Dentistry scandal
Discussion
8 in 10 "NHS" dentists not taking on children. 9 in 10 not taking on adults. Some people resorting to DIY extractions, dentures, etc.
This has nothing to do with the usual b
ks about "NHS waste" etc - this is just plain old deliberate Govt under-funding.
https://www.bbc.co.uk/news/health-62253893
This has nothing to do with the usual b
ks about "NHS waste" etc - this is just plain old deliberate Govt under-funding.https://www.bbc.co.uk/news/health-62253893
The problem is that, almost since the birth of the NHS, dentistry hasn’t been completely free (charges having been introduced in 1951 in an attempt to better fund an already unaffordable NHS):
“By 1951, the NHS was already running out of money. To help alleviate this, charges for dentures, the first charges of any kind for NHS treatment, were introduced causing much debate in government and the public arena and leading to the resignation of Aneurin Bevan, the Minister who had been crucial to bringing the NHS into existence. Other charges for treatment soon followed, and unsurprisingly, demand for services dropped.”
In 2006, a crazy new contract for NHS dentists based on ‘units of dental activity’ was introduced, making providing NHS treatment unaffordable for most of them.
https://bda.org/museum/exhibitions-and-events/nhs7...
In short, NHS dentistry was designed almost from the outset to reduce patient demand for it (as the NHS cost too much) and the 2006 contract was another big nail in the coffin, being almost perfectly designed to make it unaffordable for dentists to provide NHS dentistry services.
“By 1951, the NHS was already running out of money. To help alleviate this, charges for dentures, the first charges of any kind for NHS treatment, were introduced causing much debate in government and the public arena and leading to the resignation of Aneurin Bevan, the Minister who had been crucial to bringing the NHS into existence. Other charges for treatment soon followed, and unsurprisingly, demand for services dropped.”
In 2006, a crazy new contract for NHS dentists based on ‘units of dental activity’ was introduced, making providing NHS treatment unaffordable for most of them.
https://bda.org/museum/exhibitions-and-events/nhs7...
In short, NHS dentistry was designed almost from the outset to reduce patient demand for it (as the NHS cost too much) and the 2006 contract was another big nail in the coffin, being almost perfectly designed to make it unaffordable for dentists to provide NHS dentistry services.
chemistry said:
The problem is that, almost since the birth of the NHS, dentistry hasn’t been completely free (charges having been introduced in 1951 in an attempt to better fund an already unaffordable NHS):
“By 1951, the NHS was already running out of money. To help alleviate this, charges for dentures, the first charges of any kind for NHS treatment, were introduced causing much debate in government and the public arena and leading to the resignation of Aneurin Bevan, the Minister who had been crucial to bringing the NHS into existence. Other charges for treatment soon followed, and unsurprisingly, demand for services dropped.”
In 2006, a crazy new contract for NHS dentists based on ‘units of dental activity’ was introduced, making providing NHS treatment unaffordable for most of them.
https://bda.org/museum/exhibitions-and-events/nhs7...
In short, NHS dentistry was designed almost from the outset to reduce patient demand for it (as the NHS cost too much) and the 2006 contract was another big nail in the coffin, being almost perfectly designed to make it unaffordable for dentists to provide NHS dentistry services.
I understand the history. But child dentistry *is* free (as it is for those in receipt of certain benefits). The framework clearly isn't fit for purpose to deliver even that.“By 1951, the NHS was already running out of money. To help alleviate this, charges for dentures, the first charges of any kind for NHS treatment, were introduced causing much debate in government and the public arena and leading to the resignation of Aneurin Bevan, the Minister who had been crucial to bringing the NHS into existence. Other charges for treatment soon followed, and unsurprisingly, demand for services dropped.”
In 2006, a crazy new contract for NHS dentists based on ‘units of dental activity’ was introduced, making providing NHS treatment unaffordable for most of them.
https://bda.org/museum/exhibitions-and-events/nhs7...
In short, NHS dentistry was designed almost from the outset to reduce patient demand for it (as the NHS cost too much) and the 2006 contract was another big nail in the coffin, being almost perfectly designed to make it unaffordable for dentists to provide NHS dentistry services.
As regards the 2006 contract, that seems to be an over-simplification of the issue. This is interesting: https://blogs.deloitte.co.uk/health/2019/03/what-h...
I have sympathy for dentists. But I've nothing but hatred for those who used Covid as an excuse for clearing-out NHS patients from their lists who (for obvious reasons) did not attend for check-ups.
If most dentists are refusing NHS customers then they are not able to make enough income. The government doesn't have a limitless pot of money so one option could be to increase charges. Increasing the routine visit costs to £30 for example would still leave it cheaper than the private dentistry option.
