Can I change my mind about dental fillings?

Toothsmith

grimble37 said:

I've had broken molars (that had already been filled in the past) for quite some time, on my last check up the dentist said I should have them refilled (even though last year he said its fine if I want to leave them as they are and so have other dentists on previous occasions)

Anyway, I agreed at the time to come back for several fillings and signed something. 

I've now decided that I don't really want any more drilling etc (as I assume they'll have to put pegs in etc.) as I believe that this will cause them to get worse quicker and eventually have to come out quicker.

Will I still have to pay the extra £40 or £50 ish (the second tier of nhs dental work) if I say that I don't want the fillings?

You are quite entitled to say yes or no to a particular treatment plan. I would, however go back and speak to the dentist again about how necessary they feel these fillings are.

Nothing in the mouth stays the same over the years. Things wear, things move, decay can set in. Also the fillings and other restorations in the teeth will wear and deteriorate over time. 

When training, we learn various parameters around which teeth can be left alone, monitored, or need some sort of intervention - but they are by no means hard and fast rules, and all dentists will have different thresholds where they consider a tooth or filling is OK to leave, or requires something doing. This threshold will also vary depending on which patient is sitting in the chair. Is it one who has a high or low decay rate? Someone who wears their teeth quite quickly, or slowly. Attends regularly or poorly. Many factors.

So it is easily possible that a tooth that was fine to monitor a year ago has now crossed that dentist's threshold for being a tooth that needs work.

One thing is for sure - the dentist will be making a loss on doing a few fillings for you on the Band 3 NHS rate. So that's why I think he has a good reason for saying it needs doing.

I would at least ring up the surgery and tell them you'd rather leave them alone if you could, and ask if they'll ask the dentist's opinion on that. It might come back that he is still happy to monitor things if you really don't want it done, or it might come back that he feels it is time to sort them out now. If that's the case, I would get it done.

grimble37

Toothsmith said:

grimble37 said:

I've had broken molars (that had already been filled in the past) for quite some time, on my last check up the dentist said I should have them refilled (even though last year he said its fine if I want to leave them as they are and so have other dentists on previous occasions)

Anyway, I agreed at the time to come back for several fillings and signed something. 

I've now decided that I don't really want any more drilling etc (as I assume they'll have to put pegs in etc.) as I believe that this will cause them to get worse quicker and eventually have to come out quicker.

Will I still have to pay the extra £40 or £50 ish (the second tier of nhs dental work) if I say that I don't want the fillings?

You are quite entitled to say yes or no to a particular treatment plan. I would, however go back and speak to the dentist again about how necessary they feel these fillings are.

Nothing in the mouth stays the same over the years. Things wear, things move, decay can set in. Also the fillings and other restorations in the teeth will wear and deteriorate over time. 

When training, we learn various parameters around which teeth can be left alone, monitored, or need some sort of intervention - but they are by no means hard and fast rules, and all dentists will have different thresholds where they consider a tooth or filling is OK to leave, or requires something doing. This threshold will also vary depending on which patient is sitting in the chair. Is it one who has a high or low decay rate? Someone who wears their teeth quite quickly, or slowly. Attends regularly or poorly. Many factors.

So it is easily possible that a tooth that was fine to monitor a year ago has now crossed that dentist's threshold for being a tooth that needs work.

One thing is for sure - the dentist will be making a loss on doing a few fillings for you on the Band 3 NHS rate. So that's why I think he has a good reason for saying it needs doing.

I would at least ring up the surgery and tell them you'd rather leave them alone if you could, and ask if they'll ask the dentist's opinion on that. It might come back that he is still happy to monitor things if you really don't want it done, or it might come back that he feels it is time to sort them out now. If that's the case, I would get it done.

That's interesting, I always assumed the nhs would reimburse them very handsomely for each filling, to learn that this is not the case is quite shocking to me, how much do they get paid per filling? 

brook2jack2

Dentists are paid per UDA (unit of dental activity). 

A band one treatment (check up , x rays , simple scaling, study models , etc) earns 1 UDA and the average  a surgery will get in for that is around £28 in total including patent payment . 

A band 2 treatment (your fillings) will earn 3 UDAs and the surgery will get , on average £84 in total for all treatment including the check up , x rays etc and all fillings necessary . 

A band 2 treatment including root fillings will earn 5 UDAS £140 in total. 

A band 3 will earn 12 UDAs which includes all band 1 and 2 treatment plus treatment that incurs a laboratory fee eg crowns, dentures etc that will earn the surgery , in average, £332 . 

However it costs , in a cheap area , at least £140 an hour to run one room in a dental practice . 

Also the dentist pays a proportion of what they earn to the practice to cover costs of practice , between 50 to 70 % of the gross. Laboratory fees , hygienist, therapist fees come off that as well. So before indemnity, registration , insurances , training costs and tax a dentist will earn approximately 30% of the gross. 

