Have you got an NHS dentist?

No, nor me. For the first time in my life I, along with hundreds of others, have been told their dentist will no longer treat them on the NHS. When Pure dental practice in Totnes closed its doors in November and merged with its Dart Vale Dental clinic in Bridgetown, it ended its contract with the NHS. Dart Vale won’t take us on – and now patients there say they’ve been told Dart Vale is also ending its NHS services –

which means there will be NO NHS DENTISTS in Totnes  very soon.

Millions in the country have no NHS dentist because dentists are no longer willing to operate under a contract they say doesn’t pay enough to cover their costs. And if you can’t afford to go private –
what then? This contract came in in 2006 and has been under review ever since – but a promised Government recovery plan hasn’t emerged yet.

Everyone says there is a crisis: we have dental deserts where virtually nobody has an NHS dentist. People are reportedly taking out their own teeth. Children are having to go to hospital for operations on rotten teeth. Who knows how many mouth cancers go unnoticed. Or how many extra costs lie in wait for hospitals picking up the pieces down the line.

a Rolls Royce service for the price of a bicycle

South Hams district council says its a growing public healthcare crisis. MPs on the Health and Social Care committee say this is unacceptable in the 21st century. The British Dental Association says:
“If Government can’t afford NHS dentistry, dentists can’t be expected to prop it up out of their own pockets.” Dentists are demoralised and claim they have had their compassion crushed out of them, not just by the contract but by over-regulation from their own body, the General Dental Council, as well as the Care Quality Commission.

So how have we got to this state?

And what’s being done to save NHS dentistry – or has it gone for good? I spoke to Dr Rob Glenning, who is in a co-operative of five practices in South Devon, to get the view of an experienced dentist. A dental surgeon, he qualified in 1981 and with like minded colleagues set up the Independent Dental Group in 1998, which has 140 members. He’s disarmingly frank about what the problem is.  “The Government wants a Rolls Royce service for the price of a bicycle,” he tells me at his South Devon Dental surgery in Paignton. “Few dentists now want to work for the NHS. We are the Cinderella of the medical world. The 2006 contract – or con trick as I call it – has been wrong from day one.” He says there needs to be honesty about how much the NHS can provide for the budget it has.

Sadly, they now don’t trust the GDC, the government, or indeed, many of their patients

The real cost of “open wide”

Dr Glenning says he effectively provides a mini hospital – and this costs money. “The chair you sit in at the dentist costs around £800 a day to run – before anyone sits in it.” The 2006 contract brought in payments called Units of Dental Activity. A dentist agrees to carry out so many UDAs and is paid an annual fee. There are three bands – from basic check ups to complex things like crowns. Dr Glenning explains that even if a patient pays towards the treatment – (I used to pay £25.80 for a check up) – the amount the dentist is paid does not cover the cost.

The sums are like this – The dentist (self employed) would be paid £15, the chair etc costs another £15 to provide and run. The Government paid £5 towards that. My £25.80 plus £5 equals £30.80. Take away the £30 costs – you’re left with 80p.

A dentist gets paid the same for doing one filling as they would for doing two or more at one go. “That’s the same as expecting someone to work for the same pay whether they work one hour or four”, he said. “It helps explain the enormous time pressure NHS dentists are under.” Which is true – but not reassuring. I wonder if, human nature being what it is, this system acts as a disincentive to do a thorough job?

Years ago, my dentist (now retired) used always to give me a scale and polish. At my last NHS appointment, the check up lasted no longer than two minutes.

No Obligation

Dr Glenning also says something I didn’t realise – a dentist is under no obligation to see you again. No contract exists. It they are not able to treat you, they don’t have to. “It is not the responsibility of the dentist to look after you – it’s the Government’s”, he says.

I asked Pure Dental for a comment. Dr Catherine Tannahill, spokesperson for Pure Dental & Implant Clinic said: “Our priority remains the delivery of quality care in Totnes and the merger will allow us to maximise our resources and effectively underpin the longer-term commercial sustainability of the service.” she continues “We do not underestimate the impact of this situation on NHS patients- the decision was taken after exhausting all options and took into consideration the availability of clinicians registered to treat patients on the NHS, and the financial sustainability of servicing under-funded NHS contracts.”

