners knowing we have no funding or UDAs left.

Are practices expected to see NHS emergency patients at their own cost? Our contract doesn’t specify this. Any insight or advice would be greatly appreciated.
Thank you”

and then , after colleague advice

“Thank you all for above advice , yes dreadful situation, we did ask them to reduce our output in xxxxxx 24 so we could spread UDAs across till March , but as we are xxxxxx they did not allow us to change our opening hours or down tool a little as such, citing impact on patient access - how ironic

Pathetic , they don’t even read emails properly I send , work from home with v limited availability for a teams meeting and take annual leave every other week 😒

Nevertheless we will doing a lot of the above recommendations including speaking with local MP,

Thanks Hive mind”

What more is the practice expected to do?

That is very disappointing but in one of your messages you mention that usually you are getting NHS treatment, so I'd be inclined to agree with you and just book a normal NHS check up for when your exemption expires because as you've said yourself its bloody impossible to get onto a NHS dentist waiting list so if you've got one its not worth the fuss of one free appointment to risk giving that up.
I do agree overall its an infuriating situation to be in and of course you should have been able to have your exemption appointment.
When I booked on with my midwife she was all excited talking about how great it is that I get the maternity exemption for dentistry and I was like 'there's no NHS dentists in our town, so its essentially useless isn't it', she looked like I'd slapped her but honestly she should have some awareness of the reality of the situation!?
I've just booked a check up at a new dentist (only joined because its NHS for my child) and its costing £85 for my appointment 😭

What more is the practice expected to do?

Work for free it seems, well not even for free, but for a loss as the costs of the appointment have to come from somewhere. Most of the dentists here don't offer any NHS appointments anymore they're fully private- who can blame them?

What if the government were to add VAT to all private dental costs - they could use that to pay for more NHS dentists?

So the private patients who already subsidise NHS treatments in mixed practice get to pay even more ?

If you read the links posted above this situation has occurred because promised funding for NHS treatment , promised last year , was diverted in November to shore up over spends in the rest of the NHS. Just like the VAT would be .

Yeah that sounds fair, pay £80 for a check up plus more as VAT added so someone else can get it a lot cheaper. Lots of people have to pay privately who aren't wealthy at all and can't really afford it purely because they can't access NHS spaces; you'd been a tonne to fill in the shortfall.

I think it's the shape if things to come - already happened with private schooling - cost the state zero but the wealthy pay twice to supplement others. It could also be brought in for healthcare to supplement the NHS.

It’s not mainly the wealthy paying for private dentistry , it’s the average , the less than average , the poor because for decades NHS dentistry has not been funded properly and has now gone beyond the point of no return because we would have to pay so much to fund dental health care which is extremely expensive to provide.

This is from a year ago https://www.bbc.co.uk/news/health-67754983

The area I worked on the NHS has a household income way below the average U.K. single persons salary , yet virtually every dental practice is private and people go without to afford some dental care (if they can) L

But isn't the argument that if you can afford private you can afford an additional 20%? And if you can't, you just need to make savings from elsewhere.
Dentistry needs funding so that everyone can have good dental health.

Did you read the links posted from above? It’s from the Nuffield foundation.

NHS dentistry needs an unaffordable amount of investment to bring it back to what it was . Dentistry itself has improved but providing that improvement means it is much more expensive to provide now than 30 years ago.

A core service for the most vulnerable is just about affordable if there is massive investment now. But everyone else will pay full price for treatment.

20% increase on top of private dental fees which are subject to over 10% dental inflation a year is going to make any dental care for paying patients unaffordable.

Moreover the NHS is in such a state dental funding is not ring fenced. Which is what happened at OPs surgery that money promised last year to provide extra services was taken away this year to prop up over spends in NHS elsewhere.

I'm due to have a tooth out this afternoon, and it is costing me £290. The alternative was root canal work, which would have been over £1500.
We are by no means wealthy, and it will hurt us financially, but we can do it. Those who can't and dont have an nhs dentist - which also costs except in exceptional circumstances - are stuffed

I see there is a huge problem, but money is the solution (admittedly takes a while to implement). I'm suggesting one of the ways to raise those funds - surely the assumption 'if you can afford to pay, you can afford to pay more' is fair? It's been rolled out with great success to schooling.

31% of the U.K. population had private dental treatment last year and that proportion is climbing year on year.

Would you call those people all wealthy? They pay tax, national insurance etc and now you expect them to pay 20% vat on dentistry as well. A 20% that would go no where near funding the dentistry funding black hole , please read the link above .

Can't really see that working. Many people are going private because there is no NHS alternative, not necessarily to get a better service than the state provision, so comparing to education or wider health care isn't fair. If a properly funded NHS provision existed then demand for private dentistry would go off a cliff. So I don't think you could base funding for NHS dentistry on a levy on private services - if you succeed then you also fail by killing off the source of your revenue.

