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Student fee hike threatens NHS dentistry

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NHS dental provision could be under threat in future years as newly qualified dentists with debt in excess of £50,000 will favour the private sector, government has been warned.

Soaring tuition fees may deter students from studying dentistry altogether, stopping investment in private practice and severely reducing the number of students from low income or black or minority ethnic families.

This, in turn, creates a lack of diversity in the workforce which could potential damage future patient access, the British Dental Association (BDA) claims.

While the BDA said it accepted the need for reform, not enough focus had been given to the impact it would have on longer courses.

In written evidence to the Commons Business Select Committee examining Government reforms of Higher Education, the BDA called for a full impact assessment based on 'robust evidence' to assess how changes in admissions and increasing fees for dental courses will impact long term.

Along with not investing in buying practices, engagement in postgraduate training and education could be hit, and more dentists would turn their back on their NHS.

It said: 'Not only are there not enough salaried positions in the NHS, if debt is higher it is natural for students to seek to maximise their earning potential. With the potential decline in the number of practice owners the NHS may well suffer from a lack of dentists in the future.

'This tendency was borne out by the BDA's 2010 student debt survey where over one third of students said that debt would influence their career path and encourage them into private, rather than NHS, practice. This could be exacerbated if dentistry is included as a subject justifying the highest tier of fee charges.'

It added: 'The Browne Review's recommendations reflect the challenging economic climate. We are worried, however, about the impact the proposed reforms will have on students choosing to study dentistry. We would expect a full evidence-based analysis of the impact of raising fees for clinical courses, in particular as they are vital for the future of health provision.

'Dentistry is a longer-than-average undergraduate course and so will result in higher-than-average levels of debt. Indeed, our preliminary projections suggest that debt could reach up to £57,600 for some dental students under the proposed reforms.'

At present dental students are graduating with an average £25,545 of debt compared to the average student with £16,614. The current level is already 128% up from 2000.

Students on non-clinical courses also have more time to find part-time work to minimise their levels of debt, the committee were told.

Furthermore, the BDA asked for a commitment from government dentistry would continue to be recognised as a clinical subject, therefore ensuring part of the cost of training is met by government.

Students whose parents did not live near one of the 12 dental schools could also be disadvantaged if wanting to live at home and study to keep down costs.

From September government is allowing universities in England to charge up to £9,000 per year for undergraduate courses, raising the cap from its 2011/12 level of £3,375.

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I find it amazing that any newly qualified would want to deskill themselves by starting their career in the NHS at all. Is VT training (or whatever its called now) compulsory? WHO wants to become a "performer"? If the NHS is or becomes short of dentists it knows why. They could always continue their imports policy and I'm sure many will come to work for peanuts. However it is ,in my opinion ethically impossible to make a profit from associates working on the nector points system.

Posted by gordie 14/11/11 at 08:16

This just goes to show how inaccessible private dentists are to the common people living here, and why. What have private dentists done to curb this from happening except from profiteering as you have rightly pointed out..

Posted by sugitha 14/11/11 at 17:29

The way things are going, there will be a huge reduction in dental students. The NHS will become a core service, run by dentists from the EU, with some having dodgy qualifications from the Eastern block. Without a doubt private dentists will have to scale back their fees or go out of business. I know of one case where 4 implants retained crowns were quoted at £20,000. How many folk can afford that kind of fee? No wonder dental tourism is on the increase.

Posted by toothgerm 14/11/11 at 18:41

sugitha - where to begin 'sighs'? I'm a 'private dentist'. We charge less than £12 pcm for Denplan Essentials, and (eg) £43 for routine XLA's, £45 for 'average' composites. Who are these 'common people'? Those with Sky Plus, holidays in Spain, booze, fags, cars......? It's a matter of priorities. If they get 'free' NHS treatment, then that's the value they place on it. And on you, in my experience - and I worked for many years on 'exempts'.
As to 'profiteering', well - no profit, no practice, no employees, nothing. I'll just lie in bed all day and 'sign on'. Probably be 'entitled' to free NHS dental treatment, as well. Here's another little fact: we make LESS now than when we were NHS. But we kept our self-respect, sanity, and high clinical standards. It's not my job to sort-out the NHS dental system - that's Lansleys. But it seems blindingly obvious that they are really just funding a basic 'core service', introduced so that those evil rich dentists (as usual) get the blame. Well, stuff 'em - I'm not taking 'the blame'.

Posted by docholliday 14/11/11 at 19:44

toothgerm you are correct that fees may drop but bear in mind material costs escalated by 10% last year alone. The press always quote west end prices and top of the range at that and compare to nhs joke prices so as to emphasise the difference.We charge under 2k for a sinle unit implant crown and we use a reputable make. The margins are less than you would think. I make far more profit on cerec turnover than implants.Doc is also correct that tooth spending is not budgeted for and is taken in this country as a gimme as is medical health.
On the other hand I am not pessimistic about the future of dentistry-life is full of circles and this phase will pass .The soon to be introduced latest NHs contract will fail like all other govt/academic inspired contracts. When dentists realise that govts don't care about quality and its only about cost control then they might have the self believe and courage to tell the govt they are not prepared to work in such a system. That is the hard part.

Posted by gordie 15/11/11 at 08:51

People are not poorer in the UK than in many comparable Western European countries. They are just used to having very cheap, low quality NHS Dental treatment and have been brain washed by successive governments that NHS dentistry is high quality and EVERYTHING is available under NHS dental contract. Well wake up and smell the coffee, that is not the case.
I know of patients in the UK who have other periorities than their oral health.
One thought that £700 for a denture was too much to pay but happilly paid £3600 for a first class ticket to go to Australia !

Posted by Expat 15/11/11 at 09:28

Sugitha, I can only assume that you have never practised private dentistry or run a private dental practice. Please advise me if I am incorrect.

Posted by dannypretorius 15/11/11 at 17:24