Denplan doing OK 9 August 2020 at 10:15PM in Coronavirus Support and Help 73 replies 2.5K views

onwards&upwards

silvercar said:

onwards&upwards said:

MalMonroe said:

onwards&upwards said:

Dentistry has been in a sorry state in this country for far too long.  Maybe Covid is the push for the public to demand better, as it hopefully will be with social care. 

Has it really been in a sorry state? What makes you say that? In my experience, dentistry has improved no end since I was young.

You know the British public will never demand better (and what exactly IS that?) because that's just how it is here. 

NHS dentistry is hard to access and for a lot of people is still too expensive for them to be able to get the care they need.  

Private dentists get rich from whitening and straightening the teeth of the well off, NHS dentists struggle to make ends meet trying to care for the people who need them most.  Care of the mouth should never have been considered as a separate entity from caring for the rest of the body, it should be fully integrated into the NHS. 

Private dentists earn a lot of their income from saving teeth - complex root canals, crowns and implants. NHS dentists often can’t afford to provide these options to patients only paying the NHS charges, so end up offering extractions.

Are you offering that to counter the idea that UK dentistry is in a mess?  Because surely that actually just confirms it.  If you are well off you can save your teeth, if you aren't then you lose them.  How is that ok?

silvercar

onwards&upwards said:

silvercar said:

onwards&upwards said:

MalMonroe said:

onwards&upwards said:

Dentistry has been in a sorry state in this country for far too long.  Maybe Covid is the push for the public to demand better, as it hopefully will be with social care. 

Has it really been in a sorry state? What makes you say that? In my experience, dentistry has improved no end since I was young.

You know the British public will never demand better (and what exactly IS that?) because that's just how it is here. 

NHS dentistry is hard to access and for a lot of people is still too expensive for them to be able to get the care they need.  

Private dentists get rich from whitening and straightening the teeth of the well off, NHS dentists struggle to make ends meet trying to care for the people who need them most.  Care of the mouth should never have been considered as a separate entity from caring for the rest of the body, it should be fully integrated into the NHS. 

Private dentists earn a lot of their income from saving teeth - complex root canals, crowns and implants. NHS dentists often can’t afford to provide these options to patients only paying the NHS charges, so end up offering extractions.

Are you offering that to counter the idea that UK dentistry is in a mess?  Because surely that actually just confirms it.  If you are well off you can save your teeth, if you aren't then you lose them.  How is that ok?

Not at all.

i was offering it as a counter argument to your claim that private dentists spend their time on whitening and straightening, both of which are rarely essential treatment. 

Private dentists spend their time on saving teeth with expensive solutions like root canals rather than taking teeth out, which is often the NHS solution to patients’ pain.
Private dentists are doing more work on saving teeth than their NHS counterparts. I’m not saying it’s ok, I’m saying it is what is happening.

Dr_Crypto

As I understand it dentistry was a mess right from the start of the NHS. 

It’s always going to play second fiddle to medicine within the NHS. 

People do seem to be missing the point that the NHS basically took over all PPE until fairly recently. Even private contractor GPs were stocked via the NHS (often inadequately) but dentists were not. 

Some also forget that all cancer screening programs were suspended and haven’t meaningfully resumed yet so oral cancers aren’t an outlier in that sorry respect. 

brook2jack2

As as far as buying supplies goes NHS England still has a hold on most supplies, so if you are not in England you cannot buy them. Scotland, NI and Wales do not have similar arrangements in place. 

our local health board is supposed to be fit testing and supplying masks to dentists with NHS contracts . Fit testing only started this week but they don't know when they will be able to supply masks to dentists teams , but they are supplying ok to all other health and care staff. 

To put this into context our practice have been working all during lockdown and doing aerosol procedures since the end of June . I qualified as a mask fit tester and a commercial company very kindly lent us kits , which are in world wide shortage , so I and a colleague could fit test almost 60 local colleagues . However some of those colleagues have still  not been able to start aerosols as they cannot get enough masks for staff. 

The halt on some treatments , the onerous PPE for aerosol procedures is not dentists choice , it is the government and health regulators who imposed this. If a dentist does not comply they will be subject to extremely harsh disciplinary measures. 

Anyone who thinks it is a personal choice , in this weather, to wrap your whole body in several layers of plastic , breathing through a heavy mask on which you perch your loupes , visor , head covering and then try to do microsurgery in a get up which restricts your vision , steams up , forces you to contort your body into even more difficult ways so you can see, for hours on end , All the time your business is running at a loss,  needs to think again. 

epm-84

MalMonroe said:

onwards&upwards said:

Dentistry has been in a sorry state in this country for far too long.  Maybe Covid is the push for the public to demand better, as it hopefully will be with social care. 

Has it really been in a sorry state? What makes you say that? In my experience, dentistry has improved no end since I was young.

You know the British public will never demand better (and what exactly IS that?) because that's just how it is here. 

Like I said in an earlier post many dentists took the decision to provide services privately instead of on the NHS.  They knew, when they undertook that change, that they would be able to charge a lot more for services but would also be able to claim they are offering a better service.  They also knew that because they weren't providing a NHS service anymore that the support they were getting from the government would no longer exist.  Consequently practices should have put some of their profits aside for a rainy day fund.

onwards&upwards

Dr_Crypto said:

Some also forget that all cancer screening programs were suspended and haven’t meaningfully resumed yet so oral cancers aren’t an outlier in that sorry respect. 

