Nigel Jones talks to dentist John Renshaw, a high-profile figure in the dental profession with a forty-year interest in dental affairs and a broad knowledge of the NHS.
With John’s unique insights into the NHS landscape, due to first-hand experience in working under an NHS contract and as previous Chairman of the BDA, Nigel asks what his thoughts are on the current state of NHS dentistry and the pandemic being a catalyst for change.
Nigel: The pandemic has transformed all our lives in the last six or seven months. What’s your take on the impact that it’s had on NHS dentistry?
John: A little short of catastrophic. I see colleagues struggling on a daily basis to work out how on earth they can work within the NHS system as it stands.
I know the money has continued to come in throughout the pandemic and the requirement to provide 20% of the total UDA allocation is not asking too much now that things are a little bit more settled.
The worry I have is where this is taking us in the longer term because the opportunity for change can go two ways. COVID-19 can be seen as an opportunity to provide a better NHS or it can be seen as an opportunity to reduce it, change it or destroy it completely. That’s what politicians do and they’re doing it without a great deal of forethought.
The infection control issues have caused problems, not the virus itself, as far as dentists are concerned. I think that we are living in a shadowy world where things are ticking on respectably, but you know that at some point, there will be an end to the supply of financial support.
I worry because I see a lot of common features about this situation. We’ve had similar situations before, not with pandemics, but with other significant changes such as changes in government or the profession etc.
Nigel: I’ve heard ‘core service’ used as a term in relation to target patient groups, but I’ve also heard it in terms of types of treatment that might be available from the NHS. How might you see that unfolding?
John: The core service is based around whatever treatments are available. We already have a core service because not all treatments are available on the NHS, and never have been.
From the Government’s point of view, they might be more inclined to go down core service treatments pathway because it already exists. They could actually start eliminating treatments a little at a time and reducing what’s available as a core service.
If you look at core patients as opposed to core treatments, you have a similar situation because we already have core patients as far as payments are concerned. People with certain factors such as age, state of pregnancy etc., may not have to pay.
It’s not a stretch to imagine that in the future, only people who are financially distressed, retired or have certain medical factors would be allowed to access the service. The service would still be around but instead of getting a reduced price on a charge basis, patients would have to pay the whole price.
Nigel: What do you feel that means for the private sector moving forwards?
John: You see the advance of alternative private treatments being made available over the decades in the form of mixed practices. But you can see that the way to get a private practice off the ground properly is not to be doing the extras and the add-ons, it’s to be doing the whole thing privately and get people away from the NHS all together.
When I converted in 2006 and went fully private, at that stage I was still doing 50% turnover in the NHS. I went the whole way and said, ‘That’s it. I’ve finished with you now. I’m sick and tired of working with this lot.’
I went fully private and my gross turnover went up.
Now, that’s not to say the drop off in the number of patients was not insignificant at the time and I didn’t have any strange ideas about my popularity as an individual or dentist. I did lose some patients but my gross turnover went up anyway. I was a lot happier getting away from the NHS.
It isn’t necessarily an issue of wanting to move lock, stock, and barrel out of the NHS sector. If the NHS decides to water down its product so that the dentists find themselves doing less for less money, eventually, whether they like it or not, dentists and practices will need an alternative source of revenue because they won’t be able to sustain a practice full time.
That is a real, real long-term worry for many people, particularly if you live in an area where there doesn’t appear to be much in the way of an income base that would potentially support a fully private practice. It seems like a big stretch in many places.
Nigel: You mentioned the watering down of the NHS – I think we’ve seen that happening proportionately over a long period of time. With your company, Oral Care Consulting, you help a lot with contractual matters for individual dentists. So that gives you a bit of an insight into how the contracts work. What’s your take on that whole area?
John: When I first started getting really involved, the NHS was paying 2.6% of its gross turnover for the year into dentistry. By the time I left, it was below 1% and now it’s worse.
The actual numbers have probably gone up because the service has expanded but the percentage of NHS funding dedicated to dentistry has shrunk.
At the same time, we’ve got the NHS throwing its weight around on regulations and how things have to be done to meet requirements.
Then there’s the issue of the independent contractor status, I’m on record many times over saying I know thousands of practices that could never describe themselves as independent because they are completely dependent on NHS funding.
Take the NHS funding away and those practices are dead in the water. They have no chance. Now, that’s not a derogatory statement – it’s simply a fact of life. Somebody who tells me that they’re doing 97% NHS turnover, to me, that doesn’t equate to any kind of independence at all.
Nigel: How did you find working with the NHS itself, in terms of the people who run it?
John: I’ve seen it so many times where the people who are managing the NHS see the people who are delivering the service as the enemy.
There feels like there’s an assumption that you’re talking up the statistics and trying to fool them into giving you more money. Whereas, in fact, we’re getting really desperate and need to make a bid for some extra capital. The last thing we want to do, because we know what a painful process it is when asking the NHS to come up with more money. It goes on all the time, this hatred between the management team and the delivery team. It’s terrifying.
That’s what I dislike most about the NHS and in the end why I decided to leave. Moving completely away from it into the private sector was almost like having a very heavy, dark cloud lifted off my shoulders.
Nigel: Thank you very much, John. It’s been fascinating getting your insights into the NHS and on how the future might pan out.
Watch the full interview where John and Nigel discuss the importance of the CDO’s role, the relationship between the NHS and the NHS dentists, and how John feels the past is repeating itself.
Nigel was speaking to John as part of our ‘Inside Out: NHS Dentistry Discussed’ series.