NHS Dentistry Unravels - Central Denials and Public Anger
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- Published: Friday, 11 March 2022 09:57
- Written by Peter Ingle
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With NHS dentistry in a sorry state, patients, dental teams and bureaucrats, seem to be working their way through the five stages of grief, albeit at different stages of the process.
Denial
The various national departments of health and hapless ministers seem to be stuck here. Also, the local teams that respond to yet another practice handing back its contract with a reassuring announcement that they are working to provide replacement NHS provision, will likely have no idea how they will do this and do not expect to be able to deliver a suitable service.
Answering a written question Maria Caulfield, the Under-Secretary, who seems to have drawn the dentistry lot, said that the she expects “to announce the outcome of these (NHS dental contract) negotiations shortly”. This is undermined by her next sentence, “The development of further long term proposed changes will be progressed over the summer and autumn of 2022.” Unpicking this suggests that minor adjustments to the current contract may be announced to keep the ‘something must be done’ lobby happy, but that meaningful changes will have to wait. At this stage of the service’s decline, her answer manages to elegantly combine elements of “yes but, no but” and “don’t hold your breath.”
The strategy of denial permeates the NHS and government at all levels. Following the announcement of the closure of the BUPA dental practice in Millom, local MP Trudy Harrison had this to offer the local population, “NHS England have been actively reviewing access to NHS dental care.” This was, “so they can begin to address these issues around access to services.” No doubt her constituents are delighted to hear that NHSE are “actively” reviewing access, while imagining just how different things would be if they were doing it in passive mode.
Anger
The BDA statistic that 76% of NHS focussed associates would not recommend a career in dentistry underlines the low morale amongst NHS providers. Across the country local papers carry regular stories of practices closing or handing back NHS contracts. Many patients have taken the news from ‘their’ dentist badly, with expressions of anger and feeling let down. A good deal of this is directed at NHS funding and the government, but there are also frequent accusations of ‘greedy dentists’, and comparisons of the costs of private treatment with the NHS fees they have been used to paying. The recent announcement by a GDPUK contributor that he would no longer offer NHS dental treatment was met with patients’ comments ranging from, “I am just a little annoyed” via, “I am really disappointed” to, “disgraceful.”
Bargaining
The BDA have submitted their evidence to the DDRB. It will be a remarkable achievement if they get the full RPI plus 3% they have requested. And yet, even that would be unlikely to be enough to stop the steady loss of practices and dentists, as they leave NHS dentistry.
In his recent blog, Shawn Charlwood, chair of the BDA’s GDP Committee, did his best to keep dentists informed on reform discussions with NHS England. Writing about, “A confidential two-part process”, perhaps his most telling revelation was that “, Nothing is agreed, until everything is agreed.” Even this is open to interpretation as he then goes on to talk of some interim changes this April, described as “quick wins.” Practices may wonder if this is simply a way of delaying substantive change and, just who is achieving these “wins”. The latest letter to Welsh dentists, recently featured on GDPUK, may show the direction of travel for interim changes in England.
Depression
Writing in The Times, Libby Purves wrote about the current state of NHS dentistry with the headline, “Failing dentistry will come back to bite us.” She catalogued the current difficulties and, in particular, how poorer and low-income patients were gradually being excluded from dental care. Since untreated disease would only put more pressure on secondary care, the end result would be to damage the wider NHS.
In Northern Ireland the BDA said it was “gutted” at the outcome of talks with the Department of Health and Social Care Board, where it had hoped to secure improvements for NHS dentists. Practices were becoming “increasingly reliant” on private work to remain viable.
Acceptance
Within the profession, there are those who have dedicated their careers to NHS work, particularly younger dentists and those who have borrowed and invested heavily, or staked their future on viable contract reform. They will be having to make some difficult decisions.
There are daily announcements of practices handing back their contracts and looking to a future outside the NHS. The plan providers are reportedly very busy supporting practices converting. The GDPUK contributor’s practice mentioned before, will be offering Denplan to provide a stepping stone out of the NHS, explaining the benefits of fixed monthly costs in their letter to patients.
Meanwhile for those not yet ready for the post NHS dental world, the outlook is bleak. In Warrington, two-thirds of adults have not seen a dentist since the start of the pandemic. Local MP, Andy Carter, blamed the contract saying it needed to be replaced. But he managed to add a positive note that, “The minister has now confirmed, responding to my questions in the debate, that the government is going to do this.” Andy and his constituents, may feel badly let down when they realise that real reform may be as far away as ever, and with it the prospects of NHS dentistry’s survival.
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