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Published: Friday, 24 May 2024 08:09

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Many ex- prime ministers find the time to write their memoirs, and if he follows this pattern, it may be that dentistry deserves it’s own chapter. No previous Government has been bombarded with so much criticism about the state of NHS dentistry, and much of this had a good deal in common with reports and complaints of failure in other areas.

Sunak may be remembered as an unlucky PM, though many will argue that many of his misfortunes were self-inflicted. In the last days of the election campaign it has been revealed that the practice where not long ago he launched his plan to save NHS dentistry, is now dropping its remaining NHS adult patients.

The recovery plan, which despite its promising name came without new funding, was not well received by the profession at the time. In February 2024 the PM visited the Gentle Dental practice in Newquay, Devon, with photographs of him in a surgery, to publicise the latest minor changes to the UDA system. Shortly after this it was revealed that the practice was not taking on new adult NHS patients. Cornwall Live has now reported that existing patients are being told that they will not be seen again on the NHS, with staff telling them that recent appointments would be their last under the system. Patients who wish to stay with the practice are being offered a membership plan as an alternative.

Commenting, perhaps with a veiled warning for an incoming Health Secretary, BDA chair, Eddie Crouch said: “The Government’s so-called ‘Recovery Plan’ has been a bad joke from the outset, and this appears to be the punchline. The lesson here for all parties is that spin is no substitute for meaningful reform.”

The Mirror has been particularly critical of the Sunak administration’s handling of dentistry and with the BDA has set up a petition that now has over 220,000 signatures. It recently described the Government claims of an increase in practices taking on NHS patients in the bluntest terms.

It is a sign of the low regard held for Sunak that this national paper is openly accusing him of lying and that the chosen topic is dentistry. The basis for this damming headline is the sleight of hand changes made to the NHS “Find a dentist” website. This led to the Health Secretary’s and Prime Minister’s  boast that 500 more practices were taking on NHS patients, which was quickly and comprehensively debunked.

As reported in GDPUK, where in the past dentists were asked to state whether they were currently taking on new NHS patients, they are now asked if they would take on new NHS patients “when ­availability allows.” It is a sign of dentistry’s place in the public eye that this story has crossed from professional organisations and publications, to the Mirror group papers and heavily used websites. The paper quoted Shadow health secretary Wes Streeting, who did not hold back: “Any patient who has tried to get an appointment can see that Rishi Sunak is lying.”

Mr Sunak may have more pressing concerns in the short term. Amongst the comments following a Mirror article about access, was one that suggested that his party would share the fate of NHS dentistry: “At least the Tories will be as rare as an NHS dentist in a week’s time!”

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Fast forward fourteen years, and pretty much on the eve of an election that is likely to see Labour return to power, a former Chair of the Health & Social Care Secretary, Steve Brine MP has cautioned Wes Streeting, tipped to be Labour’s Health & Social Care Secretary, not to rely on the Treasury increasing funding for dentistry.

Answering questions from delegates at the Local Dental Committees Annual  Conference in Brighton (6th-7th June) Mr Brine, who chaired the Health & Social Care Committee’s Inquiry into NHS Dentistry in March and April 2023, said Wes Streeting should focus on “pushing down demand” via prevention, “because he’s not going to have any more luck with the Treasury (securing growing health spending) than the previous secretary of state”. 

Mr Brine questioned whether dentistry would really be at the “top of (their) inbox” and cautioned that the Treasury had been “terrified of dentistry” when he was a minister.  This was “because they could just see big, big costs”.

The Treasury has long been seen as an obstacle to dental contract reform.  At least until NHS dentists began to walk away from the failed contract, the UDA system would have been valued by the Treasury on account of its ability to deliver a high number of appointments and treatments for a very modest and fixed budget.  

The UDA model will also please Treasury spreadsheet number crunchers because dentistry, almost uniquely, manages to underspend the funds allocated to it.

