Minister's Figures Don't Add Up
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- Published: Wednesday, 09 February 2022 19:42
- Written by Peter Ingle
- Hits: 1983
Just like busses, it seems that parliamentary debates on dentistry all come at the same time.
But there is a definite change in tone and direction. Backbench MP’s have been showing a much improved understanding of how NHS dentistry is delivered in England, though the Minister may need to check her maths. Both MP’s and the Minister are beginning to look to changed models of delivery as a means of meeting the access gap.
The title of the recent adjournment debate, “Dentist Industry and NHS Backlogs”, may indicate the direction of travel. Opening, Andy Carter representing ‘Blue wall’, Warrington, spoke of the increasing difficulties in accessing NHS dentistry, and that he wanted to discuss the reasons behind those changes in the debate. It was clear from his and other speakers’ comments that problems with access were a regular subject of MP’s correspondence. There was also acceptance that this was not primarily a pandemic related problem but linked to the nature of NHS contracts.
Nor was it restricted to any particular part of the country, as Sir Peter Bottomley representing West Worthing on the South coast, reported that it was a regular issue in newspapers, and that trying to find a dentist was “like trying to find a needle in a haystack”. Sir Peter has had a particular interest in a range of dental issues over the years including some of the GDC’s more dubious practices.
Though a much more recent arrival at Westminster, Andy Carter said that he had been meeting dentists in his constituency, “many of whom have been providing NHS dentistry services for many decades”. He was also aware of the connection between dental and other health conditions, citing increased risks of heart disease, stroke and diabetes when oral health was poor. He knew that “the notion of getting on a list does not exist anymore; there are no such things as dentists’ lists”. He had spoken to NHS England, Warrington CCG and been told that the NHS website listed dentists accepting patients. As patients and practices will vouch, he had found that, “the reality is that the website is massively out of date”. He went on to talk about a local practice that was leaving the NHS, and its 8000 patients, without an NHS dentist. He said that they were cross with the practice, the regional NHS team, cross with him as their MP, and the government. Older dentists will find it refreshing that an MP, even of the party in Government, can recognise that the problem is not simply ‘greedy dentists.’ Indeed Andy Carter had spoken to the owner of the practice in question who had explained why he was handing back his contract and accepted that ”providing the treatment that he is required to deliver under the contract just does not add up”. He was not surprised that the contract, like many others across the UK was being handed back. He also thanked GDPUK contributor David Flattery, who practices in Altrincham, for his insights. He had learned from David about the UDA system and been left “scratching his head,” at how it could pay the same for a check-up as root canal treatment. It made “little sense”.
Suggestions for possible solutions began to be made. Cherilyn Mackrory, Conservative MP for Truro and Falmouth spoke of the desirability of routine school dental checks and pointed out that it was not necessary for a dentist to carry these out. She asked the Minister to pilot a scheme where dental professionals could carry out school checks. Andy Carter spoke positively of the work done by nurse practitioners in medical practices, and suggested upskilling dental nurses to become dental nurse practitioners.
He asked the Minister to instigate a national recruitment drive and introduce incentives for dentists to work in areas like Warrington. He also asked for her to bring forward a replacement for the “not fit for purpose” 2006, UDA based contract.
Giles Watling, Conservative, representing Clacton, provided the shocking statistic that every 10 minutes a child was being admitted to hospital with dental problems. He praised his local CCG and argued for more local commissioning, “Primary care trusts have had their day”. Regarding the workforce, he pointed out that the lead in time for extra dental students reaching practice was 6 years and that “urgent action is needed to increase places on the overseas registration exam”, and “recognise qualifications from top dental schools around the world” such as those in the Commonwealth. He was “delighted that Clacton had been selected as a pilot area for such training courses”. Bob Seeley, Isle of Wight, another Conservative, had his own suggestions to enlarge the workforce. Firstly, a section 60 order should increase the GDC’s discretion when recognising overseas qualifications. Secondly a 12 month course should be developed for overseas dentists to gain GDC recognition. He also asked for funding for a catch up programme of ORE exams, targeting the Indian subcontinent. He then called for a 6 month validation by experience programme for experienced overseas candidates, and enlarging the scope of practice for therapists to allow them to work without a prescription from a dentist.
In reply, Maria Caulfield, the Parliamentary Under-Secretf State for Health and Social Care, accepted that there were problems and spoke of the increasing output as practices emerged from the pandemic. It may be news to contact holders counting the cost of their abatement to hear that according to the Minister, “Throughout most of the pandemic, even though they were seeing fewer patients than their contract allowed because of infection control measures, they were getting 100% of their contract value.” GDP’s doing their accounts are likely to beg to differ.
Responding to other points the Minister said that dentists had been asked to update their information on NHS websites and operate “cancellation lists”. The recent 50 million pound announcement was referred to, and it was enjoying a “huge uptake” from dentists. Contract reform was under way, there would be a meeting with the BDA. There was to be reform of dental education with a “whole range of dental professionals” who would be used, “more effectively”, in delivering NHS dental care. Legislative changes to upskill dental nurses and others might come later this year.
The department was working with the GDC on legislation to allow “greater flexibility to expand on the registration options that are open to international dentistry applicants”. Following the GDC consultation she hoped that it would “really open up dentistry to those who trained overseas”.
Perhaps the next stage of MP’s learning about the state of UK dentistry might be to educate them about the body that will be the gatekeeper for all the new registrants, and it’s stellar performance with the therapist loophole.
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