What are the limits of NHS Dentistry?

alimac23

I agree Toothsmith, the system is shocking and I admit i think our practice would have to give consideration to opting out if it happened up here. But the problem is the system NOT the dentists, the vast majority of whom I hope are doing all they can for their patients.

My point is that while I think the service you provide to these boards is absolutely excellent, you critise a service that for many is all they can afford. This could cause undue worry and doubt to many MSE users who are in fact receiving good NHS treatment.

Toothsmith

I have often stated that it is my point of view that if less dentists in England had signed the new contract, it would have collapsed completely and had to have been rethought.

That didn't happen though. Or at least not to the extent that would have made it an obvious disaster that even the Government couldn't have put a decent spin on.

But now we have the situation where lots of dentists who have signed the contract are not abiding by it's terms, and are charging NHS patients private fees for services that should be all included in with their NHS care.

Now I know exactly why they are doing this.

It's because if they didn't, they might well go bankrupt.

BUT - it is giving the illusion that we still have any semblance of a decent NHS dental system in England, and we don't!

Whenever posters tell me that they are getting good service from an NHS practice, I use the opportunity to point out that there are still good NHS practices out there (In England).

But more often than not I am telling people that what their dentist is trying to charge them for is something that should be included in their NHS treatment.

As long as the politicians think they have got away with this abortion of a system, then things will not get any better for the patients who cannot afford private fees (That's both 'proper' private fees and the private fees being charged by some 'NHS' dentists)

And with the price of a single NHS crown now standing at £193 in England, for the regular attender, who only needs the odd item of treatment every now and then, there really isn't a huge gulf between private and NHS prices anymore.

alimac23

All points taken and agreed!

I guess that's where it's different in Scotland - taking your crown example, a gold shell crown is ~£95, bonded crown ~£120 NHS. We charge £190 for a private bonded crown.

P.S. What is don't understand is why these dentists don't now leave the NHS in protest now? Are they tied in for so long?

Toothsmith

Beats me too!!!

I suppose some feel they couldn't go private. Some maybe close to retirement anyway, and are just waiting for the NHS pension (The only good thing about it!!).

Some are probably doing OK out of it, especially when they can add in 'extras' privately that should be included!

There are ways to work the system if you're not too bothered about the sort of dentistry you provide.

The DoH wants short simple cost effective treatments, we were taught to provide the best care we could for our patients. It depends where you set your compromises really!

In my further defence, I would draw your attention to this thread http://forums.moneysavingexpert.com/showthread.html?t=548353

I spent ages trying to convince this lady she really did have a very good NHS dentist who really was trying his best and doing things perfectly correctly under the new system!

elisebutt65

I have to say, from the patient's point of view, that I have a wonderful HHS dentist. But he is getting older and I am dreading the day that he retires!!!!

I am a single Mum/Full time student so haven't had to pay for anything for well over 5 years now.

I think though, that something weird is going on. When the new contract came in - we could only see our dentist once every 12 months but this August after our check ups, he said we could go back to seeing him more often so we're going in March.?????

My teeth have never been so healthy in the 5 years that I have been seeing him, compared with the last NHS dentist who seemed to be filling happy:rotfl:

Peartree

Theoretically, I am lucky to have found an NHS dentist in my area - but actually it wasn't that hard - I asked around when I moved here and made one phone call.

I am called for a check up every six months and am automatically booked for a scale and polish every time. There isn't a hygienist, the dentist does the work. I've rarely needed other treatment but, when I needed a filling, the dentist offered me several different options, with prices, from basic amalgam (?) through to more cosmetic options with, what I thought was a very fair, explanation of all the pros and cons of each. I don't feel I am choosing 'either or' as I am presented with the options and could switch over to a treatment unavailable on the NHS if it were 'better'.

I've got HSA cover but haven't come near to using up the dental benefits in the last few years.

If you phone up for a 'non check up' appointment (ie, twinge, pain, emergency), the receptionist always offers a number of options depending on how bad you feel it is and they are very flexible. I know they have phoned me to ask if I'd mind changing my check up appointment by a day or two because they have had an emergency to accommodate so they clearly do everything possible. I feel very comfortable that I could get in pretty much immediately if I had a bad problem.

Interestingly, they do have a big whitening business and are also offering restylane and other (non-dental) cosmetic procedures so they are clearly supplementing the income in other ways.

