Dentistry Census – is NHS dentistry on the brink of collapse or in need of reinvention?

Dentistry Census – is NHS dentistry on the brink of collapse or in need of reinvention?Almost three quarters of dentists are looking to abandon NHS dentistry within two years, according to findings from FMC’s Dentistry Census.

With 45% of dentists with an NHS contract anticipating selling their practice in the next two years and almost 50% considering leaving the profession entirely (with 24% looking to retire and a further 24% simply quitting), the future of NHS dentistry is seemingly at risk.

Dentists are battling to deliver NHS dental care amid a pandemic that has created a further swathe of barriers to access. This is on top of the challenges they already faced in delivering what many suggest is an unworkable contract.

Dentistry’s newly-published census, leaving no questions unanswered in dentistry, revealed that 73% are likely to reduce this NHS commitment in the coming two years. The report marks the biggest ever survey carried out among UK dental professionals.

Where this leaves NHS dentistry hangs in the balance as figures suggest a growing trend towards more privatisation – a move many fear may prove to be the final nail in the coffin for NHS dental care.

And, whilst 52% of dentists with an NHS contract felt the NHS provides a ‘valuable service’ for patients, 87% remain unhappy working within the NHS system. On top of this, 95% argue it remains inadequately funded.

Huge uproar

Since publishing the figures, there has been huge uproar within the profession regarding expectations to deliver on UDAs.

From our dentist respondents, 61% held an NHS contract all of whom face long waiting lists and a huge backlog of missed appointments. This comes as those in England try to now hit the government’s expected 85% of UDA targets until April 2022.

Last month, NHS England committed to ploughing an extra £50 million into dentistry to provide additional urgent care. Funding, they said, will be available until the end of March and will be paid on a sessional basis.

This followed hot on the heels of BBC analysis that revealed the loss of the equivalent of 8% of dentist roles in 2021.

Shawn Charlwood is chair of the BDA’s General Dental Practice Committee. He said: ‘Fixing NHS dentistry will be impossible if dentists are left unwilling to work in it. We need a clear road map that lifts restrictions, provides needed support to all practices and makes a decisive break with a broken contract’.

Many across the profession have long argued that the NHS contract was not fit for purpose. NHS dentistry is at a crossroads once again. We have yet to see the true effects on its future in view of the past two years.

So, when it comes to NHS capacity, are we about hit a wall?

Dentistry’s top stories

‘Failing health service’

Neel Kothari is a general dental practitioner and runs a mixed practice in Cambridge. He said: ‘For years, dentists have been warning that NHS dentistry is unsustainable.

‘Virtually every year funding has been below inflation and, in real terms, this translates to an effective pay cut. It’s important to note it’s not dentists who are choosing to leave the NHS. It’s the NHS that seems to be intent of kicking dentistry out of their family of services.

‘Dentists cannot work without dental nurses, receptionists, therapist/hygienists and laboratory technicians and these people have families that they themselves have to provide for. It’s shocking that dental nurses are now choosing to work for supermarkets and other industries over our own. For many years, people have been debating if NHS dentistry will fail? Simply put, this is what a failing health service looks like.’

‘Inane bureaucracy’ of NHS dentistry

He adds: ‘Dentists are handing back their NHS contracts in droves and companies that specialise in private conversions are rushed off their feet. The additional £50 million pound is nothing more than spin. This isn’t new money – it is money derived from clawback and returned contracts made to seem like investment.

‘What NHS dentistry needs is serious reform and a cash injection to make it viable. For some, the additional funding may be worthwhile. But, I suspect for most dentists, this will be viewed as a gimmick.’

At the start of January, Simon Thackeray told Dentistry why he had handed back the final part of his NHS contract. He said that despite feeling a social responsibility to deliver NHS dentistry to his paediatric patients, he could ‘no longer work to the unrealistic NHS targets’.

He added that he had ‘no desire to continue to tolerate the ludicrous levels of often inane bureaucracy and ever decreasing sized hoops that we need to jump through, just to satisfy a tick box mentality’.

Little positivity

Sentiments echoed by our census from dentists who hold NHS contracts.

Comments included that NHS dentistry needs to be restructured. Some argue that it is currently a ‘bad deal for contractors, a disaster for users and a trap for dentists’ and that ‘the system needs to change as supervised neglect is widespread due to the banding system’. Another notes ‘there’s no provision for periodontal care’.

Others argued the current situation is ‘unsustainable’ with one respondent warning ‘if the next contract goes the way I think it will, there will be a mass walk away from the NHS. People like me will simply retire’.

