Train, Chain, Drain: Profession At Odds With Public Opinion
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- Published: Thursday, 13 July 2023 07:29
- Written by Guy Tuggle
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Guy Tuggle tunes into the Steve Nolan Show on Five Live and reports on what has already become dentistry’s next Big Debate.
Dentists are no strangers to hostile media coverage, and the suggestion by the NHS Long Term Workforce Plan that newly qualified dentists might be required to spend the first five years of their careers working for the NHS looks set to ignite a full scale culture war between dentists who oppose the idea and taxpayers who say ‘about time too’.
No sooner had the print media broke the news than the keyboard warriors were quick off the mark, muscling in to take a swipe at the profession for opposing what they perceive to be a perfectly reasonable quid pro quo arrangement.
And on Saturday 1st July, in what was billed as a ‘dentistry special’ by host Stephen Nolan, BBC Radio5Live listeners heard the BDA’s Eddie Crouch put on the rack, at times struggling to sound convincing as Nolan threw several well targeted grenades at the profession.
Many of the arguments now look destined to gain traction in the court of public opinion, lined up like ducks in a row to join the established ‘greedy dentists’ brigade. Public facing members of the profession may well now expect to be confronted with ‘we funded your training’ kickbacks from disgruntled would-be patients.
Clearly relishing his role an interrogator giving voice to millions of patients, Nolan asked why the BDA “was not in favour of newly qualified dentists completing a compulsory period in the NHS once they complete their training?”
Mr Crouch defaulted to the contract which all NHS dentists work to, citing this as the problem.
Nolan sounded unconvinced so turned up the thermostat. “But who, Eddie has trained, and paid for the training, of all those dentists? We have! The public has!”
Crouch confirmed that from years two to five the NHS invests 30k per student per year to training dental students, who typically graduate with 60k or more of debt before entering a system that really is ‘unattractive’ for them.
Sounding incensed, Nolan came back “The NHS gets its money from us, it’s the public, it is taxpayers throughout this country, pumping in 30 grand a year to each dentist year two, year three, year four, year five, and then, when those dentists are trained which the public has paid for , you’ve got a problem with the public being able to access the dentists free of charge within the NHS, despite the fact that they’ve paid for their training! How is that fair? On a working class family?”
Mr Crouch either avoided or was unable to address the ‘fairness’ aspect of the question and instead sought to deflect the proposition that NHS treatment was free, adding that most patients had to pay something towards it and that fees had recently increased by 8.5% but not funding.
Downplaying the role of charges Nolan continued “What that leads to is people like me, sitting on the BBC, hearing from families who …. can’t go and buy the private dentistry”.
Mr Nolan spoke of people “sitting in acute pain, their children are sitting in acute pain, and my point to you is the working class people of this country have contributed to those dentists, to their training, so have the middle class and the upper class. The working class, out of their pay packets, have paid for the training of these dentists who are then turning them away at the door when their teeth are sore. Is that not outrageous?
Crouch was having none of it. “It’s not outrageous. Why do you think dentists are leaving the NHS? It’s because it’s a system that has completely failed. It’s a system that isn’t properly remunerated. It’s a system that does not allow you to invest in your practice so that the service is better for your patients. This is a problem that has been created in Westminster and it needs Westminster to sort it out. Some of the things that were suggested yesterday by the PM are not the solution.”
By now the heat in the room was contributing to global warming but Nolan refused to open the windows and suggested instead that if dentists did not work in the NHS they should fully fund all their training, and not expect the public to subsidise it for no return.
“I say it again, how is it justifiable to take thirty grand a pop from the British public and then turn a lot of them away them away when those same people who have paid for the training are in pain? So why don’t those dentists say ‘OK, we want the freedom to go private so we’ll privately pay for our training?”
“This is not lah lah land, this is the money from working class communities, and others, throughout this country, and then those people are being turned away from dentist doors AND THEY’VE PAID FOR IT!!!
Dentist Dr Rhona Eskander, ‘smile-maker, speaker, entrepreneur, philanthropist’ as her website portrays her, was the first caller. Very calm and measured, she echoed Eddie Crouch’s comments adding she had wanted to be a dentist since childhood but the conveyor belt style of NHS work, seeing up to thirty patients a day in five or ten minute appointments, was bad for them and for her physical and mental health.
Dr Eskander advocated using therapists to take work off dentists so they can do more complex care as one of the keys to reform.
More restrained than patient comments on newspaper sites, the public callers’ tales were predictably about cost and access. All sided against the profession by supporting the mandatory tie-in, perceived as a fair means of expanding the workforce.
Anne in Axminster lost her NHS dentist because the practice closed. Her search for a new one proved fruitless, “the nearest one was in Worcester 117 miles away”. Her children were suffering. Asked about the tie in proposal she said “we should… I’ve worked since I was 15 and have always paid NI… I have to agree a lot of them are in it for the money … there should be some commitment in return for their training
Tony in Norwich said “absolutely tie in!” As a pensioner, “we cannot afford to pay the fees, fortunately we have not had serious pain, but the point is if you’re getting subsidised by government or anybody else for 5 years with the potential to earn, there should be an automatic contract that says a percentage, not all, off your patients have to be NHS.”
Andrew Lord of Toothless in Nottingham not surprisingly was willing to support any move that would deliver more dentists to the NHS.
Celia in Suffolk, had an NHS dentist who went private so she joined his capitation plan. Although she spent £15 a month it only covered the check-ups and there was no NHS alternative. She too supported the proposal. This caller also raised the facial cosmetic treatment “which can’t be right. Dentists offering cheek fillers when they should be doing teeth” was the essence of her argument.
Catherine from Cardiff said there was no such thing as an NHS dentist and that they should be brought into the NHS and given proper premises to work out of. “At the moment they’re out on the street, working out of grubby houses.” Catherine was “ surprised any young person would want to be a dentist. A very unattractive position to be in. I go to a dentists in a house in an unattractive area there isn’t even anywhere nice for them to go out its like an outback in the city.”
And so it continued, with Nolan almost repenting for giving Mr Crouch and the profession a hard time and he did concede that the NHS does not reimburse practices adequately for their overheads.
A cynic might stand back from the whole debate and wonder whether the government hasn’t played a masterstroke. MP’s receive voluminous quantities of complaints from constituents unable to access NHS dentistry, many doubtless claiming to have paid for it.
Those MPs can now shift the blame back onto the profession if the tie-in proposal does not fly. “We tried” MPs can claim. “And dentists said no”. Genius. Once again, it’s all the dentists fault!
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