NHS Dentists - RIP?

rwgibson98

jazzyjustlaw wrote:

...Someone somewhere said that even people are council estates who dont brush their teeth get to vote. I cannot believe someone used such people in their analogy. Most people in council estates are nice I know I grew up on one. Yes me and I went to law school - what controversy.

That was me, and was in reference to this post. I was making no judgement about council estates, and you don't know whether my family and I have lived, or now live, in one. Our better-informed dentist was commenting on how some people prioritise their money.

And whilst I'm on:

Toothsmith wrote:

...And I didn't say 'two-tier' was a stupid phrase...

except when you said:

Toothsmith wrote:

...the country is full of knee-jerk voters who latch onto stupid phrases like two-tier health system...

Moving on. I accept, to a point, Toothsmith's comment about the element of risk being higher for dentists than some other public servants, and that there should be a reasonable rate of return on such an investment. I don't see why - in principle - this has to be outside the NHS.

Toothsmith wrote:

Everything else in life has multiple tiers. Why should healthcare not?

Because not everything in life has multiple tiers. If I report a crime, do I get a choice as to the "quality" of the policeman I deal with? When I run a glass of tap water, do I get a choice as to its quality? When I use council services such as roads and refuse collection, do I get a choice then? Is that because, sometimes, it's better and more efficient if everyone gets the same? Dentistry is not a consumer product like bread, with Tesco Value at one end of the spectrum and Hovis Premium at the other. It is an essential public service.

Hmph. I don't see much money-saving here. There are many questions being left unanswered, and not a lot of solutions to my original problem being proposed.

Toothsmith

rwgibson98 wrote:

Moving on. I accept, to a point, Toothsmith's comment about the element of risk being higher for dentists than some other public servants, and that there should be a reasonable rate of return on such an investment. I don't see why - in principle - this has to be outside the NHS.

In principle you are quite correct. it's just not working in practice. The Government wants a cash limited service, and so at some point the care will have to be limited too.

rwgibson98 wrote:

Because not everything in life has multiple tiers. If I report a crime, do I get a choice as to the "quality" of the policeman I deal with?

No, but if you want to prevent crime, a whole range of things open up to you, from a simple dummy alarm box right through to full electronic surveillance and your own private security guards.

As many tiers as you want to pay for!

If you have the misfortune to get 'done' for something, then you defense can be as good as the money you have to pay for it.

rwgibson98 wrote:

When I run a glass of tap water, do I get a choice as to its quality?.

No - but have a look at all the tiers at the supermarket!

rwgibson98 wrote:

When I use council services such as roads and refuse collection, do I get a choice then? ?.

Maybe not refuse for the general public, but I have all sorts of companies competing for my trade waste, as would any other business.

As for roads M6 toll road? Congestion charging?

rwgibson98 wrote:

Hmph. I don't see much money-saving here. There are many questions being left unanswered, and not a lot of solutions to my original problem being proposed.

Which questions are those - I'll do my best. All I saw were "Is this a problem faced by other money savers?" to which the answer is "Yes"

and "What solutions have been employed?" to which you got several answers, and I gave , even if I say so myself, a rather good breakdown of the options.

If you want to know what Government are doing about it the answer is "Making it worse" but whether that is deliberate or not is a matter for discussion. If you blame dentists, then I will defend that but my only way of doing that effectively is to try and explain as best I can the economics and politics of running a health service. There is no easy answer!

payless

OK I have read what I can.....

been a same practice 15 yrs, know the original denists were against private route, I'm now out of of area , takes 1 hr each way to drive there( for some reason we swapped denists within pactice a few yrs ago)

been to my denist today, broken a bit of a tooth, that was already filled.
could not offer me appoint on last Friday, so booked in today -he was running 30 min late

£12 for a patch up filling

I go every 6 m for check up, rare any extra work, other than odd scrap/ polish


anyhow, whilst in waiting room, heard that they were no offering any appointments... appartently we are all getting letters soon!....

