Lights – music – curtain – chequebooks

It’s showtime. The BDTA Showcase exhibition is upon us, and the annual litmus paper is dipped hopefully into the professional test tube. It is anybody’s guess what colour it will be by the time it emerges.

Yet another Showcase has arrived just as the profession finds itself in uncertain times (there must surely be a message there somewhere). This time around, we have the double whammy of the dent to confidence created by the general economic downturn and the latest melee(s) in NHS dentistry. This means that neither the private practice, nor the NHS practice nor the mixed practice is immune. In England and Wales the protracted shambles continues – with the promise of further re(dis)organisation on the horizon.

In Scotland the profession is fighting a rearguard action against lifelong registration and in Northern Ireland the profession is edging itself towards something – but nobody knows for sure quite what.

The dental trade will, as always, dress up in its finery and dazzle us with new designs, new technology and new materials, as well as with our staple diet of consumables. But the blunt truth is that a lot of this excellent equipment, instrumentation and science is being funded by private dentistry, even when it may end up being used on NHS patients.

It takes a real leap of faith for any largely NHS practice to invest in equipment when you know that you will never cover the cost of it from the provision of NHS dentistry. For the benefit of any visiting martians (or those who don’t have the joy of working in NHS practice in England and Wales), I should explain that a clinical examination alone yields one UDA, after which the dentist receives no remuneration whatsoever for any X-rays taken. The government has effectively asked NHS providers to pay for all their X-ray equipment themselves, together with the cost of all the training and ionising radiation compliance, and to offer this service to NHS patients for no recompense at all.

Similarly, all the costs incurred in connection with any NHS endodontics provided (and these costs can be considerable) are also incurred and paid out of fresh air. This is because every root-filled tooth needs a restoration of some kind to seal the pulp chamber and/or restore the tooth and this yields three UDAs, with or without the root filling itself. Thus, as incredible as the visiting martians might find this, neither the state, nor the patient, makes any contribution whatsoever to the cost of providing NHS endodontics. And a second or subsequent RCT in the same course of treatment is also funded wholly out the dentist’s own pocket.

Intelligent life
The martians are getting quite puzzled by this stage. If the dentist is never actually paid for any of the X-rays taken or root fillings carried out on the NHS, has anyone stopped to ask how long it will take before sheer business necessity forces them to stop offering these treatments at all? When told that this had never crossed anybody’s mind, the martians headed back to their spaceship scratching their heads and reviewing their starting premise that there was likely to be intelligent life in planet earth. Clearly they had been misinformed.

But it gets worse, of course. Put simply, a dentist is paid a small sum for the first filling in a course of treatment, but not for a second, third or subsequent filling. So all the burs, materials, local anaesthetic, gloves etc needed when providing all this treatment within a single course of treatment must be funded by the dentists themselves with no contribution from either the State or the patient. It is rarely pointed out that even though a provider effectively receives no income in any of the situations described above, a performer generates no additional UDAs either. And for most performers (who are paid in proportion to the UDAs achieved) this impacts on their income too. At least they – unlike the provider – don’t incur all the additional expenditure attached to each additional (unremunerated) procedure.

If dentists (or their bank managers) ask why on earth they should continue to invest so heavily in all the equipment, materials and instruments needed to provide all this treatment that neither the patient nor the State pays a penny for, dentists are simply reminded of their ethical and professional obligations.

Yet go along to Showcase and you are likely to see something quite remarkable. The profession will be spending money on things that at first sight will not yield any financial return whatsoever, for the reasons stated above. Viewed objectively, it makes no business sense at all. But dental
practitioners are past masters (and mistresses) at constructing unlikely solutions to seemingly impossible problems. We have all those years of working in the NHS to thank for that.

Toy story
What is even more remarkable – although it never captures any headlines – is that practitioners still invest in quite expensive ‘toys’ even when they will be spending a significant proportion of their time using them on NHS patients. The NHS has always been an ungrateful and unacknowledged beneficiary of the provision of private dental treatment. If the NHS is foolish enough and short-sighted enough to do anything to destabilise the ‘mixed’ dental market that keeps so many practices with a toe in the NHS, it will find itself bereft of access to all the facilities that private dentistry pays for, that NHS patients then get the benefit of. And it will have itself, not the profession, to blame for this.

So spare a thought for the dental trade this month as it lights up its annual shop window and makes its case to a bruised and battered profession. When the curtain goes up, I hope that sufficient numbers of the profession will write enough cheques of an adequate size to make it all worthwhile for the trade, given the massive investment they make into Showcase. But it is just as important that the sums add up for those who are writing the cheques – and here the soprano, so to speak, has yet to sing.

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