NHS dentistry letter published in The Telegraph ‘unhelpful’

NHS dentistry

The letter, written by Tony Kilcoyne, is unhelpful for NHS dentistry, Michael Watson says

Tony Kilcoyne’s letter published in The Telegraph was unhelpful to both dentists and NHS dentistry, Michael Watson believes.

Last week dentistry hit the headlines with a letter published in The Telegraph, and signed by 400 dentists saying that the NHS system was unfit for purpose and was leading to a ‘third world’ service.

The lead author and organiser of the letter, Tony Kilcoyne, has been popping up all over the broadcast media and many dentists think he has done a great job.

I cannot agree, nor can many of those I have spoken to, who have told me it was unhelpful.

Unhelpful

The chief dental officer for England, Sara Hurley, said that many of the assertions made in the letter, and accompanying article, are ‘difficult to substantiate’.

The British Dental Association (BDA) has remained silent, wisely I feel because the story could rebound badly on the profession.

Since the new contract started nearly 10 years ago, the NHS has lost the power to decide who is seen, how often they are seen or what treatment they have, including prevention.

All it does is commission units of dental activity, with having only a limited say in what care they represent.

Perverse incentives

Unlike GPs, dentists do not have to take on more patients if they are working to ‘full capacity’, something which they define for themselves.

The system contains some significant perverse incentives.

What works best for a contract holder in business is to have a small number of patients with good oral health, see them frequently and do the minimal amount of work on each.

Someday someone is going to ask why the NHS is paying £75 for a single surface filling or £300 for a single crown or one tooth acrylic denture.

And given that in Scotland, Childsmile is a success, why should they not divert some of the money being spent on UDAs into a preventive scheme operated by therapists and trained nurses.

NHS dentistry

Doctors can only close their lists to new patients with the consent of NHS England, why should the same not apply to dentists?

All this would require is changes to the contract, but ministers may not wish to wait until the prototypes succeed or fail, if the public are clamouring for something to be done.

Add in the Chancellor’s recent proposal for time limited contracts, there could be change much earlier.

The change will not be to the liking of many dentists, but that’s what happens when you stir up the hornet’s nest that is NHS dentistry.

7 Comments

  1. 1

    The £75 can be for a simple one surface filling or a full exam, scale and polish , all the necessary radiographs, which can be quite a few depending on the treatment plan, a molar endo, and a filling on top of it.
    Incidentally £75 is a quite reasonable fee for a high quality filling in majority of the (comparable with the U.K. ) Western European countries.
    As dear Dr Watson retired before the down of the UDA’s (aka Nectar point) system and possibly still remembers the item per service system with the ridiculous fee system back then (£7 for an occlusal filling) he probably thinks £75 is a “lot of money” for a well executed dental filling.
    Well a lot of “exempt” patients in this country pay £15 – £20 to get their nails done every 8 weeks or smoke a pack (£5 per pack) cigarettes per day.
    If Mr Osborne decides to put more pressure on NHS dentists, doing a lot more for less , many will sell their practices to Barry’s current paymaster or go private or emigrate.
    And where are all these therapists and hygienists and “well trained” dental nurses to carry out the prevention?

  2. 2

    As Michael has said, it’s almost 10 years since the imposition of the new contract. This imposed contract had no resemblance to the Options for Change pilots trialled by participating practitioners for the previous two years. I was one of those practitioners. The new contract was doomed to fail and has resulted in patients having difficulty in obtaining proper courses of appropriate and necessary treatment. Prior to the new contract, NHS practitioners were obliged to make a patient dentally fit and were able to provide a wide variety of treatments. Patients were usually able to select a dentist of their choice and treatment was not rationed. For a proper service to be restored, all that needs to be done is for the D.O.H. to accept that the actions of the previous Chief Dental Officer have had a hugely detrimental effect on the oral health of the population and to return to a dental contract based on fee for item of service. To me it is of great sadness that the bureaucrats of the NHS always believe in moving forward and never think it may be helpful to look back at a time when things worked well and to ask themselves why that might have been so. As the meerkats might say, the solution is ‘Simples’.

  3. 3

    Thank you Michael for your thoughts and your insights to what Ministers and powerful Civil Servants are already thinking & planning – We both know the Secretary of State has always had the power to change everything with one signature contractually – they will do this whether we cower and stay silent to any Centralised threats, neglect and incompetence, or not, frankly!

    Do you fancy walking down children’s hospital wards with me and trying to explain that they must remain languishing in ever-increasing numbers, doomed to suffer more because Ministers don’t like public accountability in the glare of the media, so many more children must continue to suffer at Third World levels in our supposedly First World Country?

    No Michael, it is simply not acceptable to succumb to institutionalised bullying, oppression OR feeling forced into public silence about people suffering due to unfit Central Strategies and a limited/failed Dental System, publicly misrepresented as comprehensive for all :(

    It’s time to be a voice for the vulnerable Children and vulnerable Adults and vulnerable Professionals too – BAD systems and BAD planning are BAD for patients and professionals alike.

    The 400 whistleblowing should be applauded, not suppressed or made to feel guilty for speaking out in the public interest first and foremost.

    Now, let’s have that LIVE TV debate with Ministers about better Dental Health and Prevention that COULD start tomorrow – no more delays, fudges or avoiding solutions that we already know are better for all.

    What are THEY afraid of ???

    Yours Candouringly,

    Tony.

  4. 4

    The UDA system was forced upon NHS dentistry , “No change is not an option ” . The BDA was not forceful enough in defending the profession nor NHS dentistry that most could see was being taken down a one way street .
    Whilst Michael Watson talks about the £300 single crown he fails to mention that the fee includes all necessary treatment including examination , scaling , fillings ,radiographs and root canals . He also fails to mention the same £300 fee which applies for multiple crowns and bridges etc .
    We are heading yet again for another new system that will also be poorly thought out , the initial trials have already been changed beyond all recognition to other prototypes , as if changing the names from pilots will fool anybody into thinking that they are either better or will work .
    Bearing in mind he is actually writing to other dentists I cannot really understand what points he wishes to make .
    Surely its time we gave a united front .

  5. 5

    Somebody may also ask why an immigrant or poor British man with 10 cavities has to be treated by a dentist for only £75?
    Perverse incentives will remain until the nhs pays properly for prevention.
    Even the fp17 does not collect data on periodontitis

  6. 6

    The people of England have received the level of care that they pay for with the expected result of being internationally known for their horrible teeth as a culture. The media often jokes about the poor state of British teeth. This has been true for many decades and I doubt that it will change in the coming decades. While we accumulate all kinds of increasingly nicer things this has been done by neglecting our health as cost containment as it seems to have low priority.

  7. 7

    Tony and the other 400 dentists well done for speaking up.

    Michael Watson needs to be retired from writing this column. As a retired dentist he clearly has no understanding of how poor dentistry is on the “NHS”. There is no such thing as “NHS Dentistry”. There is a simple payment scale and next to no guidance is given to dentists has to the quality of care that should be given.

    RCT for £75 on the NHS is the same as an RCT done under a microscope where the appointment time may take 2 hours or so? Oh and that £75 included the diagnosis, x rays and the core for the tooth….

    This column is “unhelpful”. Any genuine dentist who wants to do the best for his/her patients knows without a shadow of a doubt this cannot be done on the NHS. To say otherwise is to protect politicians and bureaucrats not patients.

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