Why NHS Cinderella service is now so down in the mouth

Jul 10 2008 Agenda

Tim Lee, a founding partner in city centre solicitors Young and Lee, is feeling down in the mouth as he gets his teeth into trying to help prevent the crisis in NHS dentistry getting even worse.

I was at a function recently where they had a charity prize draw, the second prize being 14 days for two on an all-expenses-paid holiday in Hong Kong and first prize a place on the list of an NHS dentist.

Okay it’s a pretty crummy joke, although it might raise a smile were it not too near the mark to count as funny.

There is a crisis in NHS dentistry and unless something happens soon it is set to get a whole lot worse. Don’t take my word for it because even the Government admits there are more than two million people in this country who want NHS dental care but are unable to get it.

It’s estimated that even of those that are with an NHS dentist 20 per cent are going without treatment because of the cost. For those unable to get onto an NHS list the choice is stark – go private and pay a fortune if you can afford it or go without.

In 21st century Britain and more than 10 years into a Labour government, we have stories of people taking their own teeth out because they either cannot find a dentist or cannot afford the treatment.

I spent getting on for half of my time as a lawyer working with dentists and trying to help them deal with the consequence of the major shake-up that took place two years ago when the contractual arrangement for paying NHS dentists got turned on its head.

A decision to change the relationship from that between dentist and Government to one between the dentist and local Primary Care Trusts has turned out to be a disaster.

In the past dentists did work on a piecework basis but then someone decided all that had to change and instead they would be contracted to be paid a sum of money in exchange for so many units of work.

This allocation is based upon work completed during a 12-month period between October 2004 and September 2005.

However, many Primary Care Trusts failed to take into account special circumstances such as where perhaps a dentist had only worked part of the year because of illness or maternity leave.

Even more unbelievable the calculation did not take into account a situation where a practice only opened part way through the year.

The result of this is that many dentists are in dispute with the PCT about their contract and this is where I came in trying to help resolve these issues. It is a problem that will get worse when the second phase of the new contract begins next year.

Unless the contractual issues are resolved the inevitable outcome will be even more people with toothache chasing even fewer NHS dentists.

Dentists are probably not top of the list when it comes to public sympathy but there is a myth and false perception of the profession that needs to be addressed and the record set straight.

When a dentist comes to change his or her car what is the major dilemma they face? They have to decide whether to take the Bentley in silver or black. I am sorry for what is another crummy joke based upon a popular but damaging misconception.

There is a commonly held belief that to be a dentist is to hold a licence to print money and this is simply not true.

Of course, there are some very wealthy dentists, particularly those with a niche private practice in a well heeled area but the general picture is rather different.

We need to have a better understanding of the reality of a job that creates very special pressures.

According to the Government a dentist will earn on average between £70,000 and £80,000 a year which is a decent whack but not exceptional by modern standards. Of course, the problem with averages is that some will earn a lot more than this and many considerably less.

The profession is a very difficult one to get into requiring long and demanding years of study at university before a dentist starts to earn any money at all.

It is difficult work and highly stressful. Research shows that the suicide rate amongst dentists is twice the national average than for other professions and trades.

As a point of interest higher than average levels of suicide are a feature in the medical professions with doctors ranking alongside dentists and worst of all vets who are four times more likely than the national average to take their own lives.

Running a dental practice is also very expensive with high overheads. Staff that include receptionists and dental nurses have to be paid in addition to the cost of the premises. A particularly high cost is that of the tools and equipment.

The dental profession has also been subject to swings and changes in Government thinking that makes planning very difficult. A few years ago there was great emphasis on orthodontics and this was much encouraged but now all of that has changed. As a result professionals who have invested heavily in going down the orthodontic route have found themselves in difficulties.

Dentists that want to sell up can also be in difficulties because contracts are often with individual practitioners and cannot be transferred without the agreement of the local Primary Care Trust.

The behaviour of Primary Care Trusts differs throughout the country and inconsistency is a regular complaint. Generally, the picture is of a shortage of NHS dentists but at the other extreme I am working on behalf of a client that has been badly hit because the local PCT allowed a new practice to open less than half a mile away.

Primary Care Trusts are put under pressure from the Government to keep costs down and in turn this is applied to dentists on the frontline. A result of this can be inferior and cheaper materials used in treatments.

We are seeing a return of false teeth because they are a cheaper option to the more expensive but preferable dental implants. Some dental laboratories are reporting a 50 per cent reduction in dental implants.

Someone once said that there are two phases to very bad toothache, the first in which you are fearful that you are going to die and the second when you reach a stage of being frightened that you are not going to die. It is a thoroughly miserable condition, as people who have suffered will know.

But dentistry is not the sexy end of medicine. Most dentistry is routine, preventative and elective with emergencies thankfully rare. I think this is why Government feels able to treat the profession as a Cinderella service within the NHS.

The crisis within NHS dentistry affects the whole country but is more serious in the West Midlands where there is a stronger tradition of people having their teeth looked after by the NHS. Unless the powers that be wake up to the problem we must brace ourselves for a worsening situation.