Dentistry Question Time – ‘there’s going to be winners and losers in dentistry’

Dentistry Question TimeFollowing our Dentistry Question Time debate, Eddie Crouch speaks out on NHS targets, communication within the profession and changing public perception.

What do you think about NHS dentistry delivering a core service?

I think clearly defining what the NHS offer is different to a core service. Many people put the two together. In some people’s minds what the NHS should offer is everything that’s necessary to actually provide the basic level of oral health care that patients need. Other people – and politicians for sure – look at a core service as being a smaller spend.

You need to balance those two. If you could secure the current budget and provide a defined service for patients that would get them out of pain and provide them with a basic level of dental treatments, that’s one thing. That possibly would be the ideal solution.

But my fear – and it’s echoed in the conversations I have – is that the politicians, the Treasury, the Department of Health and Social Care, would look upon a core service as an opportunity to reduce the spending. Each individual item would consequently be poorly remunerated.

Dental practices need to make a profit to survive. But if you’re providing a service where it’s costing you more to provide it than you’re gaining as an income, there’s no incentive.

What is the situation at the moment?

At the moment, politicians are sort of convincing the population that there’s an all-encompassing NHS service out there where they can get everything they might need. The reality does not reflect this. If it was the profession that was calling for this, again it would be a difficult PR exercise to handle.

It’s been left to the dental profession and the teams to actually explain to patients many things that should have been communicated centrally from the government. The communication from NHS England to the profession has been awful.

This is one of the reasons why the BDA had relay information because the messaging wasn’t there.

Here we are – two weeks away from the start of a new financial year. We had a meeting with NHS last night about the proposal for activity levels from NHS practices. We hoped it’d be put on the table so we could at least have a sensible conversation about it and teams have sufficient time to think about how they’ll adapt if the target is raised.

But the figures weren’t put forward – they were delayed again. It’s repeating some of the mistakes that have happened throughout the pandemic.

Why has the 45% target been an issue?

A large majority of practices delivered far more than the 20% minimum that was in place last year. There were some real outliers who would reach 20% and not push to deliver much more. But the number of practices that have delivered less than 20% are incredibly small.

The timing of the 45% target was when practices were likely to have been closed across Christmas. They had to come back and adapt to that for a three-month period after just days of notice. This is especially hard for orthodontics, for example.

Previously we’d received assurances that orthodontic practices would not be given just days notice – but they were. Sadly, I think we’re in the same situation three months on.

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Why do you think there are discrepancies in delivery?

I think it will depend on the location of the practice and the physicality of the practice too. For example, some practices are in locations where it’s almost impossible to carry out social distancing.

But there’s other practices that have big waiting rooms and wide open spaces. This allows a bigger throughput of patients. We’re talking about delivering UDAs again. Some practices may have patients come in and need multiple appointments.

Others may have one patient come in and need just one procedure. As a result, it’s going to be a lot easier for some practices to deliver UDAs than others.

We see that on some of the figures that have been released by NHS England. No practice is exactly the same.

Therefore, setting an arbitrary target means there’s going to be winners and losers.

My worry is the losers will be penalised with the financial penalties enforced for those who don’t deliver 36% of their contract. Some of them may topple over.

Dentistry is a small percentage of the NHS. The reforms that are coming to the NHS, including the white paper, you’ll find it very difficult to see any mention of dentistry.

It’s often almost by inference that you have to find detail regarding dentistry. It seems to only get a cursory mention.

One thing that was a positive was the mention of fluoridation. If you’re looking at it positively, there is an ability for dentistry to integrate itself across local healthcare in the proposed restructuring of the NHS.

But that’s only providing the voices of the dental profession are heard and not swallowed up.

When do you think the profession will be able to deliver 100% of their contract?

I think we need to get back to the position where we are confident that the level of infection in the population is low enough for the SOPs to be modified.

One of our arguments going into the start of the next financial year is that because we’re still operating under the same standard operating procedures and infection control procedures, how can the target be raised significantly?

Because nothing’s changed. Even in the last few days, Chris Whitty has said he doesn’t rule out the possibility of a spike in infections again.

What logic is there in forcing dentists to try to deliver pre‐pandemic levels of care?

Do you think PPE and fallow time is here to stay?

I certainly think so. There doesn’t seem to be any urgency from Public Health England (PHE) to change the guidance that is out there at the moment. I think while we still have the uncertainty this will continue.

I know those groups – like SDCEP – that look at the fallow time issue are planning to continually look at the evidence that comes in. One can hope that things will change dramatically at some point, but I think in the short term it won’t change.

My worry is that there’s been a presumption from NHS England that any improvement in efficiency in practices will continue. But there does reach a point where you get as efficient as you can be under the current restrictions.

We’ve noticed that increasing patient numbers are starting to plateau but you reach a point where anything above that level isn’t safe. We just hope leaders listen to the clinical input put into NHS England’s decision making. This should all be based on safety, not for economic purposes.

How are you feeling about dentistry generally?

I’m feeling that dentistry has become very, very covered by the media and by politicians. We had an hour and a half debate in parliament recently on dentistry, which is unheard of.

Usually it’s pushed into smaller Westminster Hall debates where only a handful of MPs turn up. But there was an oversubscribed amount of MPs who wanted to contribute to that debate a few weeks back. It’s back on the agenda of politicians. The public have seen what a lack of dentistry looks like.

From the end of March to 8 June where significant numbers of dental practices weren’t open, the public realised now just how valuable all dental services are – private and NHS. I think the public, when dentistry first came back, were very supportive of practices being selective when it came to prioritising urgent cases.

But I think that frustration is bubbling up now that patients feel they’ve put up with it for long enough. What we do as a dental profession is so important for so many reasons.

I think it’s showed a lot of people what they were taking for granted. I feel fairly confident the profession will be high on patients’ priorities for quite a significant time.

You can watch the full Dentistry Question Time debate here.

This interview was conducted on Wednesday 10 March 2021.

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