For this reason, one of the key stress tests any proposal for contract reform faces is how much dentistry the reformed contract buys and at what cost.  Any model that costs more for the same or less delivery will struggle to pass the stress test.

Mr Brine was also asked, by the former chair of the BDA’s General Dental Practice Committee, Henrik Overgaard- Nielsen if he regretted not pushing through contract reform when he was the health minister.  

Mr Brine replied that as a junior minister he ’didn’t have much sway’ because ’the real power in government lies in numbers 10 and 11 Downing Street’. 

As followers of politics will know, Mr Brine’s explanation is accurate.  In their memoirs and in countless interviews, politicians including many former Secretaries of State, bemoan the fact that they enter government hoping to push buttons and pull leavers only to find their power to do so thwarted because power always lies ’higher up the ladder’.  In most cases the buck usually stops at the Treasury.

Mr Brine spoke with pride of the Inquiry Into Dentistry and thanked the many in the profession and its trade bodies for their input saying the government now needed to ’press ahead with change’ and end the UDA based contract.

The general election campaign has passed the halfway mark with dentistry continuing to make the headlines as voters demand solutions from their parliamentary candidates.</>p>

Whilst politicians compete for positive daily headlines, the BBC set up a ’Your Voice, Your Vote’ link to its BBC News website inviting readers to signal the key issues that will influence their vote.  

Not surprisingly, dentistry has been cited by ’many people’ as the burning issue.

One respondent was Andrew Sparkes from Locking, North Somerset. He told the BBC that he and his family had been unable to access an NHS dentist since before Covid. 

Mr Sparkes is calling on all parties to "sort out the dental crisis" and give the NHS more cash to fund dentistry.

In an experience that plays out in practices across the land, Mr Sparkes told the BBC that when he asked a receptionist about the shortage, he was told there was a lack of staff in the area.

"I have been told by a receptionist that they can’t get the dentists in, there’s not enough being trained, and they were treated so poorly during Covid that people have just let the profession," Mr Sparkes said.

The South West is an especially arid dental desert.  According to the BBC report only 69% of dental contracts are being delivered whilst in Somerset that figure plunges to 49%. 

The number of children being seen by an NHS dentist in the county has halved over the past six years, falling from 60 to 32% in 2023/24.

All parties have announced ambitious plans to address dentistry.  However, doorstep soundbites that promise to make children brush their teeth at school or provide anything from 700,000 to 2.5 million additional NHS appointments are severely lacking in detail.

From funding for additional activity to securing a workforce and, in ’deserts’, the physical premises required for teams to work in, the paucity of detail is alarming.  

Labour has suggested that its plans to offer more GP appointments will be realised via an expansion of evening and weekend appointments.  

With the Labour party election manifesto about to be released, extra dental appointments are one feature of the “Child Health Action Plan” which is being unveiled on a campaign stop in the North East.

Ahead of the visit, shadow health secretary, Wes Streeting, said the plan would help to, “put a smile back on kids’ faces.” The promise is that 100,000 extra appointments for children will be created with the aim of meeting unmet need in England. The appointments will be for urgent and emergency care and available during evenings and weekends. Labour have already revealed plans for supervised tooth brushing and pledged to start work reforming the NHS dental contract.

The £109 million cost will be met from the proceeds of tightening up the rules for non-doms and from measures that will reduce tax avoidance. Data from February 2024 revealed that there were almost 48,000 extractions in NHS hospital in England for under 10’s in 2023. Two thirds followed a primary diagnosis of caries, which was an increase of 17% over the previous year. It is estimated that the caries related extractions cost the NHS over £40 million.

On BBC’s Breakfast show, Mr Streeting said that Labour was seeking to take preventative action with children’s health and that this included dentistry. According to BBC Verify the numbers of children seen has been steadily recovering since 2021, following the huge drop during the pandemic. However they have still not reached previous levels, with about 600,000 less children seen by a dentist in the year ending June 2023, than during 2018.