But oral cancer screening doesn't take place in the hospitals that were swamped with hundreds of Covid cases and extreme levels of staff sickness/isolating in April and May.  In fact oral cancer screening doesn't take place in any standardised or systematic way, it happens when dentists are seeing patients for other things, usually.  

For the record, I was also distinctly unimpressed with the way some GP practices stopped serving their communities through this.  I know practice nurses who were literally twiddling their thumbs and reorganising the leaflets in the waiting rooms for weeks on end desperate to do something to help their patients but not allowed to even let them in the building.

epm-84

silvercar said:

onwards&upwards said:

MalMonroe said:

onwards&upwards said:

Dentistry has been in a sorry state in this country for far too long.  Maybe Covid is the push for the public to demand better, as it hopefully will be with social care. 

Has it really been in a sorry state? What makes you say that? In my experience, dentistry has improved no end since I was young.

You know the British public will never demand better (and what exactly IS that?) because that's just how it is here. 

NHS dentistry is hard to access and for a lot of people is still too expensive for them to be able to get the care they need.  

Private dentists get rich from whitening and straightening the teeth of the well off, NHS dentists struggle to make ends meet trying to care for the people who need them most.  Care of the mouth should never have been considered as a separate entity from caring for the rest of the body, it should be fully integrated into the NHS. 

Private dentists earn a lot of their income from saving teeth - complex root canals, crowns and implants. NHS dentists often can’t afford to provide these options to patients only paying the NHS charges, so end up offering extractions.

Yet when private dentists quote prices for those treatments to patients a lot realise they can't afford anything more than a checkup or a filling from the private dentist and consequently they start scrambling around looking for a NHS dentist who will take them on.  It's not unknown for people to take a holiday to Poland, which includes treatment with a private dentist there as it ends up being a lot cheaper than treatment with a private UK dentist.

Although, it's a valid point that private dentists do more for detecting problems in the early stages like by taking x-rays when patients appear to have no problems, rather than just treating problems which the dentist can see with the naked eye or where the patient complains about a problem.

brook2jack2

Around 50% os all dentistry in this country is provided privately , that is because many surgeries subsidise their nhs side with the private side. Most practices are mixed these days , a change from pre 2006 when the majority of practices did very little private work. 

In general a dentist doing majority private work will earn around 5% more than one doing majority nhs . 

In private dentistry the overheads are way , way more than NHS and a patient will have a lot more time spent on them , dentists went private because they could get off the treadmill of NHS dentistry , working faster and faster on more and more patients being unable to offer the dentistry the were taught for less and less. 

A room in a practice costs from £140 an hour  (NHS practice )to Figures well over £200 An hour  (Private);an hour to run pre covid. In the covid world after drilling eg aerosol treatment a room needs to be left for an hour afterwards before you can even clean, but the costs of running that room remain the same or higher. So a filling taking a minimum of half an hour (longer now to allow for patient to get in practice , have covid screening and be taken in and out of room without coming across any other patients ),needs at least an hour and a half of surgery time . 

The overheads of running practices during lockdown went down very little with the exception of laboratory work.  Private Dental practices received very little Financial aid, less than betting shops, but could at least furlough some staff whilst running the emergency and triage services Unlike NHS practices. 

The costs of keeping going during lockdown and for the foreseeable future on a massively reduced income would have drained even the most pessimistic rainy day fund a very long time ago. 

epm-84

brook2jack2 said:

In private dentistry the overheads are way , way more than NHS and a patient will have a lot more time spent on them , 

That's not my experience (as a 'band A' patient who has had very little work done since I lost my baby teeth - 1 filling.)  When my dentist was NHS I was getting a checkup every 6 months which included a scale + polish if needed.  Since going private my checkup frequency has reduced to every 12 months with the scale + polish still included and a few additional checks most notably a preventative x-ray being taken every few years.  Given I pay the dentist on a PAYG basis, not a monthly premium most years I don't pay much more than I would have done on the NHS but for the extra money I'm getting one slightly longer appointment rather than two shorter appointments so I certainly don't agree about the 'lot more time' claim.

onwards&upwards

brook2jack2 said:

Around 50% os all dentistry in this country is provided privately , that is because many surgeries subsidise their nhs side with the private side. Most practices are mixed these days , a change from pre 2006 when the majority of practices did very little private work. 

In general a dentist doing majority private work will earn around 5% more than one doing majority nhs . 

In private dentistry the overheads are way , way more than NHS and a patient will have a lot more time spent on them , dentists went private because they could get off the treadmill of NHS dentistry , working faster and faster on more and more patients being unable to offer the dentistry the were taught for less and less. 

A room in a practice costs from £140 an hour  (NHS practice )to Figures well over £200 An hour  (Private);an hour to run pre covid. In the covid world after drilling eg aerosol treatment a room needs to be left for an hour afterwards before you can even clean, but the costs of running that room remain the same or higher. So a filling taking a minimum of half an hour (longer now to allow for patient to get in practice , have covid screening and be taken in and out of room without coming across any other patients ),needs at least an hour and a half of surgery time . 

The overheads of running practices during lockdown went down very little with the exception of laboratory work.  Private Dental practices received very little Financial aid, less than betting shops, but could at least furlough some staff whilst running the emergency and triage services Unlike NHS practices. 

The costs of keeping going during lockdown and for the foreseeable future on a massively reduced income would have drained even the most pessimistic rainy day fund a very long time ago. 

Do you think its right that money buys access to good dental care and better oral health in this country?

Do you think its acceptable that dental care has essentially stopped for NHS patients (and for lots of private patients too) with massive variations in when people will be able to access care again?