The Current State of Dentistry

In view of Healthwatch Camden continuing to receive calls from our residents on the lack of available NHS dental appointments, I decided to look into the reasons as to why. Having retired from dentistry 18 months ago, this involved a major catch-up. Research included borrowing journals from former colleagues, attending both a Local Dental Committee meeting and a convention for practice owners, together with speaking to associate (non-practice owner) dentists.

Let’s start with good news. As of 1st July, the Chief Dental Officer (CDO) lifted all restrictions imposed during the pandemic with regards to providing treatment, meaning practices will now be able to fulfil 100% of their NHS contracts. However, although more appointments will become available, with a backlog of two years of treatment needs, waiting lists will still be in place. Compound this with staff absence from being Covid positive, staff fatigue from operating under layers of additional PPE and a general recruitment crisis, it is likely Healthwatch Camden will continue to field enquiries from concerned patients for some time.

Dentists are working with a contract imposed in 2006. A contract described by a Parliamentary Health Select Committee as “not fit for purpose”. The CDO made minor changes to this contract, however these adjustments do not mean more funds to treat patients – but merely relate to the way a practice can claim for treating high needs patients using existing funds. Apathy with the lack of meaningful changes has resulted in many practice owners returning their NHS contract. Regrettably, under current legislation, the funds from these contracts cannot be redistributed to practices wishing to treat more NHS patients. Result: even more patients denied NHS care and having to seek private dentistry.

According to NHS data, the number of dentists providing NHS care in England fell by over 3,000 in the last two years. Many more have significantly reduced the number of days per week they devote to NHS patients. This lack of dentists has left an estimated four million people without access to NHS dental care. Factor in the large numbers of dental nurses, hygienists, therapists, and technicians that have left, either the NHS or the profession completely – we can understand why patients, including in Camden, are reporting problems registering for NHS care.

Patients may well ask why dentists are choosing to leave the NHS. The aforementioned NHS contract is target driven and inflexible. Being finite, it does not allow a successful practice to accept more NHS patients. Instead, once the quota of NHS care under the contract is fulfilled, further patients can only be seen privately. There is a plethora of form filling, using valuable chairside time that clinicians would much prefer to spend with their patients instead. The contract also does not compensate for the huge rises in the cost of running a dental practice. Thus the increase in interest rates, utility bills, laboratory fees for crowns and dentures, staff wages, purchase of clinical materials and PPE, disposal of clinical waste, to name just a few, are not covered by the finite sum of the existing contract. These pressures can render an NHS practice as non-viable, resulting in closure with loss of jobs and NHS appointments. In contrast, private practices are able to increase treatment prices to remain viable.

However, despite all this gloom, Camden dentists are reporting that they are beginning to see new patients on the NHS. Indeed NHS England has requested all practices to regularly update websites to keep patients informed of waiting list times. Patients should continue to contact practices to ascertain willingness to be accepted for NHS treatment.

Healthwatch Camden in conjunction with Camden & Islington Local Dental Committee will continue to press NHS England for a better contract with more localised funding.

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