How has NHS dentistry changed since its inception in 1948? Neil Carmichael explores the evolving landscape of UK dentistry.
While Lord Darzi’s Independent Investigation of the NHS in Enlgand only contained 167 words on dentistry, I think we would all agree this is a disproportionately small number of words compared to the size of the problem in dentistry today.
Yet we must not fall back into thinking that to solve these problems we think as has been done historically. Prior to 1948 and the beginning of the NHS most dentists were single handed, and may or may not have had someone to assist them. Practices in the UK now vary hugely in size, specialities and ownership compared to 1948.
As the public had known the NHS was coming for several years many had waited for treatment rather than pay private fees. The pent-up work meant a rapid expansion in the profession was needed to deliver care, with single handed practitioners taking on associates and assistants to take on some of the work. You could compare this to the situation post pandemic, yet there has been no easy option to expand the workforce to meet demand in the last few years.
Within three years it was realised that ‘free dentistry’ was not an option and patient charges first came in for dentures in 1951 and then other routine care in 1952. This lead to the resignation of Aneurin Bevan in protest of the introduction of charges by the Labour Party. This change in charges played a big part in dentistry continuing to need to run as independent businesses and differentiated from much of the rest of the health service.
Changed beyond compare
The challenge over budget is unchanged, yet the world of dentistry has changed beyond compare. This is not just because of changes within the profession but also the world around us. Simplistically, in 1948 people expected to have teeth extracted and dentures made and the average life expectancy was 68 years.
In 2024 people expect to keep their teeth as well as enhance their smile and with an average life expectancy of 82 years there is a very altered need for the provision of dental care. Care was delivered in single handed practices, as opposed to the models we now have of multi-surgery practices, possibly with specialisation and maybe part of a larger group.
The change from mainly extracting teeth to restoring and keeping teeth worked well for both patients and dentists when payment was fee-for-service. The public could reasonably afford to keep their teeth and avoid extractions. With the introduction of the high-speed turbine in 1957 this meant faster preparation and more comfort for the patient.
Over time the development of techniques, materials and technology means treatment has gone from just what is clinically necessary to what is requested by patients for their aesthetic needs.
A wider dialogue
Dental practices have always needed to embrace technology and equipment changes, it is necessary to function! Arguably, no time more than the present, with huge advances in digital solutions over the last few years, pushing for efficiency, accuracy and sustainability.
One of the biggest changes over time has been the development and growth of the dental team. The skill mix that is now available, with increased scopes of practice, can make such an impact on patient care, especially in regard to prevention. This is so far removed from the dentistry of 1948.
While the above just touches the surface of the changes that have occurred, the main message is that we need to open any reform conversations wide into the profession. Any reform is going to need a wider team to deliver care and the mixed economy in dentistry is here to stay. To not take these key factors and groups within the profession into discussion, and consider only dentist representation, is not representative of how the profession functions today.
In a time where retention and recruitment is challenging and needs to be at the core of any discussion, teams need to feel part of the wider dialogue. Their knowledge and skill set is so beneficial to effective patient care and the sustainability of dentistry.
For more information about the Association of Dental Groups, visit www.theadg.co.uk.
This article is sponsored by the Association of Dental Groups.