So in other words before tax, indemnity, training, registration, insurances , holiday and sick pay (dentists are self employed to don’t get these) 
a dentist will earn £8 or less for a band one treatment , £24 or less for a band 2 treatment (all your fillings, scale, check up etc) and £96 or less for a band 3 treatment. 

The average indemnity will be around £5000 , GDC registration £621, sickness insurance etc £4000 a year at least, training costs vary from £150 to £30,000 depending on what you study but to cover just the essentials each year will be several hundred, then any holidays and sick days have to be covered by earnings . To put that into context just to pay indemnity and registration and very basic training a dentist will have to do 1000 band 1 treatments . 

For items that have a laboratory cost that will, often , be more than what the NHS pays for the whole treatment , so the dentist is , literally, paying out of their pocket for your treatment. 

This is why NHS dentistry is collapsing . Where else would you get the services of a qualified dentist, qualified nurse , the costs of running a practice and all the staff , running costs , consumables costs for at least an hour for the total payment of £84 when it costs at least £140 an hour to run the place? 

grimble37

brook2jack2 said:

Dentists are paid per UDA (unit of dental activity). 

A band one treatment (check up , x rays , simple scaling, study models , etc) earns 1 UDA and the average  a surgery will get in for that is around £28 in total including patent payment . 

A band 2 treatment (your fillings) will earn 3 UDAs and the surgery will get , on average £84 in total for all treatment including the check up , x rays etc and all fillings necessary . 

A band 2 treatment including root fillings will earn 5 UDAS £140 in total. 

A band 3 will earn 12 UDAs which includes all band 1 and 2 treatment plus treatment that incurs a laboratory fee eg crowns, dentures etc that will earn the surgery , in average, £332 . 

However it costs , in a cheap area , at least £140 an hour to run one room in a dental practice . 

Also the dentist pays a proportion of what they earn to the practice to cover costs of practice , between 50 to 70 % of the gross. Laboratory fees , hygienist, therapist fees come off that as well. So before indemnity, registration , insurances , training costs and tax a dentist will earn approximately 30% of the gross. 

So in other words before tax, indemnity, training, registration, insurances , holiday and sick pay (dentists are self employed to don’t get these) 
a dentist will earn £8 or less for a band one treatment , £24 or less for a band 2 treatment (all your fillings, scale, check up etc) and £96 or less for a band 3 treatment. 

The average indemnity will be around £5000 , GDC registration £621, sickness insurance etc £4000 a year at least, training costs vary from £150 to £30,000 depending on what you study but to cover just the essentials each year will be several hundred, then any holidays and sick days have to be covered by earnings . To put that into context just to pay indemnity and registration and very basic training a dentist will have to do 1000 band 1 treatments . 

For items that have a laboratory cost that will, often , be more than what the NHS pays for the whole treatment , so the dentist is , literally, paying out of their pocket for your treatment. 

This is why NHS dentistry is collapsing . Where else would you get the services of a qualified dentist, qualified nurse , the costs of running a practice and all the staff , running costs , consumables costs for at least an hour for the total payment of £84 when it costs at least £140 an hour to run the place? 

With respect, there MUST be something you're missing, I just can't believe that the dentist will be paying out of his own pocket for my fillings.

brook2jack2

No there isn’t anything I’m missing. A NHS dental surgery gets no other money other than what it is paid for treatment . As Toothsmith said as you have had a check up , will be having a seperate scaling appointment and if you had three fillings , the practice and dentist will lose money . 

Root treatments had their fees increased because any plan involving root treatment lost money . Virtually any treatment involving multiple fillings , or crowns or including dentures will lose money . 

For years NHS dental surgeries cross subsidised NHS treatment with private work , however as dental inflation has been running at 10% for years and dental fees have not gone up (patient fees have but the amount the government pays has gone down so the dental surgeries have not had the benefit of these increases) for many this is no longer feasible. 

This is why NHS dentistry is dead in the water , a graduate with £80,000 debts on graduating and massive ongoing indemnity, training,registration, insurance costs is gradually seeing their percentage of what they are paid dropping as practice owners struggle to keep businesses afloat . The most recent practice I know of that has stopped NHS work lost a six figure sum on their NHS contract last year . This is not sustainable. 

More than 75% of all NHS dental practices last year had to repay money on their contracts because despite working all out they could not hit the government targets of UDAs. 

The average spend, per patient treated, per year on NHS dentistry , including patient contributions , is around £40. If it costs a minimum of £140 an hour to run a room in a practice , how much dentistry do you think that will buy and still run a profit? 

