A brilliant accident?

Maybe, just maybe, the Scottish Government’s commitment to free care provides a solution

20 October, 2021 / insider
 Arthur Dent  

Thoughts are swirling round my head, about where dentistry was, the mire it is in, and the future landscape of our profession. I don’t have a crystal ball and, at the moment, I’m not hearing much from colleagues about where we are going and when. We’re all waiting for a change, an announcement, a proclamation of intent. Yet, there does not appear to be much drive to move on. Yes, more Covid-related chat. But I can’t get beyond it. It takes up my waking moments and many of my sleeping ones. So, I thought I might try to spur myself on, and maybe some others, thinking about what could be.

Our scene is set, that post-apocalyptic landscape from all those movies. No zombies though. Fast forward through all the trials and tribulations to the end-scene. Where we see the future in all its glory and humankind can see the path to Shangri-La. Well maybe not; maybe Govan, or Leith, or Glenrothes, bathed in sunshine and the glint of sparkling, freshly bleached teeth.

Our government has committed to providing free NHS dentistry for the populace. Once again, there was some ‘excellent’ communication on a Friday afternoon for the following Tuesday. This is the way. I suspect it will continue to be thus. The debate about what might be free seems to have been missed out too. It would appear that the current SDR will simply be continued without cost. Simple enough, no?

The inevitable tidal wave of post-Covid treatment, waiting times, lack of materials and labs, increased costs and taxation events to pay for the JRS et al., also seems to be forgotten, in favour of a semi-blank cheque to pay for dentistry. So, what could it look like?

In GDS, free NHS care would mean the tension between private and NHS care, or at least the cost differential, is altered. This could go one of two ways: patients could simply opt to only have NHS care because it’s free, or they may mix and match, save some money here to spend it more wisely elsewhere. We will have to change our perception and sales techniques a little. However, it may remove the need for a semi-temporary, low cost, compromised option. You know; the filling done instead of the crown, the extraction because root treatment is too dear. 

If cost is removed in favour free NHS care, then surely the patient can choose the ‘best option’ more easily? Will this make our lives easier? It certainly removes a significant barrier for a lot of people. Therefore, can the dental health of Scotland improve with free care? I’d like to think it can. I’d like to think that I can offer better choices to many of my patients who shrink at the thought of the expense. And if that is no longer an obstacle, then will people attend more frequently?

More frequent attendance means we can offer the best care earlier in the decay/destruction cycle. These treatments should have better longevity because they are provided before it’s too late or at least in ‘last chance saloon’. We can be intervening in wear cases earlier, as the patients will value our opinions more because they will not perceive us to be ‘just after the money’. This could be the shift in attitude we are all trying desperately to inspire every time we enthusiastically tell our patients about flossing and diet and ongoing maintenance.

Perio, our silent killer, often untreated until teeth are wobbly, has a new foe. Free scaling! Perio treatment now comes with a ‘cape of free care’ and the pants on the outside (that’s a Superhero reference, in case you think I’ve lost it).  Right, I know that cost isn’t the only barrier to people’s uptake of perio treatment. But it’s a big one. Back to the ‘perceived value’ of a professional opinion without the drive of cost. At least, in the mind of the patients, who will no longer have to put their hand in their pockets.

And so, to our bit on the side (or vice versa depending on your practice); private care.  There must be increased perceived value here too. We know there are things which can’t be done on the NHS. This appears to be continuing. That’s very simple: the NHS won’t let us do XXX, so you’ll have to pay. The barrier is going to be the choice between free or expensive.  “We could do YYY but I believe XXX is your best choice.  I know this comes at a cost but I think it’s the best thing for you Mrs Smith.”  This, sold in the right way, is also a powerful statement.  We understand that there’s a free option but, despite that barrier, we are recommending XXX. 

For me, cost-free care, at point of delivery, is an opportunity. Perhaps it’s where I work? There’s almost always a cost barrier. However, I believe that exists in most places. And where that barrier is removed, then there is an opportunity for people to spend the money they would have done on basic care, improving their appearance, spending a little extra on their teeth. Will people think of the money saved and keep it in dentistry? I think they will. 

That could be the difference between our currently depressed incomes and spiralling costs and a more balanced and profitable economic outlook for the profession. Do I think that the Scottish Government has considered this in their commitment to provide free care over the course of the parliament? No. Do I think they’ve just worked out what they’re paying under Covid support and thought they can rinse and repeat? Yes. Do I hope that it might be an accidentally brilliant solution for care in Scotland?  Maybe, just maybe…

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