Our case to the pay review body made it clear that NHS Dentistry must remain viable - not only as a career for dentists, but for crucial patient access.
Our team represented voices across the profession when presenting oral evidence to the Review Body on Doctors and Dentists Remuneration (DDRB)
Each year, we submit evidence to the Review Body on Doctors and Dentists Remuneration (DDRB), and we make the case for what dentistry needs to thrive.
Our team, which represents dentists of all types from all over the country, made a clear case for dentists and dentistry.
We asked for a 5% pay increase to go towards addressing the real terms decrease over the last eight years and support dentists in their efforts to address the increasing oral health inequalities in our nation.
We do not think this is too much to ask, even in these difficult financial times, and here is why:
1. Dentistry has stepped up
The last 14 months has been a challenging time for everyone. I paid tribute to all our colleagues, for the extraordinary way dentistry has continued to work to care for patients across the NHS.
“We called on the UK Health Departments and NHS England to finally recognise the key role dentistry plays in ensuring good oral health, and to appropriately fund it.”
I outlined the inspiring stories of practices pulling out all the stops to see as many patients as they can under difficult restrictions. That we have also seen colleagues stepping up and being redeployed, in Nightingale Hospitals, in dental hubs, in Urgent Dental Care Centres, in Test and Trace, intensive care units and even in vaccination centres. Their work was, and continues to be, inspirational and they deserve our thanks.
But the impact of the pandemic on us as a profession, and on us as 'real' people – our personal lives, our families, and friends - is huge and needs to be acknowledged.
We called on the UK Health Departments and NHS England to finally recognise the key role dentistry plays in ensuring good oral health, and to appropriately fund it.
2. What is a dentist worth?
What is a dentist worth? Perhaps we should ask what is the value of dentistry? Why have we asked for a recommendation of a 5% pay increase after expenses for dentists in the GDS and the CDS, at a time when we know Government is having to make tough choices?
I gave the DDRB an example.
We provided some supplemental evidence from Northern Ireland which showed that between 2011/12 and 2018/19 Health Service earnings per clinical day increased overall by 5%. Over the same period DDRB recommendations amounted to 9.9% (almost twice the actual increase), CPI rose by 13.8% and RPI by 21.5%.
In real terms this amounted to a decline in average earnings per day for a dentist in the GDS of 11.4% - a pay decrease.
A similar picture is described in all the regions of the UK. Overall, GDPs' earnings fell by 35.6% since 2008/09 in real terms and by 41.2% since 2006/07.
“At a time when... NHS workers across the board are exhausted and many are thinking of leaving, it is important that the dental profession is valued.”
What are dentists in Scotland to think when their Government tries to tie their hands by capping any implementation of an uplift to £800 in total for the year?
So, although to some 5% might sound a lot, it is actually only to address the fall in income over the last eight years and provide a modest uplift for 2021/22 to keep our earnings in line with inflation.
At a time when we are hearing NHS workers across the board are exhausted and many are thinking of leaving, it is important that the dental profession is valued. We need to show younger dentists entering the profession that the NHS is an attractive career – one in which they will be invested in and recognised for the important work they do.
3. What is a dental patient worth?
For us, our patients are the key, so it is really about what our patients are worth.
In our written evidence we have shown the gross spend on primary dental care in both the GDS and CDS has fallen dramatically between 2005/06 and 2018/19. Moreover, in England in 2019/20 over £139m was pulled out of the GDS through clawback while fixed costs for practices continued to rise - because of the failures of the current contractual arrangements.
In Wales we have shown that since 2016/17 the percentage of the primary care budget spent on dentistry has decreased; that over the same period the amount spent per head of the population has flatlined and so decreased in real terms.
Where in Northern Ireland, underspends in the annual dental budget are handed back and lost from dentistry.
What about those patients our community dentists are caring for? Those patients who warrant just the same five paragraphs for the last four years in the DHSC written evidence, two paragraphs in the NHS England evidence, and nothing at all in the Northern Ireland evidence.
How does the NHS value them? If the written evidence is anything to go by, I would suggest neither the patients nor the dentists are valued very highly.
NHS England say they are not aware of any difficulties in filling vacant posts in the CDS, yet we have described a large decrease in the headcount over the last twelve years in a service which needs dentists now to meet the huge backlog of treatment due to the pandemic on top of the challenging and complex ongoing care which this cohort of patients requires.
4. Where do we go from here?
We believe a 5% pay increase will go towards addressing the real terms decrease over the last eight years and support dentists in their efforts to address the increasing oral health inequalities in our nation.
Concerningly, uplifts have been delayed and dentists are left in limbo, waiting for news, knowing they have been consigned to the bottom of the pile.
We want a reinstatement of commitment payments in England, Wales and Northern Ireland. We also want the prior approval limit to be raised in Northern Ireland, so our patients can get the treatment they need.
We want pay parity between our clinical academics and their NHS colleagues.
This was a united effort, comprising a team of voices representing our profession. Myself, the Chairs of the BDA's Young Dentist Committee; England Community Dental Services Committee; General Dental Practice Committee; Scottish Dental Practice Committee; Welsh General Dental Practice Committee and Northern Ireland Dental Practice Committee, spoke to the Review Body members to ensure your voices and experiences were represented. Now the government must recognise the fundamental role that we play.
Now is the time to give dentistry the credit it deserves and to show that we are valued. We need it for dentists, and for our patients, before it is too late.
Peter Crooks, Vice Chair