Perceptions of NHS dentistry

shutterstock_109978034Following publication of the results of the second NHS Confidence Monitor survey commissioned by Practice Plan, a number of well-respected dental professionals offer their views on the future of UK dentistry.

When the responses elicited by the newest monitor were collated, it was apparent that confidence had dropped drastically among NHS providers and performers – with 95% of respondents stating that they are less confident in the future of NHS dentistry than they were 12 months ago.

Considering this statistic, Claire Roberts, principal of The Dental Health Centre in Northwich, suggested that the key influencing factors to have caused such a decrease in confidence levels across the board are: ‘Reduced income for principals and associates, endless delays and a lack of detail for the new contract, and a vindictive regulator that has lost touch with reality.’

Echoing this sentiment, general dentist and orthodontic practitioner, Charles Lister, commented: ‘I think it is in large part a culmination of a perfect “stew” of costs, regulation and professional frustration.’

He continued: ‘Combine if you will simple inability to increase earnings; ally this to a sense of helplessness in the face of the aggressive GDC. Stir the morale pot with a near £900 annual retention fee (ARF) – a tax, if you will, just to go to work. Add the bitter spice of indemnity fees rocketing skywards and for many well in excess of £4,000 per year. Throw in the garnish of professional association membership and it costs £500-£600 per month for an associate simply to go to work. Saying it’s all tax allowable, as the chairman of the GDC scoffed, ignores the reality that you have to earn it first.

‘Top all this with a little professional “gratin” of chronic frustration that many dentists simply cannot practise what they were taught at dental school; as time passes they realise they cannot practise what they see taught on a CPD day. Add to that piquancy of the previous chief dental officer, arguably the architect of much of today’s situation, swanning off to a “nice little earner” with a leading corporate NHS provider and it is clear nothing is changing. Dentistry is a time-needing activity and that is the one thing the Government does not fund.’

The NHS Confidence Monitor also revealed that dentists are very worried about their own future, with 90% of respondents saying they are less confident about their career prospects within NHS dentistry going forward than they were a year ago. In addition, 94% of respondents said they had lost confidence that practising dentistry within the NHS will offer an appropriate level of remuneration in the future.

Speaking on these issues, Claire suggested: ‘It is much easier for the Government to contract with a handful of large corporate providers than lots of small independent practices and I think this is their intended plan. This would enable them to bypass our negotiators – the GDPC/BDA. They could force down prices and the result would be an employed dental workforce, working for much lower remuneration. Independent practices would be left with the choice of selling to a corporate or leaving the NHS. Lower remuneration means lower pensions and associated costs. Those factoring in goodwill prices for their retirement may find their retirement plans much curtailed. Career progression within the NHS would be very limited.’

Dental business coach and former dentist, Alun Rees, also noted: ‘The results reflect an overwhelming discontent in UK dentistry amongst those who have shown a commitment to the state-run system. How low must the morale of the profession be when only one in a hundred is more confident in the future of NHS dentistry?’

Patient care

Confidence levels have dropped dramatically in terms of dentists’ ability to offer their patients the right balance of treatment versus prevention in times to come under the NHS, with 85% of respondents expressing fears that the balance won’t be right.

Confidence in patient satisfaction has also taken a big hit, with over three-quarters (77%) of respondents losing confidence that patients will be happy with the outcome of attending an NHS dental practice in the future, when compared to 12 months ago.

It also seems that dentists are concerned as to whether dental teams will be able to work effectively within the NHS framework as time progresses, with 89% feeling less confident on this matter than they did 12 months ago.

When asked about the idea of the Government possibly creating a core service in the future, Claire responded: ‘It is not in the interests of the Government to do this when they can force us to provide a comprehensive service, advertise it as such, but not fund it adequately. It is a win-win situation for them. Any core service will be publicised as dentists not being prepared to provide a comprehensive service for the money. It would make the profession look greedy. The reality of what we can currently afford to provide for the money would be ignored.’

Charlies Lister had this to say on the topic: ‘The results from the Confidence Monitor highlight the momentum of thought that a lack of NHS clarity is increasingly becoming a regulatory minefield for the future. Tie that to the urgent need for the business of a dental practice to increase its income from sources other than NHS funding highlighted by the survey. Then add to that the critical need that this is done in a clear and transparent way that cannot be randomly applied by individual dentists in differing ways according to post code. There is an urgent regulatory need that any patient anywhere should be able to understand where the boundaries of funding care lie.’

