Asked for Dental NHS Scale and Polish.Told "Go to Hygienist at £25 extra"

Billieblob

Supplemental, and on reflection to my previous post, Fork86, the goal posts are changing only to the new contract, and not in the light of new evidence. What happens to patients who aren't able to bring their plaque levels down to less than 20%? It is my understanding of the nGDS contract that a patient cannot be refused treatment on the grounds of their oral health status. How does your new practice policy conform with this?

boozercruiser

brighthair wrote: »

I'm quite shocked by that. I can't really afford my dentist appointment this time, but I am still going, because I only get one set, and I'd like problems spotted early on so I can have them sorted out. I joke with him about how much I pay despite the fact I have really good teeth, but it's worth it

It is obviously right for you to opt to further your dental treatment by seeing the Hygienist for the reasons that you give. Good for you.

What do your mates call you....... Pearly?:D

Yours are not the circumstance I am b!!!!ing about here.

Perhaps your Dentist will take you for a ride in his Porche?:rotfl:

boozercruiser

Thought some may be interested in this article on the Taxpayers Alliance Website... http://www.taxpayersalliance.com/grassroots/2011/04/costs-dental-regulations.html

The costs of new dental regulations
Peter Lawrence • Grassroots • Friday 01 April 2011

Andrew Lansley’s health reforms have proved to be a big source of debate. One area of healthcare that has been subjected to the full force of the reforms is primary dental care – and they will have adverse financial affects on every dental practice in England, taxpayers and the 25 million patients in England who use this service every year.
Alongside ring-fencing healthcare spending, the Secretary of State has said that efficiency savings of £20billion must be found – but at the same time Andrew Lansley has forced through regulatory and bureaucratic changes to the way dental practices are run. This will cost at least £391 million to fully implement with yearly running costs of £280 million according to estimates published by Denplan, the largest dental payment plan specialist.
Another inefficient regulator?

In England the health regulator in this area is the Care Quality Commission (CQC). In Wales, it’s the Healthcare Inspectorate Wales. But there is a big disparity in the fees charged for regulation. In Wales the current fee that a private dentist pays to the regulator is £50 a year, but in England the CQC will charge sixteen times more: £800 a year. This is a stark difference in bureaucracy and regulation. The English have a bloated, inefficient regulatory system. The Welsh, meanwhile, spend far less on regulation and this helps offset the cost of free prescriptions and hospital parking. We hear so much about cutting red tape, but the Government must follow through on this in England.
The Department of Health (DoH) in England gives two main reasons for expanding regulation and imposing a second major regulator on dental practices. Firstly, they suggest that more regulation will reduce the risks of cross infection, but they have been unable to produce any credible evidence of cross infection having happened in recent times. Secondly, when the proposal to extend regulation was put out to consultation, the DoH said that the “vast majority” wanted increased regulation. This is simply incorrect: 96 of the 230 respondents wanted increased regulation of primary dental care. It also says something about “hidden” consultations affecting millions of people and thousands of professional staff that they only received 230 replies mainly from parties with a vested interest in expanding regulation. It is shameful that the Coalition should rely on just 96 responses to justify this costly expansion and ignore the almost unanimous concerns of the professionals involved.
The CQC is charged with monitoring all health and social care providers, measuring outcomes and maintaining standards. However, the CQC seems to have some problems of its own. The chief executive Ms Cynthia Bower is the former head of West Midlands Strategic Health Authority, responsible for overseeing the “appalling conditions” at Stafford Hospital. Andrew Lansley – then in opposition – criticised her appointment to the CQC, but to date she remains in post. In 2010 a CQC staff survey highlighted rock bottom morale with 86 per cent of respondents having no confidence in decisions made by the executive board. There are reports of staff being reduced to tears and being forced to push through registrations to meet deadlines regardless of quality or safety issues.
In April 2011 it will be a legal requirement for all dental practices to be regulated by the CQC, but this is an expansion too far. Dentistry is currently and primarily regulated by the General Dental Council. It sets standards of dental practice, conduct and assesses dental education. Other regulators involved cover medicines and equipment, radiology, and NHS services. It is argued by respected opinion that UK dentistry is already the most regulated in Europe.
The CQC regulations were originally designed for large institutions such as hospitals, and social care services with large and specialist management structures. These regulations will apply across the board and no allowance has been given for the fact that the vast majority of dental practices are small and without the management resources to implement them.
The taxpayer contributes approximately £2.25 billion towards the cost of running the NHS dental service in England alone. The costs of this additional and unnecessary regulation will eventually be passed on to the taxpayer and add more than 10 per cent to this bill. Taxpayers should ask, at this time of austerity and major cuts, how this regulatory expansion could possibly be justified.

