Emergency tooth ache

mal4mac

Cameron has had plenty of time to change the contract, but has done nothing. But I agree that "New Labour" are mostly to blame for initiating it! I agree a good start would be for politicians to give us a decent service and be honest and transparent about what they will or won't pay for.

I see the BDA are seeking reform:

https://www.bda.org/contractreform

"The BDA favours the highest possible proportion of capitation in a contract, which would minimise perverse incentives."

They actually call the present system "perverse", which is strong language, but language that certainly seems to capture my experience with the system. (I tend to avoid perverse systems, which is why I haven't been to the dentist enough in the past few years, and one reason for me now losing teeth...)

I'm not sure capitation is the answer, if I understand this concept correctly. Wikipedia say:

"Capitation is a payment arrangement for health care service providers such as physicians or nurse practitioners. It pays a physician or group of physicians a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care."

To me, this would seem to also introduce perverse incentives. For instance, wouldn't dentists want to encourage those with perfect dental health to join them, and discourage those who would need a lot of work? Wouldn't they (still) have a tendency to "extract" rather than "root fill" because capitation would (still) encourage the dentist to spend the minimum amount of time with the patient?

Surely the best scheme would be to pay NHS dentists a fixed salary, as with NHS doctors?

justme111

It would. But when the state administers it it costs the state a lot more than when they pay peanuts to dental surgeries who then ration it and get the blame for rationing , thats why it has not been done and I doubt will ever be. If you know the system is perverse u have a choice of seeing someone out of the system privately. Which you chosen not to take.

mal4mac

I think the private system is at least as perverse

justme111

mal4mac wrote: »

I think the private system is at least as perverse

Do you think plumbing services or building ones or any private tutoring or mechanics are perverse ?

welshdent

mal4mac wrote: »

I think the private system is at least as perverse

Why? How else do you propose people are remunerated for their services?
Also suggesting a salary for nhs dentists is only considering a small piece of the puzzle. Who is going to pay for the nurses, receptionists, cleaners etc. Who is going to pay for the lab bills generated by provision of the crowns bridges and dentures? Who will then determine which type of restoration you can have? Because it isn't as simple as saying "a crown". You can have precious and non precious metal. You can have feldspathic porcelain or lithium disilictate. You can have all zirconia or zirconia core. You can have porcelain bonded to precious and non precious metal. You can have chrome or flexi dentures

mal4mac

welshdent wrote: »

Also suggesting a salary for nhs dentists is only considering a small piece of the puzzle. Who is going to pay for the nurses, receptionists, cleaners etc. Who is going to pay for the lab bills generated by provision of the crowns bridges and dentures? Who will then determine which type of restoration you can have? ...

Who pays the nurses and cleaners in hospitals and GP surgeries? Who pays the lab bills in hospitals? Doesn't replacing a leg, or other part of the body, introduce similar problems? The NHS finds solutions. Of course, if you have the money, you can buy "better" cosmetic or functional solutions - as long as the NHS provides "reasonable" quality of life solutions for everyone.

Part of a reasonable quality of life is not having to plough through a Kafkaesque system of "gaming" and extended waiting times brought into being by "perverse" incentives to dentists, bad planning by Blatcherite MPs, and insufficient funding.

welshdent

mal4mac wrote: »

Who pays the nurses and cleaners in hospitals and GP surgeries? Who pays the lab bills in hospitals? Doesn't replacing a leg, or other part of the body, introduce similar problems? The NHS finds solutions. Of course, if you have the money, you can buy "better" cosmetic or functional solutions - as long as the NHS provides "reasonable" quality of life solutions for everyone.

Part of a reasonable quality of life is not having to plough through a Kafkaesque system of "gaming" and extended waiting times brought into being by "perverse" incentives to dentists, bad planning by Blatcherite MPs, and insufficient funding.

