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    • Undervalued
    • By Undervalued 13th Jan 20, 11:48 AM
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    Undervalued
    Question for Brook and / or Toothsmith
    • #1
    • 13th Jan 20, 11:48 AM
    Question for Brook and / or Toothsmith 13th Jan 20 at 11:48 AM
    Could either of you kind dentists answer this for a friend of mine (although possibly also relevant for me in the future)....

    A close friend (yes, honestly) has used the same NHS dental practice as me for 20+ years, through all its ups and downs which we have discussed on other threads.

    It seems there has been yet another change of dentist at what is now a small offshoot of a much larger practice in another town. Anyway, my friend went for a checkup last week but felt so uneasy about the person they saw that they don't want to go back. They apparently need two fillings, one each side, so two visits.

    Presumably there is no way of taking that checkup result to another NHS dentist to have the work carried out?

    They are sufficiently unhappy that they would right off the NHS Band I fee and pay again for a checkup elsewhere. Is that allowed as it would be two NHS checkups within weeks?

    My friend is not somebody who is given to over dramatic reactions nor, as far as I know, do they have any particular dental phobia.

    I am due for a checkup with, presumably, this same dentist in a couple of months so I have a few weeks to decide whether to give them a try or look elsewhere. There doesn't seem to be a shortage of NHS dentists around here.

    Thanks.
    Last edited by Undervalued; 13-01-2020 at 11:51 AM.
Page 1
    • Toothsmith
    • By Toothsmith 13th Jan 20, 12:12 PM
    • 9,255 Posts
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    Toothsmith
    • #2
    • 13th Jan 20, 12:12 PM
    • #2
    • 13th Jan 20, 12:12 PM
    Brook is better placed than me for the technicalities of NHS payment rules. I've not been a part of the system since it changed in 2006.

    I would guess that 2 check-ups so close wouldn't be allowed - but I'm not sure at what point in the system it would be picked up, or what any penalty might be, as technically your friend would have 'overpaid'!

    I would say, however, that it is important to be comfortable with the person providing your dental care, so if you're not, then it's right to go elsewhere.

    Remember, though, that whether a tooth needs a filling or not isn't always black & white. An old looking filling may last ages, so where one dentist might want to replace, another might not. Also, if a tooth has quite early decay, one dentist might review in 6 months or so, another might consider that it needs filling now. So if one dentist tells you you 'need' 2 fillings, another may say you need less (Or maybe more!) That's why one dentist can't really carry out the treatment planned by another. They may, quite legitimately, have a different opinion on what is necessary at that time.

    Whether you go or not is up to you. You don't say why your friend was uneasy. It might be you feel the same, it might not. Different people do like different approaches though. You might well get on perfectly well with the new person.
    How to find a dentist.
    1. Get recommendations from friends/family/neighbours/etc.
    2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
    3. Assess the helpfulness of the staff and the level of the facilities.
    4. Only book initial appointment when you find a place you are happy with.
    • Undervalued
    • By Undervalued 13th Jan 20, 12:36 PM
    • 4,651 Posts
    • 4,049 Thanks
    Undervalued
    • #3
    • 13th Jan 20, 12:36 PM
    • #3
    • 13th Jan 20, 12:36 PM
    Brook is better placed than me for the technicalities of NHS payment rules. I've not been a part of the system since it changed in 2006.

    I would guess that 2 check-ups so close wouldn't be allowed - but I'm not sure at what point in the system it would be picked up, or what any penalty might be, as technically your friend would have 'overpaid'!

    I would say, however, that it is important to be comfortable with the person providing your dental care, so if you're not, then it's right to go elsewhere.

    Remember, though, that whether a tooth needs a filling or not isn't always black & white. An old looking filling may last ages, so where one dentist might want to replace, another might not. Also, if a tooth has quite early decay, one dentist might review in 6 months or so, another might consider that it needs filling now. So if one dentist tells you you 'need' 2 fillings, another may say you need less (Or maybe more!) That's why one dentist can't really carry out the treatment planned by another. They may, quite legitimately, have a different opinion on what is necessary at that time.

    Whether you go or not is up to you. You don't say why your friend was uneasy. It might be you feel the same, it might not. Different people do like different approaches though. You might well get on perfectly well with the new person.
    Originally posted by Toothsmith
    I have a bit of an idea but I didn't like to delve into it too much, so I won't go into more detail beyond saying I don't think it is a simply a question of them not believing that the work needs doing.

    I'm grateful for your response and fully take the point about different judgements about whether something needs doing now vs. watch and wait.

    For myself, once the place was refitted c. 7 years ago and the first young(ish) dentist installed, it seemed excellent. Sadly he left (now practices about 35 miles away - isn't Google wonderful!!) and it has been very fragmented ever since. I would much prefer a feeling of stability but where to find it?
    Last edited by Undervalued; 13-01-2020 at 12:39 PM.
    • brook2jack
    • By brook2jack 13th Jan 20, 5:58 PM
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    brook2jack
    • #4
    • 13th Jan 20, 5:58 PM
    • #4
    • 13th Jan 20, 5:58 PM
    As TS said no dentist will do work based on another dentists treatment plan . That's because there are very few absolutes in dentistry and many treatment plans are a matter of individual judgement.

