Health And Social Care Committee Hears Evidence Of The ‘Perverse’ NHS Contract
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- Published: Tuesday, 24 May 2022 13:47
- Written by Chris Tapper
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The British Dental Association’s Dr Shawn Charlwood has given evidence to the Parliamentary Health and Social Care Committee which is looking into workforce recruitment, training and retention in health and social care.
Committee Chair Jeremy Hunt started the session on Tuesday, by asking the Chair of the BDA’s General Practice Committee “What is happening to the size of the dentistry workforce, what the trend has been, and whether that size is linked to the fact that so many people are finding it so much harder to access NHS dentistry?"
Dr Charlwood began by saying in terms of numbers of dentists, we actually have the largest number of dentists on the General Dental Council register that we’ve ever had.
“The issue is that not enough of those dentists are wanting to work within the NHS dental system and in fact, in the last two to three years during the pandemic, we have 3000 fewer NHS dentists available to treat patients.”
Dr Charlwood continued “Although the numbers on the GDC register have increased and in NHS dentistry, particularly, we are facing a crisis the likes of which I hadn’t seen in my 35 years in the profession, and NHS dentists are genuinely struggling to see the light at the end of the tunnel.”
Dr Charlwood said NHS dentists are ‘voting with their feet.’
As a result he said “That’s affecting the workforce that is available to see patients and thousands of dentists have already left the NHS dental service. Millions of patients are struggling to secure the care they need. Undoubtably COVID and the pandemic has exacerbated the problem. But this problem existed before the pandemic and workforce an NHS workforce was declining.”
“I think my NHS colleagues feel chewed up and frankly spat out by a system that they work to - the NHS dental service and dentists are severing their ties with a failed NHS system.”
Dr Charlwood then gave an example of which shocked the committee. “To give you some context I was approached last week by a young dentist who has gone through five years of training and has £70,000 of student debt. He said on one day he earns nine pounds because of the perverse way the current NHS contract is structured.”
“Many of my colleagues talk about how the only thing that is keeping the NHS going really is the dentist ethical responsibility they feel towards their patients. But this can only last for so long.”
Dr Charlwood emphasised the stark reality of the access crisis.
“I don’t think it should come as a surprise to this committee that we have a genuine crisis and that unless we deal with this or Government deals with this, urgently, the situation is going to worsen and worsen.”
“And just to conclude back in 2008 this very committee reported that the contract was unfit for purpose and recommended reform to government and here we are 14 years later. In essence nothing has been done by Government.” In terms of NHS dental reform. It has been allowed to wither on the vine, and today’s crisis is the result.”
“And this must not continue.”
“Your advice, your report must not be ignored again, otherwise, this crisis will continue.”
Dr Charlwood emphasised “We need a new non UDA contract for NHS dentistry by April 2023, at the latest.”
Mr Hunt asked Dr Charlwood “What is the type of contract that you think we need to move to stop dentists moving out of the NHS system?”
Dr Charlwood replied “Government needs to work with the British Dental Association to develop a contract, and we’ve presented a paper to them with some very clear ideas. Those are structured around capitation for dentists”
He said that dentists would work similarly to doctors working in general medical practice.
Dr Charlwood said “It would allow dentists to provide the care that their patients need and the care that they’ve been taught to deliver a dental school. It would most importantly allow dentists to provide prevention, which all of these diseases that we’re treating day in day out are completely preventable dental caries and gum disease.
“The current UDA system does not allow and remunerate practices to provide prevention. And within that capitation system, we can provide weighted capitation so that would address areas of deprivation and inequality, which I think is really important.”
“We must address that there’s current evidence that patients that are least able to access NHS dental care are from some of those deprived communities that we have, and inequalities in terms of dental health are widening, and none of us want that and it must be addressed.”
Dr Charlwood explained to Labour Committee member Rosie Cooper how the UDA system worked and how a dentist providing ten fillings receives the same fee as for providing one filling.
He said “The UDA system doesn’t deliver and doesn’t allow dentists to deliver prevention. It pays for targets rather than patient care.”
Dr Charlwood explained to the Committee “The important implications of that are that new patients are disincentivized from joining a practice because new patients often have higher levels of disease.”
“They may not have been to a dentist for many years, they may arrive with a number of different oral health issues, whereas patients that have been seen regularly are more likely to be managed and their clinical health will be more stable.”
“The UDA system doesn’t deliver and doesn’t allow dentists to deliver prevention. It pays for targets rather than patient care.” Dr Charlwood said the current contract allowed the Treasury to easily measure and confine the budget.
“It doesn’t allow new practices to open. It doesn’t allow successful practices to expand their patient list. And most importantly, it disincentivizes NHS dentists from seeing new patients because once they’ve reached their allocation of UDS for the year, there is no more funding.”
“So if you’ve got a stable NHS dental practice, you will be inundated with inquiries for from new patients.”
Dr Charlwood was asked outright by Jeremy Hunt “Just cut to the chase? Are we actually having rationing by the back door?”
He said “The patients that lose out are broadly 50% of the population who do not routinely access NHS dental care, but they wish to access it on an intermittent basis.”
“Traditionally, NHS Dentistry has only been commissioned for 50% of the British population. Now I think that’s wrong.”
He added that not enough services are being commissioned.
“The people that are most vulnerable to not being able to access NHS dental care are often those that are most require care and are in the highest areas of deprivation.”
Rosie Cooper asked “How did we get here? Because government straight off, don’t start by sort of saying, well, we want to do this. There is a financial part to it.”
“I think some bad behaviour by a tiny number of dentists has led the profession to be seen as greedy.”
Ms Cooper asked Dr Charlwood “So how do we really address getting the taxpayer good value for money, but also making sure dentists prosper, but that patients are really looked after.”
Dr Charlwood replied “Dentists are not moving away from the NHS in order to earn more money. They’re moving away from the NHS in order to work in a system where they can deliver patient care, as they deem appropriate.”
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