My rough and ready understanding had been that Blair shoved huge amounts of cash into dentists pockets by agreeing the first offer they proposed for NHS treatment
(They had expected a negotiation). If this is wrong, I'm happy to be corrected.
As the country found- when you throw money at the public sector, things get better (waiting times, new schools built, new hospitals built, child care provision expanded)
But the country also learnt it had to be paid for, and a assumption of never ending growth to pay for it was sadly lacking. Especially when the chickens came home to roost for off balance sheet pfis (though the private sector did well out of them)
This dentist scandal has been talked about for years though- it's not new, as those rates have probably not changed in the intervening decades.
To steal a suggestion i saw on here about something else, the simple solution would be to pass a law mandating all MPs, Lords and senior civil servants to use the NHS for dentistry, and prohibit their and their family's access private dentistry (or health care, or schools)
Then: sit back and watch quality improve.
We could be capitalist about it, and pay dentists more to incentivise treatment for the non rich patients, so dentists aren't losing money treating NHS Vs private patients.
Or we could be socialist about it, and force dentists (who I assume mostly got their qualifications and experience via public funding) to treat a certain proportion of patients on NHS rates. They will make less money than they could, but that's what part of being society means, and should be the deal they should sign when choosing to be part of the UK health sector.
What we have at the moment is the government just ignoring it, and hoping the problem goes away.
In the meantime I will keep brushing my teeth twice a day and ignore all the idiots fixated with the turkey teeth look.
(They had expected a negotiation). If this is wrong, I'm happy to be corrected.
As the country found- when you throw money at the public sector, things get better (waiting times, new schools built, new hospitals built, child care provision expanded)
But the country also learnt it had to be paid for, and a assumption of never ending growth to pay for it was sadly lacking. Especially when the chickens came home to roost for off balance sheet pfis (though the private sector did well out of them)
This dentist scandal has been talked about for years though- it's not new, as those rates have probably not changed in the intervening decades.
To steal a suggestion i saw on here about something else, the simple solution would be to pass a law mandating all MPs, Lords and senior civil servants to use the NHS for dentistry, and prohibit their and their family's access private dentistry (or health care, or schools)
Then: sit back and watch quality improve.
We could be capitalist about it, and pay dentists more to incentivise treatment for the non rich patients, so dentists aren't losing money treating NHS Vs private patients.
Or we could be socialist about it, and force dentists (who I assume mostly got their qualifications and experience via public funding) to treat a certain proportion of patients on NHS rates. They will make less money than they could, but that's what part of being society means, and should be the deal they should sign when choosing to be part of the UK health sector.
What we have at the moment is the government just ignoring it, and hoping the problem goes away.
In the meantime I will keep brushing my teeth twice a day and ignore all the idiots fixated with the turkey teeth look.
There are no dentists in Cornwall accepting new NHS patients, not even children.
When I moved here in 1997, I had no problem getting an NHS dentist. When the contracts changed about 15 years ago, they stopped doing NHS work. I went on the NHS waiting list, but heard nothing for 3 years. I had a 50 mile round trip to see the emergency dental clinic attached to Cornwall's only general hospital. In the end, I had to go private.
My current dental practice decided last month to stop doing NHS work. I was in there 2 weeks ago for private treatment, and there was an endless stream of previously NHS patients at the reception desk, trying to find out what was happening. The answer seemed to be "pay for a monthly insurance plan".
Shocking state of affairs.
When I moved here in 1997, I had no problem getting an NHS dentist. When the contracts changed about 15 years ago, they stopped doing NHS work. I went on the NHS waiting list, but heard nothing for 3 years. I had a 50 mile round trip to see the emergency dental clinic attached to Cornwall's only general hospital. In the end, I had to go private.
My current dental practice decided last month to stop doing NHS work. I was in there 2 weeks ago for private treatment, and there was an endless stream of previously NHS patients at the reception desk, trying to find out what was happening. The answer seemed to be "pay for a monthly insurance plan".
Shocking state of affairs.
This makes me realise how lucky I got. I joined a waiting list 3-years ago and got accepted within 6-months. Added benefit is that they do private as well so I can go in for my cheap general checkup (never needed any major work being done) and then pay for the private hygienist at the same time. My girlfriend has gone private as she found it impossible to find NHS taking on new adults. They also didn’t have any waiting lists after ringing around 20 different practices.
Edited by Prohibiting on Monday 8th August 08:01
Do I think dentistry should be available regardless of affordability, of course I do.
