BDA

Schrödinger’s Recovery Plan: Minister reprimanded for misleading House on dentistry

The British Dental Association has backed Yasmin Qureshi MP as she exposed Secretary of State Victoria Atkins for misleading the House with inaccurate claims that the Government’s so-called ‘Recovery Plan’ for NHS dentistry is funded by £200m in ‘new’ money.

When launching the NHS Dentistry Recovery Plan in February, Victoria Atkins repeatedly assured the House that the Plan was backed by £200m of new funding. “There is £200 million on top of the £3 billion that we already spend on NHS dentistry in England”, she said. 

Chair of the All-Party Parliamentary Group on Dentistry and Oral Health Yasmin Qureshi MP quoted Atkins in the House this afternoon stating: “She made it very clear, adding: “This is additional money. I have prioritised dentistry across the board, but this is £200 million of additional money—in addition to the £3 billion that we spend in England.”

On Tuesday 19th March, Minister for Primary Care Andrea Leadsom MP told the Health and Social Care Committee that the Plan was not, in fact, backed by any additional investment. “This is all coming out of the £3bn that is currently so underspent” she explained.

Senior members from across Government have been dogged by problems while promoting this policy, with Ministers doing photo shoots in entirely private practices, and repeatedly making factually inaccurate statements.

Leadsom also told the Committee that the modelling behind claims on ‘millions’ of new appointments the plan will supposedly generate had “quite a high likelihood of not being reliable.”

The Department of Health later issued a statement saying that “this figure is based on robust modelling which we will share with the committee. The minister simply meant that all modelling has an element of uncertainty.”

The Minister also claimed the model was based on the views of dentists. A new BDA poll shows just 3% think the plan will result in their practice seeing more NHS patients. 43% think it will lead to their practice seeing fewer NHS patients. Just 1 in 100 believe it meets stated objectives to provide NHS dental care to ‘all who need it’.

Officials suggested the additional capacity would be based on recycling record underspends in the NHS dental budget. However, this is set to hit levels of £450m, raising questions why funding amounts to only £200m. The Minister stated she did not “want the underspend to exist anymore.”

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, said: “This is Schrödinger’s Recovery Plan. It’s based on numbers that are both ‘unreliable’ and ‘robust’ at the same time. Funded by both ‘new money’ and ‘recycled budgets’ without any hint of contradiction. The way Ministers sold this to the public has become farcical. But the results are a tragedy for millions across this country.”

BDA: Government pedalling myths on NHS dentistry

The British Dental Association has criticism the continued spin from Government on its so-called ‘recovery plan’ after evasive and inaccurate answers at today’s Health and Social Care Committee hearing.

Minister Andrea Leadsom failed to adequately outline the modelling behind claims on ‘millions’ of new appointments the plan will supposedly generate, which the BDA believes are a work of fiction.

She went so far to state “it’s not an exact science,” that “it’s a complicated set of factors… with quite a high likelihood of not being reliable.”

The Minister claimed the model was based on the views of dentists. A new BDA poll shows just 3% think the plan will result in their practice seeing more NHS patients. 43% think it will lead to their practice seeing fewer NHS patients. Just 1 in 100 believe it meets stated objectives to provide NHS dental care to ‘all who need it’.

Officials suggested the additional capacity would be based on recycling record underspends in the NHS dental budget. However, this is set to hit levels of £450m, raising questions why funding amounts to only £200m. The Minister stated she did not “want the underspend to exist anymore.”

The BDA has slammed the sophistry over the absence of new money in the plan. Minister Leadsom said the money – which is recycling budgets – is “‘new’ in the sense it was not going to be spent on dentistry.”

Andrea Leadsom also cited there is a workforce of over 60,000 dental therapists waiting in the wings. The real number is 6,198. The 240 dentists receiving golden hellos – described as “hugely beneficial” – are just 1% of the NHS dentist workforce.

The Minister cited that NHS dentistry is free for pregnant women who often suffer oral health problems. Over a million new mums lost access to care since lockdown, and have had no extension to their exemptions from NHS charges.

The professional body has criticised policies such as dental vans, which while ideally suited for treating high needs populations like the homeless appear geared towards giving government MPs lines to talk to on the doorstep at election time. Delivering mainstream care in dental vans is not cost effective, estimated at 2.5 times the cost of high street practice.  

The BDA stress Government must focus on making a decisive break from the discredited NHS dental contract, which is fuelling workforce and access crises. The Government has declined to explore fundamental reform. While the Minister said she recognised the need for a fundamental break with the contract, nothing is reflected in the Plan itself, and nothing she said gave any sense of urgency.

