Is dentistry at the back of the queue for reform?

All of the healthcare professions are crying out for regulatory reform, says Kevin Lewis – when will it be dentistry’s turn?

In making such a big show of having accepted in full the pay recommendations of the NHS Pay Review Body (NHSPRB), the Review Body on Doctors and Dentists Remuneration (DDRB), and the Senior Salaries Review Body (SSRB), Wes Streeting unwittingly lit the blue touch paper on simmering discontent amongst key health workers.

Stressing that he ‘hugely appreciates’ the work of so many talented staff across the NHS, he added that accepting these recommendations ‘gives them the pay rise they deserve’. Oh dear.

The evidence of the relevant trade unions for the various impacted health professionals was that these NHS staff deserved a whole lot more than they have been given, in part to address longstanding pay erosion.

Of course, successive governments are keen to draw a line under historical deficits and underpayments, especially when they can lay the blame at the door of a previous administration.

Pay disputes

Wes Streeting and other ministers took a lot of criticism last year for throwing significant sums of money at the various industrial disputes that they inherited without asking for or negotiating anything in return – at a time when the incoming chancellor later claimed not to have fully realised the dimensions of the much-quoted ‘black hole’.

Yet even then, what Wes hoped would be seen as a grand and popular gesture was a long way off being enough anyway. For resident medics (aka ‘juniors’) the BMA put him on notice that his offer ‘moves us about a third of the way in our journey to full pay restoration (our pay erosion would go from 31.7% at its peak to 20.8%)’.

‘As a general rule, the moral high ground is rarely to be found in the bargain basement’

So the prospect of more industrial action this year moves ever closer, now that it is clear that the pay restoration ‘journey’ is back on hold. Nor are the consultants happy. Overall the BMA claims that pay levels are, in real terms, 25% lower today that the level they stood at 16 years ago.

This appears at first sight to be a tempting open goal for the Labour government to lay at the door of 14 years of Tory and coalition governments, but Wes knows that slotting that ball into the net would require a trip into the depth of his own pockets (and those of Rachel from accounts) which neither
would relish.

As a general rule, the moral high ground is rarely to be found in the bargain basement.

‘Grotesque’ pay awards

The nurses took great offence at their award (3.6%) which was lower in percentage terms than the 4% for doctors and dentists. In monetary terms it was ‘insultingly low’ and even ‘grotesque’ they argue – and on a point of principle alone it was clumsy and short-sighted. Presentationally, it was very poor.

And for GDPs it’s the same old story, with the GDPC and the BDA rightly emphasising the missing operating cost side of the funding equation, details of which have yet to appear in order to make the final arithmetic possible.

The picture that circulated at the time of the recent British Dental Conference & Dentistry Show at the NEC was a timely metaphor, featuring as it did a forlorn, empty and unattended stand with Department of Health and Social Care signage. They obviously had other priorities that day. A pity, because if ever there is an opportunity to soak up the scale of the exhibitors’ stands and the huge investment that dentists make in delivering care, this was surely it. But for now we are at the back of what promises to be a long and feisty queue.

Regulatory reforms

There are 10 statutory bodies that regulate the various healthcare professions in the UK, the GDC being one of them. These regulators are in turn overseen by their own regulator, the Professional Standards Authority (PSA).

Regulatory reforms have been variously discussed, threatened and promised over many years. We have had plenty of consultations and a plethora of pleas from various regulators to give them the new statutory powers that they believe could allow them to do their job better.

‘To spot where dentistry sits at the back of this queue, might I suggest borrowing the Hubble Telescope for the weekend?’

But getting the parliamentary time to achieve that is seemingly a forlorn hope which keeps getting kicked into the long grass – unless it suits and facilitates the government’s agenda of course. Most of the time this procrastination allows regulators to blame the lack of these reforms for anything and everything that they are screwing up.

