Kevin Lewis and myself shared a platform with David Geddes and John Tiernan in 1989 at a meeting of 600 dentists, in Oxford, who travelled from across the UK to express their concern with the ignorant way the Tory Government were dealing with the profession. In due course we explained why the 1990 NHS contract was going to be a long term disaster, a slow motion train crash for the profession and a disaster for UK children’s dentistry in the short term, and long term all based on clinical and practice finance studies.
In many parts of England the NHS provision is now of farcical levels where professionals, as Kevin warned in 1990, are still being asked to to do ever more for ever less.
We have a situation where the dental corporates, who hold an increasing share of NHS provision, are recruiting from where ever they can across the EU to keep their dental staff numbers up in practices in deprived areas where there is high staff churn. A proportion of these recruits operate as dental assistants on the area manager’s NHS number, an area manager who in some cases will have up to five different contract numbers depending on the spread of his area and will visit the practice where his ‘assistant’ is working maybe once or twice a month. I may have retired from dentistry (thank God), but I always believed that visiting an ‘assistant’ once a month did not meet the requirement for an ‘assistant’ being ‘properly supervised’ under the Dentists Act.
I have seen this use of dental assistants in operation in inner city London, when I worked on a clinical and regulatory compliance contract for health authorities (HAs) with respect to dental and general practitioner practices within the M25 area. I reported my serious concerns of dental professional misconduct to the HA concerned, and was told if they removed their Nelsonian blind eye provision of laissez faire assistantships, then the company concerned would have to pull out of many other practices leaving a lot of people in the HA without NHS provision, and that would bring the Department of Health (DH) down on the HA. So a poorly performing dentist, with a list of patient complaints, sitting in the area manager’s pending file, continued on as his assistant.
Kevin will know better than me where the problems now are with respect to truly poor practice and practitioners, but the fundamental root of the problem lies with the British Dental Association (BDA) forcing the 1990 NHS contract onto the profession in England. The sudden need to lift annual retention fees (ARF) through the roof is yet another symptom of a failed NHS dental system in England looking for scapegoats to hide the politicians at the DH and the BDA’s inability to create an NHS dental provision in England that is equable and sustainable for all parties.
As long as the main function of NHS dentistry remains to subsidise the middle class electorate in English ‘swing seats’ for crowns and bridges, the problem can only get worse. The GDC is politically weighted to ensure this false NHS subsidy of the middle class voter and myth of universal NHS provision is maintained. The GDC has clearly been leaned on by its political masters to find enough bad boy ‘private stories’ to try and counter balance the farcical situation over the levels of NHS complaints it finds itself dealing with. How long before the Guardian or the Daily Telegraph coughs up a ‘private dentist ruined my life’ tale?
We have been here before and are once again, as a profession, being asked to pay for the political and policy failures of successive Westminster Governments and supine BDA executives. In 1990 it was with a sudden rise in practice bankruptcies and an associated increase in dental professional suicides – what will be the price to be paid this time around?
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