I know from friends that they feel compelled to stick with dentists who have gone private for adults because they were worried about losing NHS treatment for their kids or because they want to keep all the family's treatment with one practice because it is easier. Sometimes it is because they are concerned about being able to get in quickly for emergency treatment if they have a problem believing they could not do that with an NHS dentist. People around here are terrified into sticking with a dentist because they believe that actually getting a place on a dentist's list is like the holy grail and will unquestioningly stick with a private dentist and pay any amount.

But it does astound me what they are paying. I'm basing that judgement on what I'm paying for private orthodontic treatment. When I signed up for lower and upper braces it did seem to be like a jaw-dropping (no pun intended) amount of money. However, spread over two years, for monthly appointments, the time of the orthodontist, the x-rays, moulds, the braces and the paraphenalia, the free 'consumables' (like wax and so on), the retainers when the treatment has finished and the fact that if I have a problem I can be sorted out within 24 hours, on reflection, it isn't bad value.
A friend with a private dentist has paid 20% of what I'm paying for all that for one root canal treatment.

From what I've seen, the publicity doesn't necessarily reflect the reality and people are believing the hype about dentistry. When their dentist goes private, people panic because they have heard that you can't get NHS dentistry any more and don't even try to find an alternative because they don't believe there is one. Then, of course, they have to justify the amount they are paying to themselves. I don't know anyone who is getting better dental care than I am - but I know quite a few people who think they are! My root canal friend could probably get in with my dentist but, I think, solely on all the basis of all the press, doesn't believe good NHS dentistry exists. Really and truly, what is the difference in the treatment you'd get from a private dentist or an NHS dentist if you need root canal work?

Tell me if I'm wrong, but NHS and private dentists are getting exactly the same training in dental schools (subsidised by the taxpayer) like the one the new one the University I work at has just opened.

So I'm with alimac - the main problem with NHS dentistry is getting it, not what you get!

alimac23

Yeah, I'd read that one already!!! As I've said I really think the advice and time you give to this site is second to none. MSE'rs are lucky to have you! Just wanted stick up for the other side - although this is purely from the Scottish system point of view. Sometimes the NHS system can feel like a bit of a treadmill and sometimes the stress feels like it's not worth it ....... but other times, when you make a difference to someone who thought they couldn't afford the treatment or couldn't have the treatment cos they're on benefits, well that makes it worthwhile.

P.S. As a regular dental attender myself over the years ( of course!!), my hubbie and I both attend an NHS dentist. Me because I've attended his practice for several years, my hubbie because I registered him when I was a dental student and it's too far too travel from his work to mine (or maybe cos he doesn't trust me - he he!!)

Ted_Hutchinson

Toothsmith wrote: »

Beats me too!!!

No light at end of tunnel
From which I quote
The government’s refusal to consider granting a clawback amnesty over UDA targets means the prospects of many dentists continuing to work under the NHS are ‘dismal’, according to Quentin Skinner................... ‘The British Dental Association (BDA) claims that many NHS dentists are unfairly facing financial penalties as a result of the new NHS contract, and has called for an amnesty on these clawbacks. A request that the Department of Health has refused to consider................However, the old NHS fee-per-item treadmill has been replaced with a far more vicious, ratcheted treadmill. In reality, there are now many dentists failing to deliver even 75 percent of their contracted UDA delivery, and crippling clawbacks are surely inevitable. Consequently, their ability to protect, let alone earn their livelihood in year two of the new contract is likely to be as challenging as in year one.
...We are already halfway through year two, and conversion to the private sector takes some time to plan. In order to assist in coping with the financial effect of clawback, and to set their practices on a firm financial footing that is under their control, dentists with NHS contracts should be looking at a change to the private sector as a matter of urgency. Those who keep treading the mill under increasingly harsh circumstances until the end of ring-fencing in 2009 without planning their escape route right now will only have themselves to blame.’

This is only what Toothsmith has been patiently trying to explain over and over again.

alimac23

Just to reiterate - I'm not defending the system,which in all honestly I only know a little about. I'm only defending those NHS dentists who are trying to provide a decent service for patients.

judderman62

This is a very interesting thread :T:T thanks all for your input.

btw if you hear a loud scream tomorrow at 14:50 ... that'll be me - having a tooth removed and I am such a wuss :o