More tooth problems, how can dental bridges cost £650?

mal4mac

brook2jack wrote: »

Only practice owners (less than 20%) have contracts with the NHS which is the higher figure. ... Most dentists do not own a practice (80% ) so will earn the lower figure from NHS or private treatment.

Thanks, that makes sense. Terrible reporting by the BBC, you should complain....

Dentists who provide mostly NHS work earn around 5% more than those who provide mostly private work.

How does that work? Is it the blunt ten minute check ups and super-fast emergency treatments that bring in the money on the NHS?

In fact according to the Inland revenue pay scale.com is an over estimation and in 2013\2014 performer dentists in the UK averaged between £56,000 and £60,000 depending on which country of the U.K. they were in. That is 80% of self employed dentists.

That still looks like good pay to me, compared to other professionals in the "caring" professions, like teachers, academic related staff at universities, etc., who also have student loans and similar pressures.

That said, it's at the "tough end" of these professions, and so the pay looks about right.

You would expect the pay to be "about right" or dentists would convert into something equally lucrative, or equally lucrative and less stressful.

mal4mac

welshdent wrote: »

You expect this assume that yet the reality is nothing of the sort.

Probably correct, dentists are good at hiding their "game"

http://www.channel4.com/info/press/news/dispatches-investigation-reveals-dentist-overcharging

I've been gamed into a hygiene treatment, a common occurrence according to dispatches.

"Dispatches sent an undercover reporter in need of root canal treatment and a crown to three dental surgeries as an NHS patient.

This should cost him a total of £198 pounds on the NHS but he was quoted:

£480 pounds for a private root canal and a further £198 pounds for an NHS crown in one dental.
£400 for private root canal work and £198 and upwards for a crown.
£725 for a root canal treatment and a crown.
Dispatches showed the undercover footage to Dr Anthony Halperin, a leading dentist and expert witness in dental disputes.

"I have felt with all the pictures of these dentists that you've shown me that they should have been accepted as NHS patients," he says.

"They should have had treatment under the NHS, if they wished it. Which they did seem to wish. And I'm very concerned that they all seem to have suggestions of having private treatment... If the patients go in as NHS patients and are told work is not available under the NHS which is available under the NHS then they are in breach of their contract," he adds."

GlasweJen

I fell in the playground at 8 years old and about 40% of my front tooth chipped off. It was an adult tooth as my 12 front teeth top and bottom were taken out as a toddler as there was something wrong with the enamel.

The family dentist crowned it a few years later before I went to high school. The crown was miles too big for my mouth, it protruded 4mm into the gum above it and within a few years of implant the tooth below it went grey, you could see this through the implant.

I saw at least 4 different NHS dentists who wouldn't touch it, I was told the tooth was dead and the only treatment would be to remove the tooth and replace with a denture.

I saw a private dentist about another matter (wisdom tooth extraction) and asked him, he also said this tooth was dead but could be pulled and an implant would be £3500.

I then saw a dentist who was a newish friend of the family, I didn't mention that front tooth as I didn't think anything could be done. This dentist was concerned about gum disease under the implant and was astonished that the original dentist had managed to cram this massive implant into a 10 year old girls mouth.

For the sake of gum health he wanted to remove my crown and see what he was dealing with. When the crown came off this stink filled the room. The gum was purple, the tooth was black and when he started to scrape the black off the pain indicated that the tooth was alive!

So over the course of 6 weeks the tooth and gum were treated and a new crown fitted onto that front tooth.

That was 18 months ago and I've reduced the gum disease on that area down to grade 1 with no antibiotics or special mouth wash, just brushing and flossing.

I moved and I joined a new practice as I can't get home easily even though I'm only about 15 miles away. This new dentist was flummoxed that I had one little area of gum disease in an otherwise perfect mouth and it took him a few minutes to realise that the tooth below it was crowned. He's never seen such a natural looking crown.

The cost of the original job was £0, NHS.
Cost of the repair job was "mates rates", lab fees for the final crown and the temporary coverings was over £900. Our friend wouldn't take anything for the work except photos to use in advertising. He got a few referrals from my new dentist though so might make a bit of money on the back of that and the photos.

brook2jack

It is very difficult for employed people to fully appreciate the costs of running a business.

Let's take the Cerec machine.

It's £180,000 for the cost of the machine and the equipment to capture the shape of the tooth. One is useless without the other. On top of that is the costs of milling blocks (starting at £25 per tooth) burs, milling heads (which need replacing) , stains,glazes and furnace , licence for the software (bought per 100 crowns) software updates, annual servicing costs and repairs. Oh and the machine will become obsolete after a few years so you will have to start again.

In the time you are making all these hundreds of crowns to pay for all that staff will still want to be paid, consumables bills, equipment , waste, etc will still have to be paid . So I think you need to rethink how many crowns and how long it will take to repay the costs of cerec.


You have focused on dentists pay, but actually that is only a small part of the costs of running a practice.