I can tell you if you had a check up , scaling with a hygienist/therapist and fillings on the NHS you will have cost the practice and dentist money. They would have been better off giving you £10 to go away. Harsh but that’s the truth of NHS dentistry finances. 

brook2jack2

This is from NI but the situation is the same in England, Scotland and Wales as well https://fermanaghherald.com/2023/05/dentists-are-making-a-loss-on-most-nhs-treatments/

grimble37

brook2jack2 said:

No there isn’t anything I’m missing. A NHS dental surgery gets no other money other than what it is paid for treatment . As Toothsmith said as you have had a check up , will be having a seperate scaling appointment and if you had three fillings , the practice and dentist will lose money . 

Root treatments had their fees increased because any plan involving root treatment lost money . Virtually any treatment involving multiple fillings , or crowns or including dentures will lose money . 

For years NHS dental surgeries cross subsidised NHS treatment with private work , however as dental inflation has been running at 10% for years and dental fees have not gone up (patient fees have but the amount the government pays has gone down so the dental surgeries have not had the benefit of these increases) for many this is no longer feasible. 

This is why NHS dentistry is dead in the water , a graduate with £80,000 debts on graduating and massive ongoing indemnity, training,registration, insurance costs is gradually seeing their percentage of what they are paid dropping as practice owners struggle to keep businesses afloat . The most recent practice I know of that has stopped NHS work lost a six figure sum on their NHS contract last year . This is not sustainable. 

More than 75% of all NHS dental practices last year had to repay money on their contracts because despite working all out they could not hit the government targets of UDAs. 

The average spend, per patient treated, per year on NHS dentistry , including patient contributions , is around £40. If it costs a minimum of £140 an hour to run a room in a practice , how much dentistry do you think that will buy and still run a profit? 

I can tell you if you had a check up , scaling with a hygienist/therapist and fillings on the NHS you will have cost the practice and dentist money. They would have been better off giving you £10 to go away. Harsh but that’s the truth of NHS dentistry finances. 

Well, the dentist doesn't seem to be too hard up, haven't seen him at the food bank in his Mercedes, obviously some undisclosed unmentionable things going on. 

Undervalued

grimble37 said:

brook2jack2 said:

No there isn’t anything I’m missing. A NHS dental surgery gets no other money other than what it is paid for treatment . As Toothsmith said as you have had a check up , will be having a seperate scaling appointment and if you had three fillings , the practice and dentist will lose money . 

Root treatments had their fees increased because any plan involving root treatment lost money . Virtually any treatment involving multiple fillings , or crowns or including dentures will lose money . 

For years NHS dental surgeries cross subsidised NHS treatment with private work , however as dental inflation has been running at 10% for years and dental fees have not gone up (patient fees have but the amount the government pays has gone down so the dental surgeries have not had the benefit of these increases) for many this is no longer feasible. 

This is why NHS dentistry is dead in the water , a graduate with £80,000 debts on graduating and massive ongoing indemnity, training,registration, insurance costs is gradually seeing their percentage of what they are paid dropping as practice owners struggle to keep businesses afloat . The most recent practice I know of that has stopped NHS work lost a six figure sum on their NHS contract last year . This is not sustainable. 

More than 75% of all NHS dental practices last year had to repay money on their contracts because despite working all out they could not hit the government targets of UDAs. 

The average spend, per patient treated, per year on NHS dentistry , including patient contributions , is around £40. If it costs a minimum of £140 an hour to run a room in a practice , how much dentistry do you think that will buy and still run a profit? 

I can tell you if you had a check up , scaling with a hygienist/therapist and fillings on the NHS you will have cost the practice and dentist money. They would have been better off giving you £10 to go away. Harsh but that’s the truth of NHS dentistry finances. 

Well, the dentist doesn't seem to be too hard up, haven't seen him at the food bank in his Mercedes, obviously some undisclosed unmentionable things going on. 

I share your bewilderment!

I am not a dentist but I do have a lifetime of experience with small, highly skilled professional practices that need expensive equipment to operate. So in some ways similar. One of the potential buyers for my old premises was in fact a dentist.

Brook2jack2 and I have discussed this on here a number of times. I live in an area with some of the highest property prices, outside of London, in the country. Close to me is a small, primarily NHS dental surgery run by a dentist who bought the practice when the original owner retired. He has a slightly larger practice in another town about an hour's drive away. That practice is now entirely private but, from its website, certainly couldn't be described as up market! 

The practice close to me now only opens two and a half days a week, the one an hour's drive away sees to be full time. The owner lives the other side of town from me in one of the most expensive roads and Zoopla suggest his house would be well into seven figures. The cars in the driveway are similarly upmarket.

The turnover of staff / "rent a chair" dentists is very high. I must have seen five different people in as many years.

Dentists are highly skilled professionals who have spent a long time studying and are quite entitled to earn a decent salary, that I wouldn't dispute for a moment.

