Access to NHS dental care has depleted. According to a BBC and British Dental Association (BDA) investigation last year, nine in ten NHS dentist practices are not accepting new adult patients, and eight in ten are not taking on children.
Speaking to the Health and Social Care Committee in parliament today, 22 March, dentists and industry representatives told MPs that undesirable working conditions and employment contracts had caused a severe workforce shortage, essentially making access to “free at the point of service” dentistry obsolete.
What is the current state of NHS dental care?
Most dentists and associated practitioners such as hygienists and dental therapists now choose to work privately. Currently 11 million patients in the UK cannot access an NHS dentist, while a focus on ill health rather than prevention means that one in ten three-year-olds in England have dental decay.
Dr Sandra White, clinical director for the Association of Dental Groups, told the committee that the current system does not allow dentists to provide “holistic, individual care”, which has also created a demotivated and unhappy workforce.
What about funding?
In England, NHS dentistry is funded by a combination of money from NHS England and patient charges. Shawn Charlwood, chair of the BDA’s general practice committee, told MPs that NHS dentistry is on track for a £400m under-spend this year, primarily due to a lack of staff to deliver services.
He said the industry is extremely worried about the “continual erosion of the dental budget”, with fears that this £400m could be lost from dentistry all together and siphoned into other NHS services or into a “deficit account”. Dentistry has been prey to a 38 per cent cut in real-terms government spending since 2010, and England has the least number of NHS dentists per head of all four UK nations, according to recent National Audit Office figures.
Why are there so few NHS dentists?
The UK lacks both British and international dentists for the NHS. The workforce shortage was mostly attributed to the NHS dental contract and its system for delivering services, which Charlwood described as “unfit for purpose”.
White said that dentistry currently lacks “robust workforce data”, and that this needs to be addressed for the government to develop a proper workforce strategy. Improving working conditions is imperative to attracting more dentists from overseas, she said, who currently favour countries such as Canada and Australia.
What’s wrong with the NHS dental contract?
The NHS dental contract, established in 2006, requires dentists to complete a certain number of units of dental activity (UDAs), which are based on the type of treatment and are used to establish patient charges. Different treatments have different costs; for example, a clinical examination is 1 UDA, a filling is 3 UDAs, and complex treatments such as dentures are 12 UDAs. If NHS dental practices miss their targets, they can be financially penalised. Dentists are paid per course of treatment, rather than per item of treatment, which has also caused resentment.
Charlwood added that UDA rates can differ between practices and even between dentists within practices, which creates discrepancies in charges.
What are alternative dentistry models?
Professor Nick Barker, a general dental practitioner and professor of oral health science at the University of Essex, suggested that a “capitation-based” system would offer more “patient-centred” care. This would give dental practices up-front money based on the number of patients in their area, meaning that they would be funded based on the size of the local population, rather than on the treatment being provided.
Funding could also be designated based on a local area’s levels of socio-economic deprivation, added Charlwood. “Perversely, those that need us most are struggling the most to access the NHS system,” he said of the system as it is now. He added that a standardised, national tariff for costing dentistry treatment should be established, to get rid of costing discrepancies that currently exist.
What other holistic changes could be made?
“It’s not just about money,” Charlwood said. Many graduates find NHS work unfulfilling as they are fighting fires with little time to focus on preventative care. “If we don’t do something about this, we’re going to lose a generation of dentists,” he said.
Charlwood suggested the introduction of several measures, including: NHS commitment payments, which would reward dentists based on the number of NHS patients they see; a late-career retention payment for experienced dentists; establishing an occupational health service within NHS dentistry; and offering protected learning time for career development, such as peer review and clinical audits.
Where can I read more?
Read Shawn Charlwood’s piece on the dentistry crisis here.
Read more about UDAs here.
Read more about payment models for NHS services here.