NHS dentistry: Where we go beyond election day

Local Dental Committee members came together in Brighton this month amidst the worst crisis NHS dentistry has faced in its 75-year history.

When tickets were booked no one expected to be slap bang in the middle of an election campaign, where the future of the service would be a major issue.

Events are fast moving, but I wanted to capture where we are now and where we go next.

Promises on reform

Votes are set to be won and lost on NHS dentistry. It’s set a be a top issue on the doorstep, and now all the major parties have finally set out their stalls.

We’ve set out a vision for a dental service that is fit for the future, and any real progress hinges on a decisive break from a failed NHS contract.

It is disappointing that the Conservatives have pledged little more than a reheat of an inadequate recovery plan. But we have seen opposition parties pick up the baton, and this feels like progress.

There’s almost a clean sweep on contractual reform, with a promise from the Labour Party to meet on the first Monday in office to commence negotiations, should they win the election.

8 July is already in my diary. But there are real unknowns here, and we take nothing for granted.

Meaningful reform needs to go hand in hand with fair funding. We’ve seen multi-billion-pound promises from both the Greens and Lib Dems for the NHS. There is a modest pot of new money from Labour for 700,000 urgent appointments, but pledges on reform – “a shift to focusing on prevention and the retention of NHS dentists” have yet to be priced in and will likely hinge on future negotiations.

Colleagues facing these pressures should send a message to their local candidates and ask them to step up. There is real urgency here, with morale at rock bottom, and levels of clawback that are off the charts.

Getting rid of the UDA is the necessary pre-requisite to get NHS dentistry back on its feet.

Learning from the past

It is fitting that we reflect on the last five years as we prepare to move forward. In late 2019, Brexit was incomplete. Covid was unknown. And dentistry wasn’t on the ballot paper.

We are in a very different place now.

The pandemic was one of the most challenging experiences of our professional lives. And we fought to secure the financial viability of practices. Hundreds of practices that couldn’t work at all were on track to be left with little to no funding and financial ruin.

Our negotiations meant practices were paid very nearly their full contract value. Instead of practices going bust, we forced the Chancellor to dig deep and provide critical support to the sector.

Week in week out, we ensured MPs were speaking out about what this would mean for our practices and the millions we treat. We’ve made those struggles frontpage news.

We are not going to stop here.

When I became Chair of GDPC, there were practices getting paid £17, £16 even £15 per UDA.

Now, no practice in England is paid less than £28. But even in the interim we need more. I remain convinced a £35 minimum is the level of ambition that will start to make a real difference.

And I intend to make that case. Yes, reform is key but we need to show the workforce there’s a light at the end of the tunnel.

Give practice owners confidence that their business has a viable future in the NHS.

Some simple and effective recruitment and retention measures – like commitment payments, late career retention payments, and funded training, clinical audit and peer review are achievable, and at pace.

Without those first steps, we risk fixing the contract after the last NHS dentist has left the building.

The art of the possible

We’ve never lost sight of what needs to change. Reform the contract. Increase the funding. Improve the terms and conditions. And we have a chance of a future for NHS dentistry.

Preet Gill MP, the Shadow Dental minister told BDA conference last month that ”the cavalry is coming”.

We will need deeds to match the words. I honestly don’t know who will be sitting behind the ministerial desk on 8 July, but whoever it is, whatever the colour of their rosette, we will give them the same treatment.

We will hold them to account and demand bold, ambitious, and urgent action.

A reformed contract is achievable. We have the experience of the prototypes to draw on, and we can make rapid progress, if there is political will.

We have a chance to design and plan the implementation of a blended, capitation-based contract. The prevention-focused, patient-centred model of care the Health Committee have asked for.

A solid start would be to introduce capitation for children. It’s straightforward and uncontroversial.

We can then look at a capitation system for continuing care adult patients, with an activity element for those patients with very high needs.

Sessional payments have been proven as a very effective way to deliver urgent care.

Taken together we’ve got a coherent and attractive system within which colleagues could work.

One which starts to expand access, which provides a sustainable footing for the future, where financial payments align to the costs of care.

Next year

When we return for next year’s LDC conference in Newcastle in summer 2025, there is an opportunity for this service to be in a better place than it is today.

I know we have been over-promised and under-delivered many times before.

But we are prepared, fully armed with detailed plans, and ready to grasp the opportunity to make real improvements for this profession and the public.

You have my word that I will – as I have over these many years – continue to seize every chance to fight our corner.

It is an enormous privilege to be able to do that on behalf of you and all our colleagues, and I never forget that.