Farmers and dentists have more in common than you’d think, explains Kevin Lewis. Both suffer the financial consequences of inadequate government policies.
I was grafting away on this column, when I was distracted by hearing an interview on TV in the background.
The interviewee was saying that in 30-plus years in the business, he had never known things this bad. He was working harder than ever and had invested massively in state-of-the-art equipment and materials. Still, he was making a loss on many of the things he was producing.
The costs of everything he needed to buy had gone through the roof, he was struggling to recruit and retain key workers, and what he was getting paid had been falling in real-money terms for years.
Tough times for farmers
I looked up, half expecting to see Eddie Crouch – but it turned out to be a farmer.
He explained that he and his family would be better off leaving his fields uncultivated and empty than trying in vain to make money by growing any crops in them.
But the public needs and wants food, he said, and especially during the pandemic there have been a lot of fine words spoken about valuing the countryside and the key food chain workers living there.
Also, if we are to meet our environmental/climate commitments, we have to get serious about producing food closer to home rather than transporting it across the globe.
He felt a responsibility to society and to his employees. However, he wondered if anyone else felt the same way about the farming industry.
Does a stark landscape of empty fields, relentlessly nibbled away at by mindless urban development and infrastructure projects, give the public what they ‘really, really want’? No, but former farming land will make some people money, and by then it’ll be too late to go back.
Especially at a time when economic challenges are coming from every direction, the public wants affordable food. But they also want high-quality, fresh food.
A perfect storm
A lot of money is being made in the food chain, but not by the farmers who are producing it in the first place.
This year, mother nature has a louder voice than usual, with prolonged periods of exceptionally dry and hot weather for many parts of the UK at a critical moment in the growing and harvesting cycle – made even more critical because of events in Ukraine.
Meanwhile, and in parallel, a perfect storm has ravaged primary care dentistry with a backlog of NHS care and treatment on a scale that hasn’t been seen since 1948.
This time, coinciding with a bruised, demoralised and distrusting profession having become weary of being taken for granted by successive governments.
Patients also want affordable and high-quality dentistry whenever they choose to access it. In dentistry, as in farming, there’s a higher moral imperative but there’s also a going rate – and at this rate, it won’t be going for much longer.
In dentistry, as in farming, those who confidently follow their parent(s) and grandparent(s) into the profession are becoming as rare as hen’s teeth (excuse the farming pun). Those parents and grandparents are now saying ‘don’t even think about it’, which is the ultimate sad indictment of the present situation.
Perhaps the BDA should merge with the National Farmers’ Union – we seem to have an awful lot in common.
Talking Turkey
As if the hustings, live debates, lobbying and elections for the new leader of the Conservative party (and hence, Prime Minister) were not enough for the British media, Christmas has come early this year with ‘Turkey teeth’ on the menu.
They’ve gotten a right royal stuffing in the media by the BDA and by patients whose luminescent teeth put even Rylan Clark-Neal in the shade – until they all went pear-shaped, that is.
In fairness, some already looked quite pear-shaped when they were fitted.
BBC Breakfast TV treated us to Naga Munchetty interviewing Eddie Crouch and the former Love Island winner Jack Fincham – one of many who have cried foul after dental experiences in Turkey.
Mixing his farming metaphors, Jack said his Turkish temporaries made him look like Donkey from Shrek.
Rumour has it that Naga needed to ask Eddie and Jack which of them was the Love Island contestant, but Eddie still has his own teeth, so the answer was self-evident.
It’s a strange juxtaposition, with zillions of UK patients being unable to access even basic NHS treatment. At the same time, other patients – or maybe some of the same patients – are heading for Turkey’s beaches and dental surgeries for a spot of cut-price dental tourism.
Under normal circumstances – and especially at Christmas – turkeys are thankful for the two-hour time difference between UK and Turkey, and for those two precious hours on Christmas Eve, turkeys are safer in the UK. On recent evidence, their teeth are safer in the UK all year round.
Have a holiday by all means, but leave your teeth at home.
Mind your step
An ever-present hazard down on the farm is that of stepping in a pile of ****. But there is no shortage of that commodity in dentistry either.
The recent DDRB pay award is again well below inflation, there are no plans to recognise the massive recent increase in operating costs, and each of the four countries of the UK is deeply unhappy with its own version of the GDS.
In England, we don’t yet know whether the quick fix tweaks announced late last month are to be funded with any new money, or out of the same old cake. But there are some early signs that at least part of this plan relies on redistributing existing money.
I was therefore a little surprised by the almost rapturous and unqualified positive reception from various voices within the wider profession, towards the tweaks proposed by the DoH ahead of substantive contract reform, which remains a challenging and seemingly elusive work-in-progress.
I should add that things are not much better in Scotland, Wales or Northern Ireland.
Of course the marginal changes for England are welcome to that extent. Any kind of movement must be better than no tweaks at all, unless our worst suspicions are true and no new money is on offer.
In that case, the profession is being bribed with its own money yet again.
The moves are (mostly) in a positive direction, but the spin is not entirely helpful. In some respects, it’s misleading, patronising and subtly threatening.
UDA values have fallen significantly in real terms ever since 2006, so an assurance of a new minimum level only slightly worse than the 2006 average is hardly anything to shout about.
And does the offer of an extra £70 (before tax) really give practitioners an insatiable appetite for all those patients who need four, five or more appointments on a scenic tour of Band Two? Or a further £70 if it involves one or more molar root canal treatments?
I must have missed the announcement that the elves and pixies are offering to supply unlimited free endodontic instruments.
The expanded role announced for dental therapists reflects a predictable direction of travel that I recently foreshadowed in this column. Unsurprisingly, there’s a chorus of approval from the various representative organisations for DCP groups who are hopeful more will come.
The corporates similarly see this as a great opportunity to achieve UDAs at lower cost, from the magic workforce tree at the end of the garden.
It is logical task-shifting, mirroring the medical model, and an incremental step towards expanding the scope of practice envelope, at the same time as serving as a mind-concentrating message in a bottle to GDPs.
I will leave you to decide which motive was uppermost in the government’s mind.
The timing of the announcement hard up against the summer recess, means that the necessary enabling legislation for implementing some of the changes will need to wait until the politicians are back from their holidays.
This buys some more time and – the politicians hope – will be sufficient to serve as a ****-deflector for long enough to secure an undisturbed summer break.
The story of NHS contract reform was ever thus.
So, while some inexplicably spoke of wanting to ‘punch the air with the sense of victory for hard-working dentists treating high-needs patients’, – presumably while holidaying on a different planet – others were sensibly keeping their punches dry for the battles that will follow.
Catch previous Kevin Lewis columns:
- Whatever happened to NHS dentistry?
- Contextually speaking
- Whistle while you work
- Putting it into perspective
- The law of unintended consequences
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