You enquire why NHS dentists earn 5% more than private and the answer is not "5 minute rushed check ups" but overheads. If you read HMRC reports expenses take up a much higher proportion of private fees than NHS fees. In other words it is much more expensive to run a practice that does mostly private work.

A single surgery In a NHS practice in a cheap area will cost around £160 an hour to run. All of those expenses are paid by what is earned when a patient sits in the chair.

The same in a mostly private practice will vary but many work on upwards of around £200 an hour .

These expenses are running on an inflation rate of around 10% per year. This is why dental earnings have gone down year on year since 2006.

You say a "pay" of £56,000 to £60,000 compares well to other professions, but being self employed means you do not have any of the securities of employment. Eg a single handed dentist friend of mine with NHS practice developed oral cancer. He had to work during his treatment as he could not afford a locum long term and because of his treatment he could not complete his contracted UDAs so the NHS reclaimed all the money paid to him and withdrew his contract. He went bankrupt , sold the practice as a building because he had no NHS contract and no new ones were being handed out it could not be sold as a dental practice.

welshdent

Incidentally. Dentists are not responsible for the NHS dental contract. We just try and administer it as well as we can. We can be just as flumoxed by it as patients can given that health boards and LATs change their interpretations on an seemingly weekly basis to suit themselves.

You know all the fuss made in the press about the Junior Drs having a contract imposed on them? Well the dental contract was imposed on the profession by the then labour government.

Clearly mal4mac thinks we are all crooks who fix the books and "game patients" purely because of the title of dentist. The statistics and anectdotal evidence do not bear this out. Sure a few are dodgy to say the least. But when you consider how many dentists there are compared to many actually found guilty of this behavior it is a tiny minority.

Undervalued

mal4mac wrote: »

"Dispatches sent an undercover reporter in need of root canal treatment and a crown to three dental surgeries as an NHS patient.

This should cost him a total of £198 pounds on the NHS but he was quoted:

£480 pounds for a private root canal and a further £198 pounds for an NHS crown in one dental.
£400 for private root canal work and £198 and upwards for a crown.
£725 for a root canal treatment and a crown.
Dispatches showed the undercover footage to Dr Anthony Halperin, a leading dentist and expert witness in dental disputes.

"I have felt with all the pictures of these dentists that you've shown me that they should have been accepted as NHS patients," he says.

"They should have had treatment under the NHS, if they wished it. Which they did seem to wish. And I'm very concerned that they all seem to have suggestions of having private treatment... If the patients go in as NHS patients and are told work is not available under the NHS which is available under the NHS then they are in breach of their contract," he adds."

As I understand it, having read quite a bit from the dentists who post here regularly, doing a root canal on the NHS loses money for the dentist as the fee they get doesn't come close to covering their costs. Plus, to have the best chance of success, it really needs more specialised equipment than is economic to provide in a practice that does little or no private work.

So, again as I understand it, the NHS dentist is still required either to attempt the procedure or, if he deems it too complex for his skills and / or equipment, refer it to a specialist.

There is then a further complication in that such specialists are almost non-existent within the NHS system.

What he is not allowed to do is to say "I can only do it for you privately and not as a NHS job". But that seems to happen quite a bit which is clearly a breach of contract and unprofessional practice.

As I said on another thread, having run a very specialised business with similar overheads, I sympathise but none of this is the patient's problem.

justme111

Malmac , the dentists who do nhs work earn what they earn because they interpret the nhs contract so that they earn what they earn on it . What did we agreed - about 60/70 grand . Some of dentists , may be infamous dr.Melo , interpret it in a way that make them earn £2100 grand . Some interpret it in a way that let them get 30 grand only. That before tax , indemnity and all other expenses. With no holiday pay , sick pay etc. Being a dentist one could interpret a contract in such a way that one would earn minimal wage. Or even further - that what one gets for his/her work would be less than what one pays in order to produce that work making them not only earning nothing but paying out of their pocket.

From your posts I can see you have a personal axe to grind with dentists because you were told you need to spend money on your teeth and because average dentist earns more than you do. Which I am afraid the issue with most of british public - they are brought up with the idea that NI should cover dental costs and jealousy towards those earning more. So the above will be lost on you and many others probably .

Undervalued , so do you think it is right for public to demand comprehensive top quality dental service on nhs contract even though you know it is impossible to provide ?
Would you personally go to a dentist under NHS contract and demand them sticking to most favourable to you in monetary terms interpretation of dental contract ? Would you be able to accept treatment knowing the person who provided you with it earned nothing for it ? Would you be able to look that dentist into their eyes if you knew that if every patient would be like you they would not earn anything , literally nothing for the whole day/month/year of work ? Would you feel smug in getting it ?Do you think you would get what you were after ? Who will be to blame if you lose your teeth in a process ?