I also don't think the argument that if a person can afford x then they can also afford x+20% is at all reasonable, particularly when you are talking about people who may be desperate and in pain.

I understand all the practicalities/costs/reasoning but it's still a terrible situation. She's exempt precisely because her teeth are MORE likely to be damaged, due to pregnancy/her sex. So she's at greater risk of damage and won't be seen, compared to regular folk who are at less risk and can still be seen.

So what's the point of having exemptions at all?

@SlipDigby but that assumes people choosing private education are not doing it out of meeting a need. There are many many parents sending kids with likely but undiagnosed SEN to private schools and almost all of them choosing private to fulfil a need not being met by state provision.

I don't think dentistry should be any different - tax private provision so everyone can access treatment.

Perhaps if all the private patients demanded NHS dentistry something would have to change?

I am sure some are but there is a gulf between education where there is universal provision of state education across the country and in the case of dentistry where there is no provision whatsoever across entire counties.

In any case even the most optimistic projections from the government of the yet untested VAT on private schools suggests it will raise enough money to provide one quarter of an additional teacher per school across the country. Not sure that bodes well for transformational levels of funding if the same is applied to dentistry.

Agree - if there was an nhs funded space for every UK citizen then knock you socks off with vat - but this is not the case - people are not purchasing special treatment - they are buying treatment that the government is failing to provide in the first place.

People can go to a dental hospital in case of emergency - or wait for NHS dental treatment to become available. If you can afford private you can afford another 20% (let's not forget it is on bills of only tens or hundreds of pounds. Not like school fees where 20% means funding extra thousands)

The government fails to provide education that meets the needs of many kids - they are not exempt from VAT because their parents chose to meet the needs privately, dentistry should be no different. Add tax to fund it for everyone!

She had a check up 5 months ago. Her next is due in February and that has been cancelled and she was offered another appointment after April 1st when funding comes in .

In other words her 6 month check up is being put off by 8 weeks. Most people according to NHS guidelines will be having check ups every 1 to 2 years.

We are talking about an 8 week window when OPcannot book their routine check up . They are upset because their exemption runs out before then. However all during pregnancy and afterwards they have had their routine care , they had their check up 5 months ago.

Should people be manning the barricades because OP has to wait a few weeks or should people be directing their ire towards a system where there is a dental practice providing NHS dentistry who will not be provided funding to provide NHS dentistry for more people for a few months every year?

This reply is very “Tell me you really have no idea how bad the dental issues are without telling me”.

I do have an NHS dentist as have been there from being a child but for reference where I am, the nearest dentist taking on new NHS patients is 87 miles away. Now that even applies to those who would have exemptions, so that means anyone here who doesn’t already have an NHS dentist would have to either travel 87 miles for a check up, not have their teeth checked at all, or pay privately for one. I know personally of various people who have to have check ups privately because they don’t have a dentist, can’t travel the 87 miles for one, and need check ups. They aren’t carrying bags of cash, they just have no choice given their options.

The difference with school is that there is spaces, people just choose not to take them and that’s okay but it is a choice. There isn’t a space for everyone to have a dentist, so private dentistry for lots of people really isn’t a choice, there isn’t an alternative.

Have you read the Nuffield report link? It has gone too far , we cannot afford to provide a universal full coverage NHS dental system.

This is what the Nuffield group said in 2023
The Nuffield Trust think tank said the service had been cut back so much it was now at the most perilous position in its 75-year history in England.
It said restoring services would probably need an unrealistic amount of money and called for radical reform, suggesting NHS support may need to be completely scaled back for some adults

The NHS pays , including patient charges, per person treated, per year , in England around £39 . More than a decade ago the government opened dental access centres, run by salaried staff with all costs paid for by the NHS. Over a decade ago the cost of a course of treatment was £450 . The government got cut price dentistry provided by practices where dentists did the clinical work , admin work, ran the practices, financed and maintained them all out of that £39 and dental access centres showed what an efficient bargain that was.

How much dentistry will £39 buy? You couldnt even get a simple job on a car done for that.

A cheap dental surgery in a cheap area costs £140 an hour per room to run. That’s without paying a dentist. So how much would the NHS have to pay to run a service?

@Mrsttcno1

But there are not school places everywhere and there certainly are not places meeting the actual needs of kids whose parents have been forced to go private to meet that need.

I can assure you there is no difference here: the comparison is two areas where people pay privately to make up for a shortcoming of State provision.

Tax dentistry and spend it on more NHS dentists. That money is needed for more NHS provision.

Why is your partner getting free treatment? Is he exempt too?