The Minister flagged reform would be explored at a roundtable event on the 27 March. The BDA was told at the end of the meeting by officials that it was invited, but invitations have not yet been sent.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, who gave oral evidence today, said: “As long as Government place pedalling myths ahead of delivering real change, we will keep seeing Victorian dentistry in this country. Today we heard a long list of vague and inaccurate figures. Government has to stop spinning and rip up the rotten contract fuelling this crisis.”

It will take more than sound bites and dodgy stats to save service, says BDA

England’s dentists have no confidence in the new Recovery Plan, which the vast majority have dubbed incapable of meeting the Government’s stated goals, and which they say may actually reduce access for NHS patients.

A devastating national survey of dentists in England shows:

  • Just 3% think the plan will result in their practice seeing more NHS patients. 43% believe the plan will actually lead to their practice seeing fewer NHS patients.
  •  4% believe it is ambitious enough to meet the scale of the current crisis – the same proportion who say the level of investment is sufficient to make NHS dentistry sustainable going forward.
  • Only 41% of practices say they are operating at pre-COVID levels of capacity. 62% cite higher needs patients requiring more clinical time as a factor constraining their practice, reflecting the huge backlogs generated by ongoing access problems.
  • The BDA described the Government’s Recovery Plan as ‘unworthy of the title’, stressing that after an almost yearlong wait, it failed to offer the ambition or resources to bring the service back from the brink.
  • The BDA – who will give evidence to the House of Commons Health and Social Care Committee on Tuesday morning – stress that dentists have seen through the official spin that surrounded the plan’s launch. It is demanding that Government disclose the modelling underpinning the claim the plan will generate 2.5 million new appointments, given that no policies within it are capable of generating new capacity or attracting dentists back to the NHS.

The professional body understands that not a penny of new investment is included in the £200m funding the plan, with all costs covered from less than half the estimated £450m underspend taken from practices struggling to hit their punitive NHS targets. Taken together with recent hikes in patient charges, the BDA say this represents further cuts to a service paired to the bone – with higher charge levels being utilised as a substitute for state investment, as they hit millions of families on modest incomes.

There is a realistic prospect the plan will actually reduce access. A higher minimum Unit of Dental Activity (UDA) value is being paid for by dentists being allowed to deliver fewer UDAs overall. The New Patient Premium will also be paid out of existing contract values – meaning for a practice working at full capacity seeing more new patients will by definition translate into fewer NHS patients they can see overall.

The BDA have stressed the Health Committee set out an instruction manual to save the service in its report last year. The first step – a decisive break from the failed NHS dental contract, and a move to a person-centred, prevention-focused model of care – has been rejected by Government, following what the BDA believes is Treasury pressure.

Over 200,000 people have signed a joint BDA, 38 Degrees and Daily Mirror petition calling on the PM to deliver real change in dentistry. In his first run for the leadership, Rishi Sunak pledged to ‘restore’ NHS dentistry. Dentist leaders stress nothing in the plan is capable of delivering on that promise, and are taking the message in adverts to Whitehall and online, slamming horrific scenes of DIY dentistry and cases of life-threatening dental sepsis that have no place in a wealthy 21st century nation.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, who will be giving oral evidence to the House of Commons Health and Social Care Committee said: “Check-ups are hard to come by, but it will prove much harder for Ministers to find a dentist who backs their outlandish claims. This profession has seen through the spin. Empty sound bites won’t stop queues outside practices, and dodgy statistics won’t call time on ‘DIY’ dentistry. Bringing dentistry back into the 21st century requires real commitment, which is frankly in short supply.”

NHS charge increase branded ‘a slap in the face for hard pressed families’

The British Dental Association has lamented the latest increase in NHS patient charges, stressing the hike will not put a penny in the cash-strapped service, and is merely covering for government cuts.

Charges in England will rise by 4% from 1 April 2024. This will mean the cost of a band 1 treatment like a check-up will increase from £25.80 to £26.80, a band 2 like a filling will increase from £70.70 to £73.50, and a band 3 like dentures will increase from £306.80 to £319.10.

Polling conducted by YouGov for the BDA last year found nearly a quarter (23%) of respondents in England delayed or went without NHS dental treatment for reasons of cost. 45% said the price shaped the choice of treatment they opt for. Entitlements to free care are limited, with many Universal Credit recipients not being eligible.

