Michael Watson questions what is available under the NHS?

Which?Last month Which? launched a campaign to ‘clean up dental costs’, with a lurid picture of a sweating patient being attacked by an ice-pick wielding dentist.

So far it has attracted over 19,000 signatures.

It calls on NHS England and regulators to make sure all dentists comply with existing rules and make information on prices clearly available.

Further it explains that dentists need to explain the treatment options properly and make sure patients know whether or not their treatment is available on the NHS.

It begs the question however, what is or is not available under the NHS, a point made by, amongst others the British Dental Association (BDA) and the FGDP(UK), both of whom have complained about the complexity of the system.

NHS Choices says about what is available: ‘All the treatment that your dentist believes is necessary to achieve and maintain good oral health is available on the NHS.’

The chief dental officer, Barry Cockcroft, has come under fire for not enlarging on this, but why should he?

The dentist in the surgery is surely best placed to explain face to face with a patient what treatment is or is not clinically necessary.

It is well established that the NHS does not cover adult orthodontics, implants in primary care or treatments such as tooth whitening, which all improve appearance but are not clinically necessary.

The snag comes from a sentence in the Which? campaign that says: ‘Your NHS dentist is not allowed to refuse you treatment that is available on the NHS and then offer it to you privately instead’.

And statements such as ‘the NHS doesn’t pay for root treatments’ or ‘the NHS only allows me to do one crown’, are a short cut to a fitness to practise hearing at the General Dental Council (GDC).

So what is to be done (if anything)?

The decision as to what is covered by the NHS is one for NHS England, but three months before an election, no politician wants to be seen as restricting the scope of the service.

So NHS England could simply say that all treatments (except those above) are available.

It doesn’t matter what material is used, so amalgam or composite for any filling wherever in the mouth, dentures in acrylic or chrome, crowns all metal or porcelain bonded.

It doesn’t matter whether the scaling is done by a dentist or hygienist they are available under the NHS.

Is that what those shouting for a list of available treatments want?

I don’t think so.

They want only amalgam or non-precious metal crowns available for posterior teeth, acrylic dentures not chrome under the NHS, and so on.

But be realistic, if NHS England agreed to such a list, there would be a cost to dentists in the form of a cut in contract values.

All measures to restrict the availability of NHS treatment end up as cost cutting operations – a thought to ponder this week.


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    The above article is slightly inaccurate. Yes it is agreed that Withholding/denying treatment on the NHS is a definite no, then offering it privately may very well land you in front of a FTP hearing.
    The confusion for dentists is around the way they have changed the wording from what’s clinically necessary to what’s clinically indicated. Clinically necessary would allow us to provide the cheapest treatment option which satisfies the treatment needs of the patient, whether that’s amalgam fillings or acrylic dentures. The new literature from the NHS states we now have to provide what’s clinically indicated and that any NHS work has to be of the same high standard as private. Again the previous stance was that one couldn’t ‘rubbish’ the NHS in anyway, so most dentists take on it was that’s it’s satisfactory. Now we have to say it’s the same as private. The problem lies in defining what’s clinically indicated, this puts the onus on the dentist and he/she could find themselves in hot water! Nobody and I mean nobody is willing to explain the above in black and white terms, the CDO won’t say anything and the defence agencies won’t clarify either. It’s the end of mixing on the NHS as we know it!

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    Maybe it will end the frankly fraudulent use of the NHS logo – plastered all over certain UDA factories – to get ‘bums on seats’ and then ‘refuse’ vast areas of treatment (molar RCT, decent hygienist/periodontal maintenance anyone?) whilst desperately upselling what can only be described as ‘pretendy private’ work. Frankly as a private practice, we actually regard that as ‘the big lie’. If the GDC etc is going to REALLY stamp on this stuff – more power to their elbow. But I won’t be holding my breath……

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    Keep it simple.
    NHS patient gets only NHS treatment. No mixing in a practice what so ever. Does not happen at your GP practice. If needs a “private” option refer out to a honest private dentist.

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    Of course the GDC is not going to a “damn” thing about it. Why?
    They are a part of this big “lie” so is the DOH
    It is not politically viable to say that what you are getting in many cases is rubbish 3:rd world dentistry. How do you keep high “access” to this rotten system? Corporates + Cheap foreign imports of EU dentists (who are facing total unemployment in their countries i.e Greece , Spain / Portugal etc ) and are more than happy to work for £5 – £6 / UDA (aka Nectar points)
    Majority of them will not even worry about ending up in front of the GDC as they will just pack and go home.
    Pay a visit to GDC’s website and you will see.
    The interesting thing is that the GDC are wasting the reg. money by holding endless FTP / etch hearings about these dentist who have already left the country (They don’t even show up for the hearing) to line their own pockets and their solicitors. You can a bout a case where the dentist from one of the Baltic countries was suspended for 18 months (Did not show up for the hearing) and the GDC is holding another hearing for this dentist for “review” of the case and to see if he should be reinstated !!
    This is where your ARF money goes.

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    There is an NHS regulation which *obliges* us to provide the cheapest TP to make a patient dentally fit. 6 grossly carious teeth on NHS = extractions and an acrylic denture. Privately, root treatments and crowns. If it were possible to buy 12 bottles of beer for the price of one, off-licenses would find a way to sell single bottles and dozen-bottle sales would be VERY rare.

    The NHS regs are very clear and are a great help.

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    Doc, imitation is the sincerest form of flattery!
    Any honest individual, not even a dentist, would see the system of dentistry is totally corrupt and bereft of morals in the UK. I see patients all the time from “NHS” practices with such obvious neglect.

    As you say the UDA mills bring in the public to either up sell or make up the UDAs. How I laughed when a patient said his NHS practice cared about him as they said he needed 3 monthly check ups and he has needed no dentistry for 5 years and has perfect oral hygiene. How does an NHS practice employ a hygienist and have work for them under the UDA system and adhere to NHS guidance? Errr they dont….oh that means NHS practices in most parts of the country are misleading patients as to what is available under the NHS..Quelle suprise!

    And Mr Watson yes there should be a list of treatments. Then the dentists (or corporates) who are willing to provide this will do so and those that are not, will not. If there are cuts then so be it. Otherwise the public will always be misled. The only reason the UDA system has been popular has been the stability of income for those dentists who partake not the clincal care of patients. No new system will improve upon this.

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    Regarding the comment about the hygienist and UDA system. In my experience well over 95% of cleans are for cosmetic purposes. Wall-to-wall calculus and no pocketing means a private scale as there is no periodontal disease. THise of my patient who do need ‘proper’ periodontal treatment need to see a specialist and not have me putzing around.

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    With all due respect Dr Teeth,
    This is your interpretation of the NHS dental contract which is wrong and has landed a lot of colleagues in front of the GDC (I hope it will never happen to you) but the reality is that what you are writing here will be regarded as “Misleading” the patients if a patient decides to complain to the GDC
    Anybody in doubt about what my claims in this post needs to only spend a few minutes, reading the allegations against those dentists who are being investigated by the GDC and the GDC’s verdict.

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