Will I pay for treatment knowing I have to to get on the queue, of course I will.
Thankfully an inspect clean and polish is still less than 20 quid here but on general principle I have some strong reservations about how having to pay has become normalised.
I can easily agree that it’s a scandal that has been quietly accepted over the years despite the belief that the UK has a free health care service. I could make similar points on my use of private health care and belief that the NHS although fantastic is too underfunded to deal with many problems. If you’ve a critical one they’re great, fantastic , world class in some cases, but you’ll be st out of luck if you’ve a malingering non critical one. The NHS isn’t being privatised, people are being pushed into using private health care. What I think some don’t realise is the uk is not America, private waiting lists here in NI are already becoming long as the private health care system is not fit to handle the volume of those turning to it and often relies on the use of NHS facilities.
As an aside, how do dentists pick their prices? It’s never a round number and always something like £17.38 or £19.73. I’m assuming those random numbers are based on something but only really though about it whilst typing.
Will I pay for treatment knowing I have to to get on the queue, of course I will.
Thankfully an inspect clean and polish is still less than 20 quid here but on general principle I have some strong reservations about how having to pay has become normalised.
I can easily agree that it’s a scandal that has been quietly accepted over the years despite the belief that the UK has a free health care service. I could make similar points on my use of private health care and belief that the NHS although fantastic is too underfunded to deal with many problems. If you’ve a critical one they’re great, fantastic , world class in some cases, but you’ll be s
t out of luck if you’ve a malingering non critical one. The NHS isn’t being privatised, people are being pushed into using private health care. What I think some don’t realise is the uk is not America, private waiting lists here in NI are already becoming long as the private health care system is not fit to handle the volume of those turning to it and often relies on the use of NHS facilities.As an aside, how do dentists pick their prices? It’s never a round number and always something like £17.38 or £19.73. I’m assuming those random numbers are based on something but only really though about it whilst typing.
skwdenyer said:
chemistry said:
The problem is that, almost since the birth of the NHS, dentistry hasn’t been completely free (charges having been introduced in 1951 in an attempt to better fund an already unaffordable NHS):
“By 1951, the NHS was already running out of money. To help alleviate this, charges for dentures, the first charges of any kind for NHS treatment, were introduced causing much debate in government and the public arena and leading to the resignation of Aneurin Bevan, the Minister who had been crucial to bringing the NHS into existence. Other charges for treatment soon followed, and unsurprisingly, demand for services dropped.”
In 2006, a crazy new contract for NHS dentists based on ‘units of dental activity’ was introduced, making providing NHS treatment unaffordable for most of them.
https://bda.org/museum/exhibitions-and-events/nhs7...
In short, NHS dentistry was designed almost from the outset to reduce patient demand for it (as the NHS cost too much) and the 2006 contract was another big nail in the coffin, being almost perfectly designed to make it unaffordable for dentists to provide NHS dentistry services.
I understand the history. But child dentistry *is* free (as it is for those in receipt of certain benefits). The framework clearly isn't fit for purpose to deliver even that.“By 1951, the NHS was already running out of money. To help alleviate this, charges for dentures, the first charges of any kind for NHS treatment, were introduced causing much debate in government and the public arena and leading to the resignation of Aneurin Bevan, the Minister who had been crucial to bringing the NHS into existence. Other charges for treatment soon followed, and unsurprisingly, demand for services dropped.”
In 2006, a crazy new contract for NHS dentists based on ‘units of dental activity’ was introduced, making providing NHS treatment unaffordable for most of them.
https://bda.org/museum/exhibitions-and-events/nhs7...
In short, NHS dentistry was designed almost from the outset to reduce patient demand for it (as the NHS cost too much) and the 2006 contract was another big nail in the coffin, being almost perfectly designed to make it unaffordable for dentists to provide NHS dentistry services.
As regards the 2006 contract, that seems to be an over-simplification of the issue. This is interesting: https://blogs.deloitte.co.uk/health/2019/03/what-h...
I have sympathy for dentists. But I've nothing but hatred for those who used Covid as an excuse for clearing-out NHS patients from their lists who (for obvious reasons) did not attend for check-ups.
There have been (minor] reforms to NHS dentistry funding announced last month, but they tinker at the edges (https://dentistry.co.uk/2022/07/19/government-announces-significant-change-to-dental-contract/).
Bottom line is that the NHS is underfunded (whether because we don’t want to pay the tax levels needed to pay for it, waste, or whatever) and has been since inception. Dentistry has always been on the periphery of the NHS and a soft target when it comes to saving money (ie underfunding), since 1951. It’s not a Conservative issue either, as it was Labour that put in the crazy 2006 contract that meant dentists couldn’t afford to do NHS work (although the Tories recent reforms don’t amount to much, as noted above). If we really want decent NHS dentistry it’s going to cost a LOT more, which will have to come from either more taxes of making cuts elsewhere and diverting the money.
