Nigel Jones shares his thoughts on the recently released NHS 10-Year Health Plan and its implications for NHS dentistry.
Given the scale of the challenges across the whole of the NHS, it’s no surprise that dentistry warrants relatively little attention in the plan. Indeed, despite its prominence as an election issue, the lack of mention of dentistry in the prime minister’s foreword will be interpreted by many as symbolic of its priority.
References to expanding water fluoridation and supervised toothbrushing as well as fluoride varnish and fissure sealant use support the desire to move towards prevention but detail at this stage is very sadly lacking. Neighbourhood health centres sound good in theory but as I have observed over many years, finding a model that is financially sustainable and scalable is not easy even if a few passionate committed individuals have achieved localised success.
The key challenge facing NHS dentistry is workforce and the availability of clinical hours. Dentists off sick with burnout see fewer patients. Dentists going part time to avoid burnout see fewer patients. Dentists going private to avoid burnout see fewer patients. Dentists retiring early due to burnout see fewer patients. Such issues will not be solved by trapping new dentists into the NHS.
While an expansion in the use of therapists and nurses will help, I doubt it will come close to filling the clinical vacuum being created in large part by a discredited underfunded contract.
‘Another exercise in managing public perception’
We are told that the process of fundamental contract reform will begin this year and it is to be hoped that this latest attempt finds ways to navigate the obstacles that have derailed the many previous attempts to find something that works for patients, the profession and government. References to matching resources to need could simply be reinforcement of a desire to create capacity by avoiding ‘needless’ examinations or may be another hint that a core service is under consideration.
Making more effective use of the available resources makes eminent sense and I’ve seen a therapist led model work very effectively in both private and NHS practices. The challenge will be the speed at which sufficient numbers of therapists can be trained to make inroads to the access restrictions in NHS dentistry.
Although I can understand the concerns about the use of public money, using a tie-in to lock people into the NHS rather than addressing the reasons why it’s increasingly seen as such an unattractive option seems the wrong solution. Questions arise about the potential for NHS dentistry to be increasingly delivered by the least experienced clinicians and the risk of discouraging future applicants to dental schools.
While it’s hard to avoid the feeling this is another exercise in managing public perception of the government’s intent for NHS dentistry, I cling to the hope that detailed work is going on in the background from which will emerge a genuinely sustainable future for NHS dentistry. One that seeks to collaborate rather than collide with private dentistry, to reduce oral health inequality.
This article is sponsored by Practice Plan.