The BDA has long warned of the Government’s long-term strategy of using charges as a substitute for meaningful state investment. NHS dentistry’s budget has been effectively static at around £3bn for the best part of a decade, with patient charges forming an ever-greater share of the total pot until COVID. Direct Government spend on dentistry was lower as the country headed into the pandemic than it was in 2010. The collapse in patient numbers at lockdown required Ministers to increase their contributions to maintain the viability of the service. Last year’s 8.5% hike saw the return to a fatally flawed ‘business as usual’ model as far as funding is concerned.

The recent NHS dentistry Recovery Plan claimed to offer £200m in investment. The BDA now understands that none of this is ‘new’ money, but is based on recycling vast underspends, the result of practices struggling to hit their punitive contractual targets.

The Welsh Government has not adopted the same strategy as England. The BDA has demanded that Ministers explain to the English public why they are expected to pay over £100 more for treatments like dentures than their Welsh cousins. Over 170,000 people have joined a joint petition calling for fair funding and real reform of NHS dentistry in England in a month.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “This latest hike is another slap in the face for hard-pressed families across England. This won’t put a penny in to bring NHS dentistry back from the brink. The Government is asking the public to pay more for less of a service.

“Ministers need to explain why patients in England are expected to pay £100 more than their Welsh cousins for identical NHS treatment. The answer is very simple. Ministers are simply covering for cuts.”

NHS ‘Recovery Plan’ unworthy of the title?

Original: 19:02, 06/02/2024
Latest Update: 09:10, 09/02/2024
NHS Dental Recovery Plan officially announced.

The British Dental Association has said government failure to embrace fundamental reform of NHS dentistry risks condemning a generation to decay and widening oral health inequality.

The professional body says the Recovery Plan, published today, is incapable of even beginning to honour Rishi Sunak’s promise to ‘restore’ NHS dentistry, or in any way meet the Government’s stated ambition to provide access to NHS dentistry for ‘all who need it’. The plan sets up a ‘new patient premium’, which will give a bonus to dentists seeing a patient that hasn’t undergone treatment in two years – £15 to first see them, £50 if they need significant work done. It also raises the minimum Unit of Dental Activity (UDA) value from the current level of £25.33 to £28.

The professional body had strenuously made the case for the Government to ensure dentists treating higher needs new patients that require more time in the chair, do not end up providing NHS care at a financial loss. It warns progress does not go anywhere near far enough to stop dentists – who operate as contractors not as NHS employees – being forced to cover costs out of their own pockets, particularly for treatments like dentures or crowns that require laboratory work.

There is no new money for this New Patient Premium, and so any new patients seen are just recycling the same limited pot of money. Factoring in late uplifts to contracts already promised by Government the BDA estimate fewer than 900 of the approximately 8000 NHS contract holders in England are likely to benefit from the higher UDA rate.

The £200m in ‘new’ money pledged is less than the half the underspends in the budget expected this year, the result of practices struggling to hit their punitive government targets. The BDA stress the ‘ring fence’ promised by Ministers to protect the dental budget remains an exercise in semantics, and that budget raids will remain the norm in cash-starved Integrated Care Boards.

Any additional investment will barely begin to compensate for a decade of frozen budgets. Last month Department of Health and Social care accounts revealed the service’s £3bn budget has barely changed in a decade, with no effort to keep pace with demand, or rising costs. In real terms the budget has been cut by over £1bn since 2010.

The plan falls well short of the criteria set by the Health and Social Care Committee in its damning inquiry into dentistry. The BDA believes it singularly fails to honour MPs’ call for the “scope and ambition… to immediately address the crisis of access people across the country are experiencing.”  The Government has ruled out reform of the discredited contract fuelling the exodus from the NHS. The Committee had stressed “fundamental reform of the dental contract is essential and must be urgently implemented, not only to address the crisis of access in the short-term, but to ensure a more sustainable, equitable and prevention-focussed system for the future.” In the absence of any meaningful change the BDA describe the package as amounting to little more than an exercise in ‘rearranging the deck chairs.’

With oral health inequality now widening the BDA has also said pledges merely to consult on preventive programmes like water fluoridation in the North East are close to meaningless, and that frontloaded investment in tried-and-tested schemes like supervised brushing are needed now.

The government is also reportedly going to offer dentists cash incentives to take on extra NHS patients, as well as sending teams to schools to treat children’s teeth. Under a plan to boost services in England, seen by the BBC, dentists will receive a “bonus” to take on more NHS patients, while up to 240 dentists will also be offered £20,000 to work for three years in under-served areas.

