Following the Labour government’s discussions with dental leaders on how to fix NHS dentistry, we hear some proposed solutions from the dental profession.
Vincenzo Marino, CDT and owner of Advanced Aesthetics of Cambridge
My solution for creating a more efficient NHS is lessening the burden on GDPs as they have too many eggs in the frying pan.
I would propose spreading the services provided to other specialisms and other health practitioners such as clinical dental technicians. Are they not specialists in constructing dentures? Each CDT has nine years of studies mostly in making dentures.
This accompaniment to the dentist would free him or her of at least two hours in the day to concentrate on specialised services. The CDT would work in tandem, offering an exacting and less frustrating service to the patient. In turn, patients would appreciate that they are being supplied prosthesis by the person who makes them – this in itself is comforting.
In addition, there could be qualified clinical dental technicians (CDTs) able to construct, supply and fit dentures for patients either in surgeries or in their own practices directly. CDTs offer dentures not only to meet patients’ needs but also sometimes eliminate the need for a GDP, creating a comfortable relationship of trust in another field
This service would not only free-up time, but it would help dentists have a less stressful day, another important factor for peace of mind.
CDTs do not carry out all denture work without having to refer – this extra tag on could easily be added by extra CPD. Just think of the dental service in the UK; we would be so ahead of Europe with a service second-to-none. This change in the dental service and provision could ease the pressures on the NHS.
As a result, CDTs could free-up dental time, saving the NHS and preventing patients from extracting their own teeth. We should look to a future of brighter changes instead of moving to darker times in dentistry.
CDTs are currently working closely with the GDC on changes for a brighter future.
Anonymous
The big issue in NHS dentistry is obviously funding. Since the contracts have been introduced back in 2005, no yearly adjustments have been made.
Since then, the practices gradually had to cope with rising yearly costs whilst trying to deliver the same quality and quantity of service.
Furthermore, some practices had their contracts reduced, resulting in future reduction of services without the option to increase the contracts should the practice increase their productivity.
The knock on effect of this funding crisis also led to dentist recruitment problems as well as staff retention problems, all of whom see the private sector as more rewarding.
Unfortunately, it also leads to a skills reduction in the NHS – the private sector headhunts all the more experienced workers.
Possible solutions would be:
- Increase all UDA values by inflation. The Bank of England shows a 71.4% cumulative inflation since 2005. Then add inflation every following year
- Yearly clawback for underperforming is fine, but do not reduce contract values (underperformance can be temporary due to illness, maternity or recruitment issues) and be open to negotiation if a practice is growing
- Keep the patient contributions as is. A lot of the NHS patients are refusing treatment due to cost
- Introduce a wider scope of essential treatments, eg surgery (wisdom teeth, surgical extractions, apicectomy) which will ease the pressure on the hospitals
- Create a separate contract for hygienist services in order to manage periodontal health better
- Compulsory NHS service for all dentists and hygienists for five years.
Anna Slupik, dental hygienist and therapist
I have been a dental hygienist and therapist for over 13 years now. I trained in London and qualified from the Royal College of Surgeons in 2011.
Sadly, I have not been able to use my qualifications to full capacity, neither has anyone else who qualified as a dental therapist, due to the fact we are not able to become an NHS provider.
We are also not able to prescribe local anaesthesia (until this year I believe), but not being able to become a provider means we cannot treat anyone on the NHS. This is a shame as we train in full paediatric dentistry and adult restorative dentistry, and our scope of practice stated in the GDC guidelines is huge.
Dental therapists could fill the gap in the NHS sector. We have been trained by the NHS and yet not able to provide services for it. I hope this changes at some point for us.
It would also be helpful to have a bridge course for dental therapists to qualify as dentists (who currently have to go back to dental school for the whole five years despite training for three already). Two extra years would bridge these qualifications. At the moment, there is no course that would allow them to qualify as a dentist in a shorter time.
Dental therapists in the UK can provide a range of services, delivering dental care and promoting oral health. They are trained professionals who work alongside dentists to provide preventive, therapeutic and restorative treatments.
Relieving access pressures
At the moment, those with dental hygiene and therapy qualifications are limited to private dentistry. As many private sector providers notice, the private sector users expect dentists to treat private patients, but private dentistry does not accommodate us at all.
To be able to work for the NHS, we need a provider’s number given to us by the NHS system which is not possible at the moment. Without being able to obtain the provider’s number, we are not able to work within the UDA system of points paid by the NHS.
There are over 5,000 dental therapists registered with the GDC at the moment, compared to 43,315 dentists.
Since 2013, dental hygienists and therapists have been allowed to do what they are trained and competent to do without the patient having to see the dentist first.
Our skills could be used in hospitals under supervision of maxillofacial consultants or paediatric consultants, including extraction of teeth under general aesthetic, community work and all the general NHS practices that provide routine dentistry.
There are 8,870 dental hygienists registered in the UK. They could also fill the gap in NHS practices by providing preventative scaling, fluoride applications and advice under the UDA system. They could work in community, schools and domiciliary visits sector as well.
Raj Rattan, Dental Protection dental director
Dentistry in the UK is at a crossroads. Important decisions – ranging from changes to the NHS General Dental Services contract to GDC reform – which have been deferred and delayed must now be addressed. This new government needs to implement a wide package of much needed reforms to secure, strengthen and safeguard dental services for the future.
The GDC itself has been calling for legislative reform for some years, as the current framework continues to limit its ability to deliver functions with efficiency. Successive governments have, however, failed to deliver on substantive reform to the legislation. For too long, regulation reform proposals have focused on other larger regulators such as the
General Medical Council (GMC) and Nursing and Midwifery Council (NMC) with much needed reform to the GDC relegated to an afterthought.
It is time for GDC reform to be placed at the front of the queue. We urge the government to provide timescales for GDC reform and commit to delivering reforms to the professional regulators within this parliamentary term.
Contract reform
As a dental defence organisation, we also believe that better access to NHS dentistry could play an important role in improving the patient experience and thereby reduce the risk of complaints. Contract reform needs to enable dental care professionals to work in different ways and to make the best use of the skill mix within the practice.
The process for contract reform started in 2010 and the length of time this has taken has left dentists disillusioned about the prospect for reform. Fully utilising the skill mix within the dental team could also help to tackle the child oral health crisis.
Dental Protection is keen to support the new government in overhauling these vital policies and making positive progress as swiftly as possible.
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