The Conservatives are still claiming that 500 more practices have opened their doors to NHS patients as reported here, as well as promoting their recovery plan, including the new patient incentives.

Liberal Democrat proposals include an emergency scheme that will guarantee free check-ups to priority groups. They have also pledged to fix the dental contract, and even bring dentists back from the private sector.

The Greens have said they will offer everyone access to an NHS dentist as a result of extra spending on health, which would reach £50 billion a year by 2030.

Reform UK would set a zero rate of basic income tax for front line health and social care staff as well as offering tax relief on independent healthcare and insurance.

At the same time, the BBC website was carrying a more personal dental story. With the title, “Why can’t I get an NHS dentist?” it featured Emma from South Hams in Devon. She asked the BBC to look into the state of dentistry. She had been without an NHS dentist for six months after her previous one stopped offering NHS care.  In response, the BDA figure that 60% of dentists in the South West were seeking to reduce their NHS commitments, was quoted. The BBC South West health correspondent went on to explain that most dentists are independent contractors, and that their costs were not always covered by NHS fees. The UDA system’s potential for higher needs patients to leave practices at a loss was explained.

Pensions: Labour Promise to NOT Reinstate LTA

The sound of screeching brakes and the smell of burning rubber. The signs of a hasty political U turn, and on this occasion one that will be welcomed by many dentists.

There were strong expectations that the Allowance was going to make a comeback, given Labours criticism when it was abolished. Soon enough, financial experts and advisers began to offer their opinions on how to protect pensions and avoid being hit by the expected changes.

LTA’s were the brainchild of former Chancellor George Osbourne, a consummate stealth taxer. Despite their name suggesting a benefit, they exposed portions of larger pensions to new tax penalties. Like other taxes that had seemed like a good idea at the time, LTA’s soon started delivering some unwanted and unintended consequences. In particular, medical personnel in their 50’s and early 60’s who were beneficiaries of the NHS pension schemes were finding that they often had pension pots that would soon exceed the allowance. This was in many cases a deciding factor in taking early retirement and medicine and dentistry lost experienced practitioners who might otherwise have worked for longer.

By the 2023 Budget, the LTA stood at £1,073,100 and was failing to keep pace with the cost of living. There was also a workforce crisis with vacancies proving difficult to fill in GP and dental surgeries. In that year’s budget Chancellor Jeremy Hunt abolished the LTA.

At the time Labour criticised it as a tax break for some of the nation’s higher earners, safe in opposition and not having to worry about the workforce. They described Hunt’s move as the “wrong priority, at the wrong time, for the wrong people.” Later, as they increasingly became favourites to form the next government, there was talk of exemptions from a returned LTA for NHS workers, but this would have been complicated and divisive.

There has now been confirmation that Labour will not look to reintroduce the LTA should they win the election. Iain Stevenson, Head of Dental at Wesleyan, a mutual with strong dental connections, said: “This is a win for financial planning because it delivers clarity and consistency – the pillars upon which good financial strategies are built. Dentists can now continue to save and plan for retirement with greater confidence that the current system won’t be upended in a few months’ time. Fundamentally, re-introducing the LTA would have risked re-introducing the pension tax issues for some of our most senior, experienced clinicians that were effectively punishing dentists for just doing their job. And proposals to try and get around this by adding new LTA rules to treat public and private sector pensions differently would have also had undesirable outcomes – creating an unfair wedge between taxpayers and making an already complex system even more complex."

Interest has now focussed on the possibilities of a reduction of tax relief on pension payments, cutting the amount that can be taken tax free from pensions, or making some pension assets eligible for inheritance tax.

YouGov Poll: Dentistry A ’Top Issue’ On Doorsteps

While the media obsesses over Dianne Abbott’s status as a candidate, ’who won’ the first leadership debate or how much tax will have to rise by to fund free breakfast clubs for children in deprived areas of Newcastle, it’s local issues like dentistry that worry the voters.

