As NHS dentists face a difficult winter, Practice Plan sales and marketing director Nigel Jones spoke to BDA chair Eddie Crouch, to get his views on how he feels they will fare.
The historian and broadcaster, David Olusoga, said: ‘Whether we like it or not, there are moments in history when pessimism is the appropriate response.’ Do you feel now is one of those moments for NHS dentistry, Eddie?
EC: Possibly so. Look at how things are now. Expenses in general practice are going through the roof. Laboratory charges are escalating and there are treatments now being done where the laboratory charge is more than the fee that the dentist gets, and that can’t be right.
Another big issue is workforce, it is so hard to recruit and retain good staff and it’s getting worse because so many dentists see their future not in the NHS. They know that they can dictate how much money they earn if they leave and go private.
I know of practices where the associate has turned around to the dentist and said: ‘I’m happy to stay here, but I’m not happy to stay here and continue to deliver your UDAs for you. If you want me to stay, I’ll stay, but I’ll provide private care only.’
And I know that’s happened with the corporates. Because they know if they’ve spent two-and-a-half years trying to recruit a dentist into a practice, forgoing their NHS contract, or paying claw back is probably the better business decision than letting them walk away and then having to try to recruit someone else to fulfill the UDA delivery.
Also, the wages of dental care professionals (DCPs) in comparison to what they’re now expected to do with the high levels of PPE and the things they’ve been through in the pandemic, have not kept up, and they’ve had enough.
It’s not what they signed up for. So, a lot of those people are walking away from dentistry. Will we realistically get an expense element uplift to compensate for that? I don’t think so.
We’ve had a year of promised change where a number of announcements (or non-announcements, most recently) have been made but without any substantial changes to improve the lot for NHS dentists. You speak to the government minister responsible for dentistry quite often. What hope do you have there’ll be change for the better for NHS dentistry?
EC: In my two years now as chair of the BDA, I’ve had four ministers responsible for dentistry. One of them only lasted six weeks during the summer.
When I met the latest minister he came to the table saying, ‘Let’s start with a blank piece of paper. What do you want? How can we solve these problems we’ve got? How can I help my MPs that keep bombarding me with problems about access?’
But I don’t see any desire to spend any more money on solving dentistry.
So, I think we’re going to have to have a frank and open discussion along the lines of, ‘if this is how much money you’re going to spend, what do you want for it? Do you want a basic level service for the whole of the population, or do you want to target the money that you are spending on the patients who really, really cannot afford any alternative to having a national health service?’ And I think that’s probably the direction of travel.
But I know that, unless they get support, there will be a lot of practices over the winter that can’t survive economically on the current level of funding.
They will also deal with the uncertainty of not being able to recruit and retain staff to deliver on a contract. And if they end up having to pay huge amounts of claw back it will just take them under.
And that’s the reality of it.
Those views chime with what we’re hearing from a lot of NHS practices who are getting in touch with us, Eddie. I can’t see that the government has come up with a credible plan to remedy things, either.
EC: I’m afraid I have to agree.
The Secretary of State for Health, Therese Coffey, has said she’s going to lay legislation down before parliament to make it easier for us to be able to recruit from overseas.
However, the GDC’s sole remit is to ensure that anyone who works as a dentist in the UK is fit to be on the register, so they’re not going to lower their standards just to allow people to come in and solve a workforce problem.
And any changes that are put into place in legislation will require a period of consultation with the GDC which will mean that these solutions are about 12 to 18 months away. So, by the time they actually do that, how much of an NHS dental service will be there?
How do you think things will pan out?
EC: I think it’s clear what the profession is doing at the moment because activity levels for units of dental activity are falling.
As the pandemic eased a little bit and we were given harder targets to achieve, most practices did chase them and the amount of activity was rising. However, it wasn’t anywhere near what they wanted and they were being set unrealistic hurdles to get over. This is why so many practices will have failed and will face claw back and be destabilised.
But it’s clear to me that from the 1st of April, a lot of practices decided they’d had enough and decided to bank the money while they investigated their options in private practice.
They know that they will have to give a lot of it back as they intend to hand back their contract. A lot of practices are looking at their options and having conversations with people like Practice Plan at the moment.
I’ve been banging my head against a wall to try and get reform and improvement and investment into dentistry for approaching 20 years now. And I don’t think we can do anymore as the British Dental Association.
I think in the last two years, we’ve managed to educate the public about what the problems are. We’ve managed to turn the tide a little bit that it’s not all greedy dentists and I think the public realise that the fault for the current state of NHS dentistry lies with the politicians.
It wouldn’t take a lot of money to fix dentistry and they can find the money when they want to. The money that was spent wasted on the procurement of PPE that wasn’t fit for purpose during the pandemic would’ve solved dentistry for a while.
Compared with bailing out people from £6,000 fuel bills, fixing dentistry would be a fraction of that. But it’s whether they’ve got the will to do that and it doesn’t appear to be obvious that they have at the moment.
Thank you for sharing your thoughts, Eddie. I fear it’s not pessimism, it’s realism.
If you’re considering your options away from the NHS and are looking for a provider who will hold your hand through the process whilst moving at a pace that’s right for you, why not start the conversation with Practice Plan on 01691 684165, or book your one-to-one NHS to private call today practiceplan.co.uk/nhsvirtual.
For more information visit the Practice Plan website www.practiceplan.co.uk/nhs.