Once again, Practice Plan’s Dental Business Theatre saw key industry figures debating the most important issues in dentistry under the heading ‘Dentistry’s biggest questions answered’. The session that garnered the biggest audience was ‘Is there a future for NHS dentistry’ hosted by Practice Plan’s Creative Director, Les Jones. Here we share some of the views expressed by NHS dentist and Head of Indemnity at the BDA, Len D’Cruz.
Les Jones: Looking at NHS dentistry at the moment with the number of NHS dentists leaving and becoming private showing no signs of slowing down, as well as people leaving the profession post- pandemic, are we at the point where the future of NHS dentistry as we know it, is almost beyond the government’s control? Have we reached that tipping point where it can’t be recovered?
Len D’Cruz: I’m a strong advocate of the NHS. I still believe in it but my patience has been tested. We were in the pilot scheme for 10 years and last year NHS England pulled the plug on us. So, we’re back doing the UDAs. So, I have issues about the NHS but I also have issues about trying to run the practice as well. Workforce is the major issue and that’s in relation to dentists, nurses and the whole dental team.
Young dentists don’t want to work in the NHS. I’ve advertised for a dentist in my practice and as soon as I say there’s an NHS component, they either say they don’t want to come and work for me, or they ask for the NHS element to be reduced as they want to do more private work.
People of my age will stick with the NHS but there is no connection between young dentists and the NHS anymore. What they want, quite rightly, is to do the best dentistry they possibly can and they see no future doing so in the NHS. I also struggle to get dental nurses. People can blame all sorts of things, including Brexit. But the truth is we don’t have the workforce and nobody wants to work in the NHS or in dentistry per se.
However, even if dentists keep leaving and we end up with fewer NHS dentists, the service still has to deliver good quality dentistry. What we can’t do is have a two-tier service where people unable to afford to pay for dentistry get a substandard service. We need to have a quality service.
LJ: Is providing a quality service achievable as an NHS dentist in the current economic climate?
LDC: Good point. Rising costs is something else that makes NHS dentistry challenging. If my practice were fully NHS, I would not be able to afford to run it anymore. All the overheads have gone up, including salaries. I have had to pay my staff two lots of 10% increases which I could not afford on the NHS. The income from my private dentistry has subsidised our NHS work. And it’s fortunate I’m able to do that because I have fantastic staff but I wouldn’t be able to do that if I were a purely NHS practice.
Purely NHS practices are suffering badly because they don’t have any more income. In the last 10 years, these practices will have seen around a 34% decrease in income. So, in answer to the question, do I think NHS dentistry has reached a stage where it can’t recover? I think we probably are just at that tipping point. But it’s because dentists and dental staff don’t want to work in the system anymore. Yes, we probably have reached that tipping point.
LJ: Thanks for sharing your views, Len.
Len D’Cruz is a general dental practitioner, foundation trainer and practice owner and Head of BDA Indemnity. He has more than 20 years’ experience as a dento-legal advisor supporting dentists with complaints, clinical and regulatory issues and clinical negligence claims. He is lead lecturer at the University of Bedfordshire teaching on the MA in Dental Law and Ethics. He has authored and co-authored two books: “Understanding NHS dentistry” and “Legal aspects of general dental practice” (Churchill Livingstone) and has contributed legal and ethical content to a number of textbooks, journals and websites.