Billieblob

welshdent wrote: »

There is a school of thought that bpe's of 4 and obviously the corresponding 6ppc's needs specialist attention yet there is very limited access available in the nhs system. Hell they can't find room for decent endo!! I personally am comfortable with the non surgical approaches I provide but I wouldnt be happy doing any surgery. I couldnt really afford to farm all my work out though. I get lots of practice instead ;-)

Once again I think we discuss the same point from a different angle. A patient has a right to access all treatment (whether you provide it or not, and whether it is available on the NHS or not). The GDC is perfectly clear on this.

If you cannot for whatever reason provide treatment that is in your patient's best interests then you must refer that patient. You will not get any mitigation if (your phrase) 'your farm out all your work'.

I do sympathise with your position, however you seem highly motivated and relatively newly qualified. If this helps, this is an example of how I would treat and charge a perio patient.

Prior to first visit: Pt informed of practice policies by phone contact. Info available on website, welcome letters sent to patient. Email and text reminders sent.Med History and 'Smile Check' also sent for patient to fill out prior to first visit.
Appt1. (£45). Consultation (note -not check up/exam/tooth count -but consultation). Booked for 15 mins but usually takes far longer (apologies to subsequent patients!). Patients often remark that this is notably the only time they have ever been able to speak to their dentists.
During Appt 1 I will ask questions. If I have time to do an exam I will, but I may delay that depending on the patients needs.

Appt 2. For a perio patient I will usuallly have got an OPG by now. Using this and OHE aids I will discuss the causes, complications and sequelae of perio disease. (30mins=£90)

Appt 3. OHI. Using disclosing tablets and conducting a full mouth examination (6ppc) including recession abrasion abfraction bop PI mobility etc etc. Then I will give OHI. Aids (such as id brushes, corsdyl etc are included in the £90 fee). The patient will then be (unless contraindicated) given a prescription for 3/12 Periostat.

Appt 4. Single arch subgingival debridement (NOT root planing!!). Under LA, usually with corsodyl in pockets >4mm. Again fee = £90.

Appt 5. As for Appt 4 only opposing arch.

Appt 6. 8wk review following active treatment. £90. Further decision made on pockets greater than 3mm then (after discussion with patient!!!).

Appts6+. Perio surgery/Referral to perio specialist/periochips/dentomycin etc etc.

As you can see, perio treatment can cost at least £500. The question for the patient is- are they receiving value for money? In a recent questionnaire 100% of my patients agreed that they were getting value for money - even as you can see it costs significantly more than NHS fees.

I don't wish to come across to you welshdent as a patronising 'old fart', but please don't feel that you have (as the MP Keith Barron put it- ' a moral obligation to work on the NHS' (curious that MPs feel justified in lecturing us on morality!). I hope I have been consistent in my views, and whilst I don't in any way disparage NHS dentists, I do (and I hope I make the difference clear) disparage the NHS dental contract.

