1 Nov 2018  •  Blog, NHS  •  7min read By  • Stephen Hudson

‘NHS dentistry is done, it’s just waiting for someone to turn off the life support’

That’s quite a bold statement, but judging from the results of the latest NHS Confidence Monitor survey* it could be one that many can understand – if not, concur with. It came from Stephen Hudson, a dentist who left the NHS and author of ‘The Stressed Dentist’s Guide to Dental Law’.

I interviewed Stephen to find out his experience of practising dentistry and his thoughts on what the survey results suggest about the state of the profession today. You can access the full results here, but to give you an insights into what they reveal – NHS respondents to the survey reported feeling unhappy in relation to seven aspects of their work such as remuneration, work/life balance and job satisfaction, compared to private dentists who felt much happier in these areas.

All dentists, whether NHS or private, reported some level of anxiety around the risk of complaints and litigation – although the latter were much less anxious. The vast majority of NHS respondents said they don’t see themselves operating in the NHS within five years’ time, with almost a quarter of those planning to leave the profession entirely.

Within that context, it is perhaps unsurprising that a practising dentist like Stephen, who is also qualified in dental law and ethics, feels the way they do. Read the full interview with Stephen below…

Zoe Close (ZC): How do these results marry up with your own experience of practising dentistry?

Stephen Hudson (SH): I left the NHS because I saw no future in it. Every month it seemed like the goalposts were being moved to make it harder to meet the targets, and every year it became more of a chore to do the UDA’s, meaning less was being spent doing private treatment. Whilst I never missed a target, it became less about treating the patients and more about keeping bureaucrats happy…it was almost as if things were being designed that way.

ZC: An average of 86% of NHS dentists said they were unhappy or very unhappy about all seven aspects of working life we asked them about, while an average of 83% of private dentists said they were happy or very happy. What are your thoughts on this discrepancy?

SH: In my opinion, private practice has much more control over the delivery of care. They also have more freedoms:

  • You can charge what you are worth, not what the Government says you are worth
  • You don’t have to worry about NHS diktats and rules that are constantly changing
  • You have full control over who becomes YOUR patient, safe in the knowledge that you won’t fall foul of some obscure NHS regulation you never even knew about
  • You can spend as long as you need building rapport with patients and charge accordingly if you feel like it. Market forces apply to your business so you can thrive and succeed on your own merits
  • Because you can spend the time to create great relationships with patients, you can build loyalty and a reputation untainted by the NHS brand
  • Too many dentists working under an NHS contract feel they have to let themselves be walked over for fear of upsetting the Local Area Team.
ZC: What kind of future do you see for NHS dentistry, given that the survey showed that 86% of the NHS dentists don’t see themselves in the NHS within five years and, of those, 24% are intending to leave the profession altogether?

SH: There is no future. NHS dentistry is done, it’s just waiting for someone to turn off the life support. Anyone who thinks that any new system will be fit for purpose is in cloud cuckoo land. The only way for NHS dentistry to survive is with a core service or a massive influx of government money. And neither of those is going to happen. The NHS will continue to be underfunded, and will continue its death spiral as more and more clinicians jump ship. EVERY dentist working under an NHS contract (in both primary and community services) needs to be making plans to leave for the private sector. Those who plan will likely make the transition without too much problem.

ZC: What, if anything, do you think can be done to change this?

SH: The only saving grace would be a LOT more money from the Government or the implementation of a core service.  Neither are likely to happen.

ZC: The majority of dentists whether private or NHS reported some level of anxiety about the risk of complaints/litigation – what are your thoughts on that?

SH: Where do I start? Dentists across the country really need to start getting to grips with how to work in this litigious and regulatory environment because there are still too many that haven’t adapted. That means full consent and building rapport with patients. I no longer believe that dentists should treat anyone who comes knocking at their door, dentists now need to be selective (not in a way that discriminates) about who they allow to become members of their dental practice. Dentists need to learn to say no more often, and listen to the little voice that often warns them about a patient’s unsuitability. At the same time, we need to tighten up the environment we see patients in. Practices need proper systems and patients need to understand, from the beginning, what the rules are.

ZC: What do you think that organisations like the BDA and GDC can do to improve dentists’ worries about complaints and litigation?

SH: I don’t see the BDA being able to do anything more than they already are…and as I’m not a member, I’m not even sure what that is. The GDC need to concentrate on the core of what they are there for. Dragging a dentist over the coals because he ‘bounced balls of putty in the corridor’ or ‘couldn’t keep his hair out of his face’ just embarrasses an organisation that’s lost its way. I think the main change the GDC need to make is in the quality assurance of the Expert Witnesses they use.  In the past, too many of them allowed ego and bias to infect their reporting. If an expert is constantly being criticised by the Professional Conduct Committee panel, maybe the GDC should think about no longer using him/her because, ultimately, such sub-optimal expert witness work embarrasses the GDC.

ZC: What are your thoughts on what these statistics say about practising dentistry today?

SH: The profession, as a whole, are scared. And the pendulum will have to swing further towards them before things get better. The key to surviving today is to treat patients that you like and respect, work within your competency and spend the time you need to get consent, rapport and to do the job properly. I’m afraid that these can’t consistently be done under an NHS contract, even at the higher UDA rates.  All the lawyers and the GDC have done is speed up the demise of NHS dentistry as more and more clinicians leave either the profession or the NHS aspect of it. Ultimately it is the patients who are the losers through higher fees and fewer dentists

*The NHS Confidence Monitor survey was conducted for the sixth time between May and July 2018 and was filled in by almost 500 NHS and private dentists.

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