9 Oct 2019  •  NHS Dental Landscape, Options Out Of The NHS  •  8min read

Your dentistry questions answered: dentists’ ability to take control of the future

At a recent major dental exhibition, we gathered a panel of well-known dentists to answer the biggest questions in dentistry today.

As the host of the panel, I had some pre-prepared questions, however the audience was also able to ask the panel anything. There were two questions from the audience that suggested there’s a general feeling that dentists, as a collective of colleagues and organisations within the profession, need to be more courageous to drive change within the NHS.

One of those questions was: ‘Does NHS dentistry exist because of the willingness of dentists to undervalue themselves and a lack of backbone and timidity from dentists and politicians?’

Another audience member said that ‘We’re all disillusioned by the NHS, so why don’t we come out and say it – why doesn’t the BDA and LDC, and other groups, produce bumper stickers that say ‘don’t do NHS dentistry’, and tell dental students the same?…if we all turn around and say ‘don’t be an NHS dentist’, the Government will have to eventually listen.’

Taking those two questions together, it feels like there is an overall question being asked by some: Is the lack of change in NHS dentistry due to inaction within the profession?

Below is how the panel answered:

Eddie Crouch: We all know the facts – there’s less funding from the Treasury, dentists’ pay is falling – that are making it difficult, financially, to run a dental practice. Last year, 160 contracts were handed back, or ‘gifted’ back as the NHS would say.

I don’t think it was a gift, people are struggling so much and you only have to look at corporates selling practices for £1 to see that.

At the LDC Conference last year I put forward a motion to ask if the profession would be prepared to do a CPD day collectively. One day where we could show people what the lack of NHS dentistry would look like.

The BDA sent out a survey asking people about this and only a tiny number were prepared to take action. Sadly, we haven’t got a backbone. I would like to rally the troops and fight back, but I look behind me and there isn’t anyone there.

Taking a day or afternoon off to do something like this might be a hit to the pocket, but look what’s happening. We’ve had a 30% drop in income and patient charges are increasing. We’re already taking a hit in the pocket every day and yet people aren’t prepared to give up one afternoon.

Some of us will say ‘don’t do NHS dentistry’, but we won’t get the volume of people saying it that we need to make a difference.

John Milne: My challenge back to this kind of question would be that the Government decided in 1948 that the best way to tackle health inequality across the whole of the UK was to make healthcare available to all and free at the point of delivery.

I know that dentistry doesn’t do that now. But I would say that within our profession there are many who passionately feel that dental health is still an essential part of healthcare and should be available to the whole of the population on an equitable basis.

So, do dentists undervalue themselves? Yes. Does the Government undervalue dentists? Yes.

What can be done about it? We look to our trade union colleagues to do work on our behalf. There’s nothing wrong with fighting for good conditions for dentists and, equally, it’s absolutely right to work with good opportunities for oral health for the whole of the population. 

Tony Kilcoyne: I’ve always been told: don’t put down to conspiracy what can be explained by incompetence. But there does come a point when you have to question how repeatedly incompetent those in charge can be.

I keep swinging between thinking they are just incompetent or that it actually is a conspiracy because actually the way NHS dentistry is being ran now largely suits the Government’s agenda.

Goodwill is the thing that keeps NHS dentistry going. And so it should. We’re patient-centred, we’re professionals, it’s all about putting patients first.

Is that now being abused? I think a lot of people would say ‘what other conclusion can you come to?’, because there’s only so much that can be explained by incompetence.

The second thing that is propping up the NHS is not just the goodwill of those working within it, but the private sector.

If tomorrow the Government suddenly scrapped private treatment and millions of patients suddenly joined an already over-stretched, funding-capped system then the whole thing would collapse, there would be no care for anybody. It just couldn’t cope, it would break.

The Government has to be more honest with the public that we are in a mixed dental economy.

Should we be more focused on the vulnerable? Yes. Should we look at prevention? Yes, absolutely.

But any Government has got to be more honest with the public and say, ‘we’re putting in half of what’s needed nationally, so we’re going to prioritise and focus the care now’. This would also add clarity to dentists’ contracts so we know what can be done on the NHS and what can’t, realistically.

Those in charge are not delivering the service they promised to the public. And we’re getting the blame and the stress. It’s not our system but we’re making the best of it and propping it up with goodwill and other funding. Goodwill is helping it limp along, but that can only be stretched so far.

It’s time for a fully open and transparent discussion with the public!

The panel debate was a very spirited event, and my thanks to both the panel members and audience delegates for their input.

Twenty-nine years ago, I attended my first BDA conference and even then, dentists were telling me that changes happening at that time amounted to constructive dismissal from the NHS. Listening to exchanges like this brings to mind two things.

One, is just how little seems to have changed in terms of delivering an NHS service that works for patients and dentists. The second is simply the remarkability of the resilience of the profession.

The panel touched on the goodwill of dentists and their adaptability to work within whatever system is imposed upon them. Soon, the reformed contract will begin being rolled out and it remains to be seen how much of the profession will be willing to adapt once again.

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