‘The monster we call the NHS has grown into an uncontrollable beast’: this month, The Secret Dentist discusses the NHS’s effect on the perception of dentistry compared to medicine, and explains how redesigning the dental profession could help.
Over the last 50 years in the UK, dentistry and medicine have taken increasingly different paths.
Currently, most dentistry occurs in independently or privately run practices, some of whom agree to take on NHS contracts. There is almost universal agreement within the dental profession that these NHS contracts are not fit for purpose and do not adequately fund the work that the NHS require to be provided.
In contrast, most medicine is carried out in NHS owned and run facilities by employees of the NHS. There is widespread agreement that the monster we call the NHS has grown into an uncontrollable beast. At one end of the spectrum, it spends millions of pounds providing world beating treatments at the forefront of science.
At the other end, it forces patients to wait for hours and hours just to be seen when they have had a medical emergency, or sometimes even if they wish to visit their general medical practice. There is an increasingly large black hole of finance that is, in part, caused by an inability to manage the NHS beast.
The above has led to the dentist being in independent practice and the doctor being an employee of the NHS. Thus, the dentist has total, independent control of the direction of their career. Whereas, the doctor is ‘part of the system’, with their choices limited to pathways within that system.
How does the NHS put dentists at the ‘kiddy table’?
Let us focus on the reasons why, in the eyes of the public, dentists find themselves at the ‘kiddy table’ of professionalism. Why are they seen to ‘just drill teeth’, while doctors are considered to be fully fledged and respected healthcare professionals?
The main driver of this has been the NHS dental system, and the (short sighted) decision-making within the dental profession. This decision-making has been, in part, caused by the requirement to survive financially within the NHS system. This would effectively cause a dentist to go bankrupt without cutting corners or ‘making the system work’.
The system has caused dentist to dumb themselves down. The dentist is just as intelligent and has had the same training in anatomy, physiology, and biochemistry as the doctor. The dentist then switches to becoming a head and neck specialist whereas the doctor becomes a total body generalist. Arguably, the dentist goes on to develop better empathy and patient management skills due to the nature of the work.
Unfortunately, that is where the NHS dental system intervenes and causes the dentist to become a ‘drill and fill merchant’. Why? Because that is what pays the bills. I might add that drill and fill replaced ‘take ’em out and give ’em dentures’. The system has caused us to become glorified navvies rather than healthcare professionals at the top of our game.
The equivalent in other professions would see the architect actually building the whole building himself once he designed it. Why does the average dentist, in NHS dental world, spend 80 to 90% of their time doing a manual job, mainly replacing an old filling with a new one? Madness!
What can be done?
There have been opportunities to change this, but the powers that be, our senior colleagues, the BDA and the GDC, have been blinded by the three letters of the UK’s scared cow – the NHS.
We are at the imminent death of NHS dentistry in its current form, and operate in a world where less that 50% of dentistry is delivered by the NHS. It is time to break free from the shackles. It is time to redesign our profession and redesign general dental (and wellness) practice.
Read how in part two next month.
Catch up on the Secret Dentist’s previous columns:
- Does the pressure ever stop?
- Is there any light at the end of the tunnel?
- We are unique, you are unique
- The damaging NHS contract and ‘detached’ GDC
- A country in chaos
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