Is this an appopriate time to mention the word 'discuss'???!!:)

Billieblob

boozercruiser wrote: »

Thought some may be interested in this article on the Taxpayers Alliance Website... http://www.taxpayersalliance.com/grassroots/2011/04/costs-dental-regulations.html

The costs of new dental regulations
Peter Lawrence • Grassroots • Friday 01 April 2011

Andrew Lansley’s health reforms have proved to be a big source of debate. One area of healthcare that has been subjected to the full force of the reforms is primary dental care – and they will have adverse financial affects on every dental practice in England, taxpayers and the 25 million patients in England who use this service every year.
Alongside ring-fencing healthcare spending, the Secretary of State has said that efficiency savings of £20billion must be found – but at the same time Andrew Lansley has forced through regulatory and bureaucratic changes to the way dental practices are run. This will cost at least £391 million to fully implement with yearly running costs of £280 million according to estimates published by Denplan, the largest dental payment plan specialist.
Another inefficient regulator?

In England the health regulator in this area is the Care Quality Commission (CQC). In Wales, it’s the Healthcare Inspectorate Wales. But there is a big disparity in the fees charged for regulation. In Wales the current fee that a private dentist pays to the regulator is £50 a year, but in England the CQC will charge sixteen times more: £800 a year. This is a stark difference in bureaucracy and regulation. The English have a bloated, inefficient regulatory system. The Welsh, meanwhile, spend far less on regulation and this helps offset the cost of free prescriptions and hospital parking. We hear so much about cutting red tape, but the Government must follow through on this in England.
The Department of Health (DoH) in England gives two main reasons for expanding regulation and imposing a second major regulator on dental practices. Firstly, they suggest that more regulation will reduce the risks of cross infection, but they have been unable to produce any credible evidence of cross infection having happened in recent times. Secondly, when the proposal to extend regulation was put out to consultation, the DoH said that the “vast majority” wanted increased regulation. This is simply incorrect: 96 of the 230 respondents wanted increased regulation of primary dental care. It also says something about “hidden” consultations affecting millions of people and thousands of professional staff that they only received 230 replies mainly from parties with a vested interest in expanding regulation. It is shameful that the Coalition should rely on just 96 responses to justify this costly expansion and ignore the almost unanimous concerns of the professionals involved.
The CQC is charged with monitoring all health and social care providers, measuring outcomes and maintaining standards. However, the CQC seems to have some problems of its own. The chief executive Ms Cynthia Bower is the former head of West Midlands Strategic Health Authority, responsible for overseeing the “appalling conditions” at Stafford Hospital. Andrew Lansley – then in opposition – criticised her appointment to the CQC, but to date she remains in post. In 2010 a CQC staff survey highlighted rock bottom morale with 86 per cent of respondents having no confidence in decisions made by the executive board. There are reports of staff being reduced to tears and being forced to push through registrations to meet deadlines regardless of quality or safety issues.
In April 2011 it will be a legal requirement for all dental practices to be regulated by the CQC, but this is an expansion too far. Dentistry is currently and primarily regulated by the General Dental Council. It sets standards of dental practice, conduct and assesses dental education. Other regulators involved cover medicines and equipment, radiology, and NHS services. It is argued by respected opinion that UK dentistry is already the most regulated in Europe.
The CQC regulations were originally designed for large institutions such as hospitals, and social care services with large and specialist management structures. These regulations will apply across the board and no allowance has been given for the fact that the vast majority of dental practices are small and without the management resources to implement them.
The taxpayer contributes approximately £2.25 billion towards the cost of running the NHS dental service in England alone. The costs of this additional and unnecessary regulation will eventually be passed on to the taxpayer and add more than 10 per cent to this bill. Taxpayers should ask, at this time of austerity and major cuts, how this regulatory expansion could possibly be justified.

Please accept my thanks BC, not only for initiating this thread (which has meandered in its intention more than the Amazon) but also for bringing to public awareness the CQC.

Patients in this thread are often surprised and understandably aggrieved by the defensiveness and aggression of the dentists they encounter. Whilst this in inexcusable in a caring profession, please (in this instance) allow me to offer some element of mitigation.

