In an exclusive interview with Dentistry.co.uk, Practice Plan’s Nigel Jones considers some of the options before dental professionals in light of the three sets of results gathered by the NHS Confidence Monitor.
Dentistry.co.uk: What did you set out to achieve by conducting the NHS Confidence Monitors?
Nigel Jones: We know that the NHS is the single biggest influence on the dental marketplace as a whole, so I think monitoring what’s going on in the NHS and how people are feeling is extremely important. The sad truth is that the awareness of the changes that are going on in NHS dentistry – or have the potential to be introduced – is very low.
With all of this in mind, I look at the NHS Confidence Monitor as a way of stimulating debate and engaging more people than might otherwise be the case. Too many are focusing solely on the day-to-day clinical aspects of dentistry and are losing sight of the longer-term picture. I hope that the debate and discussions that come from the NHS Confidence Monitor results will help more people be better informed about what the future may look like and therefore what choices they might have to make – to maximise the chance that practising dentistry is worthwhile, both clinically and financially.
Dentistry.co.uk: The fourth survey is currently underway, but with three sets of results so far, what is your overarching view of what the figures are telling us?
Nigel: From my perspective, the results have shown that any optimism that was there at the beginning of the monitor’s rollout at the end of 2014 has dwindled quite rapidly. It is important, however, that dentists and their teams don’t forget that while the profession as a whole has a negative public perception as a result of media coverage, the view of individual dentists by their own patients is very positive. They should never lose sight of that.
Yes, the results suggest that the profession doesn’t have confidence in the future of NHS dentistry but, thanks to the NHS Confidence Monitor’s results bringing the challenges to the fore, that uncertainty can now be exchanged for information and debate about positive options to improve the outlook for dental teams and
Dentistry.co.uk: What has shocked you most about the results?
Nigel: What shocks me most – but doesn’t necessarily surprise me – is the lack of confidence in dentistry as a career, with 70% of respondents stating they wouldn’t recommend dentistry as a career to a friend or family member, and dentists the least likely of all team members to make such a recommendation. I completely understand how people who have been in dentistry for a number of years have become disillusioned.
I still think it’s a fantastic career choice, because fundamentally dentists are still in a position to completely change the lives of their patients. I’ve met so many people who feel indebted to their dentist for improving their oral health and whose lives have been transformed by their dental treatment. It’s a real shame that the weight of all the pressures dentists currently face means that this sense of professional satisfaction has, and is, getting lost.
Dentistry.co.uk: Do you find any of the outcomes more worrying than others? If so, why?
Nigel: Aside from the recommendation figures, which we have already discussed, the other aspect that worries me is that of patient outcomes, with 74% of survey participants lacking confidence that patients will be happy with the outcome of attending an NHS dental practice in the future.
For many years, I have had the sense that the majority of dentists have protected their patients from the impact of the NHS tightening up and changing, often at the expense of their health, wealth and home life. I believe many of these dentists are reaching their limit now and that poses a considerable challenge for the profession in terms of what’s next for them and their patients.
Dentistry.co.uk: You’ve carried out three surveys so far; what external factors have changed between them and in what way – if at all – have they affected the results?
Nigel: I think that what has happened in the last year – in particular since the general election – is the continuation of austerity. With increased awareness and, in many cases, acceptance of the need for tighter financial management of the NHS comes the perception that NHS dentistry will be lower down the list of priorities than other areas.
I think that the pressure of operating under the existing NHS contract is growing and you can see that practically manifested in more rigorous management of NHS contracts as well as the 1% uplift in contract values, which really only equates to about 0.75%. At the same time practices are taking the flack for both the 5% increase in patient charges and the stricter enforcement of eligibility for exemption from NHS charges.
I also think that things like the introduction of the Compass management system, along with its flaws, have just added even more challenges to a pressurised situation. Belief that there is light at the end of the tunnel seems to be eroding by the day. George Osborne’s announcement regarding time-limited contracts last year also signals the possibility of major change, the repercussions of which I think the profession understands and will also have affected confidence.
Dentistry.co.uk: What has been delivered so far is certainly proving to provide an insight into the profession, so, with this, what’s the next step for Practice Plan and the NHS Confidence Monitor?