Police have recently had to break up crowds of hundreds attempting to get on the books with a new practice in Bristol. In the face of ongoing access problems new BDA surveys indicate 8 in 10 dentists have treated patients that have undertaken some form of ‘DIY’ dentistry since lockdown, amid reports of life-threatening dental sepsis surging, and British nationals even choosing to head to the Ukraine for care.

Leaks to the Daily Telegraph indicated that government was attempting to limit the political damage the crisis is doing in the coming General Election. The BDA stress the inadequacy of this plan will effectively ensure dentistry remains a major issue on the doorstep. From today the professional body will be working alongside the Daily Mirror and 38 Degrees to mobilise the public, to push for real change. https://38d.gs/SaveNHSDentistry

BSPD welcomes Government’s new dental recovery plan but flags absence of dental contract reform

in response to the Government’s dental recovery plan announcement, the British Society of Paediatric Dentistry welcomes the inclusion of measures to improve children’s oral health. This promise of funding and the implementation of measurable outcomes is pivotal to ensuring that at last the beleaguered NHS dental health services get the support needed to address the crisis in oral health in the UK today. However, the Society flags that there is an absence of a dental contract reform proposal to enable this.

Professor Claire Stevens CBE, BSPD Spokesperson, said: “This long-awaited plan includes some measures to tackle the crisis in children’s oral health. However, we cannot see a plan to review and revise the dental contract which is central to kick-starting the UK dental recovery. Is this the ‘elephant-in-the-room’? For too long we have had podium announcements which sound good, but are actually unworkable on the ground. We have been calling for clinically-informed policies with measurable outputs. The current dental contract is not fit for purpose and reform is long overdue.

“We need to ensure the funding is put to good use and supports the dental health workforce with a contract that works.  In the run up to an election, we want to feel confident that these initiatives won’t just be shelved once the focus is off getting votes.”

Included in the plan are proposals to support water fluoridation, which BSPD has long supported as a proven intervention to improve oral health.  There is mention of other initiatives such as the creation of mobile dental units.  However, BSPD has some concerns regarding the value of mobile vans which include questions about a clear plan as to who will staff them, and secondly, requests reassurance that they will not just be for check-ups and fluoride varnish treatments, when the focus should be on targeting the most vulnerable children and rendering them dentally fit.

Professor Stevens added: “Our starting point if we could advise the Government would be to show them our 10 step Blueprint to dental recovery, which we sent to the secretary of health in November. We would want, as a minimum, the Government to commit to funding supervised toothbrushing schemes for the 20% most deprived children in England.  This would be taking on board the valuable work done as part of the CORE20PLUS5 CYP  initiative – which recognises that to make health care equitable, not just equal, some children will need more support to ensure that every child has the best start in life.

“BSPD supports the fluoridation of public water supplies in communities where the burden of dental decay is severe enough to warrant this public health measure and fluoridation is technically feasible. We look forward to seeing the details regarding the Government’s fluoridation plans.

“A preventively-focused dental services plan with funding and measurable outcomes is what we need.  We look forward to seeing more details as the plans unfold and remain willing to work with all parties who commit to improving children’s oral health.”

College of General Dentistry issues ‘interim response’

The College has issued an interim response to the government’s press release announcing a ‘Dental Recovery Plan’, pending publication of the plan itself, which is expected later today.

Commenting on the proposals in the release, Dr Abhi Pal FCGDent, President of the College of General Dentistry, said:

“The government has today set out a range of initiatives intended to help tackle some of the many longstanding problems facing NHS dental provision in England. These include some potentially positive new initiatives, which we welcome, alongside previously made announcements. However, while some further positive changes to the dental contract are anticipated later this year, the Dental Recovery Plan does not represent the more fundamental contract reform which is required, nor will the additional £210m in funding behind the plan, welcome as it is, restore universal access to NHS dental care.

“We welcome the proposed Smile For Life programme, with its focus on intervening early to prevent oral diseases in children. Tooth decay remains the leading cause of hospital admission for 6–10-year-olds in England, and a preventative approach has the potential to reduce the need for restorative treatment. However, we wait to see whether sufficient resources will be invested for the programme to be a success.

“The additional temporary funding aimed at those who have been unable to access dental care for two years or more is much needed. However, we would like to see consideration of the ongoing care of individuals benefitting from this initiative.

