‘Not fit for purpose’ – why change is needed to save NHS dentistry

Sarah Canavan opens up about her 25 years of experience working in NHS dentistry and what she thinks needs to be done to save itSarah Canavan opens up about her 25 years working as an NHS dentist and what she thinks needs to be done to save it. 

I became a dentist because I liked the idea of doing something that involved me helping people. But without the lack of sleep involved in becoming a doctor.

My cousin is a dentist and I had seen him at work, it seemed like a good way to go. I suppose the important question is why I’ve stayed a dentist. I qualified 25 years ago and to be honest I don’t know what else I’d do.

I’ve been through periods prior to COVID where I considered giving up but I’ve thought: ‘Why should I?’ I’ve worked hard to get to this point, I’m not giving up without a fight. It’s been tempting, trust me.

What’s your experience in NHS dentistry been like?

It’s a mixed bag to be honest. I started in the CDS and spent pretty much the first half of my career there. In my experience they were stressful posts for different reasons than being in practice. UDA targets at that point weren’t an issue.

However, there were the obvious difficulties with huge waiting lists even then. Plus the stresses related to the types of patients we were seeing. I loved the sense of achievement that we all felt, patients included, when we did what we set out to do. My experience in NHS general practice has changed over the years.

When I first started, UDAs did not exist. Personally, I felt as clinicians we were able to assess and treat our patients less as a commodity and more as people. Obviously UDA targets come with their issues and, in my opinion, they need to go.

The fact that we are treated as the poor relations by the DOH, NHSE etc has always been prevalent, but does appear to be worsening.

Personally, I think the thing that has changed the most over the years is how defensive our dentistry has had to become. I just want to do what’s right for my patients. I shouldn’t constantly have a niggle in the back of my mind regarding the notion of: ‘Will they make a complaint?’

How has COVID-19 impacted dentistry in your opinion?

Good and bad. Good highlighted our plight a little. Bad. The obvious. Not being able to see patients at all for nearly three months. It’s soul destroying listening to a patient crying in pain down the phone and not being able to do a damn thing for them.

Even now when we open for face to face, the logistics of three operators providing enough appointments, AGPs etc to scratch the surface when we work in a listed, two surgery very old practice is daunting. Hopefully it means UDAs will go as they weren’t fit for purpose when we had full capacity and are completely unworkable now.

It’s made us realise how much our patients don’t get it and how low their opinion is of us. It’s also made me appreciate the ones who have supported us. That the government doesn’t give a damn and how much ridiculous red tape there is involved in decision making. Especially for the CDO office in England.

Not fit for purpose

I think it’s separated us as a profession. Private against NHS dentistry. Associate against practice owner. Labs closing. DCPs leaving the profession. It’s an awful state of affairs.

On a more basic level, I can’t pay my bills. I don’t even want to think what will happen if things don’t change. I’ve been luckier than some because at least 50% of my work is NHS. So I got some help, but it doesn’t really touch the sides.

My ability to pay all my bills and have a life is completely reliant on my private income. I’m not willing to sacrifice my NHS patients by seeing private patients instead of them, or only seeing them if they pay privately. However, that means I don’t have enough time to earn the extra income.

What do I sacrifice? My ethics or my ability to pay my mortgage? The NHS income is not fit for purpose. It makes me smile that MPs are likely to have yet another ‘raise’ when NHS associates haven’t had an increase in income for over 10 years.

How has your experience of dentistry been impacted by the pandemic?

At the risk of repeating myself, it’s the detrimental impact on our patients that is by far the worst outcome of this pandemic. What were small problems are now big ones. Oral cancers missed. It’s tragic.

What needs to be done to support the profession?

Firstly, the government needs to acknowledge that we exist and that we cannot provide the service it expects with the funding it provides.

Secondly, the general public needs informing in no uncertain terms that dentists, particularly NHS, don’t earn a fortune and how we work needs to be explained.

I’m not an expert, so this is a purely personal response. I’m sure people will scream from the rooftops ‘that won’t work’, but I believe the following. We need a core NHS service that provides the ‘basics’. The things that get people out of pain, allow them to function and look ok in photos. It’s got to be what’s clinically necessary in the most economic way possible.

Yes, that will mean metal crowns, dentures and not bridges etc, but that’s what’s affordable. Prevention has got to take centre stage so hopefully people won’t get to the stage where they’re making horrible decisions.

Take responsibility

Also, and this may be considered a step too far, people have to take responsibility for their own oral health. Unless it is completely beyond them for specific reasons eg physical disabilities etc.

UDAs need to go. Maybe we should work as a GP service where we get paid by the NHS to carry out check ups, including cancer screening, and provide the core treatments. We should still have access to NHS secondary care for extractions beyond our clinical competence, cancers, TMJ issues etc.

Anything beyond that eg molar endodontics of non crucial teeth, cosmetic work, perio on smokers or people who don’t maintain good OH. Basically any treatment that any dentist reading this who is honest to themselves and asks ‘why the hell are we doing this on the NHS?’ should be referred to a private dentist.

That can be yourself. We shouldn’t have to do something on the NHS just because we can.

Unfounded complaints

We need more support regarding complaints. Patients and our colleagues should absolutely have the ability to raise concerns regarding us as clinicians or the quality of our work. But this needs to be managed well. We, as dentists, private or NHS, shouldn’t have the constant fear of unfounded complaints hanging over our heads.

Especially when these complaints are made by ‘serial’ complainers. Or over subjects such as ‘she didn’t tie her hair up’ or because the patient was an hour late and wasn’t seen. Just a couple I can think of.

When a letter arrives at the practice even – if you absolutely know it will come to nothing – the amount of work involved in getting the requested paperwork together or contacting your defence union is insane. That doesn’t even factor in the stress. Even when you know you’ve done nothing wrong.

Jumping ship

But somehow it goes further. You’ve got to live with the fact that the person who made the spurious complaint gets a handout because it’s cheaper than going to court.

We need to have a system where the untrue and ridiculous complaints are dealt with at the earliest stage possible. Maybe we need crown indemnity in which case this might happen.

As I said, I have been an NHS dentist for the 25 years since I graduated. It is a different world and in my opinion, not a better one. I’ve contemplated leaving the NHS for a few years. Obviously I was very grateful that I hadn’t when the pandemic reared its ugly head.

However, unless things change with the government and public perception of us, with the way NHS dentistry is provided and remunerated and with the support we most definitely need, then I won’t be the only ‘lifer’ jumping ship.

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