Come fly with me
The current way of remunerating dentists means NHS dentistry isn’t reaching the population that mosts needs dental care.
Imagine, if you will, a nationalised airline.
The deal it is offered is that it will be paid a fixed sum for each scheduled flight, according to its length, not according to the number of passengers taking seats.
The Government will receive the fares from the passengers, so the more that are carried, the more money the taxpayer makes, but the airline receives the same per journey.
The reason why such a nationalised model would not work is because it makes no difference whether the airline carries 30 or 300 passengers, therefore it will lean towards the lower.
And it’s not working for NHS dentistry either.
Dentists are paid the same amount whether they see 1,000 or 2,000 patients a year, always provided they offer a fixed number of courses of treatment, weighted according to their complexity (UDAs).
It makes good business sense and is less risky to see a smaller group of patients who can be relied on to come regularly and keep their appointments, than go out looking for new patients, who may be unreliable.
Healthwatch Bradford, where Judith Cummins, who raised the matter in Parliament, is the MP, has said: ‘We’re looking at whether it’s possible to increase capacity for dental care by extending the length of time between check-up appointments for adults with healthy teeth.’
Probably very true, but where is the incentive for dentists to do this?
There may well be a financial disincentive if the appointments freed up by moving dentally-fit adults to yearly appointments are not taken up by new patients, with a resulting clawback.
Additionally, there is little incentive to NHS England in encouraging dentists to see dentally-fit adults, who by and large pay NHS charges, with children or adults who are exempt from charges.
Yes, the system is ‘bonkers’ and the contract needs reform, but not perhaps in the way the British Dental Association (BDA) means.
There is no point in commissioning more UDAs, another BDA suggestion, if dentists cannot or will not use them.
Nor is it a question of underfunding, since the NHS in Scotland, with a similar level of funding, achieves registration levels of over 90% (94% for children).
To see why let us return to the airline analogy.
Easyjet and Ryanair move into the market in competition with our nationalised airline.
They have a financial incentive to fill as many seats as possible, because their income comes from passengers, not the Government.
If no wants to fly from Luton to Malaga on a Thursday afternoon, they don’t schedule a flight.
Likewise, in Scotland, not operating under the UDA contract, there is a financial incentive to register as many patients as they can.
Yes, dentists are only treating half the population, but are we treating the right half, those with fundamentally good oral health?
I would contend that these should be treated in the private sector, with NHS funding directed at those who need it most.
This would infringe the right of dentists, which has been in existence for nearly 70 years, to see which patients they choose and provide care deemed appropriate.
The question is whether the BDA and the profession will accept this degree of control in a new contract.