An inexorable path
Insider: Without clear leadership, workforce improvement and incentives to invest, the political posturing will come to nothing – and NHS dentistry will fail
It’s general election time! Six weeks of rhetoric and fantasy about how politicians will change our country and make everyone healthy, wealthy and wise.
Too cynical?
The latest wheeze of our incumbent government is to reintroduce National Service. My kids are appalled at the thought of being forced to do anything. Going to school is bad enough but being forced into the Armed Forces seems like a step too far. I understand their concerns, but I can see that a well organised system where young people do good works to improve society, learn new skills and work hand-in-hand with people from different cultures and walks of life could be a great thing.
Remember the idealistic thought about the NHS at its inception? We would take care of the populace from ‘cradle to grave’. Somehow, dentistry got involved in that thought. I read a post from the British Dental Association (BDA) recently saying they were not partisan but “unashamedly political” and they’d fight for the rights of their members and those that they care for. The problem is everyone has a different idea of what the way forward should be, be it National Service or NHS dentistry. From my kids’ point of view, they won’t have any say in it and can’t possibly see how it’s going to be any good. From someone in NHS dentistry (primarily), I have a similar feeling.
How can I influence the future of NHS dentistry, or dentistry at all? As a member, do I really get a say in BDA policy? Do they have any idea whether they’re trying to save NHS dentistry or help it on its way to becoming a distant memory? What do those of us in the system want, and how do we make it happen?
We have a cash-strapped government, a cash-strapped NHS and a cash-strapped population. Yet dentistry seems to be on an inexorable path towards a private model. Corporates are keen to maximise their hold on dentistry and their business models involve increasing private uptake. Ordinary dentists seem very keen to move towards a private model too: fewer patients, less time pressure and more remuneration. What’s not to like?
The last time there was a Labour government with a significant majority, the ‘Dental Action Plan’ came about in 2005. There were significant improvements in funding, much of it directed towards the improvement of practices and incentivising ownership and an increase in the number of students. Sound like the kind of thing that could benefit dentistry today? I’m not trying to influence your vote,
I’ll leave that to the politicians, but if you hang around long enough, you’ll see the same patterns repeat.
One thing in the Action Plan which always grated was the ‘golden hello payment’ directed towards young associates with little or no option than to work in NHS practices. It was too early to get value or drive a choice and too little to really decide a dentist’s private or NHS future. Shift forward 20 years and we see the same thing: students given free education with no NHS tie-in, £12,500 given to vocational dental practitioners (VDPs) in certain areas with no requirement to stay on and no ability to do enough work to warrant the payment. All the while NHS Education Scotland is slashing its budget for training those VDPs to the core (trainers can’t even get a sandwich at induction day).
Capitation payments made for a service not received by registered patients. Practices where dentists have left and not been recruited have patients transferred to a ‘holding list’ for the practices’ benefit. Yet many patients are told: “We don’t have a dentist for you and therefore, can’t see you for routine treatment.” Emergency slots for NHS patients are limited. I understand the dilemma for practices which can’t recruit. However, these payments are being made based on contracted ‘terms of service’ for care which is not there. This is not a secret. Health Boards could check up on this and make recoveries. It’s just not politically expedient; it would prove NHS dentistry is not available in many places. Patients are left with no service and, often, no ability to switch practice for the services they need because there’s no one taking on patients.
Politicians will see this as money well spent; it keeps registrations looking high, it shows they’re doing something to improve NHS dentistry. The changes to Determination One have been generally well received. However, I don’t think it’s driven anyone’s decision to go or stay. I don’t think it’s creating more NHS access.
We need people to do that. If the BDA or anyone else can make dentistry a manifesto item, then real questions need to be asked about where the plan is. NHS dentistry is withering on the vine and has been for over a decade. Fee changes are an improvement, but we need to look at the whole winery, not a bag of fertiliser.
We need to think about staffing, training, infrastructure, property portfolio and encourage dentists to make a positive choice to work in NHS dentistry. It requires those within the system to invest in practices and put our money where our mouth is. Without clear leadership, a pathway to improvements in workforce and incentives to invest, the political posturing will come to nothing, and NHS dentistry will fail. I hope our profession grasps the opportunity to improve NHS dentistry and care for another generation of NHS patients.
Arthur Dent is a practising NHS dentist in Scotland. Do you have a comment or question for Arthur? Email arthurdent@sdmag.co.uk