Dentist Fraud

brook2jack

Root filling is a band two treatment. That means all treatment (check up , x rays, fillings, hygiene, root fillings ) generate 3 UDAs. The average uda value in my area is £23 , so that means , including the patient charge , the practice earns a total of £69 for that treatment.

There are no other payments from the government that £69 covers all the practice running costs, material, training,equipment, building costs etc.

The average NHS practice in a cheap area will cost upwards of £140 an hour to run. Obviously in a big city it will be more.

A band two treatment with root treatment will take at least three visits (check up , first root treatment visit , second root treatment visit to fill. ) and that's if there's no other treatment to do.

A root filling on a molar (back tooth) will take a minimum of an hour to do.

The instruments used for root treatments are single use disposable and cost around £35 each. Some of the specialist root treatment cements like MDTA cost around £50 a vial.

For tricky root treatments a microscope is essential but at £15,000 it is impossible to expend this money in NHS practice.

So taking the example of a person who just needs a root treatment on on one tooth and nothing else a practice will take in £69 , and spend a minimum of £170 in surgery time expenses and a minimum of £35 in additional equipment expenses.

It would save a ton of money offering a patient £20 to go elsewhere.

The statistics tell the story 20 years ago 95% of all dentistry in this country was done on the NHS . These days it is getting to around 50%.

A private dentist doesn't earn any more , they just see far fewer patients and use better equipment and facilities.

The £23 average uda rate is paid irrespective of whether you are a newly qualified or older dentist. In fact older dentists earn less on the NHS because they cannot physically work as fast as an experienced dentist in their thirties can.

The vast majority of dentists in NHS practice are self employed. The majority (80% and rising) do not own a practice and the average annual earnings now is around £51,000 in England (less in NI, Scotland and Wales) and dropping each year. 20% in the last 6 years.

sweetbabu

In the past, perhaps two years, I had moved dentists three times. The first dentist I moved from was struck off for doing work that didn't need to be doing (we moved before this happened), the second dentist was struck off for nefarious practices and we all had to have blood tests, the third filed right through my tooth and now I hate it when I smile and the last lot were actually fantastic.

This is within a very small network of villages. So I don't know why you can't find a new dentist?

With the last dentist, I developed a horrendous pain in my tooth/jaw, even just when swallowing. Turns out it was infected and I had to have an emergency root canal. It only cost me around £19, and I would happily have paid many, many times more. I am ashamed to say that I hadn't had a checkup for the past year (I was working in a temp job and was paid for the time that I was there, travel time and waiting times would have meant at least three hours off work plus treatment times.). I wasn't going to have an anaesthetic, as I hate needles, but the dentist said I'd need it - surely she didn't need to do that? She would have saved money/made more if I hadn't had the injection.

Despite all the nonsense I've had with dentists, they really do get a bad rap. I can pretty much guarantee that they did not roll over and let the government do as they pleased. They would not have had a choice - and, as has been said, it's the dentists themselves who get the bad rap, not the government.

welshdent

Mohawk I will do my best to answer your points as best as I can.

Fist we need some history.

Historically we had 2 problems with the dental contract.
1) Government could not control spend. It was a cash unlimited system
2) The fees were low per item so it "encouraged" dentist to see more patients thus do more work to be able to generate income for the practice. If work was not done they were not paid. This led to a "treadmill" effect.

A dental practice could set up from scratch though and start seeing patients with the NHS providing payment. Arguably this did not mean practices set up where there was a perceived statistical need, however logically a business is not going to set up where there is no demand. So on the flip side, practices set up where patients wanted to go to them.

The labour government of the time decided to change all this. The did trial some systems to maintain practice funding which were well received, however this led to a drop off in NHS fees collected by patients and as a result, less work done.

The government had a few aims. Cap spending on dentistry or at least have a determinable amount that is spent on dentistry, maintain the patient charge revenue and reduce the amound of complex work that the government funds.