Nearly a third of voters identified dentistry as a top local concern (28%) compared to 24% for crime, 19% for high street shops, 15% for public transport, and 11% for schools and education.

Only the state of roads (42%), GP services (40%) and affordable housing (36%) scored higher than dentistry.

Worryingly, especially for incumbent Conservative MPs whose party has failed to adequately address the crisis, almost one in twenty (4%) say the dental access crisis will ’directly impact on how they vote’ with a staggering 80% saying the government should be doing more to improve NHS dentistry.  Only 9% believe that the government has done ’all it can’.

On national issues voters cited the cost of living/economy (63%) and health (38%) as their top concerns. The BDA stresses that this explains the status of dentistry, where the cost of living and NHS access crises converge.

Commenting on the poll’s findings, Chair of the BDA Eddie Crouch said "NHS dentistry is now a top issue on the doorstep because millions have no options.  Access and cost of living crises have collided, and thus far the Government hasn’t stepped up to the plate.  Politicians might lose their seats if they fail to act, but voters risk losing this service for good.”

Methodology: 1707 adults in England were interviewed between 28th - 29th May.  Full results here

Streeting To Meet BDA "First Monday After The Election"

Speaking from Worcester to Richard Madeley on GMTV (29th May) Mr Streeting was asked "What are you going to do about people pulling out their own teeth in their kitchens with pliers because we have such a shortage of NHS dentists, how are you going to fix that?"

Streeting said that NHS dentistry "had to be rebuilt" and spoke of targets to provide an additional 700,000 appointments primarily to see emergencies.

Mr Streeting suggested that the country had sufficient dentists but that too few were attracted to working in the NHS. 

Contract Does Not Pay

"The contract is so out of date that it just doesn’t pay what dentistry is worth, so we are going to have to negotiate a new dentistry contract.  I’ve committed to getting the British Dental Association in on the Monday after the general election - if we win - because I see it as that big a priority"

Mr Streeting’s declaration was welcomed by the BDA.  A statement issued by the organisation on ’X’ (formerley twitter) said "Pleased to see @wesstreeting repeat his pledge to meet with us the first Monday after the election - should Labour win - to begin negotiations on the NHS contract.  

We need all parties to grasp the urgency here. 

Without real and rapid reform this service won’t have a future."

Image: Chris McAndrew, CC BY 3.0, via Wikimedia Commons

LibDems Pledge End of Dental Deserts

The Liberal Democrat leader Ed Davey MP chose dentistry as the focal topic of his Party’s Scottish election campaign launch. Flanked by Scottish Liberal Democrat Leader Alex Cole-Hamilton, Mr Davey said the Conservatives nationally, and the SNP in Scotland, had presided over policy failure as he pledged to "end dental deserts". 

Noting that 4.5M children did not see a dentist last year whilst thousands were  admitted to hospitals for extractions, Mr Davey said “Some Ukrainians have even travelled back to Kyiv for dental care because the air-raid sirens, drone strikes and cruise missiles are less daunting than the waits in Scotland’s NHS.

“The SNP promised to scrap dental charges, but instead they have introduced new charges and doubled the price of some procedures. Dentists are being driven away from the NHS because working with this SNP government is harder than pulling teeth" Mr Davey said.

“No matter how much pain you are in, seeing an NHS dentist in Scotland is harder than ever before. It’s a stark reminder of how the SNP make empty promises and can’t get the basics right.”

The Liberal Democrats’ plan to end dental deserts would include introducing what it calls an ’emergency scheme’ which would guarantee access to free NHS dental check-ups in England and Wales for those already eligible: children, young mothers, those who are pregnant and those on low incomes. 

The party says it would bring dentists back to the NHS from the private sector by fixing the broken NHS dental contract and using flexible commissioning to meet patient needs.

The Scottish Liberal Democrats have announced plans to overhaul the SNP’s Recovery Plan which they claim  ’barely mentions dentists’, as well as boost the number of NHS dentists with a workforce plan. 

