From the sublime to the ridiculous

shutterstock_250122331Kevin Lewis examines a week of two halves for the profession’s mainstream image.

From the sublime to the ridiculous there is but one step. If one believes the popular account that these words were uttered (in French, presumably) by none other than Napoleon Bonaparte as he trudged wearily back from his ill-starred Russian campaign in 1812, one ignores the minor detail that the words had already been written and published in a slightly different form almost two decades previously (in English) by Thomas Paine in The Age of Reason.

The sublime and the ridiculous are often so nearly related, that it is difficult to class them separately. One step above the sublime makes the ridiculous, and one step above the ridiculous makes the sublime again.

Unlike Napoleon on his retreat from Moscow, the UK dental profession almost had a spring in its step after the screening in early June of the two-part BBC TV programme The Truth About Your Teeth. There was a refreshing human and caring feeling about the whole programme, free from all the usual stereotypes and an engaging presenter that wanted to celebrate dentistry rather than trash it.

So much for the sublime, then. We knew it couldn’t last and we did not have to wait long for normal service to be resumed. Just five days infact. Many of the usual suspects were involved and clearly they took the view that if you are going to get it wrong, you might as well get it spectacularly wrong as long as it makes for a better story and sells newspapers.

‘Clean up Dental Costs’

The Consumers Association has been on the trail of UK dentists and dentistry for some time now. You may remember that in January of this year, its flagship publication Which? launched its latest campaign ‘Clean up Dental Costs’.

Picking up on many of the themes contained within the Office of Fair Trading’s report into The Dentistry Market in 2012, that campaign called for better communication of dental treatment options and costs.

The response to this call to arms had proved to be rather underwhelming, prompting a statement released at the end of March 2015 welcoming the lone voice of support by the General Dental Council but bemoaning the fact that in the first three months of its campaign there had been an eerie silence from all other major dental stakeholders, notably including the NHS itself.

‘The lacklustre response in correcting the problems we’ve identified is worrying. We’ll be stepping up the pressure when the next government is formed after the general election’.

What it failed to mention at that time, five weeks ahead of the election, was that this attempt to resuscitate a limply supported and limply constructed campaign was being pump-primed by some new research.

This was overtly being conducted as part of the same campaign but was infact exploring something else entirely.

During March 2015, 500 dental practices were contacted by researchers posing as potential new patients, and asked about their NHS appointment availability. These practices were listed on the NHS Choices website as offering NHS treatment availability. Of the 500 practices contacted, just under half could offer an initial appointment within two weeks, while 150 reported no current availability at all.

Immaculate timing

If you want to choose one time of year when practices might already have delivered and exhausted all the UDAs that the NHS was prepared to pay them for, then March would be perfect for that purpose.

Little wonder, then, that you might be able to telephone some practices during the month of March that would offer you an appointment not immediately, nor next week, but in April as soon as the next financial year started (perhaps three to five weeks later depending upon what stage in March the research was carried out).

In some parts of the country, where NHS availability has been reduced as a result of dentists and practices being driven into the private sector by the shambles of the UDA remuneration arrangements, the NHS practices that remain are busy.

So it should not be entirely surprising if the staff of these practices are not sitting around idle in their waiting rooms. The busiest and most popular of these practices – often reflecting the fact that they are offering an exceptional service – may well feel an obligation to their existing patients, to give them access to appointments without having to wait unacceptably long for them.

In many cases, this can only be achieved by putting a brake on new patient acceptance from time to time, to allow supply and demand to get back on an even keel.


Any or all of these factors could explain a shortage of NHS appointment availability at any time of year, but especially in March. Anyone who does not understand this would be well advised to stay silent rather than reveal their ignorance of the workings of NHS dentistry to the world.

Instead the Consumers Association and the Daily Mail went on the offensive – in the case of the latter, under the outrageous front page banner headline ‘Greedy dentists fleece families’. Not content with this, it was followed up in the leader column under the sub-heading ‘Dental malpractice’ and NHS dentists were collectively accused of ‘fraud’ and ‘exploitation’.

On the other hand, perhaps Which? knew exactly what it was doing when choosing March for its follow-up survey, in the hope of reinflating the lungs of a campaign that was not managing to engage either the public or key stakeholders. If anyone is misleading the public and deceiving patients on this occasion, we need look no further than Which? and the Daily Mail.

I am not suggesting that there has been no occasion where a dental practice has featured on the NHS Choices website as being prepared to accept NHS patients, when in fact they have no plans to do so any time soon.

What is patently ridiculous, however, is to extrapolate from that possibility so extravagantly and sensationally in order to discredit and vilify NHS practitioners as a whole. The very dentists who are trying to keep NHS dentistry alive get a communal kicking.

Thus we moved in five days from the sublime to the ridiculous. If Thomas Paine was right, a return to the sublime cannot be far away.

But I hope you will forgive me for pointing out that things didn’t turn out like that for Napoleon who found himself at Waterloo exactly 200 years ago this month. And the rest – as they say – is history.

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