The future of NHS dentistry: we need an honest conversation

Practice Plan sales and marketing director Nigel Jones caught up with BDA chair Eddie Crouch to get his take on the prospects for NHS dentistry.

Nigel Jones (NJ): Eddie, I see there have been 1,200 media appearances and 8,000 mentions in local press post-pandemic. They’re impressive stats! I’ve been working with the profession for over three decades now and I have been used to the BDA ‘warmly welcoming’ things. But then on the BDA Instagram account you had Rishi Sunak’s three-point plan for dentistry – gin, pliers and a bit of brute force. And I’m thinking, who are you and what have you done with the BDA? 

Eddie Crouch (EC): Yes, the media appearances have been phenomenal. Representatives across the BDA from young dentists through to me have been in the media so many times. We’ve seen the level of debate in parliament at unprecedented levels too.

During the pandemic the BDA did what it could to support the profession and we had a lot of criticism, as we always do. But what we’ve been trying to do in the last few years is concentrate on the core message that the NHS really needs support. It needs fundamental change. Our colleagues are leaving the NHS on a regular basis, and one thing we have tried to do is get away from the media interview where the interviewer just accuses us of being greedy dentists.

I was interviewed recently by someone in the northeast, who said: ‘They’re giving you £50 to see a new patient. What more do you dentists want?’

Are dental schools the answer?

EC: When I sit down and talk to MPs, the first thing they say is: ‘We need a dental school in my constituency.’

They believe that’s going to solve the problem for them. You’re probably aware that they’re developing a therapist school in Ipswich, and I spoke to a local MP recently. He was all excited and said: ‘We’ve got the recovery plan and we’ve got a training school in Ipswich.’ Within 20 minutes of talking to me, he had his head in his hands.

I’m not sure that’s the sort of reaction I wanted to get, but across the BDA, we have done our best to make the case for the profession and for the millions of patients who sadly have been sitting at home taking teeth out in their own kitchen, which is shocking.

NJ: I agree. It was good to see the BDA being so forthright in its messaging because we’re in a serious situation. Also, the Nuffield Trust quote about the fact that this is pretty much the end for NHS dentistry if we’re not careful. There are a lot more voices now saying just how bad this crisis has become. So, it’s good that you’re not mincing your words as an organisation.

It’s been great to see how successful you’ve been at separating the profession from the system and the contract. That’s been important because a lot of fears around the greedy profession tag have held people back. And because you’ve achieved that separation, it’s worked well.

The NHS dental recovery plan

NJ: On the dental recovery plan, I recall some very positive comments made when it was launched by Andrea Leadsom, Jason Wong and the secretary of state. I couldn’t quite square them with the reactions I’ve seen. So, what are the BDA’s thoughts?

EC: If we go back to the Health Select Committee report that came out, Neil O’Brien, who was the minister who gave evidence to that committee, announced that he was going to launch a recovery plan. The civil servants I saw in parliament that day were scratching their heads – it was the first they’d heard of it. But it gave him the opportunity to go in front of the Health Select Committee and say: ‘We’ve got a plan.’ Although at that stage he had no detail.

Neil O’Brien is a clever man. He’d worked in the treasury, and he worked up a recovery plan that he was discussing with the BDA that was far more adventurous than the one published but would have cost money to deliver. I think Andrea Leadsom was given a remit to look at Neil’s plan to see which elements would not need additional investment.

So, she picked out the things that would make it look good – 2.5 million extra appointments sounds fantastic! But when she was asked for the calculations, she had to admit that their modelling was unreliable. When questioned about the £200 million extra investment, she had to admit it was not new money and was coming out of clawback.

For dental teams, the changes to Band 2 and the new patient premium will make a difference. It will reduce the amount of clawback they pay back. But to say that this is new investment was just not the case – we had to call it out.

What does the profession think of the recovery plan?

EC: We surveyed our members about what they thought of the recovery plan and a shockingly low percentage who were thinking of leaving the NHS thought it would give them impetus to stay in the NHS. It wasn’t ambitious enough.

What we’ve got from the recovery plan is the ability for a conservative politician, an MP or a prospective candidate, when they go out campaigning and are challenged about NHS dentistry, which they will be, to say: ‘Look at all these things we’re doing about dentistry.’

We are going to have 15 vans where you’ll get your initial inspection and maybe some emergency treatment; but then you’ve got to wait four-and-a-half months till the van comes back round again. Vans have a place in delivering care for certain types of patients, such as the homeless, but it’s not a place for delivering a comprehensive dental service. It’s a bonkers system.

Every single minister I’ve sat down with has said they want to fix NHS dentistry, but there’s no more money. In the Nuffield report they said, if there is no more money, we need an honest conversation about where the money available is going to be targeted. Whether that’s anyone over 80, under 18s, people with a medical problem, or who need urgent and emergency care, so we can get them dentally fit. Let’s have that conversation. But none of the parties will say they want to develop a system where anyone who can’t pay for private dentistry can have it on the NHS. They will not say it.

NJ: Thanks for your insight, Eddie. We must wait and see.

Follow on Instagram to keep up with all the latest dental news and trends.

Get the most out of your membership by subscribing to Dentistry CPD
  • Access 600+ hours of verified CPD courses
  • Includes all GDC recommended topics
  • Powerful CPD tracking tools included
Register for webinar
Add to calendar