Dentistry in the UK is the most highly regulated profession anywhere in the world. In addition a UK dentist is twice as likely to get sued as his or her colleague in another country (c/w a few years ago when USA had that honour). There is no evidence to prove that dentists here are twice as bad!!!

Every dentist in the UK has to be registered with the GDC. The fees for which have increased astronomically in the last decade (largely to contend with the amount of litgation cases they have to deal with!). Also in January 2011 the essential requirements for HTM01-05 came into effect, resulting in an increase in overheads for dentists, furthermore in April 2011, CQC registration also came into effect. All these extra regulations have an increased administrative burden (and therefore overheads) on your dentist. This almost invariably IMO results in increased fees (private) or busier practices (NHS)

As a consumer you should not accept any decrease in the standard of care you receive from your dentist, whether they be NHS or private.

Whether your dentist be NHS or private the question you should always ask yourself is: Am I getting value for money?

?Discuss?

boozercruiser

Billieblob. I feel honoured for you to want to thanks me in the way that you have. As you say the thread has meandered more than the Amazon but thousands of people have clicked on it and every now and again someone revives it, perhaps some after doing a Google for 'Hygienist'.

If the thread has helped just a few people insist on better treatment from his or her Dentist, and perhaps saved some cash along the way...then I am HAPPY.

Your valuable opinion "As a consumer you should not accept any decrease in the standard of care you receive from your dentist, whether they be NHS or private.

Whether your dentist be NHS or private the question you should always ask yourself is: Am I getting value for money"?......is one I would hope no one can argue with...be it Patient OR Dentist.

Best Regards

Boozercruiser (Kenny Thain)

welshdent

Billie I do appologise I wasn't clear with my farming out - I mea t I can't afford to farm out nhs scalings and perio to the hygienist because I'd be the one paying for it hence doing it myself.
Completely agree I have no moral obligation to work for it. I do feel I have a moral obligation to my patients though. The area I work in has very low demand for private care and few fully private jobs. I have applied for some but my best offer was 1 morning a week. Thats in Cardiff! Not to say there are not private practices. It's just not that easy to get in to them. I have mentioned this before but as you are a nublet here you won't have seen - I bought a microscope 2 years ago mostly for endo. All for 3 uda's a pop. I find it abhorrent but I do have a duty IMHO to provide the best I can so within reason I will always try to. But make no mistake, I am very much planning my way out while getting as much experience as I can.

This may shock though, id rather be doing perio than making dentures lol.

I do feel thoug that your prices for perio on here may give a good insight in to the manner into which the DOH treat IMO vital aspects of dentistry such as perio and indeed endo. They consider them worth peanuts yet reward people in effect, more for an extraction. That mp you mentioned was (to use your phrase) ... Discussed .... On my Facebook page when he made this comments. I was no amused! Lol

welshdent

Fwiw I take the view it shouldn't matter how much something costs. If you under take the treatment, you should always endeavour to do it to the best of your abilities. A rubbish system isn't the unsuspecting patients fault.

Billieblob

welshdent wrote: »

Fwiw I take the view it shouldn't matter how much something costs. If you under take the treatment, you should always endeavour to do it to the best of your abilities. A rubbish system isn't the unsuspecting patients fault.

'I do feel I have a moral obligation to my patients though.' (welshdent)

'I do feel thoug that your prices for perio on here may give a good insight in to the manner into which the DOH treat IMO vital aspects of dentistry such as perio and indeed endo. They consider them worth peanuts yet reward people in effect, more for an extraction. That mp you mentioned was (to use your phrase) ... Discussed .... On my Facebook page when he made this comments. I was no amused! Lol' (welshdent)

Yes, yes, yes, I completely and wholeheartedly agree!

:T:T:T:T

coldstreamalways

Billie, you do know that litigation is different to FtP with respect to the GDC don't you? Our retention fees ahve gone up because of the number of FtP cases. Our indemnity fees have increased in line with increased litigation. A small but IMO important point.