A meeting will be held between dentists and ministers within the next few days that is likely to have a profound effect on the future of the nation’s teeth. It has been prompted by imminent reforms of NHS dentistry that aim to make it more accessible by stopping the long-term drift of dentists towards more lucrative, and usually more congenial, private practice. As many as four million people are in danger of losing access to an NHS dentist.
Quite sensibly, the main thrust of these reforms has been to make dentists happier within the NHS; the alternative would be the continued public misery and governmental embarassment of pre-dawn queues to sign up with that rare species, the new NHS dentist. Yet this can be a hard species to please. Despite substantial increases in spending, much of it earmarked to fund a generous new contract with streamlined administration, the profession has denounced the reforms as “shambolic” and cautioned about more defections to the private sector. It is time for the Government to hold its nerve.
Since the war, NHS dentists have worked wonders with the national smile. They toiled for decades, faced with poor oral health as an endemic national trait, in crisis management mode, drilling and filling and, if necessary, pulling, with scarcely any time for preventive care and education. Such care should now be their prior-ity, they argue, but instead of being given the freedom to provide it they are being asked to step off one NHS treadmill straight on to another.
The chief object of their anger is UDAs, or units of dental activity, by which NHS dentists’ output is to be measured from April 1. The British Dental Association regards them as an unnecessary and obstructive set of targets. It argues, above all, that they do not allow for preventive care. This is dubious. Good dentists will always wish they had more time with their patients, but in a taxpayer-funded system limits must be set, and “examination, diagnosis and preventive advice ” is the first order of business in any NHS dental appointment under the new guidelines. There will be time for more than homilies on brushing.
Some dentists have already said that they will leave the NHS if these reforms are enacted. Their claim to be motivated solely by patients’ needs and not at all by their own earning potential is scarcely credible; some patients in remote areas may be denied access to any affordable dentistry as a result. Special provision must be made for them, but the broad outlines of the reforms are sound.
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In return for a fixed number of UDAs based on their existing workloads, dentists with a “ high commitment” to the NHS will typically earn £80,000 and receive another £80,000 to cover expenses. The current range of more than 400 individually priced dental services will be replaced by three fixed-price bands to cover basic check-ups, routine treatments and more complex surgery. And dental budgets will be controlled by primary care trusts, not central government. The new system needs more flexibility, but the alternative is unmanageable, and manifestly failing.