“The intention to bring NHS dentistry back to some of the many communities who have lost access to it is also very welcome. While mobile units may help in the short term, bricks-and-mortar dental surgeries should remain the backbone of routine ongoing care delivery, and appropriate funding should be put in place to support the re-establishment of NHS practices to address lack of access and meet the volume of need.

“The planned ‘golden hello’ scheme brings implicit recognition of the difficulties experienced by dental practices in the recruitment and retention of clinical staff to deliver NHS dental care. However, we are concerned that this short-term offer may fail to overcome many practitioners’ long-term concerns about embarking on a career in NHS care delivery, among which are burnout, lack of career progression and insufficient recognition for enhanced skills.

“We are already looking forward to the expansion in the number of dental school places available for dentistry and dental hygiene students, and to the implementation of medicines exemptions for dental hygienists and therapists. Greater recognition and use of the full range of skills of all team members will enable the delivery of more care and make NHS dentistry more attractive to dental professionals. We also look forward to further proposals which empower the wider dental team when the next set of contractual changes are consulted upon.

“We also recognise that an increase in the minimum UDA value will support a small number of practices to continue delivering NHS dental care. And we support the intent to introduce community water fluoridation in areas of high need as this has the potential to reduce the prevalence of oral diseases and the need for invasive interventions.

“Finally, while dental practices struggle to recruit and many patients struggle to access care, there are many dental professionals who have qualified and practised overseas and who could be providing care here in the UK, but are unable to do so due to the waiting lists for the Overseas Registration Exams. So we welcome the possibility of provisional registration, and await the detail with interest.”

Denplan, part of Simplyhealth, issues response

Catherine Rutland, dentist and clinical director at Denplan, said: “The state of dentistry in Britain and scale of dental deserts has been a growing issue over the last few years. The initiatives suggested in today’s Dental Recovery Plan offer a glimpse of hope for the future – but only if introduced as part of wider policy changes.

“We can’t offer dentists more money for NHS patients while ignoring essential reforms to the dental contract so they can better treat the patients they have. The ability to offer a mixed NHS and private model would enable better support for both patients and professionals.

“Commitment to teach nursery pupils to avoid tooth decay is important to embed those early habits. However, we must also consider how we support parents with wider oral health habits, including dietary considerations, education and regular dental visits.

“This is a promising first step but more needs to be done – for our children, society, and our dental teams, many of whom are mentally and financially affected by the challenges facing the sector.”

Bas Vorsteveld, Haleon Vice President and General Manager Great Britain and Ireland, comments on behalf of Haleon

“Across the country we know that dentistry is under pressure and the this is having a major impact on the oral health of the nation. Latest figures show that 1 in 5 people have avoided visiting the dentist due to cost, more than double the same time last year. Today’s news of the UK Government’s Dental Recovery Plan marks an important moment in attempts to reverse that trend and build a more inclusive and accessible NHS dental service.

“At Haleon, we know that to truly tackle the major crises we face in the UK’s oral health we need to redouble our efforts on prevention. I’m pleased to see some steps in the Recovery Plan, such as the new ‘Smile for Life’ programme, which aims to tackle that. As a company we have extensive experience in this area, with our Aquafresh Shine Bright Academy, reaching kids in schools and showing them the benefits of better oral health. Focusing here is the way to sustainably improve oral health in the country and move pressure off oral health professionals.

“We also know that many oral health professionals are struggling to offer preventative advice due to short appointment times and lack of access to easy-to-share information. In fact, our recent Dental Health Barometer found that just one third of oral health professionals said they always offer preventative care advice to patients. With this in mind, the industry needs to work together to provide preventative care advice at different touch points – beyond the dental chair. This will ensure preventative advice is accessible to all and help encourage long-term oral health across the UK.

“We at Haleon are proud to continue to provide support and resources to dental health professionals in the UK. Although the impacts of the funding and initiatives may take some time to be felt, these are steps in the right direction with a long-term view. We are looking forward to seeing the roll out of the new Dental Health Recovery Plan and further steps needed to improve the oral health of the nation.”

Comment from the Oral Health Foundation

The Oral Health Foundation has broken down the key points of the plan to see if it’s really going to make a big difference, could be a good step forward, or should be dismissed as nothing but words on paper.

Dr Nigel Carter, chief executive of the Oral Health Foundation, says: “The new NHS dental recovery plan, while showing glimmers of hope with confirmed prevention policies like water fluoridation and expanded roles for the dental team, ultimately falls short of expectations.

“The heavy focus on childhood initiatives in underserved areas rather than addressing broader oral health disparities appears inconsistent and inadequate. It’s akin to applying an Elastoplast on a gaping wound.