    There is no reason why you friend cannot go to another NHS dentist and have a check up , however even if the treatment plans are different then that does not mean either dentist is at fault , give two dentists the same patient and you'll get three different treatment plans.

    To be honest life is so difficult as a dentist practicing in the NHS , particularly if practicing in a corporate practice rather than an individually owned practice there is very little incentive for dentists to stay long . A recent survey says 86% of dentists want to leave the NHS in the next 5 years.

    If you are looking for stability an small family practice will more likely give you that , and , dare I say it , private more likely than NHS.
    • Undervalued
    • By Undervalued 14th Jan 20, 8:36 AM
    • 4,651 Posts
    • 4,049 Thanks
    Undervalued
    • #5
    • 14th Jan 20, 8:36 AM
    • #5
    • 14th Jan 20, 8:36 AM
    As TS said no dentist will do work based on another dentists treatment plan . That's because there are very few absolutes in dentistry and many treatment plans are a matter of individual judgement.

    There is no reason why you friend cannot go to another NHS dentist and have a check up , however even if the treatment plans are different then that does not mean either dentist is at fault , give two dentists the same patient and you'll get three different treatment plans.

    To be honest life is so difficult as a dentist practicing in the NHS , particularly if practicing in a corporate practice rather than an individually owned practice there is very little incentive for dentists to stay long . A recent survey says 86% of dentists want to leave the NHS in the next 5 years.

    If you are looking for stability an small family practice will more likely give you that , and , dare I say it , private more likely than NHS.
    Originally posted by brook2jack
    Thanks for responding.

    As I said in my reply to TS, I don't think my friend's primary concern was about whether the proposed treatment was necessary.

    I take your point about stability and it may well be that going private is the only way to get that. It is not a case of "dare I say it", I value your opinion. I was probably unlucky with my attempt to go private, which we have discussed in the past. It likely would have given the stability but what it didn't seem to offer was any other obvious benefit for the substantial up front cost (which was open ended) and ongoing monthly payment. It struck me as very much like the NHS practice I had used all my adult life, before it started its ten year decline!

    I will review options again in the next couple of months.
    • Sammy2018
    • By Sammy2018 14th Jan 20, 6:37 PM
    • 54 Posts
    • 5 Thanks
    Sammy2018
    • #6
    • 14th Jan 20, 6:37 PM
    • #6
    • 14th Jan 20, 6:37 PM
    I would guess that 2 check-ups so close wouldn't be allowed - but I'm not sure at what point in the system it would be picked up, or what any penalty.
    Originally posted by Toothsmith
    If someone was paying for their NHS dentistry, could they have as many check-ups as they like? With as many different dentists as they prefer? And all within 6 months of each other?

    It's not a drain on NHS finances so I personally can't see a problem. I will stand corrected though.
    • brook2jack
    • By brook2jack 14th Jan 20, 9:35 PM
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    brook2jack
    • #7
    • 14th Jan 20, 9:35 PM
    • #7
    • 14th Jan 20, 9:35 PM
    Two things

    In England and Wales dentists have a limited number of dental units of activity , in other words once their contract is used up they cannot do any more dental treatment on the NHS. So if you had multiple check ups you would directly be depriving other people of treatment.

    In England and Wales for the majority of dentists the government tops up by a tiny amount the money a patient pays for treatment. Although it is true that for quite a sizeable chunk of dentists the value of the dental units is the same as the patient charge and for a small number of dentists what they get is less than the patient charge (which is , effectively a government tax that dentists have to collect.)

    So you would be depriving the health service of money .

    In Scotland and NI the government pays 20% of the cost of NHS treatment but check ups are free as they are for certain groups in Wales so again you are directly costing the health service money.

    I also suspect the computers would pick you out if you had multiple check ups and you would receive a letter from the NHS business authority.
    • Undervalued
    • By Undervalued 15th Jan 20, 8:10 AM
    • 4,651 Posts
    • 4,049 Thanks
    Undervalued
    • #8
    • 15th Jan 20, 8:10 AM
    • #8
    • 15th Jan 20, 8:10 AM

    To be honest life is so difficult as a dentist practicing in the NHS , particularly if practicing in a corporate practice rather than an individually owned practice there is very little incentive for dentists to stay long . A recent survey says 86% of dentists want to leave the NHS in the next 5 years.
    Originally posted by brook2jack

    In England and Wales for the majority of dentists the government tops up by a tiny amount the money a patient pays for treatment. Although it is true that for quite a sizeable chunk of dentists the value of the dental units is the same as the patient charge and for a small number of dentists what they get is less than the patient charge (which is , effectively a government tax that dentists have to collect.)
    Originally posted by brook2jack
    We digress and I know we have touched on some of this before...