Totally agree with your view with reasonable quality. Never ever disagreed with you on that but it has happened because dentists still need to be able to pay the staff and the bills all off the money supplied by the NHS. The constant moving of the goal posts by the NHS and HMG is what perpetuates the problems.

Incidentally if we do not send a claim for treatment within 2 months of completion - and there are many reasons as to why this may be delayed. They will not remunerate the practice at all but take all patient charges recieved for it. So the dentists gets minus pay.

all general practices are privately owned businesses that run very efficiently. In order to do what you suggest either the NHS needs to go on a mass purchase of buildings or go on a mass construction effort while at the same time stripping all NHS dental practices of their NHS contracts this leaving them unable to pay the business loans for premises and equipment. That would serve at least in the short term to make thousands of dental and support staff unemployed and many banks left with unpaid loans totally probably billions.

mal4mac

Couldn't dentists work in the same way as GPs?

"GPs have always been self-employed practitioners who mix private practice with contracted work from the NHS. When the NHS was set up in 1948, GPs kept their independence but agreed to register all patients and provide 24-hour care. This established universal access to family doctors for the first time in the UK. GPs were paid on the basis of the number of patients on their books and also received payments for specific activities, including out-of-hours visits, maternity care and vaccinations."

This actually sounds like the "capitation" system recommended by the BDF So maybe my objections to this can be overcome!

"Surgeries are handed an average of £136 a year to provide care for every patient on their list."

Couldn't the same be paid to dentists? I'd happily pay around £200 a year more in tax to get away from the current system! (I'm assuming I'll be subsidising the poverty stricken, and those with even more teeth problems than me... which I don't mind doing...)

welshdent

mal4mac wrote: »

Couldn't dentists work in the same way as GPs?

"GPs have always been self-employed practitioners who mix private practice with contracted work from the NHS. When the NHS was set up in 1948, GPs kept their independence but agreed to register all patients and provide 24-hour care. This established universal access to family doctors for the first time in the UK. GPs were paid on the basis of the number of patients on their books and also received payments for specific activities, including out-of-hours visits, maternity care and vaccinations."

This actually sounds like the "capitation" system recommended by the BDF So maybe my objections to this can be overcome!

"Surgeries are handed an average of £136 a year to provide care for every patient on their list."

Couldn't the same be paid to dentists? I'd happily pay around £200 a year more in tax to get away from the current system! (I'm assuming I'll be subsidising the poverty stricken, and those with even more teeth problems than me... which I don't mind doing...)

you would the problem isnt you unfortunately. Also - a lot of people pay no or minimal tax so they would need to be accounted for by you too. Do you know presently how much of the NHS budget goes on general dental services?
bearing in mind a lot of dentistry is self funded by patient contributions.

It is around 2ish%. Captiation also doesnt account for things like lab bills.

A basic un characterised porcelain bonded to metal crown can be provided for around £30 in lab bill. a basic uncharacteristic all ceramic crown would be around £60. A decent one is over £100. a basic zircona unit upwards £90 ish. Depends on labs but thats a ball park. for a well characterised "natural" looking crown is going to cost LOTS/.

brook2jack

There are already government owned clinics where dentists are salaried. There are two types

Dental Access Centres . These are put in areas where it is difficult to get dentists to open practices to take NHS patients. The average course of treatment costs are between £280 and £480 per course of treatment.

Community dental clinics. These treat children and adults who otherwise could not be treated in practice due to physical or learning disabilities . The average cost per filling is around £120.

In general NHS practice the average course of treatment including patient charge cost is £36.

The difference is in a general practice the dentist/owner does all the admin, a lot of the maintainance, for which extra people would have to be employed , all the dentists pay their own sick, holiday , pension, training costs etc and to a certain extent private treatments subsidise NHS costs. Also dentists have seen their pay go down by 20% in recent years to cover spiralling costs , these increased costs would be paid direct by the government.

As a country we could not afford to buy all the dental surgeries and equipment, equip and staff them . It is far more expensive to run a dental surgery than a gp practice.