Let’s not be viewed as nay-sayers
Starting a lively debate is the only way change can work well for all stakeholders
Sitting down to write this article, I wanted to embrace the positivity of the New Year. However, I am filled with concern for the future. The Scottish Government is proposing potentially revolutionary change in terms of new models of care, finance and, possibly, information technology. I have doubts about where that will end and how dentistry will move forward. I have aired other concerns in articles previously but I am going to try to stay positive and encourage debate over what our future profession will look like.
I have no post-grad qualifications, but I have a great deal of clinical and practice owner experience. I think about the future and wider issues in dentistry regularly. In my view, we have to set a baseline of what the profession wishes to achieve and how we want to achieve it. We must take into account the working patterns that younger practitioners want. We should take heed of the problems our medical colleagues have in recruitment and retention of GMPs. A quick look online demonstrates many vacant associate positions. We already have a problem and the desire to work fewer days will add to this tension. The counter to this is the need to service the demand for early morning, late night and weekend appointments.
Most practices in Scotland are mixed so we should all add to the consensus between NHS and private care. As corporates increasingly buy-up practices, they should have a fair say on how the profession moves forward.
However, it is contingent on the Government to ensure that public money is not being stripped from the service to create profits for distant owners or investors with deep pockets. But by the same token, there has to be enough profit in dentistry to ensure continued purchase and development of practices. Without an economic benefit, dentistry (in particular NHS dentistry) is seriously at risk.
Where’s the positivity? Well, here goes. I would like to see the Government reduce their input in dentistry to include only policy, payment and monitoring. I would strip out the individual health boards’ input and raise these elements to a national level, thereby reducing administration levels. Strip out all the extraneous costs, like Denpro, which can be achieved through individual negotiation by practices. Take the savings and add to them to develop the quality agenda.
If we are serious about improving quality, it needs to be funded. It starts with improvement of facilities.
Grants should be reinstated to continue a move to larger centres with more dentists and greater skills-mix involving special interests which are driven by patient need. I don’t believe this can be done in smaller practices – larger, more professionally run and developed practices must be beneficial for patients and dentists alike. Audit facilitators and educators should develop practices and practitioners using evidence gathered in practice. Dentists should be happy to embrace the potential benefits for their patients and the Government has to accept that this will lead to more options, many unavailable on the NHS. There should be an open discussion about what can and should be available through the NHS.
I would like an expansion of specialist input available through the Public Dental Service (PDS). Its role needs to shift. Its property portfolio is too large. The dental schools are overrun by referral patients that can’t be seen within reasonable timeframes and younger practitioners are more inclined to want to specialise. If the PDS was utilised like a local extension of the schools, with demand-based specialists then treatment plans and better care could be delivered locally. Once again, this needs to be funded – not just the posts but the facilities and training.
I would dearly like to avoid a ‘core service’. I believe in NHS dentistry and I feel that reducing the availability of provision will be bad for the public. I believe it will be a public relations nightmare and that it will sit at the feet of the profession, not the Government. I think that there is room for private dentistry but that it shouldn’t rely on running down the NHS and limiting the options for people who can’t afford it – and the reality is, in Scotland, there are a lot of people in that category.
I haven’t even touched on many other thoughts I have about how things could or should be. There are many risks and opportunities which must be explored. However, I am very much of the opinion that we should be leading this debate. Not waiting for committees of academics to tell us what will happen without any idea of the real needs of patients, the real caries rate, the difficulties of practice, and the economic realities and drives which prompt people to risk their future on buying and running practices.
I don’t pretend to have all the answers but if we don’t start driving this in the media, we will miss the opportunity to shape the future. We will not get patients involved or on our side. We may end up looking like the nay-sayers and reactionary professionals concerned about ourselves or worse, our profits, rather than visionaries concerned with the best interests of our patients and the future of their care. We should be the masters of our own destiny and starting a lively debate is the only way I can see this working well for all stakeholders.