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Waiting for NHS dentistry to collapse? Dentists highlight crisis to the pay review body

Blog Author Eddie Crouch

Blog Date 23/04/2018

​The BBC's Today programme this week highlighted that GPs are fearing medical and financial collapse and are handing contracts back.

 

Existing practices are struggling to deal with increased caseloads, patients are waiting for weeks to see a GP and it's looking likely that some patients will not be able to find a GP to register with. And one GP even said that the access problems are now similar to those seen in dentistry

We've all known for some time that dentistry is facing the same crisis – with the race to the bottom to commission dentistry at unsustainable prices. 


How can dentists' pay be improved?

One of the most important things the British Dental Association (BDA) does each year is to submit evidence to the Doctors and Dentists Review Body (DDRB), which makes recommendations on NHS pay uplifts.

 

As part of that process, we give oral evidence to the DDRB, which is made up of an appointed group of economists, academics, former NHS senior managers and HR specialists. 

That happened recently and as the chair of the BDA committee that collates in-depth evidence to the review body, it's my job to lead that delegation, which includes the BDA chairs from all four countries in the UK, along with back-up from senior BDA staff, experts in NHS and dental policy.

Each year we provide the DDRB with substantial evidence of the difficulties we face across dentistry, and – year after year – we have been frustrated by their reluctance, or maybe refusal, to listen to what we have to say. 

They might be unable, given the constraints that governments (if not the Treasury) have placed on them, but they definitely show a history of being unwilling.

We're hoping that this year will be different, given that the public sector pay cap seems to have been eased at last.

 

Highlighting the situation of dentists on the ground

Once more, we didn't hold back and I told them in my opening remarks that we were extremely unhappy about the unacceptable delays in processing the evidence for the DDRB. 

To say that we were annoyed about the delay in being called to give evidence after a new financial year had started would be an understatement.

In the normal course of events, the timetable for this would be to submit our written evidence in September, and this would be followed up by any questions the DDRB might have, usually in November. 

I pointed out that although we had chosen to engage in the DDRB process this time around, this was only after considerable debate by the respective committees across the UK. A motion passed at last year's Annual Conference of Local Dental Committees voted to withdraw from this, if the public sector pay cap remained in place - demonstrating the levels of frustration amongst practitioners.

We expressed our anger at the disconnect between the evidence we submitted on the difficulties in recruiting and retaining NHS dentists, and the evidence submitted from the departments around the UK, particularly by NHS England and the Department of Health and Social Care. 

In effect, they said there are no known recruitment issues, and quoted the gross numbers of dentists, ignoring the fact that increasing numbers are working part-time.


We pointed out that we shouldn't have to wait until NHS dentistry collapses before the funds are found (as appears to be the case elsewhere in the NHS) to invest in the nation's oral health.

 

Rising dental patient charges

There are huge inequities between the steep rises in dental patient charges – a 15% increase in charges in England in the last three years – and the fact that 330 practices are being paid less per UDA than the patient charge.


If patient charges are not going to be reinvested in dentistry – and it seems that it is unlikely they will be – is it surprising that more dentists are wondering why they should remain in the NHS when the books just don't add up?

 

A flawed dental contract

In no uncertain terms, we told them how dentists were still struggling to work with the wretched contract that was implemented 12 years ago.

 

I personally gave evidence about the massive rise in the numbers of dentists who I know are unable to fulfil their targets, and how clawback jumped from £55 million to £81 million in one year in England, while in Wales, it had doubled in one year to £6.6 million.

 

Practices are struggling to hit targets and also feel that they are not being given enough time to treat patients to the best of their abilities. 

 

We highlighted the great uncertainty in Scotland after the publication of an ambitious Oral Health Improvement Plan that hasn't been costed and is lacking detail. 

 

We pointed out that the salaried service in Northern Ireland still suffers from a political impasse on a contract that should have been implemented in 2016.

 

We left it in no doubt that the viability of NHS dentistry is under threat as we've never seen before.

 

We told them that contracts are being handed back in many areas in England and Wales, and that even one of the major corporates is offloading practices and contracts that even it cannot make profitable 

 

We asked the panel why they thought a practice with a £1.4 million contract chose to give it up in Northumberland recently.

 

The massive cost incurred in procuring NHS dentistry is a false economy – and the money that NHS England spends on chasing contracts from the lowest bidder is failing taxpayers, and frankly driving dentists out of business.

 

We see this in the current orthodontic procurement, where the contractor is seeking bidders at values lower than those paid 12 years ago.

 

Nothing the DDRB will do will replace that fall in income: this race to the bottom will see contracts fail as they have done so spectacularly this year in construction.

 

What happens next?

I'm not holding out much hope that the DDRB recommendations will do much to stop the slide into crisis that is evident everywhere in the delivery of dental services, but the review body seemed to be more receptive this time around.

Of course, the proof of this pudding will be in how much is eaten up by the next pay uplift – which we'll know by summer, assuming this isn't delayed again, and then more time lost on backdating.


We think that both practitioners and patients deserve that. We will keep you updated on developments. 

Eddie Crouch, Vice Chair

BDA Principal Executive Committee


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