NHS Dental practice only open one day a week?

Undervalued

The NHS dental practice I use is now owned by a dentist who has a larger practice (3 or 4 dentists) in another town nearly 40 miles away. Since the Covid full lockdown the practice near me only opens 1 day (or two half days) per week so anything at all not deemed an emergency is repeatedly rescheduled. As far as I am aware the larger practice is operating normally.

I realise that the Covid precautions drastically reduce the number of patients that can be treated in a day, particularly if aerosol procedures are required. However if that is compounded by only opening at all for one fifth of the normal hours I have to wonder what is going on? Should they not at least be offering annual checkups to regular patients?

I also understand that legally, once a course of treatment is complete, they never have to see a particular patient again. However in the past then have always tended to operate as if regular patients were "registered". Indeed, even now there is no suggestion of that but they just repeatedly contact patients to re-book in three or six months time.

Is this an acceptable level of service or are NHS practices required to meet certain minima?

Toothsmith

As you know UV - I've not had a lot to do with NHS for quite a few years.

One thing I do know about the current situation though - the NHS area teams 'looking after' dentists are requiring dentists to prioritise their appointments in terms of patient 'need' rather than patient loyalty.

They actively  don't want the 'worried well' in with their contracted dentists. They want to make sure the people who contact the red top newspapers saying they had to pull their own teeth out don't make them look bad. Those that have early signs of cancer missed, or even less sever dental problems picked up early, due to not being seen just aren't on their radar, as they rarely get headline stories and a slot on Jeremy Vine.

Now yes - I would agree with you that preventative check-ups are vitally important - but the powers that be simply don't agree with that at the moment (if they ever really did) and are actively discouraging it.

Why it is different at the main practice to this one - I don't know.

Staffing issues, different contractual arrangements with NHS, different NHS area teams, Less NHS reliance at main practice? All or any could be factors. 

There aren't 'service minimums' on the NHS for patients with no obvious or painful problems though. 

brook2jack2

The enormous stresses and strains , both physical and mental , of covid practice in dentistry have had a massive impact on the workforce. Many ,many dentists, dental nurses and technicians have left the profession , causing  staffing crisis . The numbers on the dental register are dropping . https://www.gdpuk.com/news/latest-news/4027-gdc-registration-report-reveals-significant-drop-in-dental-nurse-numbers

Most surgeries are in buildings that are not purpose built so cannot be adapted for the ventilation requirements for covid era dentistry, meaning those rooms cannot be used for eg drilling appointments . 

The problems of isolation and covid infections (dental staff who have household contacts still have to isolate for 10 days ) mean booking appointments too far in advance is impossible because you do not know how many staff will be in that day.

practices have been working full pelt and staff are now starting to suffer from burn out with a combination of longer hours , very, very difficult working conditions and an increase in abusive and threatening behaviour from a small minority of patients. 

Finally 60% of practices are unable to hit the targets imposed by the NHS during this crisis , particularly as they have been told to prioritise emergency treatment rather than check ups . Many practices are handing back their contracts rather than waiting for the financial penalties that not hitting targets will bring.  

The end result is many practices are struggling with man power and resources and cannot man every surgery to the extent they did precovid. Those that are working in the NHS are rapidly getting further and further behind as everything takes so much longer and they can no longer see the numbers of patients a day they used to. 

Toothsmith

If only it were such a simple party split!

It was the same Labour government that invented the NHS that put the first charges on NHS dentistry in 1951. Although, to his credit, Bevan did resign from the government over this. The demand of a huge proportion of the population for free false teeth was in danger of bringing the whole project down. 

It was in the early years of the Blair Government that I first made the move away from NHS dentistry when they kicked a long awaited reform of the NHS dental service (Options for Change) into the long grass. Ironically, a couple of years later (2001) Blair made his rather infamous (to dentists) pledge that "within two years, anyone who wants access to an NHS dentist will be able to get it" 

It was also the Blair Government who introduced the current dog's breakfast of the English and Welsh NHS dental contract in 2006 - which was the direct reason I gave up doing any NHS dentistry. 

In all that time, the only party to ever seem to row against the stream of trying to squeeze dentistry out of the NHS have been the Lib Dems, who occasionally have 'free dental check ups' in their manifesto - although no real ideas of how to ensure there'll be any dentists who actively want to deliver such baubles!

Undervalued

Interesting as the history is, we are where we are.

My question really was whether there were any minimum standards of service required of an NHS practice. TS's first reply suggests that there are not which I find extraordinary.

