Wednesday, July 02, 2008

Talk about stating the obvious...

Apparently the new dental contract introduced by our lords and masters (and opposed by the majority of dentists in this country) two years ago is letting patients down and according to ITN news nearly a million FEWER people now see a dentist then before the changes were introduced.

In the Bad Old Days before the new contract dentists were paid piecemeal. ie, for every item of treatment they were paid a fee. The system was unnecessarily complex and in need of an overhaul (for eg, when dental pay rises were staggered over the year, this meant the NHS price list was changed twice a year, which was wasteful, costly and confusing). The new contract was meant to take dentists off the treadmill of what was known in the trade as bashing the Nash, because they saw so many people during the day. (When you go private my dear readers, what you are paying for is more time with your dentist and slightly better materials). The new contract was meant to change all that. By introducing a three tiered banding system, and paying dentists by units of dental activity (UDAs), dentists were going to be freed up to work in their patients best interests.

Instead what has happened is that they have replaced one form of treadmill for another. The first year the new contract was in place, Spouse had a target based on his previous NHS earnings. As he is a very good (ok I'm biased) and productive NHS dentist, his target was rather high. Net result was by February of the first year (year end is April) he was 13% BEHIND his target. He worked like a demon, under immense stress to hit it, otherwise he'd have lost out financially. In the past, he earned money on how productive he was, now he has a figure to achieve, but if he doesn't hit his targets, he will lose out. Last year was better, but at the end of this year, he faces the great imponderable, as all the money PCTs paid to dentists were ring fenced for three years. Come next April, the whole lot gets renegotiated again, and I bet no one is planning to renegotiate upwards.

The NHS obsession with targets (or the government's obsession with everyone hitting targets) is not only absurd, it is positively detrimental to good practice in dentistry or any other form or health care. The new dental contract has done nothing to improve dental care - if anything from what Spouse says it encourages less scrupulous dentists to be neglectful, or to opt for pulling teeth out rather then mending them, because it's cheaper to have a tooth pulled out (band 2, £44.60) rather then have some restorative work done (band 3 £198). This is crap for the patient. It's also crap for the dentist. If you have one filling or ten, you still get to pay £44.60 - so looking after your teeth does you no good, and the dentist has to work harder on the patient who doesn't care for their teeth for the same money. It's a barking system thought up by some faceless bureaucrat who's clearly never seen the inside of a dental surgery in their life.

No wonder people aren't going to the dentist and NHS dentists are flocking to the private sector. This was all too predictable two years ago, and I agree with the Health Committee which has just decided it was extraordinary that the Department of Health didn't trial this first. Well, they did actually, but only using a very small sample of dentists.

The tragedy is of course, that patients lose out. One of the advantages of seeing your dentist regularly is that he or she can pick up signs of other health issues, Spouse refers to the mouth as being the window on the body, and all sorts of things can crop up their which indicate problems elsewhere. It could potentially cost the NHS more for people not to visit their dentist, if preventable health problems get picked up too late.

But will anyone think of that? Somehow I doubt it...

1 comment:

musicobsessive said...

Absolutely right! I've just found another NHS dentist after 3 years of looking. (My last one retired and the practice closed). But I just don't see the logic of the band charges.

My wife is a teacher and the beaurocracy involved now is mind-numbing - don't even get me started *quick nurse, my pills*

Where will it all end??