They decided upon the "unit of dental activity" or UDA.

This is a nominal way of measuring activity and generates revenue for the government as they can relate it to a banded course of treatment and therefore a recognised fee to the patient.

They promised the practices the same amount of money they generated in the reference period of 12 months prior to the contract introduction. They looked at all the work done by the practice. converted the activity done in to how it would have looked in the new system. This related to a practice value of "UDAs" for X amount of gross income.

That means EVERY practice is different. Every practice had a unique value attributed to its own unique UDA target.
As a rought guide it ranges from £16 - £35 depending on the practice. It is NOT geographical or needs based. It is purely based on what was generated when they had a reference period.

Some issues - if a dentist was on maternity leave for say 9 of the 12 months, they did NOT extrapolate the 3 months worked as a pro rata measurement. They only awarded the practice 3 months of fees.

Likewise if a dentist opened a practice or began working in an established one and had 1 month of earnings in the reference period, the practice was only allocated 1 months of income.
The practice is allocate a set amount of UDAs and each one equates to a specific cash value. The practice has 12 months to do them all (or to 95% of them). If the practice falls short of 95% they have money "clawed back" from them. If they are within 95% the 5% is rolled over to the following year when they must then do 105% (or however many % remained). Unless permitted by the local authority, If the practice goes OVER their allocation, the health boards do NOT give an UDAs to the practice but do take the patient charges for the course of treatment off the practice. Therefore not only is the practice working for free, they are having money taken off them.

What does a UDA relate to?

We now work on bands of treatment NOT items.

Band 1 - diagnosis and PRevention which equals 1 UDA

This is means examination, x rays, scaling where there is no active gum disease, fluoride application to name a few things.

It does not matter if the dentist does an exam, and exam and x rays or an exam x rays and a scale and polish. It is still just 1 UDA and 1 course of treatment.


Band 2 - This is intervention not including lab made prostheses. This equate to 3 UDAs.

Included here - Everything within Band 1 then fillings, extractions, periodontal disease treatment, Surgery, Root canal treatment.

So all of the above (exam, exam and scale) plus however many fillings or extractions or root fillings as necessary.

1 filling, 2 fillings, 4 fillings, 1 extraction and 2 root fillings - doesnt matter. It is a band 2 and therefore 3 UDAs.

Band 3 - This is 12 UDAs relating to a course or treatment including everything in bands 1 and 2 then lab made items such as Crowns, Dentures, Bridges etc.

Again, Numbers of items is irrelevant.
1 crown or 5, it is still 12 UDAs,

15 fillings and one crown is 12 UDAs.

1 Crown no fillings - 12 UDAs.

There is also an urgent band. This is 1.2 UDAs

IN here are basically measures to get people out of pain or prevent a situation worsening before definitive treatment can be provided. Dressings, temporary fillings, nerve removal, one single filling or 1 extraction.
With the other bands, we must render the patient dentally fit or as fit as they are prepared to accept. This emergency band does not have the same requirements.


Issues with this contract:

Well firstly no practice is funded the same way - a check up is worth differing amounts to different practices. The patients pay the same but some places have half the remuneration.

Contracts must be commissioned hence the bidding wars and "race to the bottom"

Even if you HAD a contract and an allocation of UDAs - the likelyhood is you would have no Allowances made for you being a new practice with no established patients. Clawback is very likely.

In an area of high need many patients would require a lot of work and multiple appointments. Similarly "new patients" who havce not been to a dentist for a long time often need a lot of work.

In an area of well maintained patients patients may only need the odd broken filling or crown replaced.

If you are working all day every day treating a great deal of disease it will be VERY hard to hit your target. So if you dont you get money taken off you.
Dont forget, it doesnt matter if you need 1 or 10 fillings, it is still just 3 UDAs.

in the area of low need, stable patients. they can tick over nicely, easily hit their targets without much hassle in plenty of time - no clawback.
3 UDAs for 1 filling.