I read Brook's comments and various linked articles and have no reason to doubt them. However I also look at the local setup and simply can't understand it or "square" it with what I see on my doorstep.

brook2jack2

The majority of dentists (78% ) do not own a practice and this percentage is growing because young dentists cannot afford to buy dental surgeries. 

The majority of owners of mostly NHS practices are dentists in their mid fifties upwards . They have stayed in NHS because they practiced in better times , don’t have student loans , have mostly paid off their practice loans and equipment loans and are staying on because of the pension (not available to younger dentists). When they retire new owners with massive loans and costs to service  cannot afford to NHS and mostly start the conversion process. 

The “turnover “ of staff in NHS practice is high because ,as I have explained , the pay is dreadful for the vast majority if engaged mainly in NHS dentistry. 78% of dentists do not own a practice , their pay is falling year on year , whilst their student loans and expenses to be able to practice are increasing. As NHS work becomes more and more of a loss the pay to the 78% is decreasing . Once upon a time , after practice expenses , they got 50% of what they earned , now it’s going towards 30%. 

When you have £80,000 student debt and ongoing expenses to remain registered , insured and indemnified etc of £10,000 plus a year receiving £8 for a check up or £24 for an entire course of treatment involving fillings is unsustainable. 

People talk about making dentists practice for two years etc after qualifying in the NHS but they already do. Very few have done the courses or have the skills to be offered a role in a private practice after only a couple of years. NHS dentistry is propped up by older dentists close to retirement and young dentists who have no choice but to do NHS work. 

This is an excellent view from a young colleague https://www.practiceplan.co.uk/blog/why-ive-changed-my-mind-about-a-career-in-the-nhs/

As someone who was involved for decades in training newly qualified dentists I have never felt so sorry for them as I have now . There is a good reason why the vast majority of dentists would not recommend the career in the U.K. 

Finally when even BUPA , a massive corporate , cannot make a profit from NHS dentistry and had to shut 85 practices surely that is yet more proof of what dentists have been saying for decades now https://healthcareandprotection.com/bupa-slashes-dental-services-following-646m-hit-in-2022/#:~:text=Bupa%20has%20blamed%20a%20dearth,dental%20practices%20across%20the%20country.

Undervalued

brook2jack2 said:

The majority of dentists (78% ) do not own a practice and this percentage is growing because young dentists cannot afford to buy dental surgeries. 

The majority of owners of mostly NHS practices are dentists in their mid fifties upwards . They have stayed in NHS because they practiced in better times , don’t have student loans , have mostly paid off their practice loans and equipment loans and are staying on because of the pension (not available to younger dentists). When they retire new owners with massive loans and costs to service  cannot afford to NHS and mostly start the conversion process. 

The “turnover “ of staff in NHS practice is high because ,as I have explained , the pay is dreadful for the vast majority if engaged mainly in NHS dentistry. 78% of dentists do not own a practice , their pay is falling year on year , whilst their student loans and expenses to be able to practice are increasing. As NHS work becomes more and more of a loss the pay to the 78% is decreasing . Once upon a time , after practice expenses , they got 50% of what they earned , now it’s going towards 30%. 

When you have £80,000 student debt and ongoing expenses to remain registered , insured and indemnified etc of £10,000 plus a year receiving £8 for a check up or £24 for an entire course of treatment involving fillings is unsustainable. 

People talk about making dentists practice for two years etc after qualifying in the NHS but they already do. Very few have done the courses or have the skills to be offered a role in a private practice after only a couple of years. NHS dentistry is propped up by older dentists close to retirement and young dentists who have no choice but to do NHS work. 

This is an excellent view from a young colleague https://www.practiceplan.co.uk/blog/why-ive-changed-my-mind-about-a-career-in-the-nhs/

As someone who was involved for decades in training newly qualified dentists I have never felt so sorry for them as I have now . There is a good reason why the vast majority of dentists would not recommend the career in the U.K. 

Finally when even BUPA , a massive corporate , cannot make a profit from NHS dentistry and had to shut 85 practices surely that is yet more proof of what dentists have been saying for decades now https://healthcareandprotection.com/bupa-slashes-dental-services-following-646m-hit-in-2022/#:~:text=Bupa%20has%20blamed%20a%20dearth,dental%20practices%20across%20the%20country.

Interesting articles, thanks.

I see the first one is almost six years old. Presumably you feel the situation has got even worse since then?

Interestingly there is a BUPA dental practice in the city where I live. That is not on the closure / merge lists at the end of the second article. 

A quick Google shows that the current dentist (presumably a chair renter) at the NHS practice near me used to work at the BUPA practice until recently. Now seems to do two days NHS plus two days at a newly established private practice about 10 miles away. I would guess they are about 40 so unlikely to be newly qualified. Unless the NHS work is out of a sense of duty / charity it is hard to fathom out?

How easy is it for a practice to walk away from a NHS contract? Are there penalties if they break mid term?