From ‘forcing dentists to work fast’ to ‘very stressful for achieving targets’, the thoughts expressed were unified. One simply said that ‘UDAs are a detriment to patient care’.

Many said the system ‘urgently needs contract reform’ and that the current contract is ‘bad for dentists, public purse and patients’. Another commented on the ‘snowball effect of the pandemic on top of a very, very poor NHS contract that needs urgent change’.

Only one signalled a positive note, with: ‘The system of remuneration to dentists needs to change. The 2006 contract gave patients who require slightly above average treatment very poor access to good quality dental/preventative care’.

But added: ‘The 2006 contract has however, in my opinion, due to the way we are remunerated, been better for providing good preventative care for children (under 19 years old). I have been able to continue to carry out a high standard of prevention on the children attending my practice.’

Looking to the future, one suggested the contract ‘needs to be means tested so kept for those who find access to private care unaffordable’. Another commented it should become a basic service that ‘properly remunerates dentists for quality care’.

Reformed service

One of the chief protagonists for NHS dentistry reform is the BDA’s Eddie Crouch, chair of BDA Principal Executive Committee. He is unsurprised at the figures and feedback shared in our Dentistry census.

He said: ‘The BDA have said that NHS Dentistry is hanging by a thread. This Dentistry census backs up that assessment and the results very much mirror surveys we have conducted by the BDA.

‘The mood of the profession is low. It has been angered with the introduction of harder expectations at the same time that patients were cancelling and staffing issues were exploding with the Omicron variant.

‘For many, this may have been a last straw on their future decisions – either for their career or on-going support of NHS provision. Coming on top of the abandonment of those prototypes has given an image of a system unlikely to have radical replacement anytime soon.’

NHS dentistry needs to be ‘radically improved’

He adds: ‘The BDA have reiterated to NHS England the urgency of reform. The need to send out a message to the profession that UDAs are to be replaced as soon as possible otherwise there will be so few colleagues left to provide a reformed service.

‘Shawn Charlwood, as chair of the General Dental Practice Committee, is calling for ambitious plans but is yet to be convinced. We know 1,000 dentists left the performers’ list last year but many more staying on the list are doing far less NHS dentistry than previously, so in reality the provision has dropped.’

Eddie concludes: ‘It’s too late for April 22 for significant reform. But the quick wins that NHS England refer to must involve moves that assist everyone – including those tasked to provide care. Longer-terms plans need to be ambitious and not be caged in the mantra of “there is no more money”.

‘The prototypes may have failed because, to be truly successful, funding needed to be radically improved from a budget the BDA estimate would need more than £800 million to even bring it back to spending of a decade ago – inadequate even then.’

We contacted the OCDO for comment.

So, what does a typical dentist working with an NHS contract in 2021 look like? Here, we pull out some key learning points…

Mixed versus private: Difference in earnings

Dentists holding an NHS contract:

  • 16% earn between £50,000 and £74,999
  • 18% between £75,000 and £99,99
  • 19% earn between £100,000 and £124,999

Dentists who solely deliver private dental care:

  • 18% earn between £100,000 and £124,999.
  • 18% earn between £150,000 and £199,999
  • And 18% earn over £200,000.

Main areas of clinical interest

Dentists with an NHS contract:

  • Restorative dentistry – 84%
  • Tooth whitening – 47%
  • Minimally invasive dentistry – 38%.

Dentists without an NHS contract:

  • Restorative dentistry – 75%
  • Endodontics – 45%
  • Implant dentistry –45%
  • Tooth whitening – 45%.

Associates pay

Typically, 66% of dentists with an NHS contract pay their associates 50% of private treatment fees, whilst 59% of those without a contract typically pay associates in the region of 33-49%.

What percentage of the dental practice is NHS?

  • 20% say less than 10%
  • 12% say between 40-50%
  • 12% say 80-90%.

How many UDAs their practice is contracted to provide per year (England, Wales or NI)

  • 16% said less than 1,000
  • 8% said between 7,001 –8,000
  • 7% said between 2,001 – 3,000
  • 7% said between 11,001 – 12,000.

How much dentists are paid per UDA (England, Wales or NI)

  • 13% – £25-£25.99
  • 11% – £24-£24.99
  • 11% – less than £18.

Mental health

  • 45% of dentists with an NHS contract say their mental health had ‘worsened slightly’
  • 36% of solely private practitioners, said their mental health had ‘worsened slightly’.

Selling up or expanding

  • 45% of dentists with an NHS contract anticipate selling their practice in the next two years
  • 30% of dentists with an NHS contract are looking to expand their practice in the same timeframe.

Click here to download the full census.

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