Zoe Close spoke to key industry figures about the future of NHS dentistry – should dentists find a way to work in the NHS or accept that they’re fighting a losing battle?
At this year’s Dentistry Show at the NEC, Practice Plan devoted its programming of the Dental Business Theatre to answering dentistry’s biggest questions.
Head of Sales, Zoe Close, hosted a panel of key industry figures including Shawn Charlwood, chair of the BDA’s General Dental Practice Committee, Simon Thackeray of the BAPD and Practice Plan sales and marketing director, Nigel Jones, as they debated whether there is a future for NHS dentistry.
Here’s a flavour of the discussion.
Zoe Close: We can see NHS dentistry isn’t working. So, should we be looking to see what can be done for vulnerable patients and those in genuine need? Should we draw a line and accept that we’re fighting a fight we can’t win?
Shawn Charlwood: That’s the honest conversation that government needs to have with the profession. And for obvious political reasons, they are reluctant to do that. At the moment, they sell the service as available to all and free at the point of delivery. We know that’s not true.
There isn’t enough cash in the system and enough dentists to deliver the service to even half the population. I think the British population is starting to realise one of the reasons they can’t get access to NHS care is that there just isn’t enough dentistry commissioned and there aren’t enough dentists.
Government needs to take ownership of this. If they wish to ration care, it needs to come from them, not the profession. But if government wants to come to me and my team and say, ‘we have a problem, we can’t spend any more money’, we are prepared to have a conversation with them around what they are able to afford.
It might be a rationing of the list of care. Individual items might be rationed or maybe a rationing of care in terms of who can access NHS care.
So, these are conversations that I’ve certainly been having for 30 years. There’s a degree of honesty about it that many politicians, for political reasons, will shy away from. They’ll be very nervous talking about it in the next 18 months in the run up to a general election. But those are the types of conversations the team are prepared for.
But it is for government to outline this. It would be a big mistake if it were the profession who started to sell and promote rationing of care. It’s not for us to determine what is spent on NHS dental care. It is for government to provide enough funding to deliver care for all of the population.
We’ve had scenes of people queuing up in King’s Lynn for a dentist. The images I saw reminded me of the old Soviet Bloc, where people used to have to queue at a bakery for bread every morning. As a member of British society and the profession, it is absolutely shameful.
We still live in a wealthy developed nation by world standards, so let’s hang onto that. We should have NHS dentistry as a core element if people wish to take part in the NHS dental system.
Simon Thackeray: The system is broken and it doesn’t matter how much we try and rearrange it. We have the fundamental issue of people not wanting to work within it because it’s draconian. Regulations are difficult to understand, and the fear and risk of litigation is high.
Dentists are expected to provide care to the same standard as a private practitioner and at nuclear speed, leaving no time to develop rapport. Some are difficult or high needs patients, and my heart goes out to many of my NHS colleagues. I have no idea how they continue to do this.
Or are they genuinely unable to see that there is light at the end of the tunnel? Are they still so socially and emotionally involved with trying to provide for these people and prop up the failing system themselves? If there are enough of them propping it up, then it won’t collapse.
Or is it time to just say, ‘we can’t do this anymore as a profession?’
We’ve talked about strikes. We can’t strike generally as a profession because, as self-employed and business owners, we hurt ourselves.
But what I think we’re doing as a profession is we are striking by leaving the system that’s not working. That might be a partial strike or working to rule, or it might be a full strike where you walk away from it.
But the government doesn’t listen. To restore NHS dental funding back to where it should be, without the cost of living issues that we’ve then got with inflation at 10% to 15%, then you need a 38% increase.
Anybody who thinks that the NHS funding will go up 38% is deluded. It can’t because the country can’t support it.
But there’s also the other aspect that if the money is tight, is it better spent on other aspects of healthcare that are potentially more life-threatening than dentistry? And should there be a core service delivered by, maybe, a salaried service. Or a well-defined system where you know what you’re going to get and where you can get it from?
It’s unlikely that any private dentist will go back into the NHS. Once you smell the freedom of not having to jump through the hoops, most private practitioners won’t go back.
Nigel Jones: One of the things that interests me is the fact that 50% to 60% of the population attending the dentist once a year, or more frequently, is often positioned as if it’s a failure because we’re worried about the other 40 to 50%.
I think the profession’s done an unbelievable job that 50% of the population is willing to turn up for a health screening that most of them have to pay for, that could result in extra cost and even discomfort after that. It’s amazing. You find me another form of health screening that gets that kind of engagement from the population.
So, there’s something important there about the regard for the profession and the positive way that patients view it, and we should never lose sight of that.
The reason I mention that is I think government rely on the consciences of dentists to prop up the NHS. They’ve relied on fear of the alternatives and of dentists believing they will not secure enough loyalty from patients to make a success of ‘going private’.
And I think the profession was misled sometimes by the negative portrayal in the press of the dental profession. This was rife when I started my career in 1990. You don’t see much of that now. I think the BDA has done a tremendous job to separate out the profession from the system.
The government has boxed itself in by being so critical of a dental contract introduced under the last Labour Government, such that it’s much harder to pin the blame on the profession. So, all that increases the position of strength for the profession.
About four years ago, I said I thought flexible commissioning might be a way of achieving a core service by stealth. And I still feel that could happen. We have clients who are now wholly private engaging with flexible commissioning to offer urgent care sessions. There are some interesting things that could be done there.
But those practices are negotiating with their LATs from a position of strength because they don’t need to do it. They’re choosing to do it because they want to play their part in society; they want to contribute; they want to help with the oral health inequality.
And I think that’s the kind of reframing we need to do. Stop thinking about it as NHS versus private but think about how we work together.
At Practice Plan, we are growing faster than at any point since Simon was leaving the NHS in 2005/6. And we are seeing success in all sorts of demographics, all sorts of situations.
Despite the cost of living crisis, we are not seeing people cancel their dental plans. And that to me, says people value dentistry. But also, there’s an awareness that if they cancel the plan, they might lose a dentist and might not get them back.
So that strengthens the position of the profession to then start reframing that discussion with the NHS and think differently about how we have a common objective of tackling oral health inequality, rather than what seems to be happening all the time which is dentists getting ever more competent at adapting, adjusting and compensating for the deficiencies of the system. We should flip it on its head.
Zoe: Thank you all.
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