Obviously any dentist who doesn't like the NHS system can opt out and practice entirely privately, as TS has apparently done. Fair enough, it is allegedly a free country after all!

What fascinates me, as a semi informed observer with some experience of small professional practices / businesses and a former involvement with professional standards in another somewhat less regulated field, is that there appears to be little if any compulsion to provide an acceptable service whilst under an NHS contract.

Given the drastic reduction in capacity caused by the Covid restrictions I am amazed that it is acceptable to then decide to compound this by closing completely for 80% of the week without any explanation. 

I suspect (but don't know for certain) that their larger practice in another town does a significant amount of private work, although it too offers NHS treatment. Maybe, as Brooke has suggested, staffing is difficult. If so I would guess that the staffing is being diverted onto the private work? Obviously, if I am right, there is a clear business incentive for that but what I find unacceptable is that they are allowed (?) not honour their NHS commitments? I have no problem with them opting out of the NHS at the end of any current contracts but I am concerned if they are neglecting their obligations before then.

brook2jack2

NHS targets are absolutely non negotiable. If a practice does not hit its targets and misses by more than 5% it is in breach of contract. Not only will they have to pay clawback but they will also lose their NHS contract. 

The NHS in England has told NHS practices they are to prioritise toothache and emergency appointments and should not be booking in "routine" appointments unless there is space. 

By doing mostly emergency treatment it is impossible to hit targets (even the reduced covid targets) because the time involved and the amount of appointments that are failed by emergency patients make it very difficult. The majority of NHS dentists in England and Wales are currently not hitting targets. This means that they will have to pay large clawback payments to the NHS and possibly lose their NHS contracts or have them renegotiated to an even lower level than present. 

A practice that is doing such a small percentage of treatment will not be doing so by choice because they will lose their contract and , in addition, pay punitive clawback . They would be better off handing back their NHS contract now , rather than continuing on in reduced fashion. 

Undervalued

Thanks.

Ultimately it is none of my business, other than as a patient, but I have always found it interesting how different types of professional practices operate and I really struggle to work this one out. On the face of it, based on what you and TS have told me over the years, it was hard enough to see how this one was viable even before Covid struck.

I have no personal quarrel with them or any problem, as far as I know, with any the limited treatment I have had. However several friends who also go there are very unhappy, in some cases with their treatment and particularly at the minimal availability which is obviously compounded by being closed the majority of the time!

Toothsmith

NHS practices are operating to instructions from their paymasters. It is just as frustrating for them as it is for the patients.

Undervalued

Toothsmith said:

NHS practices are operating to instructions from their paymasters. It is just as frustrating for them as it is for the patients.

So are you saying they are likely to be instructed to only open one day a week despite the huge backlog? If so, then I am amazed it has not been all over the popular press!

TELLIT01

The NHS dental practice we use was staffed predominantly by EU nationals prior to lockdown and Brexit.  All the staff there now appear to be Brits.  My guess is that the practice the OP uses simply doesn't have enough staff to go round.  First thing to be dropped will / should be annual checkups as they aren't critical, or even important, for most adults.

Toothsmith

TELLIT01 said:

 First thing to be dropped will / should be annual checkups as they aren't critical, or even important, for most adults.

You don't work for a Local Area NHS team do you? Sounds like their sort of attitude!

I'm not saying the NHS will have instructed them to close the practice UV - they wouldn't do anything as direct, decisive or attributable as that.

They have set the rules regarding who should be prioritised, they have said who should be low priority, they have set the rules for the protocols that NHS practices should follow for decontaminations between patients dependent on what procedures they have had done, and they set the targets each quarter for what % of their normal contract they should aim to achieve that quarter.

NHS targets were lowered during the pandemic and they are moving up again now, it is very hard to reach those targets seeing the patients the NHS want them to see using the protocols handed down by the NHS. If targets are not met - as Brook has often said, the contract holders will face a clawback of the funds already paid. This could well be devastating for a practice if it has already spent those funds keeping a practice open to see unreliable casual emergency patients who will as likely as not fail to turn up if the toothache that was 'killing them' when they rang 101 has disappeared overnight.

So yes - the practice might well have decided that the best way to survive over this period, and therefore to still be around for their 'regular' patients once all the silliness comes to an end - is to close for now everything but a skeleton emergency service, take the NHS payments, give back what the NHS demands when targets aren't met, and then get back to normal once the rather Kafkaesque world they find themselves in at the moment has passed.