overheard the girls talking to a rep... sounds like they are going private ( in house!)and originally denist is retiring

suppose fair enough, if the NHS sscheme is changing that much... not sure what they will charge, will consider staying

what annoys me is that my son has started NHS bridge work recently , dealt with by retiring chap... sounds like they will refer him eslewhere ( receptionist vague, retiring denist out), are we likely be left in the lerch if no one can take over on NHS for this bridge work

rwgibson98

To those readers who are still awake:

There are some very interesting parliamentary discussions minuted in this document from the UK Parliament website:

http://www.publications.parliament.uk/pa/cm200405/cmselect/cmpubacc/167/167.pdf

It's a bit long (57 pages), but the committee of Public Accounts interviewing witness Dr Lester Ellman of the British Dental Association, and Sir Nigel Crisp from the Department of Health (pages 29-48) make fascinating reading.

You can cut to some of the juicy bits by looking at an MP's personal website:

http://www.durhamlabour.org.uk/steinberg/pac041214.htm

Some selective quotes:
...(you are)...misleading the Committee, in my view. The reason why they are leaving the NHS and leaving patients in despair is because they are going private and taking private patients, and they do not give a monkey's about their patients - they just take them off their lists and leave them, and if they cannot afford dentistry they do not get it...

...it is an absolute disgrace the way we are today. That is not just this government, the last government as well - they have both destroyed it. But do not come and tell us that the dentists are all altruistic - they are not altruistic at all; what they are doing is looking for the biggest amount of money that they can make and that is why they are going into private practice...

Meanwhile, the BDA themselves say that:
...On average, a full-time dentist with high commitment to the NHS will earn around £80,000 per year... source

One key element of the government's new proposals was that dentist's income would be guaranteed for three years. The BDA's response to this? They walked away from discussions with the government. On the front page of the BDA website is "A free practice assesment tool for members wanting to assess their readiness for private practice conversion.." source

There are the remains of a 2005 Which? campaign for NHS dentistry here. Their response to the new contract is:
Frances Blunden, principal policy adviser with Which? (formerly known as Consumer's Association) and member of the Working Group on dental charges, said: "Patients have the right to know the likely cost of treatment before they sit in the dentist’s chair. Today’s announcement at last gives people something to smile about and is a new and fairer way of approaching dental charges on the NHS. The changes mean a better system for patients, a better system for dentists and will hopefully lead to a better future for NHS dentistry." source

Any dentist who has left, or is leaving the NHS is no part of a health service, but in the health business. They deserve no more (and no less) respect and admiration than a manager of a high-street opticians franchise.

It takes two parties to have an argument, and it seems that both the govenment and the BDA are to blame for their fall-out, which leaves the general public with no option but to pay dentists through the likes of the Denplan schemes.

Toothsmith

An excellent piece of work.

I can't believe you've read all those references though and still believe it is justifiable to only select the pieces you have! I would urge everybody interested to read those links.


Steinberg is an absolute idiot, as anybody reading his questioning of Lester should see. Inland revenue figures back up Lester's assertation that dentists in private practice earn no more on average than NHS dentists. Earning power has long since been dropped from the real argument - even by the Daily Mail! It's not about what you earn, it's about how you have to earn it!

Your last two paragraphs are exactly right, and I take no offence from being called a manager of a health business.

I am the owner of that business though, so maybe more of an entrepreneur wouldn't you say?

I have an excellent business because I have loyal satisfied customers. I supply a product and I am proud of my product. If that product was not in demand I would go out of business.

Before you say people have no choice though, in my situation a new NHS 5 surgery practice has just opened within 3 miles of me. The vast majority of dentists in my town have been private for 6+ years and no one has been taking on new NHS patients for miles for ages. It's been 3 months since the PCT has released the phone number to book for this new practice. I've been giving it out to parents when I tell them that their kids too will have to be private after 1st April. In our local paper last week, it seems less than 2000 people have so far registered! That's barely enough to keep 1 dentist going!

Some people appreciate the difference!

Toothsmith

payless wrote:

what annoys me is that my son has started NHS bridge work recently , dealt with by retiring chap... sounds like they will refer him eslewhere ( receptionist vague, retiring denist out), are we likely be left in the lerch if no one can take over on NHS for this bridge work

I'm a bit unclear here Payless. do you mean 'bridgework' - replacing lost teeth with complicated crown structures - or do you mean 'braces' - moving teeth around to overcome crowding/alter bite/ make things look better? How old is your son?

