The intentional dismantling of NHS dentistry.
We must start from the beginning!
Margaret Thatcher wanted to introduce compulsory private health insurance, but was dissuaded by hercabinet, urged to take a step by step approach.
TheThatcher government also wanted NHS dentistry to be removed from the Health Service.
When Tony Blair came to office, many dentists suggested removing crowns, bridges and veneers from the NHS dentistry menu to allow decent fees for higher quality prevention andconservation. No reply!!!
Governments of all persuasions treated dentists abominably-particularly
-abolishing the agreed formula for reimbursing practice expenses-(on an average basis, not individualised)
-reducing fees if dentists worked harder-from a limited gross fee per dentist
-reducing the fees for items they wanted to ration and reduce-crowns particularly: acrylic faced crowns were falsely promised to be durable-and got a higher fee. Porcelain faced crowns were more durable, but fees were lower... and most acrylic crowns had to be replaced early: a very false economy
The 1990 contract was forced on NHS dentists-
a failure because it forced low capitation fees on children: dentists were deterred from child fillings... extractions under GA in hospital soared...
A system of UDAs (Units of dental activity) was forced: total UDAs for each dentist were rationed, delivered late and eratically by Crapita
Many dentists turned to a subscription service, privately, like Denplan, but soon altered to subscription for exam, x-rays and hygienist only-fillings, crowns etc extra.
They had had enough!!!
Covid brought severe problems
Surgeries were prohibited from using aerosol-generating equipment-cavitron scalers, high speed turbines-the very nub of dentistry
Sterilisation, half hour settle times, hepa and ultra violet sterilisation air con, surgeries completely rejigged to allow wipe dowmn-vast expense and little income
Some dentists gave up, others realised that the NHS was never going to adjust the contract with higher fasir fees, and went private
Dentists had to provide higher quality treatment, allow more time for assesment, discussion, explanation, better materials, tecniques
The only problems were the poor are exccluded
there is a huge backlog of treatment needs dur to the pandemicremain solvent, guard their mental health, and reduce hours and stress.
In 1972, Professor Crabbe, highly respected Professor of Conservative Dentistry,
at Leeds, returned from his regular sabbaticals to Russia, highly excited by
capitation. He told how Russian dentists were paid “for keeping their
patients healthy, not for fillings and crowns”
My reaction was that practice expenses were high, conservation was highly exacting work, which dentists would prefer paying for..
His post grad student, Steve Noar, transformed the idea into Denplan- a capitation
system grading monthly fees by the number of existing fillings, and provided
all conservation needed including fillings, periodontal, root fillings under
the subscription-patients only paying the technicians charge for crowns, bridges,
The snag is that previous treatment is no measure of future work needed...
As a way to tempt patients into private treatment, when government repeatedly
cut NHS fees, it was good, but had disadvantages…
Dentists did little work for the fees, patients got fed up getting little for the fees and leaving.
It was swiftly changed to individual dentist's versions- only exam, scale and two x rays-now £38/month-and you paid individually for, say, whitefillings-£100, root fillings-£2-300, and crowns- £200-300 etc
Additionally, dentists could say that white fillings were not available on the NHS
In 1990, the BDA refused to reject a new contract, and the government imposed
Government also threatened leaders with sanctions-sequestration, seizures of house, assets if they urged strike action.
A renewed Dental NHS
At present, NHS dentists are fined if they treat too many patients, and fined
if they treat too few.
“Permissions to work” are chaotically awarded too late by Capita et al-so dentists cannot treat patients.
The “units of dental activity” (UDA’s-yoo dahs) pay a dentist the same very low fee for a difficult white filling as a simpler amalgam; the same fee for one filling or several... The same low UDA for a crown, a bridge or a chrome denture... which unsurprisingly, became extinct under the NHS...
The item of service payments before the disastrous 1990 contract allowed dentists to be paid for work done: these should be reinstated, with additions for ppe, virus down time. Expenses are high, but necessary to provide good equipment, good nurses and reception staff, good laboratories etc
A low capitation fee for children saw children’s fillings plummet... Hospital extractions under anaesthetic soared...
The government treated NHS dentists abominably; fees were cut and cut-dentists could only do high quality treatment privately: they were driven out intentionally by government.
In the Covid pandemic, dentist are prohibited from using ultrasonic scalers and high speed turbines; many initially wondered how to survive at all
There might be deletion of chrome dentures, crowns, bridges- but basic root treatment, fillings and acrylic dentures should be retained, with decent fees for prevention, fluoride and diet advice to cut decay, and upgrades to allow Covid precautions-aircon, masks, gloves, downtime, cleaning.
Previous governments decided they could eliminate NHS dentistry- patients relying
on the dental NHS have been short changed
Universal privatisation strategy-underfund the service, decry the service, wither on the vine: behold, private dentistry, Treasury off the hook!!!
Despite valiant efforts, dentist cannot always make silk purses if they are only paid for a sow’s ear... No wonder those who can say “Begger this for a game of soldiers!”
This leads to a shortage of dentists willing to accept any new NHS
Now, Covid requires down time between patients, cleanup time, ppe, masks, shields etc, and air extraction units-very expensive
For a time, dentists wondered how on earth they could carry on...
They could not use air turbines, ultrasonic scalers because of atomisation of fluids...patients.
New dentists owe tuition fees of £60.000 when they qualify
To equip a new surgery requires a building-lease or mortgage
staff, equipment, computer systems-say £100,000 over five year term...
Electricity, water, gas, rates...
My grandfather was a private dentist before 1948: extractions 10/6d, adverts
in the paper for "painless dentistry..."
My father, my wife, my brother were all NHS dentists-all driven out by government cuts to fees...
With a subscription service
reputation is all
dentists may choose not to provide root treatments, but refer
may choose not to provide child extractions, but refer
root treatments may have a fee of hundreds of pounds
crowns may be hundreds...
Many dentists would like to offer
fibre optic handpieces
intra oral cameras-to demonstrate the state of dentition
root canal measurement devices, operating microscopes, loupes,
diagnostic infrared decay detectors
computerised x ray equipment
computer record and recall systems
computer milled crowns
the lease or capital costs can be hundreds, thousands of pounds
Dentistry is now a far more difficult profession than pre-1990, involving huge risk and capital investment. Government have stubornly, intentionally, refused to improve the NHSc dental contract
the fewer dentists who battle on against the government are overwhelmed by
pent up backlog of demand-the only way out is to take the brave pills and go