As a patient, I just don’t get it
Why is NHS dentistry not provided by well-funded – and leading edge in their expertise – practices, that are purely NHS?
Here’s my Nye Bevan anecdote; the founder of the NHS once bought my mum a fish supper. I remember, as a child, her telling me this and her specific use of the phrase “fish supper”. Which is odd, given she was born in Murton, County Durham, where her father was a miner and a local councillor. Or perhaps not. Possibly fish supper is a phrase commonly used in the North East of England. I don’t recall. Sweet and sour chicken and fried rice was more my thing as a teenager growing up in Durham City; more effective, come the end of an evening, at absorbing previously consumed pints of beer. Or possibly it was because of a family affinity with Scotland.
Anyway, I digress. On the occasion of the fish supper, Bevan was in Murton campaigning on behalf of my grandfather. What I had not known, shamefully until quite recently, was that Bevan – and Harold Wilson – resigned from the Labour Government in 1951 because their colleagues forced through a proposal to introduce prescription charges and fees for dental and optical care. Now, here we are today, with the SNP’s manifesto commitment – and the new Scottish Government’s policy – to scrap the patient charge for NHS dental care. What can possibly go wrong? Plenty, according to the profession.
As we report in the June edition, scrapping the charge – which currently subsidises the provision of dental care by around £75m – coupled with the increased demand from patients, caused by lifting this barrier to access, would require between £90m and £100m in funding. This is according to an analysis presented at the annual conference of Scottish Local Dental Committees (LDCs) and an estimation by the British Dental Association (BDA).
In my naïve moments, I wonder why NHS dentistry is provided by what are effectively small businesses
Is the Government going to faithfully replace that £75m funding of NHS dentistry and top it up with another £25m to meet the increased demand (and that’s without even taking into consideration the increase in demand caused by deteriorating oral health experienced during the pandemic)? “A hae ma doots,” as my mum might have said (ok, possibly that’s stretching it a bit). Scepticism aside, if only it was that simple.
Before we were so rudely interrupted by the pandemic, the Government had been working on its – increasingly infamous – ‘new model of care’ which was intended to replace the then existing Item of Service funding model with one that rewarded prevention of disease, not treatment. As I have written previously, it’s difficult to discern what work – if any – has been done on this during the 12 months-plus of lockdown.
As we also report in the June edition, Tom Ferris, the Chief Dental Officer, and his team are currently working on the first part of SNP commitment on dentistry, to remove dental charges, within 100 days, for care leavers and young adults. The second – free care for all NHS patients – is to be delivered over the lifetime of the parliament; that is, five years. He said they were “mindful” of the potential for increased demand, even initially with care experienced patients. “In terms of the free dental care,” he said, “in my mind that’s tied up with the new model of care that we were hoping to do. There’s probably no point in having two major policy changes over the course of the Parliament – ‘let’s make dentistry free and then let’s completely change the system of how we deliver dentistry’. Our view is part of that system reform will bring in a new, preventatively focused, patient centred dental system that is free at the point of care, and we’ll do both things together.”
And we could be talking five years.
As Scottish Dental went to print, there was a warning of “flaws” in the Government’s plans for interim tiered support arrangements. It is understood that the Government currently plans to use Item of Service (IoS) as the sole measure of activity in the forthcoming arrangements. It is said that using IoS as the sole measure of activity will force young patients to the back of the queue, widening the gap in dental health inequalities and increasing the likelihood of life-threatening and avoidable general anaesthetic procedures. Using IoS, as the sole measure of activity also does not take into account the administrative demands of the new Standard Operating Procedures. In all, it is claimed that NHS dentists effectively face a pay cut of up to 45 per cent.
In my naïve moments, of which there are many, I wonder why – and this is speaking from the perspective of a patient, rather than the editor of a dental journal – NHS dentistry is provided by what are effectively small businesses (and, increasingly, corporates). I get that an entrepreneurial approach can help meet demand where the state might be too bureaucratic and slow to respond. A community needs a practice, or an additional practice? Go for it. Young, aspiring practitioners fulfil their ambition and communities are well served with a mix of NHS and – if they can afford it – private care. But then other times, I just don’t get it. Why is NHS dentistry not provided across Scotland by well-funded – and leading edge in their expertise – practices, that are purely NHS? If there remains a demand for purely private care – as there is in general health provision – that’s fine.
Of course, that’s probably a step too far for those currently tasked with formulating the long-term model for NHS dentistry. There are currently around 1,100 mixed practices in Scotland. What would it cost for all but say, 100, to be fully funded by the NHS? Considerably more than the ‘missing’ £100m that the profession is currently concerned about, obviously. As I write this, Friday evening is approaching. I may have a beer, or two. And a fish supper; perhaps its alcohol absorption properties are equal to sweet and sour chicken after all.
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