“The recovery plan lacks the comprehensive, immediate solutions required to rescue NHS dentistry. The government’s vague response to a new dental contract is frustrating and deflating. This lacks any kind of detail or vision for the future of NHS dentistry, amounting to mere words. The absence of a commitment to scrap the unfair UDA payment system leaves patients and dentists in limbo. It feels like a postponement tactic, kicking the can down the road and passing the issue to the next administration without tangible progress.”

General Dental Council (GDC) welcomes the government’s positive response to improve international registration of dental professionals

The GDC welcomes the government’s commitment to improving the routes through which internationally qualified dental professionals can register to practise in the UK as part of their dental recovery plan.

The benefits of the legislative changes that the regulator encouraged the government to introduce last year are already being seen, with substantial increases in the capacity of the Overseas Registration Examination (ORE) already in place. But those legislative changes are still not fully in force, and it will take time to capture the full benefits, which starts with letting new contracts to providers. The procurement process for that is well underway.

The GDC is also pleased to see that the government has recognised the case they have been making for the introduction of provisional registration for internationally qualified dentists. This has the potential to bring dentists into the workforce more quickly, to help them adapt to practising in the UK environment with support and supervision, and to provide a valuable alternative to the ORE.

The regulator looks forward to working with the government to support the legislative changes necessary to create the provisional registration route – and to working with the health services and education providers of all four nations to develop the practical arrangements required.

As the government has acknowledged, exploring automatic recognition of international qualifications from outside the EEA is also a potential route to increase the number of dental professionals who can practise in the UK.

For all new dental professionals seeking to work in the UK, whether qualified here or in other countries, the GDC’s priorities are that standards are maintained, patients are safe, and the public are protected. Internationally qualified dental professionals make a vital and very welcome contribution to dental care across the UK, and the GDC wants to ensure that the registration process does not impose unnecessary obstacles. Increasing the flow of new international dental professionals can make a useful contribution to addressing the wider challenges of dental provision, but it cannot provide a solution to them.

Stefan Czerniawski, Executive Director, Strategy at the GDC, said: “We very much welcome the government’s openness to new ideas for ways of streamlining international registration. Provisional registration is an exciting opportunity that will require commitment and collaboration from across dentistry on the design and delivery of the new approach – we need to move at pace, but we need to take the time to get this right.

“We will not compromise on the standards we expect new registrants to meet, so we will need to work together to ensure that dentists will be effectively supervised and supported to practise while working under provisional registration, so that the public is protected.”

BADN welcomes plan as “a first step in the right direction”

The British Association of Dental Nurses (BADN), the UK’s professional association for dental nurses, has welcomed the Dental Recovery Plan as “a first step in the right direction” – but says the Plan “does not adequately address the current dental nursing recruitment and retention crisis”.

“The Recovery Plan is certainly a starting point,” said BADN Honorary President Joan Hatchard. “But it fails to take into account the fact that increasing the number of dentists/hygienists/therapists requires a similar increase in the number of dental nurses, as clinicians cannot work with dental nurses.  The Plan blithely states that the NHS will also encourage more dental nurses to pursue training programmes – without giving any specific details on how this will be achieved!

“The recent survey carried out by Dr Debbie Reed of the University of Kent, in collaboration with BADN, shows that dental nurses are disillusioned by low salary levels (often only minimum wage), lack of career pathways, lack of recognition and support from their employers and are leaving the profession.  The crisis in dental nurse recruitment and retention can only be resolved if these issues are addressed.

“BADN is happy to work with the appropriate organisations regarding implementation of the Plan, but urges those organisations to bear in mind that dentistry is not just dentists – dental nurses are the largest registrant group and the mainstay of the dental team. Dental nurses, and their needs, must be included in the equation!”

 

700 Northern Ireland dentists press for urgent action to save service, with authorities ‘asleep at the wheel’

Health Service dentistry in Northern Ireland is caught in a “death spiral” without radical action, over 700 dentists have warned.

In an open letter, backed by the overwhelming majority of NI’s high street dentists, signatories warn DoH Permanent Secretary Peter May, that a combination of the looming ban on dental amalgam, paralysis at Stormont freezing health budgets and a financially unviable contractual framework could doom the service.

Northern Ireland looks set to be subject to the EU ban on dental amalgam from 1 January 2025, with practices braced for a huge hit from increased costs and time pressures from the shift to alternative materials. NHS dentistry works to a discredited high volume/low margin model, that has already seen practices delivering some treatments at a financial loss, fuelling an exodus to the private sector.