Edited by chemistry on Monday 8th August 08:51
roger.mellie said:
As an aside, how do dentists pick their prices? It’s never a round number and always something like £17.38 or £19.73. I’m assuming those random numbers are based on something but only really though about it whilst typing.
What NHS dentists can charge is set by the government, in various bands:https://www.nhs.uk/nhs-services/dentists/dental-co...
NHS dentists then get paid a fixed amount based on what work they do (UDA). Unfortunately this is often less than the cost of providing treatment. For example, fillings fall into one band, so if a patient arrives needing seven the dentist gets paid the same as if they need one (and the patient pays the same £65.20, regardless of whether 1 or 7 fillings need doing at the same time).
After living in numerous locations I can only offer my experience, and that is that in larger towns and cities NHS is possible, as you get the footfall.
But in smaller towns you will only have private available, regardless of if there are enough potential customers.
I have seen surgeries that are like mini hospitals, very expensive cars outside 25h a day care, ludicrous fees.
And I have been lucky enough to be with a fabulous NHS dentist in a small town, but UI have had to move sadly and now have to pay over the odds for care in a brand new, glitzy surgery with state of the art equipment.
I also think dentists understandably do a few years as NHS to get their foot in the door then will look for a private surgery.
Government could do something about it for sure, but they have enough on their plate and the privates suit their idea of capitalism!
But in smaller towns you will only have private available, regardless of if there are enough potential customers.
I have seen surgeries that are like mini hospitals, very expensive cars outside 25h a day care, ludicrous fees.
And I have been lucky enough to be with a fabulous NHS dentist in a small town, but UI have had to move sadly and now have to pay over the odds for care in a brand new, glitzy surgery with state of the art equipment.
I also think dentists understandably do a few years as NHS to get their foot in the door then will look for a private surgery.
Government could do something about it for sure, but they have enough on their plate and the privates suit their idea of capitalism!
JagLover said:
If most dentists are refusing NHS customers then they are not able to make enough income. The government doesn't have a limitless pot of money so one option could be to increase charges. Increasing the routine visit costs to £30 for example would still leave it cheaper than the private dentistry option.
I disagree, the govenment seems to have unlimited cash when it comes to its own hobby horses. UK is a developed First world country, no?V8covin said:
Do NHS dentists also have private paying customers?
All of those I've contacted in recent months do both. No idea what the ratio of NHS to private patients is.I've had to switch to private as I've been unable find a NHS dentist.
I only found one dentist that was even accepting people on to an NHS waiting list and that was already at 500+ in a town with a population of approx 7500.
I've not been to the dentist for about ten years. Started with a bit of tooth ache last week. Rang round a few with NHS waiting lists numbering 1600odd..so looking at years.
But then happened upon a surgery that happily saw me next day, quick look, x-ray, follow up booked and I'm ok as an NHS patient!
I was frankly amazed as I fully expected to have to sign up to a private provider.
But then happened upon a surgery that happily saw me next day, quick look, x-ray, follow up booked and I'm ok as an NHS patient!
I was frankly amazed as I fully expected to have to sign up to a private provider.
Puddenchucker said:
All of those I've contacted in recent months do both. No idea what the ratio of NHS to private patients is.
I've had to switch to private as I've been unable find a NHS dentist.
I only found one dentist that was even accepting people on to an NHS waiting list and that was already at 500+ in a town with a population of approx 7500.
The ratios have been moving in favour of private for some time. I work in a separate healthcare field, so only have a rudimentary awareness of how dental businesses work. I've had to switch to private as I've been unable find a NHS dentist.
I only found one dentist that was even accepting people on to an NHS waiting list and that was already at 500+ in a town with a population of approx 7500.
That said, what I do know is that increasingly the ratio is not just slightly but is significantly in favour of private work (for the reasons stated above - the UDA model has driven this).
Like other primary care - pharmacies, GPs - dental practices are private businesses. Where pharmacies make their money through dispensing prescriptions under the main NHS contract, and GPs are contracted with the NHS (and have fantastic property deals as well) but are prohibited from doing private care from NHS funded sites, dentists are much freer to devote whatever percentage of time to private work.
As always, the issue is not just “the NHS” or “all dentists” but the reality of how the system has been set up and operates - who (unless they’re a true socialist) wouldn’t seek to maximise their income?
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