open wide…
Earlier this week I went to the dentists. Now, in and of itself this is neither interesting nor newsworthy but, with ‘DIY dentistry’ apparently on the rise, it’s something you hear less and less. Over-the-counter kits for remedying lost fillings, caps and crowns are now popping-up in supermarkets and pharmacies, dental cement is being used to glue back missing teeth and tales of in-pain people pulling-out their own peggies are becoming commonplace. How did we get here?
Approximately 90% of dentistry is provided by independent high-street practices, which are contracted to deliver NHS services, of which the government pays 70% and patients 30%. The NHS is meant to provide basic dentistry to all, although since 1951, adults who are not on low-income have contributed to each treatment. However, actually finding an NHS appointment has become increasingly difficult of late: nine in ten NHS dental practices across the whole UK aren’t accepting new adult patients, eight in ten aren’t taking on children and as many as one in five practices recently reported they were on ‘the brink of collapse’.
As with the rest of the NHS, staff shortages are a critical issue. Over 2,000 out of just 24,000 dentists quit the health service in 2022, leaving perhaps four million people without access to NHS care. Brexit, together with the Covid pandemic, have also had a significant impact on staffing levels as many foreign and European staff returned home. However, the malaise goes back way further than this and not even I can solely blame the tory government of the last thirteen years. The current problems can be traced back to a new contract system brought in seventeen years ago by Tony Blair’s Labour government.
Before 2006, dentists were paid for each and every piece of work they did, but the reforms of that year changed this into a ‘block contract’ committing them to perform a certain number of ‘units of dental activity’ and for which they were paid a negotiated fee. Surprisingly, the amount of ‘units’ allowed is capped and the British Dental Association describe subsequent funding as both insufficient and unfairly structured as it does not take account of time, complexity and multiple units in individual cases. Furthermore, fail to complete over 96% of those units and they have to give back some of the cash. It is estimated by the body that the current funding level is sufficient for only 50% of the population’s need.
Successive governments have recognised that the current system is both inadequate and untenable but precious little has been changed. Our previous Health Secretary, the overweight and chain-smoking Therese Coffey, who held the position for exactly 49 days, included dentistry on her “ABCD” list of priorities – ambulances, backlogs, care, doctors & dentists – and promised to reform the contract. Sadly, not a lot has been heard from her welcome replacement and it would appear dentistry remains the poor relation of the NHS. With the lowest per capita ratios of dentists in Europe: 54 per 100,000 people compared to 65 in France and 82 in Germany, there appears to be little ground for optimism. Reform and considerable investment is necessary but if nothing else, a return to the previous system would be an initial step in the right direction. In the meantime, keep brushing and start flossing.
