Dentist Neel Kothari shares his views on how the cost of living crisis will contribute to the collapse of NHS dentistry.
There is no doubt in my mind that the cost of living crisis has the potential to eclipse the chaos of that colloquially known as ‘lockdown one’. Almost all sectors will be impacted by ever increasing inflation forecasts and will no doubt take measures to protect their businesses.
This may work for some. But there are some glaringly obvious issues for the provision of NHS dentistry, in that it is riddled with high overheads, increasing fixed costs and an inability for an independently-owned practice to increase its fees without government approval.
Whilst fees are not unique to NHS dentistry, they have always been controversial. It was due to the cost of dentistry that NHS fees were first introduced in 1951 (for the provision of dentures) to stop the NHS running out of money.
This led to the resignation of Aneurin Bevan, who was the minister of Health in Atlee’s post war government who initially launched the NHS. The essential values were, firstly, that the services helped everyone.
Secondly, healthcare was free. Finally, that care would be provided based on need rather than ability to pay.
Unaffordable
I think we can all agree that in its current form, NHS dentistry fails to meet these ideals.
Nevertheless, there is an even more pressing issue. The business of NHS dentistry relies upon UDA targets to be completed and, with forecasts of inflation now hovering around 18%, this means that a significant proportion of the public will not have enough disposable income to afford NHS dental fees.
Simply put, NHS dental fees have become a form of taxation in all but name. If the NHS chooses to continue its policy of funding dentistry through increasing patient charges, there should be no doubt that this will be devastating for both patients and the ability for practices to complete their UDA targets.
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Skyrocketing prices
This is already evidenced by the 2018 adult dental health survey, whose findings tell us that 7.7% of patients having a band 2 course of treatment could not afford it. A further 21% report that they would struggle to pay this charge.
The data for band 3 affordability looks even more bleak with 21.8% reporting that they could not afford band 3 fees. A further 24.6% stated they would struggle to pay this charge.
At this point we can only speculate what will happen over the next year as energy prices and inflation skyrocket and vast swathes of the population are dragged into poverty.
The toxic cocktail of rising inflation, increased patient fees and below inflationary contract uplifts leads to the unavoidable conclusion that an ever increasing number of people will not be able to afford NHS dentistry and dental practices will find the delivery of NHS dentistry less viable.
Tough challenges
Accordingly, it is entirely foreseeable that many practices will struggle completing their UDA targets. They will face record levels of clawback, obliterating their profits.
Whilst this is challenging for most, I have a particular concern for some associates who have signed contracts with obligations to repay 100% of whatever they have underachieved.
Without going into why such clauses exist, small reductions in claiming UDAs could be crippling to those dental associates, who could potentially find themselves in financial distress.
This needs to be treated with a sense of urgency and it is my personal view that each dental associate gives serious consideration to what this could mean for them, especially if it becomes clear that one cannot meet their UDA targets.
At this stage, NHS dentistry very much feels like the final stages of the game Jenga. The cost of living crisis has the potential to remove at least one of the blocks from the bottom row.
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