NHS dentistry – is a core service inevitable?

NHS dentistry – is a core service inevitable?

During Practice Plan’s recent webinar, sales and marketing director, Nigel Jones, spoke to BDA chair, Eddie Crouch to get his views on NHS dentistry and its future.

We have a fundamental problem of an ageing population that will have increasing health needs. We are going to have a lot more retired people and fewer taxpayers. So, there are some massive challenges for all health provision in the country.

It feels like what we really need is some honesty and some frank discussion about what’s possible and how much money can genuinely be made available, given all these competing demands.

But surely the only way forward is a core service, or restricted service, or something that targets what limited resources there are at those most in need. That must be where we’re heading isn’t it, Eddie?

I’d want to have conversations about that. I reminded Will Quince, who was the Minister for Dentistry under Liz Truss, and is still in the Department of Health, of the meeting we’d had when Liz Truss was in office.

I had told him then we needed an open and honest discussion about what they wanted from my colleagues on the high street with the amount of money that they are prepared to give them. Whether they wanted to target that at people who can’t afford to go private, people who are on benefits, and children. Or maybe just children in areas of social deprivation.

Our worry has always been they’re going to target equivalent type funding, ie they’re going to cut their cloth. And they’re going to offer a budget which they say is adequate to treat everyone who is exempt from charges, or all children, for example.

So, what we’d have to secure was the global spend on dentistry being utilised properly on those people. And I’m not convinced that would be easy to do. I think they would look on it as an opportunity to make savings.

I share your misgivings. And I understand the ‘core service means core funding’ line of thought. I feel that it’s inevitable and that what we should be lobbying for is to preserve the level of funding and target it to more people.

The latest stats I saw from Laing Buisson showed about 59% of the adult population have been to a dentist at least once in the last year, and the majority of those have been twice. But that’s a chunk of people that aren’t going at all, and the budget doesn’t even cater for them.

So, an awful lot of those are likely to be less financially advantaged, potentially less educationally advantaged. So, they’re the very people we should be reaching out to. And it would seem wrong if the core service, core funding risk materialised. I would be deeply uncomfortable with that.

At the BDA we’re doing some research on the volume of patients out there that haven’t got access. And I’m guessing that it’s probably north of 10 million people in England alone unable to access NHS dentistry care. Now, whether they could afford to go private or not, we don’t know.

But a significant number of those, certainly in the economic climate we’re in at the moment, are having to worry about bills and whether they’ve got enough income to pay them at the end of the month.

I do think patients value dentistry far more than they’ve ever valued it before and they will find the money if they need it for their oral health. And in fact, lots of patients I talk to say they’ve gone to see a private dentist and they’ve found the fees far more reasonable than they thought they were going to be.

That’s very true. It definitely isn’t the case that everyone can afford private dentistry, or dental plans. But more than enough can, which means that dentists can make a success of going private. Yes, of course it depends on your particular location, and the demographic of your patient base. But as a general rule, that option exists. And I think that’s going to be the problem: persuading people not to take up that option.

We tend to talk a lot about access in terms of the availability of resources. Are there enough dentists? Are there enough dental nurses? That kind of thing. But even charges in NHS dentistry could be unaffordable for a proportion of people. The working poor in particular as we go into this cost-of-living crisis.

Also, your ability to navigate the system, that is not always easy. Some people are more adept at that than others. So, access is a much bigger thing than just availability of resources. I fear for what’s going to happen to a proportion of the population and to oral health inequality.

But I don’t have a fear for the dental profession going forward. I think the dental profession has found itself in a position of some strength, because of its ability to go private if it chooses to. What I do fear for a significant chunk of the population. I think one thing the profession can do is join the BDA, because the greater the membership, the more clout, the more people you represent, the more people will pay attention to you.

The more resources we have, the more we can do for the profession. We want to do quite a lot of studies and produce a lot of data and get the headlines for the work that we do. But we need the staff to do that. And we saw a boom in membership when we had a pandemic.

I don’t want it to be another crisis that drives people to the BDA. I want people to come to the BDA because they recognise what we’re doing.

And we have just launched a new strategy. People say we’ve been too focused on NHS dentistry, and that’s a fair criticism. And there’s a lot in our strategy where we are looking to encourage, or provide services to our private colleagues that they will value.

We need to engage with other members of the dental profession and be more encompassing with the dental team as we develop. And we will try and do that as well.

So, we are doing what we can, but without the adequate resources of membership. We know dentists are struggling to pay their own bills. And membership of the BDA is a discretionary spend.

I hope dentists think it’s one of those discretionary spends they want to keep going. Because without the BDA doing some work on dentists’ behalf, I don’t think that there’s anyone else out there that can do it for them.

Eddie Crouch and Nigel Jones

And for me, the really important thing is the spotlight you shine on the challenges, and on issues like the oral health inequality and the growing issues that are going to happen with that. And even if an individual dentist doesn’t feel he or she needs the BDA, I think we as a society need the BDA to stimulate debate about how we cater for the population needs going forward.

Even in orthodontics, it seems the specialist practices are thinking: ‘You know what, I’m going to be better off out of this system.’ And unless people wake up and realise that, we will be the ones that said: ‘We told you so. And we’ve told you often enough.’

But I’ve been campaigning for a long time. People say to me: ‘Why are you still going? Why don’t you just give it up?’ Well, anger, I suppose, and frustration is what drives me on. So, I hope that I can carry on being angry and putting the case across to a lot of people in the media and the politicians on behalf of everyone else.

I also hope you carry on being angry, Eddie, because I think that’s what’s needed now. And your example of the orthodontic contracts is a good one. Because I think that shows for me a fundamental truth, which is that the NHS needs the dental profession more than the dental profession needs NHS dentistry. And the sooner they realise that, the sooner they’ll start making proper change.

If you’re considering your options away from NHS dentistry 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.

For more information visit the Practice Plan website.

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