Looking forward to a brighter future within dentistry
Michael Watson puts the century’s difficult teenage years behind him and looks with optimism for the future and the hopeful 20s.
The teenage years
The last decade was, in many ways, the ‘teenage years’ of this century. Like teenagers, we rebelled against those in charge, most dramatically by ignoring their advice and voting for Brexit.
In dentistry, we rebelled against the General Dental Council (GDC), the Care Quality Commission (CQC), and the NHS and its hated contract.
By the end of the decade, many dentists were saying that in five years’ time they would no longer be in the profession.
Yet, it started with some hope. The late Professor Jimmy Steele published his report in July 2009. It promised an end to the iniquities of the General Dental Services (GDS) contract.
In December 2010, the coalition government had published its proposals for piloting a new dental contract. But nine years later, the pilots continue.
As a nation, we appeared to have weathered the global financial crisis and near-collapse of the banking system.
We were looking forward to saying goodbye to the Blair/Brown years and welcoming in a new, young prime minister, David Cameron.
But we were living in a fool’s paradise. The coalition government and its young chancellor ushered in a near decade of austerity. For us, this meant a real terms fall in NHS funding of more than a third and static incomes with tiny annual increments in contract value.
Until then, the GDC was largely elected by and run by dentists. We did not foresee that it would become a small, government-appointed body where lay people, not dentists, predominated.
We did not foresee the appointment of Bill Moyes, who became the first lay chair of the GDC in 2013. He said that complaints against dentists were ‘staggeringly high’. This lead to a breakdown with the profession and more than doubling of the annual retention fee.
We did not foresee the establishment of a new regulatory body – the CQC – which would inspect and rate dental practices.
We did not foresee that an unelected and largely unaccountable body, NHS England, would be put in charge of commissioning NHS dental services and administering GDS contracts.
This led, by the end of the decade, to clawback of millions of pounds from dental practices. It also led the recent fiasco of recommissioning orthodontic contracts, all with no discernible advantage to long-suffering patients.
In 2013, the GDC defined the scope of practice of each group of registrants. This allowed dental therapists to carry out 70% of the work of a dentist. We did not foresee that NHS England would ignore this change and carry on allowing only dentists to initiate a course of NHS treatment.
All the while, the prospect of a new, reformed, dental contract moved further and further into the unknown future.
So, in this ‘teenage decade’, we, like countless teenagers before us, complained and protested. But all to little avail as the ‘adults’ held all the levers of power.
Years of hope
As the century moves into its 20s, maybe the profession will move forward into years of hope. This may put the disillusionment of 2010-19 behind us and help us look forward to a brighter world for dentistry.
Change there will certainly be. The profession has come a long way since I first entered Guy’s Hospital Dental School 60 years ago this autumn.
The upcoming challenge is to make sure improvements help all those who need care. This means going beyond those who attend our practices whether as NHS or private patients.
The scandal, to use the description of a former health minister, of children attending hospital for extractions needs to end as soon as possible in this decade.
Prevention must be the key to improved oral health. This is suggested by every review and report on dentistry since the Dental Strategy Review Group of 1980.
And access – every change to contract or regulations from the 1990 new contract to today’s prototypes has had the avowed aim of dentists seeing more patients. None has succeeded.
But also, surely in this coming decade we must recognise that the NHS cannot do everything, no matter how much money the taxpayer throws at the NHS. The private plays a role and this should have recognition.
So why, with such seemingly intractable problems, did I express optimism that they could be solved?
Firstly, there is the establishment of the new College of General Dentistry in the UK. The college has a vision of leadership – ‘to foster excellence and confidence in oral healthcare, for all’.
Secondly, I remember my trip to BDIA Dental Showcase last year, visiting the stand of the Office of the Chief Dental Officer (OCDO). It was full of young dentists, debating and discussing their and the profession’s future.
As a former OCDO clinical fellow, Natalie Bradley wrote in her blog: ‘Many organisations in dentistry are now recognising the importance of hearing the younger generations voice in making decisions… we are the future of dentistry.’
Lastly, dentistry is no longer the sole province of dentists. Many more dental care professionals – therapists, hygienists and nurses – must be brought fully into the delivery of dental care and recognised as such by the NHS.
We can then move from what I remember of my student days of dentistry as something carried out by dentists in a surgery setting and delivering an agreed treatment plan to those who wished to see us.
Instead, dentistry should be carried out by all members of the dental team. We need to take the preventive message and care to people where they are. We need to deliver not just a succession of treatment plans, but a care plan that extends a lifetime.