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Why is dentistry treated so differently from medicine?


  Posted by: The Probe      13th December 2019

Former Chief Dental Officer, Barry Cockcroft, looks at current provisions within dentistry.

I recently found myself watching ‘health orals’ in the House of Commons (something I remember well) and was struck by the way questions on access to cancer care were handled so differently to questions on dental access.

In response to a question from the shadow secretary of state for health on long waits for cancer diagnosis and treatment, the answer focussed on growing the workforce, investing in the latest equipment, developing team working and addressing the serious issues caused by George Osborne’s ill conceived changes to the NHS pension scheme. In the response to the question there was no mention of the contract and remuneration system under which the NHS delivers these services, as opposed to dentistry where any question about access elicits the response that “we are working on reforming the contract”.

It seems to me that the DH and NHS England are using contract reform as a fig leaf to cover up their lack of commitment to creating, in a timely fashion, a workforce that is sufficient and suitable to deal with the needs of the population and the providers of services who deliver on the statutory duty that the NHS has to meet the need for dental care.

Since 2006 the number of people seeing a dentist on a regular basis has grown from around 30 million to around 36 million though the growth has been almost totally in the non NHS sector. The pressure on workforce makes no differentiation between the NHS and private sectors so it is no surprise that we now face serious workforce issues. No amount of contract reform will address this, if the workforce is not sufficient patients will, increasingly, find access more difficult.

Patient charges for fee paying NHS patients are now rising faster than inflation and contract values so it should come as a surprise to no one that the growth has been in the private sector. I suspect that the DH and NHS are quite content to let this continue as it enables them to redirect financial resources to other parts of the service which need further investment and which are now a higher political priority, without being candid about this being a policy.

Just like primary care dentistry, primary medical care is also under severe workforce pressure and the BMA is doing a fantastic job on behalf of their GP colleagues by not focusing on their earnings or contract but by focusing on workload and pressures. The general public have little sympathy with regard to the earnings of medical and dental professionals as they are in a different league to the average person but when they cannot access the services they need, then they are concerned. The nuances of contracts and the impact they can have is lost on the general public, and indeed many in the profession. Dentists have always complained about their contract, and probably always will. Some of those who are most critical of the current contract actually withdrew from the provision of NHS services as a result of dissatisfaction with the previous system.

Prevention is obviously important but given that there are 8736 hours in a year and most people probably spend less than a couple of hours at most in the surgery in a year, it is clear that getting the right messages out to those most in need is key and that is beyond contractual arrangements. The current legislation is very flexible and the NHS ought to be using some of the money it is taking back from under delivering contracts to tackle the remaining inequalities.

Oral health has improved significantly overall in the last ten years but that seems to have been overlooked in all the media coverage, repeated CQC reports rate dentistry as the best performing sector of healthcare, but again, no recognition of that in the media.

At the current rate of progress on contract reform and roll out of the prototypes it will be the latter half of this century before significant movement has been made to a capitation based system, and the revision of the NHS patient charging system which will inevitably be needed (assuming there is no new investment).

If the DH and NHS England are serious about improving access to dental services then they should do something now about the workforce, or do they no longer care?

‘Crisis’ is a much overused word but crises happen when people take what is referred to as ‘business as usual’ for granted and dentistry appears to have become business as usual in the minds of DH and NHS England leaders but they have a statutory duty to deliver primary care dental services and the signs are there now that they are not delivering on that.

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