The view of fed up dentists everywhere is summed up in this article in the British Dental Journal from 2022. “Dentists are not saints and have never claimed to be. However, the combination of the government-imposed UDA contract, together with perceived fear of the GDC’s draconian processes, have been highly effective at crushing compassion out of many NHS dentists. The GDC has helped to destroy patients’ trust in dental professionals but has failed miserably to replace it with anything either measurable or worthwhile. The perverse outcomes have been that many NHS dental clinicians are disillusioned and demotivated and many have run out of compassion. Sadly, they now don’t trust the GDC, the government, or indeed, many of their patients, to be fair or reasonable or tolerant of even minor or unpredictable problems.”

So where do I go next?

My goodbye letter from Pure says, not unhelpfully, that I can use the NHS Find a Dentist service. So a few days ago I went onto the site…
From Bridgetown to Plympton, 30 practises are not accepting new NHS patients. Six others only take people needing specialist care by referral only. Others haven’t updated their status. That leaves either going without check ups (and any treatment) – or paying up.

As my shock at realising we are in a dental desert subsides, the problem of where to go remains. Should I pay nearly £400 a year for the “enhanced care membership”, or £166 a year for the basic
private service? Should I go down the insurance route and take out a policy on my gnashers like I would my car?! Dr Glenning says he has clients, not wealthy, who chose to spend money on a private service. But what if you really can’t afford it?

Is there a solution?

Dr Glenning says one solution might be more DACs ( Dental Access Centres ) which are wholly owned by the Government and are staffed by salaried dentists. These remove any financial barriers between the patient and the clinician.
In December South Hams councillors voted unanimously to encourage local MPs and the Devon Health and Wellbeing Board to work with dentists to set up a pilot scheme for a “no frills” dental service. The board is part of the county council. Cllr Ged Yardy said “At the heart of our community’s concern lie the issues of access and affordability. The challenge is to address these issues effectively while maintaining a sustainable and ethical practice model. Patients are primarily concerned with affordability, value for money, and the standard of care they receive.”

Cllr John Birch said “We as a council are concerned about the health and wellbeing of our residents and this extends to the adverse effects arising out of the local dentistry crisis.”

I have asked both Totnes Mp Anthony Mangnall [Response below in Addendum 11th Jan], and former MP Sarah Wollaston – who is on the Health and Wellbeing Board, for comments. So far I haven’t heard from them – when I do, you will be updated. So, where do we all go from here? There must be many of you who have stories to tell – please let us know below in the comments what you think about the NHS dentistry service.

Perhaps we should campaign for a Dental Access Centre here in Totnes? Something has to be done before we all resort to home dentistry!

[Addendum 11th January 2024 – Anthony Mangnall MP has responded.]

• The Government recovery plan for NHS dentistry will be coming……soon.
  That’s the only clue our MP, Anthony Mangnall, who spoke about the dire state of Devon’s NHS provision in the Commons this week (Dec 9), could give about this much heralded reform. It’s the “irritatingly frustrating” answer to the question given by the health and social care department, he said.
  
• He agrees that the 2006 contract which brought in payment for Units of Dental Activity has failed and needs reforming – not least the post-code lottery of the payments made to dentists. Apparently in London the UDA base payment is £50 – but in Devon it’s only £17. “It’s a massive geographic disparity.” He says this is driving the flight from NHS dentistry. And the Covid shut down means the
  remaining NHS dentists are trying to deal with a backlog of patients.
• The contract has recently seen a rise in payments for more complex cases but its been too little, too late for many practices. Because so many dentists have handed back their NHS contracts, there’s a lot of money in the central kitty that hasn’t been spent. In Devon it’s a tidy £50 million….. Mr Mangnall thinks this should be spent on a dental access centre, mobile dentists, child friendly
  practices and incentives to get dentists to treat people in pain.
• At the moment if I had a raging toothache, or worse, my best hope would be to ring the NHS 111 line, or throw myself on the mercy of the (already overstretched) hospital emergency department.
  The Government is thinking about asking newly qualified dentists to work for the NHS for a time – at the moment about two thirds of freshly qualified dentists do NOT go into NHS work.
• Mr Mangnall said he was “optimistic” that we’d see some real progress in the near future. One concern dentists have is that the unspent cash may be diverted to other parts of the NHS rather
  than our teeth.

We wait with interest to see if any solutions appear any time…..soon and we will be keeping watch.