That'll Do Nicely by @DentistGoneBadd

Well, what do YOU think would help the NHS General Dental Service Survive? A It More Posh Would Be Nice - Saving The NHS by @DentistGoneBadd

A couple of weeks ago, the House of Commons Health and Social Care Committee announced the launching of an inquiry into NHS dental services. Chaired by Dr Sarah Woolaston MP, the Committee has invited evidence from the public, organisations and others with relevant expertise.

On the Committee’s webpage, it said “Previous governments have acknowledged that the focus of NHS dentistry has been too focused on treatment rather than prevention. The Government is currently testing prototypes for a new dental contract with an emphasis on prevention.”

The committee aims to address a number of aspects of NHS dentistry provision and is inviting submissions.

The following forms the basis of MY submission.

Morning All.

My Name is Mr DG Badd. I’m a recently retired NHS dental surgeon with 30 year’s of experience working in the NHS General Dental Service. I worked as an associate in various practices from 1988-1994 and ran my own independent NHS practice from 1994-2013. I worked for a dental corporate from 2012 till December 31^st 2018. I have been in psychotherapy since January 1^st 2019.

1.)What is the state of the relationship between the NHS and dentistry? How satisfactory are the arrangements for the provision of dental services by the NHS? Are current arrangements contributing to the widening of health inequality?

What do YOU think? As dentists, we are on the edge of the NHS, clinging on to it by our fingernails until Matt Hancock tap dances on our digits and sacrifices us to the Great God of Brexit. Successive governments have marginalised dentistry by stealth over the years. No government has had the guts to come out and say “Look lads, we can’t afford you, you ever thought of going private?” So what previous governments have done is erode fees and reduce the ability of dentists to remain viable and wait for practices to nearly go bankrupt before jumping on to the private life raft. Then they accuse us of being ‘greedy dentists’ through columns of The Mail and The Telegraph.

Of COURSE, the current arrangements are contributing to the widening of health inequality. The UDA system is insane. Dentists struggle to make a living because they can’t hit the impossible targets and then more dentists are forced to leave the NHS either because they are either on the edge of mental despair, bankruptcy or both. The consequence of this is….anybody… anybody? That’s right, it reduces the number of NHS practices available to provide treatment.

2). How could access to NHS dentistry be improved? Are there inequalities in access to dentistry services? If so, why, and what could be done to address them?

Where do I start? I suppose by seeing the above. The problem with governments ‘addressing’ issues in the NHS is they tap-dance around trying to find solutions by reorganising and setting targets that don’t tackle the fundamental problem – underfunding. How can access to NHS be improved? Adequate funding to enable practices to open their doors to NHS patients. And that goes for local community and access centres as well as oral surgery and specialist departments.

You KNOW full-well there are inequalities in access to dentistry services. There’s been enough publicity in the general and dental press over the years and the past few months in particular – remember Portsmouth? Even a corporate couldn’t make the NHS work apparently. There are pockets of the UK where the lack of NHS dental provision is critical and not only where the overheads are particularly high. The rest of the UK is at ‘Amber.’

As for what could be done to address the inequalities? Duh! See above.

3). Where does dentistry fit within NHS primary care services? What opportunities are presented by the development of primary care networks?

Well the dental service is sort of crowbarred in like a difficult Austin Allegro hubcap, but it sort of fits there. It’s alright exploring opportunities to be presented by the development of primary care networks, but what the Hell does that mean? You may as well be talking Bill and Ben, The Flowerpot Men. “Be Bop Schbobble Ob.” The reason the general NHS dental service is failing is because of, do I say it again? Underfunding. Fund the service properly and you will get a nice snug fit. It’d be like emptying a can of WD40 on a rusty hinge.

4). What issues are affecting the wider dental workforce? What steps need to be taken to address them? Is sufficient data available on the workforce and if not how should it be improved?

Again, you’re tiptoeing over 0.5mm thin ice, trying to find a thick bit when there isn’t one. Where do we begin? Underfunding leading to poor morale and difficulties in recruiting. It’s like trying to keep a canoe afloat when there’s a hole the size of the Isle of Wight ferry in the bow.   Many NHS practices struggle to keep up with meeting guidelines and infinite regulations and their attached increasing costs. Many staff members have to juggle budgets on behalf of practice owners and practitioners have to make do with sparse equipment and materials on a day to day basis, which in itself causes stress, as does the increased workload practices have to cope with in order to hit UDA targets.

As for sufficient data, why is that relevant? Most NHS practices will tell you they struggle to recruit staff, let alone associates who won’t work for the low UDA values that practices are forced to offer.   Why not nip down to the job centre and see how many nursing jobs are unfilled? More accurately, have a look to see how many trainee nurse jobs are available. Trainees are more likely to be taken on these days to replace experienced staff, to keep costs down.

5). What are the issues in commissioning and payment systems for NHS dental services? How can they be improved?

Now then. The practices most likely to survive in the current system are the corporates. They pare costs to the bone which enables them to undercut independent practitioners in bidding for contracts. Their ability to reduce material costs due to bulk purchase gives them a major advantage over independent practitioners.   The NHS England finds the corporates easier to deal with since they can negotiate in bulk and faced with much lower contract values, who can blame the NHS for dealing with them. The consequence though is that the independents get squeezed out. At face value, the corporates seem a good bet. The staff and dentists that work in the corporates (I was one of them), know how difficult it is to work under shocking conditions. Until something big and nationally scandalous happens, hopefully soon, the NHS continue to work closely with the corporates.

6). What needs to be included in, or removed from, the forthcoming NHS dental contract?

There was a study out a few weeks ago that proposed that routine scale and polishes should be removed from the list of treatments allowable on the NHS. Don’t do that. It’s taken years for us to get a population reasonably orally healthy. Why push us back 30 years? I know the answer to that – penny pinching. Keep it all in. Why are you even asking the question? If you decide to add stuff, the government will underfund it. If you remove stuff, the government will still underfund it. Currently, there is no extra treatment ‘fat’ to trim.

7). Is there enough focus on prevention in dentistry and what are the avoidable harms that could be addressed? What more can be done to encourage prevention and what can be learnt from best practice in other parts of the UK and EU?

Come on people. The UDA system when it was imposed on us was supposed to give practitioners time to deliver prevention advice. What happened to that notion? What can be done to encourage prevention, is give us the time to deliver it without our time being taken up chasing our tails and impossible targets. Until you address the basic failing of the NHS general dental service (underfunding, if you haven’t got my gist by now), more can’t be done to encourage prevention, no matter how much we want to deliver it. And what other parts of the UK are you talking about, exactly?

8). What should be done around fluoridation policy and what is the evidence base to support it?

Seriously? You’re asking that question?

Plenty of evidence.

Just do it!