    Why then does anybody take over what was a very run down NHS only practice, in a very expensive area of the country, completely refit it to a high standard and continue to run it 95% + NHS? It doesn't seem to make any sense. The place is less than 100 yards from my house so I know exactly what it would sell for!

    The dentist who took over the practice lives in one of the most expensive roads in the town. He drives a car to match and owns a practice with about four dentists in another town about an hour away. Although property etc is far less expensive there, that practice seems to 50% or more private. As best I can judge, their private charges are middle of the road. Certainly there are some "up market" practices round here charging at least twice as much!

    Maybe that practice makes him a very good living? As long as they do a decent job (and I have no reason to suspect otherwise) then good luck to him. However, to me at least, it makes having the one near me, as it currently is, all the more strange.

    Edit....

    I have just looked at its Google reviews. Pretty damming on the whole, averaging only two stars. The larger practice in the other town scores far higher.
    Last edited by Undervalued; 15-01-2020 at 8:13 AM.
    • Toothsmith
    • By Toothsmith 15th Jan 20, 9:26 AM
    • 9,255 Posts
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    Toothsmith
    • #9
    • 15th Jan 20, 9:26 AM
    • #9
    • 15th Jan 20, 9:26 AM
    You would need to know a lot more about the accounts, the source of the capital, and the way it's being run and the accounts are being written to even begin to make a stab at how this is working.

    I have several theories.But the only one I'm prepared to write down is that this chap must be independently wealthy, and is using his good fortune to benefit your community.
    How to find a dentist.
    1. Get recommendations from friends/family/neighbours/etc.
    2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
    3. Assess the helpfulness of the staff and the level of the facilities.
    4. Only book initial appointment when you find a place you are happy with.
    • Undervalued
    • By Undervalued 15th Jan 20, 9:48 AM
    • 4,651 Posts
    • 4,049 Thanks
    Undervalued
    You would need to know a lot more about the accounts, the source of the capital, and the way it's being run and the accounts are being written to even begin to make a stab at how this is working.

    I have several theories.But the only one I'm prepared to write down is that this chap must be independently wealthy, and is using his good fortune to benefit your community.
    Originally posted by Toothsmith
    Maybe? Although there seems to be no shortage of NHS practices round here, some advertising for patients.

    Unless it is a limited company (unlikely?) or a registered charity (even more unlikely!) then there is no public access to the accounts. So we will probably never know!
    • Toothsmith
    • By Toothsmith 15th Jan 20, 10:31 AM
    • 9,255 Posts
    • 11,155 Thanks
    Toothsmith
    Limited companies are a lot more common in dentistry nowadays - my own practice is a 'Ltd' and it's pretty small. Dental practices were banned from doing this up until relatively recently. It can make a lot of financial sense to do it though.

    There are dental practices run as charities too. I knew a chap who ran a 'not for profit' group of practices, and he drove a lovely Bentley! 'Not for profit' doesn't mean that people aren't paid for what they do!

    But - there are advantages to a practice for still being NHS - so it is still very popular, and much of this country's dentistry is provided through it. There is the good pension scheme that will be available to the dentists with contracts, and of course, the 'NHS' logo that sits outside the practice will draw people in who you can then 'upsell' private stuff to.

    The downside is that you have to put up with even more regulation and inspection of your practice, there is the constant fear of 'clawback' of fees if you do not hit your targets, and you have to make the judgements and justify what you will and won't do on the NHS for patients based on incredibly vague guidelines.

    If you're good at selling stuff, though and don't have too many patients that take you to task over what you should be doing for them on the NHS, and are generally happy to 'top up' what you will do on the NHS with private fees - then you can keep things ticking over quite nicely.

    Even better if you have a steady stream of associates who are willing to work on very tight contracts, for a low percentage of their gross income and bear their burden of any practice clawbacks.
    How to find a dentist.
    1. Get recommendations from friends/family/neighbours/etc.
    2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
    3. Assess the helpfulness of the staff and the level of the facilities.
    4. Only book initial appointment when you find a place you are happy with.
    • brook2jack
    • By brook2jack 15th Jan 20, 3:03 PM
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    • 4,107 Thanks
    brook2jack
    Should point out that 86% of dentists and increasing do not own their practice and in the current climate will never own a practice.

    Also newer graduates pension is much less favourable than the pension of old farts like us .They have also graduated with circa 80,000 debt to service and in the last 10 years or so dental incomes have fallen every year, particularly for associates ie those who don't own practices.

    So in other words who owns a practice and how they make a profit is a red herring , its the conditions for the dentists who provide the treatment that determines whether they stay or not and most dentists want to leave the NHS as soon as possible. https://www.dentistry.co.uk/2019/03/25/nhs-dentistry-facing-mass-exodus-dentists/
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