In this unprecedented call to arms, signatories say the financial situation facing HS dentistry is now unsustainable, and that continued inaction by authorities is no longer an option. They say officials must urgently follow the lead of the Scottish Government, who rolled out wide ranging changes to a similar contractual framework in November. They stress the Department of Health needs to reinvest the significant underspend projected for this year’s dental budget to aid struggling practices, who are unable to deliver pre-pandemic levels of activity. The BDA understand that spend on HS dentistry will be more than £10m below ‘normal’ levels, not because of any lack of demand, but because of capacity issues at struggling practices.

Text of the Open letter to DoH Perm Sec Peter May delivered by BDA NI on Tuesday 30 January 2024:

Dear Peter

We, the undersigned General Dental Practitioners feel compelled to write at this time, to ask: What is the Department of Health’s plan to ensure Health Service dentistry has a future?

Despite clear evidence and repeated warnings issued by the British Dental Association about the death spiral Health Service dentistry in Northern Ireland appears to be in, we have seen inaction from the authorities.

Vital public services are at stake. Livelihoods hang in the balance. We ask that you are transparent with us, and with the patients who rely on our services.

Scotland has recently moved to reform dental payments. Meanwhile, your Department has so far failed to bring forward any serious proposals to put dental services on a sustainable financial footing.

We now have an underspend projected for this year’s dental budget. Not because of any lack of demand from patients, but because struggling practices need support to deliver. DoH has failed to commit to reinvest this underspend into stabilising a service which is on the brink.

The imminent ban on dental amalgam represents an existential threat to NHS dentistry. In Strasbourg, MEPs backed amendments calling on member states to support practices with the added costs of alternative materials, and to reduce the clear impact this will have on the patients who need us most.

We require the Department to do no less.

Our signatures are testament to the intolerable pressure which this service is under. We cannot go on as we are. We need your Department to show leadership and take action now.

Evidence shows that the move away from Health Service dentistry is well and truly underway. In the continued absence of payment reform proposals, colleagues will be increasingly driven out of Health Service dentistry to keep their practices afloat.

We are passionate about maintaining a future for Health Service dentistry, and we want to continue providing access to these vital services for our patients.

But this now hinges on you acting, urgently in the public interest, and investing to stabilise and reform the service. Continued inaction will result in significant detriment to the provision of this vital public service. We cannot wait on if, or when, politicians decide they want to restore a devolved Assembly and Executive.

This isn’t a matter of the Department finally delivering a late pay rise this year. We need to know what you intend to do to fix the crumbling foundations this service is built on.

Please share your plan for Health Service dentistry with the profession, and the public.

NHS Dentistry sees biggest fall in budget in decades

With millions struggling to access care, Government spending on NHS dentistry has seen the biggest annual cut in decades, according to accounts set before parliament today.

The Department of Health and Social Care report and annual accounts 2022/23 shows that £2.899bn was spent on NHS dentistry – levels seen when the Coalition first took power. This has translated into savage cuts, with the budget falling by over a third in real terms since 2010 – a real cut of £1bn. [1]

The professional body says this is a result of both a decade of austerity and recent ‘underspends’ in the dental budget. This is not because of any lack of demand for NHS dentistry, but simply reflect struggling practices unable to hit their targets. While the Government has promised a recovery plan for the service, there are no clear signs it will offer the reform or needed investment to ease the current recruitment and retention crisis, which is fuelling current access problems.

Dentist leaders stress that if the coming plan comes without new funding it will lack credibility, especially given Government’s stated ambition to provide access to NHS dentistry to all who need it.

The Prime Minister and Health Secretary have repeatedly boasted about the service’s £3bn budget. However, no attempt has been made to keep pace with inflation and population growth, meaning savage real terms cuts over the last decade. OECD data from prior to COVID demonstrated that of all European nations, the UK spent the smallest share of its health budget on dentistry.

Despite the PM pledging to “restore” NHS dentistry in his first run for the leadership and protect the dental budget, NHS England has given Integrated Care Boards license to raid these underspends to plug huge deficits. The BDA understands the service is on track for similar levels of underspends in this financial year.

British Dental Association Chair Eddie Crouch said: “Ministers need to explain why – when desperate patients are pulling out their own teeth – they’ve let funding for NHS dentistry fall off a cliff. Promised ring fences have been torn down around a budget that’d already been cut to the bone. The PM promised to ‘restore’ NHS dentistry. Instead, he’s taking it back in time.”