Nigel: I think it is time for us to evolve the NHS Confidence Monitor, to find a credible way to explore the different options available to dentists. We have to find ways forward to counter-balance the low morale that we have found; we will do that that by helping to empower people through various means, including the Insights Panel, made up of key opinion leaders and experts from the dental profession who will explore and debate their significance and implications for the future of NHS dentistry, as well as informative articles and blogs.
Dentistry.co.uk: Are there any members of the NHS dental team that the figures indicate are more worried than others? If so, why do you think that is?
Nigel: The direction of travel for the NHS would seem to me to make the life of an NHS associate more and more difficult. As well as downward pressure on their share of UDA values, the drive for a cheaper delivery model seems to be pushing towards the use of hygienists and therapists in a more extensive way that poses a threat to the role of the associate.
That’s nothing new but I’m not sure enough associates are giving sufficient thought to how their careers will pan out over the next 10 years or so. At least if time-limited contracts come in to force, the likelihood is the goodwill value of NHS practices will suffer and potentially be brought within reach of associates for whom practice ownership is not currently a viable option.
Dentistry.co.uk: What do you think are the government’s criteria for success and in what way do they have the potential to affect the profession’s confidence?
Nigel: I think it’s all about budgetary control and controlling – if not reducing – spend, while at the same time minimising the risk of any negative PR associated with the public’s perception of the government’s commitment to NHS dentistry.
Dentistry.co.uk: In your opinion, to what extent are factors beyond the NHS contract affecting confidence levels?
Nigel: Without a shadow of a doubt the risk of litigation and complaints ending up with the GDC are very worrying for a lot of practitioners. There is also a link between complaints and the NHS, because I think it is increasingly difficult to meet the requirements of the GDC within the constraints of an NHS contractual arrangement with a low budget.
This was very well articulated by the letter earlier this year from the Federation of London LDCs to the GDC. Dentists know that they have to provide a full range of clinical options to patients and communicate effectively but are nervous about having adequate time to explore all the options and meet patient expectations.
Dentistry.co.uk: Based on the comments Practice Plan has received from the profession, as a result of the surveys, can you in any way envisage the future of any elements of NHS dentistry? And if so, what might they be?
Nigel: Well, it’s hard to be confident in the future as many are losing confidence that the current prototypes are genuine forerunners of a new contract. However, I think there will be an oral care pathway and a version of a dental quality outcome framework. There is also likely to be a shift away from activity to capitation but I’m not sure in what proportion.
A further likelihood is a greater focus on measurement and management information, as the government seeks to show the taxpayer is getting value for money. That in itself is a worry, because I believe the amount of time that will be consumed to compile, verify and argue over such data and management information could be better spent on patient care.
Dentistry.co.uk: What do you think is needed to improve the situation, both in the short- and long-term?
Nigel: Greater clarity in terms of future changes and timescales would improve things, as would an acknowledgment by the government and the NHS that it is very difficult to provide all things to all people within a fixed budget. However, I’m not sure what the government would gain by providing any of that information. Dentists need to take back control by individually assessing their circumstances and properly evaluating the options that are available to them, so that they are in a position to start making things happen for themselves, rather than waiting for thing to happen to them.
Dentistry.co.uk: Is there anything else that dental teams need to be aware of or think about in terms of dentistry in the UK?
Nigel: I believe they should be thinking about what the future holds from the patients’ perspective, because people want more out of life than ever before and dentistry is no exception. This leads on to a need, not only for restorative treatment, but also a strong interest in aesthetic dentistry. If I roll forward 10 or 15 years, I think there could be an enormous amount of pride in being part of a dental team, but they have to be confident in the future to achieve that. There is a path dental professionals can go down that will be extremely rewarding but will probably take them out of the NHS.
There is, of course, another pathway that will be rewarding within the NHS, and that will be one that focuses on those most in need. The views of NHS dentistry currently held by many members of the public – that it can be free at source of delivery, totally comprehensive and at the same time be of the highest quality – will be dispelled sooner rather than later, and when we reach a time when patients can make truly informed decisions about NHS or private options for their dental care, that will make life much more exciting for dental teams.
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