Thursday, March 29, 2007

A Word on NHS Dentists....

As no doubt you all know, getting an NHS dentist is as easy as pulling hen's teeth, or whatever the expression is.

Apart from, if like me, you are married to one of the rarest of breeds.

I am not going to talk about this issue at length, because Spouse doesn't like me too, but I will just say this to Rosie Winterton who I heard pontificating ad nauseam yesterday on the Jeremy Vine show...

MOST NHS dentists don't choose to become private (if anything the bureacracy and form filling is even more scary when you don't have the NHS behind you) but have been forced into it by successive government policies. And Tony Blair's promise of NHS dentistry for all is sounding increasingly hollow. But hey, what does he care? He's out of here, soon and I doubt Gordy cares too much about NHS dentistry...

Many years ago under the Tories, NHS dentists were set targets to improve patient care. If you bring x number of patients in they were told you will get y amount of money. Being a hardworking and dutiful bunch, they did as they were told, only for the government to turn round and say, Oh shit, we didn't expect you to actually achieve that target, what we really meant is for you to bring in z number of patients. That was in 1991, and as a result of this constant shifting of goal posts loads of NHS dentists decamped and went private.

Scroll forward to now and we are just about to celebrate the anniversary of the new contract between dentists and the NHS, imposed on them from above, it is a contract that the majority of dentists didn't want. In theory the contract is supposed to take them off the treadmill of the NHS. Now instead of being paid per item of treatment, they get paid depending on how many units of dental activity they have achieved. No problem, you might say until you realise that we are not measuring like with like here.

For example, this time last year if you came in with a bog standard filling, you would have paid, say fifteen pounds, half of which went to the dentist, the other half of which went to cover the running costs of the practice. If you came in needing two bog standard fillings, plus several big fillings in your back teeth, you would have paid individually for each of them, paying more for the more difficult ones.

Not anymore you don't. The powers that be decree that if you come in in need of fillings, how ever many you need, that counts as one unit of dental activity. So now if you come in with a bog standard filling it costs more for you, and you lose out, but if you come in needing loads of fillings, you pay less, but the dentist loses out because he does all that work but gets paid the same as if he had done one filling.

I should also add here, that this is not about dentists feeling badly treated in terms of their pay (though without a doubt they are going to see it reduced over the next few years), but about them feeling they cannot provide the sort of service they want to under the new system. Most of the dentists I know (Spouse included) are highly professional, ethical and have a strong sense of wanting to do the very best for their patients. A system which allows benign neglect (as a patient you now only have to see a dentist once a year), and doesn't pay enough for dentists to spend the necessary time/use the best quality materials is always going to be one that lets the patients down. And that is where we're at, folks.

And far from being taken off the treadmill, the sense of being a rat in a run has increased a hundredfold, as twinkling away in the corner of the computer screen are numbers assessing how close to your target no of UDAs you are. At the beginning of this year Spouse was 13% behind -with the threat that if he didn't make it up, he would have not got paid for March.

They really now how to motivate people in Rosie Winterton's department...

Luckily, he has done it, but it has been a hell of a stressful ride.

Is it any wonder NHS dentists are deserting the sinking ship in droves? Or that the ones we have are mainly Polish?

Next week Spouse gets set a new target, and the whole rigmarole will start again.

I can't wait for this time next year...

PS Two days to go and counting...


h&b said...

Hmm - I don't know a LOT about the English Health System, besides the fact it's scary .. even as someone with bad teeth, excessive work, and who has paid enough $$ to dentists to fund many holiday homes, sports cars, and family vacations ....

BUT, even with my mouth as a basis for argument, i'm still on your side. Putting myself in your shoes, I am happier charging $10 for a tooth, $30 for three, $20 for a molar .. more for a root canal and etc.

And ferchristsakes, this is England ! - is there ANYONE without a mouthful of holes ?! ;)

I sympathise.

( and exciting about the impending birth !! :)

As a patient, I also expect this.
I'm not HAPPY, but then, i'm not happy paying $100 for shoes I feel should be $20.

Nic said...

Yet another thing that is bonkers in this country...

PS. Have I missed something re: the countdown??!

h&b said...


Forgive me on the 'birth' comment, and confusing your other readers.

Y'see i'd had a wine, and confused the countdown with another Briton who IS due any day now.

How embarrassment.

Jane Henry said...

Ha! And I had had some wine too and was assuming you meant you were having a baby, then got mighty confused as I looked on your blog and you didn't appear to be, so I thought, bugger it it's too late and I'm going to bed, which I did!!

The countdown has nothing to do with babies, but is to do with a peculiarly English tradition, which involves sofas and hiding behind.

All will be revealed tomorrow to those who haven't guessed...

And I for one can't wait.

Am so sad that I have told my dinner party guests for tomorrow night not to turn up till after eight o'clock...

love Janex

PS After four goes I think I've done my bit for ensuring my genes carry on...

h&b said...

Thank God for wine !

It solves all of our problems ;)

The Patient Connection said...

Research Blog on UK Dental Treatment

We at The Patient Connection are currently running a research blog or online discussion on the subject the use of private dental care in the UK. We are seeking the opinions of both people have had any dental treatment in the UK either privately or on the NHS.

In particular we are interested in your experiences with specialists

We would love it if you could share your story and your thoughts on using private dental care.

To participate please go to

The blog is anonymous and easy to use so I’d like to thank you for your contribution in advance.

Best wishes

The Patient Connection

PS Please email me if you have any queries about the blog or any of our projects.