Dental article in today's Telegraph

Undervalued

I was wondering if any of the very helpful dentists who post here had seen this article......

http://www.telegraph.co.uk/news/health/11350853/Could-you-dentist-be-destroying-your-teeth.html

It would be interesting to hear the other side of the story.

brook2jack

I've seen the article.

My standpoint is that pre 2006 I was 100% NHS. Post the new contract I have a very reduced NHS contract and am mostly private. My difficulty was I could no longer earn a living under the new NHS contract.

The difficulty is the government promises everything is available that is clinically necessary to secure dental health but will not specify exactly what is or is not available on the contract. This leaves interpretation to individual health teams and individual dentists. (This is England and Wales, Scotland and NI still work under the old scheme which is much clearer).

Most dentists who work under the NHS do their best under a very difficult system but this lack of clarity does leave some leeway for the very small number of unethical dentists to top up nhs fees with private work which should be available on the nhs.

The situation has evolved because despite dentistry evolving and becoming more sophisticated and better (more expensive ) treatments becoming available the amount available for nhs treatment is derisory.

The average spend per patient treated on the nhs including the patient contribution is between £28 and £34 a year.

A dental surgery in a cheap area will cost £150 an hour per room to run. How much high class advanced treatment will the NHS spend buy?

The cost of providing dentistry is ever increasing and as a result dentists incomes have fallen year on year since 2006. According to some sources over 20% last year.

The present contract is from everyone's perspective a mess. No one understands it properly not even the people who commissioned it. New contracts have been piloted and continue to be a mess because the bottom line is more time needs to be spent with people and time costs money, money which cannot be pumped in.

The uda system is a joke . The lady in the article was told she needed three hours of treatment. That would be a continuing process as gum disease is never cured only controlled. A nhs dentist would be obligated to provide this for a grand total of £66 on average including government contribution. I'll leave you to work out the loss a surgery incurs with this treatment. The irony is if someone then needed specialist treatment, in my area there is no nhs provision for specialist treatment , not for gum problems, endodontics, restorative treatment. Nothing.

The vast majority of dentists working in the NHS do their best but the present system does no one a good service and it is any wonder that the number one cause of a child needing a hospital stay is tooth decay when the present rate of spend on dental health equates to around 15 minutes a year of clinical time per person treated?

Undervalued

Thanks for that.

Having run a small specialised business myself, in a leased premises that would have been ideal as a dental surgery, I can well understand what you are saying.

The lady in the article was told she needed three hours of treatment. That would be a continuing process as gum disease is never cured only controlled. A nhs dentist would be obligated to provide this for a grand total of £66 on average including government contribution. I'll leave you to work out the loss a surgery incurs with this treatment.

If what the newspaper article says about this lady is true then I can understand her being upset. There is no reason why she should know what happens behind the scenes and is entitled to expect professional advice and good treatment.

Would it be fairer / simpler if NHS dentists were prohibited from offering private treatment to a person they were seeing on the NHS?

Also, what should happen to a dentist who lies to a patient recommending a 10 min extraction when a 90 min root canal would be an equal of better option?

brook2jack

What happens to the dentist is they are

A sued (you are more likely to be sued as a dentist in the UK than anywhere else in the world

B investigated and struck off by the GDC. A uk dentist is thirty times more regulated than anywhere else in Europe and at the moment a record number are involved in GDC hearings.

In the past dentists were not permitted to mix nhs and private treatment. However the rules were changed with the current contract because apart from anything else a dentist can be found negligent if they do not offer all options including private.

Many dentists feel offering a core contract ie only allowing basic treatments such as fillings, extractions and dentures on the nhs everything else private would be the best use of a limited nhs budget which would require a massive hike to adequately fully cover dentistry. This would allow a lot of the work to be done by cheaper dental therapists and once and for all clarify properly what is and isn't available on the NHS. However it would be a brave government that would admit the budget and contract for NHS dentistry is not fit for purpose and certainly cannot provide all necessary treatment.

Undervalued

brook2jack wrote: »

In the past dentists were not permitted to mix nhs and private treatment. However the rules were changed with the current contract because apart from anything else a dentist can be found negligent if they do not offer all options including private.

Seems to me this is a dammed if you do, dammed if you don't.

I would have thought it inevitable though that most patients will be suspicious of the motive each time this crops up? Totally unjustly in many or most cases I'm sure but it must always a difficult situation?

peachyprice

Undervalued wrote: »

Would it be fairer / simpler if NHS dentists were prohibited from offering private treatment to a person they were seeing on the NHS?

I don't see how that would be fairer or simpler.

I have two children with dental needs beyond the scope of NHS treatment, my dentist tells me a) what she can do on the NHS and b) what she thinks is best, I then make an informed choice as to which treatment I want for my child. If she were prohibited from offering private treatment she would not be able to offer the best treatment possible (in her professional opinion) for an individual.

Edit: Neither of my children have bad teeth, one has a front tooth that was half broken off in an assault, the other has a puberty related gum condition. Just had to add that in case anyone thought I hadn't looked after their teeth properly

Undervalued

peachyprice wrote: »

I don't see how that would be fairer or simpler.

I have two children with dental needs beyond the scope of NHS treatment, my dentist tells me a) what she can do on the NHS and b) what she thinks is best, I then make an informed choice as to which treatment I want for my child. If she were prohibited from offering private treatment she would not be able to offer the best treatment possible (in her professional opinion) for an individual.

That is fine providing you are completely confident that what you are being told is true and is not being influenced by what is financially best for the dentist.

Now I'm sure in the majority of cases that is so but the article highlighted situations where that doesn't seem to be the case.

Equally, if someone was less confident in their dentist (or a new patient) they may well do the dentist an injustice by being suspicious.

brook2jack

The vast majority of dentists are honest and ethical. The big problem they face is the VAST majority of publicity , news reportage etc is grossly negative about dentists.

Although polls would indicate dentists are amongst the most trusted of professionals and satisfaction levels of patients are higher than with eg medical GPS the UK public is not used to the true cost of healthcare and although a dentist is obliged to discuss all options for treatment and let a patient decide this can be viewed with suspicion.

However in an increasingly litigious and regulated age a dentist does not have the option not to discuss this. Dentists are warned not to decide for a patient what they may or may not want/afford and what their priorities are.