Vital signs of life in UK dentistry

Most of us will have experienced those moments when we lost the will to live while travelling on a low-cost, ‘no frills’ airline. But in future I will keep my views to myself after the story that broke over Easter, featuring the elderly gentleman who was already dead, strapped into his wheelchair, at the time his family were busily completing the check-in formalities on his behalf.

The man was himself a former airline pilot so the prospect of an EasyJet flight was probably the final straw. When the police were called, they were assured that he was still alive when they left home. Well, we would all would hope so, wouldn’t we?

Overworked EasyJet check-in staff haven’t got time to waste asking deceased passengers all those ‘could anyone have interfered with your luggage?’ questions. I daren’t ask how the family members answered the question ‘Has anyone asked you to carry anything on board for them?’

Highly trained and experienced EasyJet ground staff knew in a flash what they needed to do. It is at times like this that all those long hours of training pay dividends. On lifting the aforesaid passenger into an EasyJet wheelchair in order to check his own wheelchair in, our eagle-eyed,
orange-clad hero noticed that the gentleman was motionless and unresponsive, his skin was ice cold and there was also the small detail that he wasn’t breathing.

These bizarre events at John Lennon Airport, Liverpool, were in a sense a metaphor for UK dentistry. Everyone wants it to be alive and well, everyone continues behaving as if it still is alive and well, but on closer inspection, one can see that the patient has seen better days.

In the NHS, all the constraints of the public sector under the tightening thumbscrews of the Treasury are hardly creating a climate of frenzied optimism. As all the political parties have in recent weeks laboured to persuade us that the NHS is safe in their hands, they are of course not talking about our bit of the NHS. Sorry for that misunderstanding.

It really is the stuff of smoke and mirrors to say that the overall funding of NHS primary care dentistry is secure and ring-fenced, when the actual money is spent incrementally, being drip fed under specified terms to individual practices to achieve selected outcomes.

It is not the same as putting the money into a national fee scale that everyone has equal ‘access’ to (no pun intended). It is scant comfort to know that the overall fund is the same or even bigger, if you can’t get your own sticky paws on any of it. And if in desperation you agree to a Warburton (PDS Plus) contract, because it is the only way to get in on the action, you know in your heart that you are at the same time becoming part of the next soundbite, highlighting all these practices enthusiastically embracing the popular new contractual model.

Anyone who was around at the time of the 1990 ‘new contract’, which introduced registration and continuing care, will remember that list sizes were used then in exactly the same way; quoted regularly as the numbers grew and grew, to demonstrate the success and popularity amongst both patients and practitioners of the new conceptual model for delivering primary care dentistry.

In fact, the money for continuing care payments had simply been stripped out of the fee scale and registering patients as quickly as possible was the only way to get it back.

If looks could kill
Not every passenger boarding an EasyJet flight is deceased, of course. Those that have passed away may not be looking their best, it is probably fair to say. But this is equally true of some of the others who are heading East in search of medical and dental procedures that might otherwise have been provided on home soil.

Nips and tucks, crowns and root canals, dental implants and breast implants. Quite a bit of this work is elective, cosmetic stuff that allegedly comes much cheaper on the other side of the channel, and cheaper still on the far side of Europe. This is private dentistry that UK dentists can ill afford to lose in these challenging economic times.

Nor is this phenomenon only affecting the UK; dentists in Ireland, France and Germany are also witnessing the same kinds of incursion from medical tourism. What surprises me is that nobody seems to be fighting back by reminding British patients that they have much better levels of protection and quality assurance here, and those extra layers of governance, legal redress and accountability are part of the reason for the price difference. We should be pointing to things like the (free) Dental Complaints Service as a positive reason to have this work done here at home instead of allowing this trend to gather pace.

And if – heaven forbid – you end up with serious complications in some deep and distant corner of Eastern Europe, and end up dead, who will bring you home then? I think you can safely cross EasyJet off the list for starters.

Smile time
Now in its 9th year, the World Aesthetic Congress in London could hardly be taking place under less favourable economic conditions and quite a few practices who have positioned themselves in this field tell me that they have noticed quite a sharp downturn in demand. But others I have spoken to tell me that they are busier than ever.

At times like this, when most people are feeling the financial pinch in one way or another, patient
expectations will be higher than ever when they do decide to part with their hard-earned cash – or what is left of it after the Treasury has had its share.

Understanding dental aesthetics is no longer an optional extra for today’s dentist – and nor should we confuse dental aesthetics with ‘cosmetic dentistry’, or assume that all of dental aesthetics involves the liberal use of an air turbine. If past years are anything to go by, 500 or more enthusiasts in the field of aesthetic dentistry will soon be on their way to Westminster to get their annual aesthetic ‘fix’ from some of the best known speakers in the field.

How ironic, therefore, that the short-and-medium-term fortunes of so many dentists who are heavily involved in this field will be determined by what happens a few weeks earlier, just a short step from the QE2 Conference Centre where WAC is due to take place.

The sooner that economic confidence returns and people feel themselves to have money in their pocket again, the sooner people will start smiling again and taking a greater interest in what they look like. And we all know what that means.

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