[1] The General Dental Services Budget (England) from DHSC Report and Accounts

Budgets deflated by the BDA using RPI inflation:

BDA backs breakfast club brushing plan

The British Dental Association has welcomed moves by Labour to roll out supervised brushing programmes in breakfast clubs.

Historic modelling from Public Health England indicates targeted schemes could generate £3.06 in savings for every pound spent in the short to medium term owing to reduced treatment need. [1]

National programmes overseen by devolved administrations in Scotland and Wales have secured record breaking improvements in oral health, and elements have been adopted worldwide in countries ranging from Chile to Israel. 

While some English local authorities have financed schemes, the UK Government has failed to even take forward historic pledges to consult on rollout. 

British Dental Association chair Eddie Crouch said: “Supervised brushing is a tried and tested policy, that the Government’s own modelling shows pays for itself. It’s a scandal that decay remains the number one reason for hospital admissions among young children. Prevention isn’t just better than cure it’s cheaper too.”

Reference:

[1]https://assets.publishing.service.gov.uk/media/5a80ee0bed915d74e6231403/ROI_oral_health_interventions.pdf

Government offers big ambitions but no action to save NHS dentistry

The British Dental Association has lamented the Government’s failure to fully embrace the Health and Social Care Committee’s recommendations, specifically its unwillingness to fix the broken contract fuelling the current access crisis. 

In its official response to the Committee’s inquiry into NHS dentistry, overdue since 14 September, the Government reiterates a bold ambition to “ensure that every adult and child who needs an NHS dentist can access one, regardless of where they live.” However, the BDA has stressed it does not see any real evidence of the required urgency and ambition to deliver that objective.

The Government has not fully accepted recommendations to reform the discredited contract driving severe recruitment and retention problems, and with an unprecedented access crisis. Dentist leaders say the Government has singularly failed to show it shares the aspirations of the Committee, who offered a roadmap for rebuilding a patient-centred, prevention-focused service.

A recovery plan for NHS dentistry pledged by the Government in April remains undelivered. The Health and Social Care Committee has stressed any plan must have “the scope and ambition required to immediately address the crisis of access people across the country are experiencing. This should be accompanied by the necessary funding and a plan for swift implementation.”

The BDA have underlined that a break from the failed NHS contract is the only way of realising stated ambitions from the very of top of government to ‘restore NHS dentistry’.

BDA Chair Eddie Crouch said: “The Government claim they want access for all but appear unwilling to make any commitments that could actually achieve that. If Minsters won’t fix a failed contract NHS dentistry will remain built on sand, and risks being swept away. We’ve heard big ambitions but no action, and our patients will continue paying the price.”

 

SmileDirectClub: 5 dentists responsible for care of 65,000

The British Dental Association has told dental regulators that urgent reform is needed to stop the next SmileDirectClub putting patients at risk.

The BDA understands the remote orthodontic giant had just five UK-registered dentists overseeing cases. It is unknown if these clinicians were UK-based or covered by appropriate professional indemnity. The professional body has now asked both the General Dental Council and Care Quality Commission what expectations are on them to finish incomplete courses of treatment.

The BBC have reported the company had 65,000 patients. As SmileDirectClub only launched in the UK in 2019, the BDA have expressed fundamental concern over its ability to maintain basic clinical standards based on these numbers. 

The company has signed off telling its patients not only to maintain payment plans, but to find a ‘local dentist’ to take responsibility for future treatment. The BDA warns this could prove a minefield given potential cases of inappropriate treatment. The professional body has urged the dental regulator to ensure any dentists who step in to correct damage or complete treatments will not be liable for mistakes made by the company. 

The BDA have stressed that historic guidance from regulators must reflect good practice – requiring a full assessment by a dentist working within their competence, informed consent, continuing care and putting patients’ interests first.

Dentist leaders have warned the GDC that the profession and patients rely on it to prosecute the illegal practice of dentistry and that it must now look into the business practices of any providers operating under similar business models currently or in the future.

BDA Chair Eddie Crouch said: “It beggars belief that five dentists would be enough to provide continuing care for the company’s reported 65,000 UK patients. It shows why change is needed, so that the public are protected, and corners are not cut. This could prove a minefield for any dentist stepping up to help. We need assurances that any clinicians attempting to undo damage will not be liable for mistakes made by this company.

“A full clinical assessment isn’t a nice to have or an optional extra – it should be required no matter what. If we’re going to protect patients the basics of decent care must be in place for all.”