Ministers 7, Contract Reform 0

As Dame Andrea Leadsom DBE MP becomes the latest senior Conservative and government minister to announce she’s standing down at the upcoming election, it will be back to ’square one’ for the dental profession in its quest to secure a workable NHS contract, 

Mrs Leadsom represented South Northamptonshire since 2010 and has occupied a succession of senior roles on the government benches including Economic Secretary to the  Treasury.  She was promoted to the Cabinet to serve as Environment Secretary then  ’Leader of the House of Commons’, Business and Energy Secretary and latterly served as Parliamentary Under Secretary of State in the Department of Health and Social Care.

In her health role, Leadsom was responsible for launching and steering the government’s Dental Reform Plan (’DRP’).  Mrs Leadsom spoke with pride of the ’Plan’, despite the fact that each component of it had been picked apart by The British Dental Association and other professional bodies.  In her resignation letter to Rishi Sunak she included the DRP in a list of health related initiatives it "had been a great privilege" to roll out.

Polling suggests fewer than 5% of dentists believe the DRP will, in any meaningful way, confront the enormity of the dental recruitment and access crisis.

Mrs Leadsom was the seventh Minister to occupy the ministerial role responsible for primary care.

Chair of the BDA Eddie Crouch posted on his ’X’ (formerly Twitter) account "Whatever happens at the election it will be minister number 8."

Whatever happens at the election it will be minister number 8 @TheBDA pic.twitter.com/m58bnqXHt4

— Eddie Crouch (@EddieCrouch) May 24, 2024

Dentistry On The Doorstep

The starting gun has been fired and 650 seats in the House of Commons are up for grabs. Power shifts, temporarily, from the corridors of Westminster to the hearts and minds of the electorate.

For many voters, for the first time ever, dentistry, of all things, will be a factor as they consider their choices. Candidates can expect to get their ears burned by angry voters - there are 12 million of them - who have no NHS dental access. 

At his first PMQs in October 2022, Mr Sunak was asked by  Heather Wheeler, MP (Con) for South Derbyshire, to provide better processes to allow overseas dentists and doctors to work in the UK.    

The Prime Minister, who was frequently asked about the crumbling state of NHS dentistry throughout his 2022 leadership campaign, replied "we are working to simplify the registration, for dentists in particular, that are not trained here to practise here. That’s how we will help to deliver a long-term workforce plan for the NHS and ensure everyone can get the care they need.’

Fast forward to Wednesday 22nd May 2024, and at his last PMQs before announcing the election date, the Q&A session opened with a question about dentistry. 

Gen Kitchen MP (Lab) for Wellingborough told Mr Sunak that in May 2022 the Association of Dental Groups had identified her constituency as a dental desert.  She welcomed the PM’s "grand scheme to send dental vans" to the area but regretted that just "months on, he’s had to U-turn because there aren’t enough vans. Why can’t the minister address this issue seriously?".

Sunak replied that as a result of the Dental Recovery Plan "we are delivering 2.5 million additional appointments’, referenced the new patient premium adding that since the plan was announced in January "over 500 more dental practices are accepting new patients".  

All these claims have been hotly disrupted or disproven by the British Dental Association (BDA) but voters can expect them to be trotted out by Conservative politicians time and again over the coming weeks. They must be challenged. 

Labour, meanwhile, has promised 700,000 additional appointments, ’golden hellos’ and early intervention in nurseries and schools. There’s no explanation of where the workforce will come from or indeed the practices for the said workers to practise at. 

As the opening salvos are fired, neither party has placed before the electorate or the profession a viable solution in the form of contract reform.  As the profession knows, until NHS dentistry is transformed into a place where clinicians wish to work, it is doomed.  

GDPUK will be following the campaign and invites readers to share their own observations.  

Eddie Crouch, Chair of the BDA says the organisation is "non-partisan, but we are  avowedly political. We will fight for what’s right for our members and the millions they treat.  Underfunding and failed contracts are political choices, and they can be solved if politicians choose to."

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