Undervalued

justme111 wrote: »

Undervalued , so do you think it is right for public to demand comprehensive top quality dental service on nhs contract even though you know it is impossible to provide ?
Would you personally go to a dentist under NHS contract and demand them sticking to most favourable to you in monetary terms interpretation of dental contract ? Would you be able to accept treatment knowing the person who provided you with it earned nothing for it ? Would you be able to look that dentist into their eyes if you knew that if every patient would be like you they would not earn anything , literally nothing for the whole day/month/year of work ? Would you feel smug in getting it ?Do you think you would get what you were after ? Who will be to blame if you lose your teeth in a process ?

What utter nonsense!

Why should the average NHS patient have any knowelege or interest in the economics of a dental practice? Few, I suspect very few, have any idea that most dentists (and NHS GP's) are actually self employed small businessmen and women. I only really found out through here and took a more than average interest having run my own business and been very involved in my professional body.

So, if what we are being told here is true (and I have no reason to doubt it) running a one man NHS only practice does not generate enough turnover to leave the dentist with the equivalent or a decent professional salary.

I appreciate the dentist will have studied for many years at considerable expense and I have no doubt the equipment is very expensive. Rent, rates, heat, light etc etc all add up as I know only too well. Financially there are up sides as well as down sides to being self employed and again I fully understand the need to factor in the equivalent of paid holidays, sickness etc.

But none of that is the patient's concern. They are told by the government that a dental service is available and, if they have the means, they will pay one of three flat rate charges for various types of routine treatment. If their clinical needs are more complex than that they will be referred on to an NHS hospital where they won't have to pay at all. Rightly or wrongly that is what our taxes supposedly pay for.

What they should not experience is a system where a dentist says, in effect, I will only do the more complex bit properly if you pay me privately!

If the overall economics of a NHS practice don't add up (and that is not the same thing as an individual treatment being uneconomic) then surely the professional thing to do would be not to renew the contract. If enough do that then either the demand for private treatment would grow or the government would have to come up with a better package.

brook2jack

[QUOTE=Undervalued;70157869)

If the overall economics of a NHS practice don't add up (and that is not the same thing as an individual treatment being uneconomic) then surely the professional thing to do would be not to renew the contract. If enough do that then either the demand for private treatment would grow or the government would have to come up with a better package.[/QUOTE]


I utterly agree with this. Until 2006 there was not a single dental practice in my area that did much private work. After then most of the independent dentists went wholly or mostly private , the only practices providing Mostly NHS treatment are large corporate practices with a large turnover of dentists who struggle with the demands of a dental contract in an area of high needs.

However most of the practices, like our own, were long standing practices with dentists who had been there many years . In this sort of practice you will look to retain about a third of your patients.

The decision to leave mostly NHS practice after twenty years was one I agonised about as did my colleagues, but we could no longer pay the price financially, physically or personally.

If I had the massive student loans , practice loans and lack of loyal patients that a younger colleague has the decision would have been even more difficult.

Our practice still trains newly qualified dentists. The jobs they go onto leave them in no doubt they need to leave the NHS as soon as possible but gaining the skills , training , experience for private practice is difficult and expensive and those sort of jobs do not come up that often .

welshdent

Actually I completely agree it is none of the patients concern. They trust that when they come to see one of us we will treat them properly and appropriately for their need. The average patient actually is in my experience very appreciative and understanding of what we can and can not do. We do however get some with ridiculous expectations. They want the rolls royce when the corsa will do just fine. Examples would be wanting a high end ceramic crown on a molar tooth that no one will see when a standard metal or bonded crown would be fine. Thats not really the discussion here.

The problem is the government publically tell everyone they can have a comprehensive dental system knowing full well that they are not funding one. They fund a core service but expect high end. Their budget spend is capped so its down to the dentists to make it work in effect. But I agree that is not the patients problem.

What is particularly galling to me is that we have the GDC telling dentists that they can not go beyond their scope of practice and abilities.

Root canal treatment IS a complicated procedure. I dont care what anyone not in the know says. I KNOW it is complicated. Without the right eqipment we dont even know ourselves how complicated it is.

We have an NHS saying if it is needed we do it within the course of treatment which as has been noted - means we get not funding to provide the root filling.
With the increase in litigation and the approach that the GDC take against us for even minor errors we are expected to provide in effect specialist level treatment with these treatments but without the funding to be able to pay for the microscopes and other specialist equipment and training. If something goes wrong such as a broken file or perforation then we could potentially be hit with being struck off or suspended and face massive pay outs relative the low fee it attracted.
Additionally whereas in the past there was a degree of back up from dental or district hospitals who had a specialist service, they now MASSIVELY restrict who they will see. Anyone they WILL see face a 2 or so waiting list. This may encourage a dentist under pressure from a patient to "have a go" which leads to problems
The government know that they got no come back because they arent paying out. They expect it to be done but wont pay for a specialist service because as far as they are concerned .... why doesnt the dentist do it? and when the dentist DOES do it .... they are the ones carrying the can. It is a ridiculous system.

Imagine a system where the NHS expected your GP to do knee or hip replacements because they wouldnt fund the orthopedic surgeons?