It bears NO resemblance to actual work done.

Also the band 3 fee bears NO resemblance to the costs of lab fees.

The dentist have the same fee for 1 or 5 crowns but the Lab making them will bill for however much work they do. 5 crowns? Thats 5 lab fees.

It is VERY easy to spend more on the treatment than the NHS pays to provide it.

Moving on to root canal treatment.

Root canal treatment is an alternative to an extraction. When at the stage they are needed, they are the only 2 options available.

Extraction and Root canal treatment are both band 2 items.

Extraction takes maybe 15 minutes. Root canal treatmemt, takes in my opinion at least an hour.

Now you cant JUST do a root filling. hat just treats inside the tooth. You MUST place a filliing or a crown on top. Therefore whichever way you look at it, the NHS does not provide funding for root fillings.

A filling alone is band 2. A crown alone is band 3. Add a root filling in - it is still band 2 or 3 respectively.

The files cost a bomb. They can be in the region of £30 for just the nickel titanium rotary files. We also need smaller stainless steel ones and then you should ideally have a rubber dam placed on the tooth to isolate it then bleach to disinfect it and gutta percha.

Add the costs of these together and then a crown on top and all of a sudden its not the NHS paying for the treatment it is the dentist.

That is assuming it is only one root filling too. Again, if more than one is needed there is no additional funding. It is still 3 or 12 UDAs depending on the course of treatment banding.

So why did the dentists accept the contract? Well reminiscent of the recent junior doctors - this was an imposed contract. Dentists were told sign it or leave it but it isnt changing.

Believe it or not we do care about our patients and we DO want to be able to provide care to as many as we can. For many practices Not going with the NHS contract was simply not a viable option for their patient base.
We also have staff to consider. We generate the income to pay their wages. If a conversion to a private list did not go as well as hoped then people are being made redundant.
Also a hell of a lot of dentists do actually believe in the NHS and view the situation as not being the patients fault.

BUT every day dentists up and down the country are making decisions they shouldnt have to make, to provide care and minimise the impact it has on themselves and the practice.

Incidentally, in the last 10 years, there has been a MASSIVE increase in regulation. CQC, HIW etc did not exist a few years ago. They do now. the GDC has increased their fee from around £300 a year to £890.

Indemnity firms are now vastly more expensive than they used to be. I pay around £4000 a year.

In the same time I cant think of a single associate dentist or many principal dentists (contract holders) that have had anything approaching a meaningful increase in the basic value of the UDA. I have effectively had a pay cut every year for the last 10 years and I am not alone. The amound per UDA offered to dentists has not increased. Next year there is to be a 3% increase in pensionable earnings contributions. At best the practice will get a 1% uplift in the contract value which will again NOT be passed on to the dentists because as usual it is swallowed up by increasing costs.

there are many reasons I hate this contract. It is terrible. I wont bore you any more but I do hope I have addressed some of the points raised.

mohawk

Brookjack & welshdent


Many thanks for your kind efforts in spending so much time explaining some of the nuts & bolts of this ghastly NHS system. It really helps me a lot to understand exactly what has been going on and how this is reflected in my experiences over the past ten years.

I would describe my collective experiences as dental hell, and now I can see exactly why. I was the average patient, that is, completely ignorant of what was going on and just expected the NHS to provide what ‘was necessary for the health of my mouth’.

What I experienced was appallingly poor treatment (in the non clinical sense) from every single dental practice I used. Because of peculiar personal circumstances, I ended up with a huge number of different dental practices over a period of time.

In the world of private practice you rightly blame the dentist for this kind of experience because the private dentist is being paid all lab costs by the patient & a decent hourly rate for the dental practioner’s skill; and a patient will expect to pay a lot more for exceptionally highly skilled, specialist practitioners. So there is no reason for not getting the best possible treatment, unless that dentist is cutting corners. But, normally, he/she would never want to cut corners or have any motivation to cut corners; so it doesn’t usually happen in that private patient environment.