The government’s plans for the NHS are increasingly thwarted by blocks in the system. So given all the noise in the NHS and the workforce crisis, it came as no surprise a couple of weeks ago when the government announced that they were about to burst into action – but approaching this task in stages, beginning with the GMC, the Nursing and Midwifery Council and the Health and Care Professions Council. To spot where dentistry sits at the back of this queue, might I suggest borrowing the Hubble Telescope for the weekend?

GDC response

The General Dental Council’s response was direct but non-confrontive but makes a masterly attempt to cover its derriere in areas where it knows it is falling badly short. Its press release stated: ‘We have been calling for comprehensive reform for some years now to unlock the prescriptive and outdated legislation under which we currently operate.

‘Our legislative framework continues to limit our ability to deliver our statutory functions more effectively and efficiency.

‘We have welcomed the intent to introduce a flexible framework, and the template for reform is taking shape, but more work is needed to develop legislation that will work for all health and care professional regulators, including the GDC.

‘The proposed template does not yet give an indication of the approach policy makers will take on issues specific to dentistry, and more thought is needed on proposed legislation that will assure regulators that professionals continue to keep their knowledge and skills up to date.

‘The timetable for full scale reform remains uncertain, but it is at least several years away.’

In fairness, the GDC is not alone in being a bit economical with the truth. Wes Streeting’s statement which accompanied the NHS pay announcement sought to reassure those who didn’t know the full story, implying that a new dental contract was about to be implemented, reversing the exodus from the provision of NHS dental services. Good luck with that one, Wes.

The golden invite

There was a time when foreign leaders were flattered and thrilled to be pictured in the oval office with the US president, this being a formal recognition of a place at or near the front of the queue for the US president’s affections.

That all changed with the ritual humiliation of President Zelensky and the shameful choreography of that occasion. The massed ranks of the navy-suited, white-shirted, red-tied and red-necked gospel choir of presidential aides were placed directly in Zelensky’s eyeline, with the presidential attack dog JD Vance snarling close at hand.

Suddenly the oval office became a venue to avoid at all costs and let’s face it, not every visiting world leader has the trump card (see what I did there?) in his inside jacket pocket in the shape of an invite from HM King for a much-coveted state visit to the UK. As flak jackets go it was thin – but highly effective.

It wasn’t wholly edifying to witness our PM so visibly excited as he prepared for the big reveal. At one stage he looked like he was on the point of wetting himself but mercifully we were spared that.

‘Most world leaders – the sane ones anyway – have concluded that the risk-benefit ratio for a meeting in the oval office is so unfavourable that it’s no longer worth considering. There is no queue, anywhere in the world, that they would prefer to be at the very back of’

Truth vs agenda

President of South Africa Cyril Ramaphosa was plucky enough to visit the Oval Office in mid-May, as it happens on the day the NHS pay results were announced here. This time the oval office furniture had been shuffled to include a large plasma screen which was a fair clue that another mugging had been planned for.

There was a curious interlude of Trump holding up grainy copies of social media feeds and declaring in turn ‘death’, ‘nasty death’, ‘not very nice death’, ‘horrible death’ and so on.

Clearly a devotee of the evidence base, Ramaphosa cutely asked Trump where all this genocide had taken place. South Africa – your country – came Trump’s reply. In Trumpland (and especially in his presidential office) the truth is not the same thing as the agenda – the truth is whatever Trump declares to be the truth at any moment in time.

Most world leaders – the sane ones anyway – have concluded that the risk-benefit ratio for a meeting in the oval office is so unfavourable that it’s no longer worth considering. There is no queue, anywhere in the world, that they would prefer to be at the very back of.

The fickleness and self-serving nature of politics generally (and world politics in particular) was beautifully captured by Boris Johnson when he wrote: ‘We were told by President Obama that in respect of international trade, we would have to get to the back of the queue – not a position that America normally requires the United Kingdom to be in when it comes to other matters, such as the Iraq War.’