First of all let's deal with some background facts on the NHS dental service in England.
We often hear the comments from patients with regard to NHS dentistry which are based on out-dated assumptions, generally founded on how the NHS system worked prior to 2006. Here are some of them with explanations;
“I’m registered with ABC practice (or XYZ dentist), I’ve seen them for years” - Well sadly you are not.
Currently there is no registration with a dentist or a practice within the NHS dental system, there used to be prior to the current contract system. Yup that’s a decade ago.
“My gran died recently & was seen at your practice, can little Jonny have her place?” – Again sadly it isn’t that simple.
Most NHS dentists would like to take on family members in this way, but this isn’t necessarily fair as the system is based on a first come first served principle for everyone, and secondly the dentist or practice may or may not have capacity/time to see little Jonny.
“I’ve got toothache & I came to your practice 6 months ago, I need an emergency appointment” - You might think you have a legal entitlement to an appointment, but you haven’t sadly.
Another one of the changes brought in back in 2006 was that you are only ‘entitled to an emergency appointment’ if you are currently undergoing a course of treatment with that dentist or practice. This all goes back to the principles of 1st come 1st served, capacity, & free access to all. We will always endeavour to fit someone in if at all possible, but there are only so many working hours in day/week so we can’t always manage it.
“You keep putting up NHS fees every year, it must be for a Porsche” – We don’t set the NHS charges.
NHS fees are set by central government, the Department of Health issues a statement around April every year with the new fee prices which we as dentists have no control over.
The government land the responsibility of collecting the charges with us & also dealing with all the flack that these charges can generate.
Interestingly if you pay NHS charges (i.e. you do not have an exemption ) you are actually paying the lions-share of the NHS fee for that treatment, currently this is set at 80%, with the Dept. of Health topping up the other 20%. So much for NHS treatment being free for all at the point of provision eh?!
Moving on from these day to day scenarios we would like to make comment on how the NHS funding system works for us as practitioners & how this impacts on you as patients. We will preface this with;
'These comments are our own opinions/views on the contracting situation as it stands today.'
We would also like to state that these views may not be held across the whole profession & may not be the way the Dept. of Health would want us to ‘spin’ it to you.
NHS dentists/practices are contracted on an annual basis to produce a targeted amount of treatment based around the patient charge bands you pay, these are given a unit number value, & over 12 months we are targeted to produce X,000 units. Go over the X,000 units & there is no guarantee we will be paid for them, fall short of the X,000 total & fees are clawed back, have to be added to next year’s total, or if we’re not even close then the whole contract is up for renegotiation. ‘So what’ you may say! This is the way of the world in business these days, & you are correct, but does it always foster the right frame of mind with every NHS dental practitioner & how does it all affect you the patient??
We’ll try & explain….
As clinicians we are trained to treat patients, fix teeth, prevent disease, maintain your oral & medical health, & generally look after you. Nowadays this is not enough, we also have to be business people and provide VFM (value for money). If we are not our practice could fail on financial grounds & then where would you get your treatment. Yes dental practices’ do fold!, just like any other business. Hence the reason why you see more of the corporate dental group practices around like ‘Oasis Dentalcare’ & ‘My Dentist’ etc etc as they take over & buy out practices, run them and let the dentists get on with fixing mouths.
Sadly though this just leads to more targets, as their management then target their dentists to produce over the year. Targets in sales, marketing & general business are all fine & dandy, but do they really work in healthcare???
True, they focus clinicians’ minds to do certain things, but surely WE should judge what is right for you in your situation NOT what the NHS thinks is the right thing for you, or some corporate manager want us to produce under time pressure to produce them.
This is what we term a ‘Lack of Clinical Freedom’.
Q- If you needed surgery to remove your appendix, or your child needs ear grommets, would you expect it done in 15mins otherwise if the surgeon took 25mins to do it she/he would miss target that day??
Most people looking at dentistry from the outside don’t realise we are not guaranteed anything from the Dept. of Health/NHS England & yet we have our hands tied behind our back by them on what is financially viable vs. clinically available, & also to do a mountain of paperwork, audits, questionnaire’s, reviews & checks to prove it. Hence there are many dentists leaving the NHS to work independently with schemes like Denplan, Practice plan or just pay as you go privately.
Money is NOT the major factor causing many dentists to leave the NHS (as many believe), clinical freedom, personal ethics, & providing a better service for their patients are generally bigger motivators.
So where is NHS dentistry heading in the future?
Currently the Dept. of Health is running several pilot funding schemes around the country to test various different ideas. The patients at these practices are still being charged the same, in the same way as the rest of NHS practices in England it’s just how the paperwork & funding in the background is done that is different. Ultimately though you’ve got to ask can the country afford to keep paying for NHS dentistry on top of all the other new cost & treatment demands on the NHS?
NHS dentistry is proportionately such a small percentage of the NHS budget it should be easy to say yes, but successive governments (regardless of their politics) over the last 30 years have tinkered, changed (not necessarily for the better) & generally tried to ‘squeeze’ NHS dentistry in our view. I remember 12 months after I started in general practice the government of the day cut NHS dentists fees by 17.5% overnight, could you take that sort of cut in income?
Anyway enough of the doom & gloom, we will end with on a tale of a local family who are on benefits & so get NHS dental treatment for free, but having been to several corporate run NHS practices for a number of years came to us wanting to join the Denplan scheme. They value their oral health & could see the value of spending some of their limited income on dental care outside the NHS. Is this right that they should feel the need to do this………