I have paid for the very best & most eye wateringly high end treatment and absolutely never ever had an issue with the work the dentist did. I did grumble a bit to myself about the cost as it was Wimpole Street rates, but accepted it and got excellent treatment.

But since my income has now sunk to the bare minimum & I am obliged to depend on the NHS, I have found it a sick joke, and of course who else to blame but the dentist ? I mean, you go along knowing pretty much what should be done and the NHS says the patient is legally entitled to whatever appropriate work is needed . But you are treated like an idiot when you try to find a dentist. Then when you do find one & commence treatment all sorts of unpleasant things happen to give you an overriding impression that the dentist is behaving very badly, so of course you blame him/her for what eventually becomes obvious is very third rate treatment.


Recently, I started asking a few questions here and there. The problem is it that is difficult to talk to any dentist actually treating you as your mouth is full of dental equipment and usually the dental nurse’s hands as well as the dentist’s. He/she is also trying to concentrate on what they are doing so sensible conversation is not possible.

It always amuses me how dentists will ask you a question just as they fill your mouth with at least one pair of hands together with sundry hardware, possibly a screaming drill and deafening water spray and suction device and expect you to answer the question they’ve just asked ! And then the dentist is so rushed as he has to cram all those treatments into impossibly tiny amounts of time to try and make ends meet, that there is no possibility of being able to talk to him either at the begining or end of the treatment session as the next patient is already waiting.

Because of a couple of curious incidents I recently experienced and a bit of enquiry here & there, it has gradually dawned on me that all these dentists are basically being forced by the NHS to provide a very second rate dental service to NHS patients and it is not the fault of the dentists, but entirely the fault of the NHS.

‘Burueacracy makes good people into bad people’ is a quote I came across somewhere. How true that is. It explains exactly how there is a vast army of idiotic bureaucrats employed directly & indirectly by the Government to run the entire Government machine for and on behalf of the politicians. These bureaucrats are not properly accountable to anyone, and so can dream up things like the total nonsense of this dental contract with it’s positively lunatic UDAs.

I have, personally, had numerous surreal experiences with these bureaucrats in several different areas other than dentistry in recent times. Those experiences have been Orwellian. And while I am writing this I am reminded of one local council idiot bureaucrat telling me “There is no room for common sense here’.

That nasty person then wilfully acted unlawfully in making a seventeen year old teenager sleep on the streets for six months when there was a highly suitable alternative of a family available to look after the teenager instead, which solution that unpleasant bureaucrat wilfully thwarted. And as a result of this, that teenager’s life, unsurprisingly, worsened a great deal & ended up hugely increasing the burden on the State - all because of a smug moron of a bureaucrat acting wrongly & spitefully. That was just one of many, many Orwellian experiences I have had with these parasites.

And so, I came here to see if I could get a better understanding what I suspected was going on as I felt I could no longer blame the dentists for what seemed to me to be something caused entirely by the bureaucrats. But I wasn’t entirely sure until you both explained what you have explained and which fills in a few cracks in what I have gleaned elsewhere.


I am very, very fed up with what I have experienced & want to do something about it. But it is only now abundently clear to me that as the dentists are not really to blame, it is the NHS/Gvmnt machine which needs a kicking.


I’ll write some of those bad experiences down here when I have the time. Meanwhile does anyone have any ideas on what could be done to change things ?

welshdent

They could start by actually listening to general practice dentists as opposed to the yes men and women they surround themselves with. One thing that has been almost begged for is an outline of what the dentists can legitimately say is and is not available on the NHS. We were given a loose "cosmetic" treatment is not available. But outside whitening this is not very clear. The government will NOT clarify it because yet again they like to shift the blame of any complaints on to the dentist who in turn has to answer often unpleasant letters while their already expensive indemnity rises.

MichaelViscione

Yes there are many fraud dentist available which treat your teeth in different way. So I advice you please hire a personal dentist which have complete BDMS degree.