Continuing with this idea, Charles mulled: ‘So is it a core service, or a defined service? I would argue it should be a defined service. The Government’s fiscal limitations may apply a de facto core need to the offering. NHS dentistry is already a means tested service; it does not take a big leap of imagination to suppose that those who pay contributions could be asked to pay more, but in a way that makes dentists look like the bad guys!’

Also speaking on this issue, David Houston, joint principal of The Houston Group of Dental Practices, remarked: ‘I cherish the variety and scope of dental care provided by the NHS and believe that a broad range of treatment can and should be available – provided that the correct and realistic funding for it is in place.’

‘Confidence can only be re-instilled back into the profession by engaging with us, listening to our concerns and then acting upon them swiftly and decisively to save a cherished and much needed public health service. Sadly, however, I do not see any signs of a political will to act in this way.’

Looking to the future

Focusing on what could be done to improve confidence across the board, Claire’s response was focused and succinct: ‘Abolish UDAs, sort out the new contract and the GDC, improve remuneration and cut red tape.’

She then went on to express concern about the role to date of organisations such as the BDA and GDPC in persuading the Government to bring about swift negotiated change for the better: ‘They do not seem to be loud enough or proactive enough. However, I am not party to what goes on behind the scenes so it would be unfair of me to say they are not doing enough. There is no guarantee the Government is actually engaging or listening to our leadership either. There is a long history of the Government promising one thing, then imposing something quite different, without adequate negotiation or the support of the profession. Maybe there needs to be some joint action but I suspect, unless the queues of patients return, nothing swift will happen.’

Charles also offered: ‘Each dental practice must grasp its future in its hands. If you own your dental business, you have to decide whether to run with a lower cost NHS model likely centred on dental therapists instead of associate dentists, or to move away from the dependence on NHS funding. Confidence will come from paying the bills at the end of each month. Confidence comes from practising dentistry properly for a patient who expresses gratitude. Confidence will come if the “indemnity-plus-GDC” axis of costs can be tempered. Whether that can be achieved by increasing the element of self-funded care within a busy NHS practice will depend on local circumstances. The problem is that the rules on mixing are deliberately fuzzy, according to the former CDO. But in a climate of the GDC offering an “open hunt” season on dentists, fuzzy rules are unacceptable. To what extent the leadership bodies such as the FGDP or the BDA can help is unclear. Whether it is clarion calls for change, or loud speeches to a gathered throng, perhaps the occasional press release, it can sometime seem that action rarely follows the words.’

As secretary of the Birmingham LDC and immediate past chair of the BDA Central Counties Branch, Eddie Crouch is in a unique position to observe the current situation and consider the future: ‘I think the profession must have one collective voice and engage with its patients to put pressure on the politicians to raise the profile of dentistry. Obviously for me that would be the profession uniting behind its trade union, the BDA, in much larger numbers to show the powers that be that the profession is united in dissatisfaction with the way it has been treated.’

As dental academic Nairn Wilson says in response to the results: ‘If the Government makes nothing of these results and persists with “more of the same”, commitment to the provision of NHS services could suffer a significant setback.’

Over 300 NHS dental professionals completed the second NHS Confidence Monitor, a comprehensive and independently verified industry survey conducted on behalf of Practice Plan, sharing their views about the future of NHS dentistry.

The aim of this on-going survey, which will take place every six months, is to gain insight into the profession’s confidence levels in NHS dentistry over the coming months and provide a snapshot of the mood of the profession going forward.

To be able to compare how confidence levels had changed over the six months since the first survey, once again respondents were asked about the following issues:

  • The future of NHS dentistry
  • Dentists’ career prospects
  • Getting the balance of treatment versus prevention within the NHS right
  • The possibility of earning the right level of remuneration
  • The ability of the team to work effectively within the NHS
  • Whether patients will be happy with level of care provided.

To read the full responses to the survey results from dental professionals including Claire Roberts, Eddie Crouch, Nairn Wilson, David Houston, Simon Thackeray, Sheila Scott, Charles Lister and Jimmy Steele, please visit

Please note that all views expressed are individual’s personal opinions only and do not represent or reflect any affiliated or associated institution policy or thinking.

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