Bridgework, unless really complex, is done over a few appointments and finished within weeks. It has been very very hard to get bridgework approved on the NHS for ages. He would more likely have a denture made on the NHS.

Braces (orthodontics) are quite a specialist thing, and are not done by every dentist. It could be that the chap about to retire has an interest in ortodontics, and so does his own simple cases. Most dentists refer all cases to a specialist.

If there is no other dentist at the practice to refer to, then your son would have to be refered elsewhere. Hopefully this shouldn't cause too much of a problem though. It should still be completed on the NHS as well.

Hope that helps. If it is 'bridgework' could you give me more information, and I'll try to work out what's going on.

payless

Sorry , yes meant braces

The older chap ( our original denist , until he passed on some of his list to a new partner a few years ago) seems to be the local chap ( not so local for us now) that does the braces .

A little upset that he started this work only 2 months ago, surely he must have known he was retiring, although perhaps the decision over new NHS contract / private , was the final straw , however pleased to know that it should still be under NHS ( hopefully more local) , are you implying its not likely to be with a denist, rather a specialist . Otherwise it might be an issue if we don't move to this new practice as well?

Guess we will have to decide if we stick with current practice under whatever system they set up , or move more local

Out of interest , whats the average cost for a couple under a monthly private plan , as I think ( overheard) kids staying NHS at old place ( is this possible?)

Toothsmith

rwgibson98 wrote:

Did you mean my DocPlan idea? That was meant to be a (ridiculous) extension of the private dentistry scheme. I really hope none of that comes anywhere near happening.

Read THIS and then let me know if you still think your idea is that ridiculous!

Toothsmith

payless wrote:

Sorry , yes meant braces

The older chap ( our original denist , until he passed on some of his list to a new partner a few years ago) seems to be the local chap ( not so local for us now) that does the braces .

A little upset that he started this work only 2 months ago, surely he must have known he was retiring, although perhaps the decision over new NHS contract / private , was the final straw , however pleased to know that it should still be under NHS ( hopefully more local) , are you implying its not likely to be with a denist, rather a specialist . Otherwise it might be an issue if we don't move to this new practice as well?

Guess we will have to decide if we stick with current practice under whatever system they set up , or move more local

Out of interest , whats the average cost for a couple under a monthly private plan , as I think ( overheard) kids staying NHS at old place ( is this possible?)

Hi Payless.

If the NHS general dental stuff is a shambles at the moment, orthodontics is even more uncertain.

Starting ortho treatment within a couple of months of his retirement certainly isn't going to benefit the retiring dentist in any way that I can think of.

From your son's point of view, if treatment has started, then he will certainly be a 'priority case' when it comes to finding someone to take over the treatment. I think that this is probably what was going through the dentists mind. It could also be that the more 'ongoing' cases the practice has, the more likely they are to secure future NHS orthodontic funding in the new world of the new contract. This is just a guess though.

I appreciate that you may feel a bit like 'piggies in the middle' here. I'm not sure what I'd have done if I was that dentist. Whether to explain all this to you or not? I'm sure that you finding out about their future plans through overhearing conversations in the waiting room was definitly not part of the plan though, and by the time you 'officially' get to find out about it, the arrangements may well have been agreed.

Had he not started treatment though, then you could well have been passed from pillar to post in order to try and get the treatment, and it could well have ended up that you'd be paying privately for it, or not having it at all.

I'd be interested to hear how this pans out, either on the boards, or via PM.


EDIT :- As to average costs, I really couldn't say. It depends on the practice, the system used, the condition of your mouth etc etc. Somewhere between £10 and £20 PM at a guess, but I realise this is a big varyation. Just wait for the letter!

Rikki

I would like to say Thank You to Toothsmith for his patience is answering everybodies grievences with NHS Dentists. I think he does well to stay focused and no get into arguments.

I have acted on advice offered by Toothsmith and I am happy with the results.

I find these threads enjoyable to read. Keep up the good work. :T