Cuts are the wrong cure: Dentists warn future of service now at risk in Northern Ireland

The British Dental Association has warned officials that planned cuts will devastate a service already on the brink.

In an open letter to Peter May, Permanent Secretary at the Department of Health, representatives of every field of practice in Northern Ireland stress “If the axe falls on dentistry – indeed if there is a failure to provide needed investment – this service faces collapse. The price will be paid by patients across Northern Ireland.”

Dental leaders say Northern Ireland faces ‘a three-tier system’, where those who can’t get registered for NHS care but can’t afford to pay privately are left without routine access, short of accessing emergency services.

The letter cites bleak evidence from the frontline, with the crisis on the high street being felt acutely across community and secondary care:

  • Oral cancers: Red flag referrals for suspected oral cancers from high street dentists to secondary care set at 2 weeks are currently running at 8.5 weeks in some areas
  • An access crisis in primary care: Last year the BBC found 90% of practices were not accepting new adult patients and 88% were not accepting child patients. Activity levels have only recovered to approximately 80% of pre-COVID levels. A workforce crisis is fuelling this access crisis, combined with unviable fees to dentists for providing NHS care. 60% of dentists intend to increase their amount of private work. 41% of practice owners intend to decrease their health service work. This picture is set to worsen.
  • Multi-year waiting times: We have 5-6 year waiting times for routine assessment for Oral & Maxillo-facial services; 219-312 weeks Hospital Orthodontic waiting times for patients with facial deformities; currently reliant on a surgeon from Wales to come over every two months to treat children with cleft lip and palate. Cuts could mean waiting times increasing further, and some treatments being no longer available in Northern Ireland
  • Widening Health inequalities: NI residents are twice as likely to have filled teeth as their counterparts in England, and children are three times as likely to have multiple teeth extracted under General Anaesthetic. Children in our most deprived communities are least likely to be even registered with a dentist (63% registered in most deprived areas vs 80% least deprived). Health inequalities will widen further if, as a result of reduced funding access to the full range of dental services is reduced.
  • Plummeting Morale: COVID has had an enormous impact on the dental profession. 63.6% of community dentists – treating the most vulnerable in society – say their morale is ‘low/very low’, with a key factor being the ongoing patient backlog. Existing difficulties accessing theatre space is having an impact on the vulnerable groups these dentists serve. 
  • A growing pay gap: Additional in-year funding will in effect not be available for pay uplifts here, rather it will be prioritised to settle the £297m debt. Northern Ireland has a shameful track record of delivering late pay uplifts. The possibility of no uplift would have a devastating impact on recruitment and retention and the financial sustainability of practices. In hospitals, Dental Core Trainees (DCT) have a pay gap of up to 25% compared to other UK nations. This is having a huge impact on recruitment with 9 of 22 DCT posts currently unfilled.

Michael O’Neill, Head of General Dental & Ophthalmic Services wrote to dentists on 3 May that work is ongoing to secure savings and raise revenue across health budgets.

In the absence of government, the BDA is calling on MLAs to step up, and protect the future of NHS dentistry across Northern Ireland.

Scottish Dentist juniors to join strike action

The British Dental Association has announced that dentists in Scotland employed under the same contract as junior doctors, will join their medical colleagues in a 72-hour walkout, the dates of which are yet to be confirmed, if BMA ongoing negotiations with the Scottish government do not result in a credible pay offer.

The overwhelming majority of voters (91%) from this small but important cohort backed industrial action, on a turnout of 79%.

British Dental Association Chair Eddie Crouch said: “Our members stand ready to do whatever it takes to secure a fair deal on pay. Just like their medical colleagues these dentists aren’t worth a penny less than they were a decade ago. We are hopeful that a negotiated settlement can be found. But our members will take strike action if the Scottish Government fail to come back to the table with a serious pay offer.”

BDA responds to Williams judgement: ‘We need reflection from GDC, clarity from NHS England’

The British Dental Association has responded to news of the judgement in Lucy Williams’ recent case at the Court of Appeal, which confirmed that “top- up” private fees in addition to band three NHS charges – in this case for a more aesthetic ceramic crown – were permitted by the relevant NHS regulations.

This appeal was brought by the GDC following a judgement by the High Court, which overturned the original professional conduct committee (PCC) decision of the General Dental Council (GDC) in January 2022, which had resulted in Dr Williams’ erasure. The High Court ruled that the PCC was wrong to have found that Dr Williams was not permitted to charge ‘top-up’ fees in the way she did for three patients, and therefore quashed the PCC’s finding of dishonesty and replaced the erasure with a nine-month suspension, reflecting other findings in the case.

The BDA stress there is no doubt that dentists can mix on the same tooth e.g., an NHS crown with a private root filling, and that this has been the case since 2006 notwithstanding dental guidance issued to practitioners throughout the intervening 17 years to indicate otherwise.

The BDA note the GDC must also reflect on whether this interpretation of the regulation has implications for other historic fitness to practise cases where charges of dishonesty have relied upon registrants’ approaches to mixing NHS and private treatment. In many cases, that will not be a straightforward assessment, given that there will often have been multiple charges of dishonesty brought. Nevertheless, the regulator has an obligation to review previous approaches

NHS England now need to confirm whether the guaranteed treatment provisions along with the two-month charging rule applies where patients have agreed to top up their treatment with private fees. The professional body stress that officials must now provide clarity on multiple fronts, and until that point practitioners should familiarise themselves with the relevant regulations again, read this judgement carefully and ensure they do the following to avoid any misunderstanding:

  • Discuss with your patient their treatment options under the NHS and privately, explaining the outcomes, differences and costs clearly
  • Provide a treatment plan and ensure where private treatment is agreed, the patient signs the FP17DC or equivalent
  • Ensure that you carefully document in the clinical notes, the conversations you have with your patient regarding the options available to them.

A detailed commentary on the judgement is now available

Len D’Cruz, Head of BDA Indemnity said: “Lucy Williams has faced lengthy and traumatic regulatory court processes. Lawyers engaged by both sides in the original GDC hearing failed to recognise regulations removing ‘same tooth’ mixing landed in 2006. It might well have saved much anguish and a significant amount of heartache, not to mention cost for everybody concerned, had they done so. The GDC must now reflect on every FTP case and erasure from the last 17 years that did not acknowledge these changes.

“Judges have recognised that dentists shouldn’t be left out of pocket when providing a private crown alongside other NHS treatment on this, and that this is closer to “the spirit of free dental services. That’s progress. But there are many unknowns. What we need now from NHS England is clarity across the piece.”

BDA slams Sunak for rose-tinted take on dental crisis

The British Dental Association has slammed the Prime Minister’s latest attempts to gloss over the crisis in dentistry at today’s PMQs.

In response to questions from Norwich’s Clive Lewis, the PM offered misleading lines on workforce, funding and reform which have been repeated, almost verbatim, time and again at PMQs since the start of 2023. The professional body is unclear whether officials at Downing Street or the Department of Health are responsible for this wholly inaccurate briefing.

Last week the PM failed to respond to questions from Durham MP Mary Kelly Foy on whether NHS dentistry is “in crisis”. BUPA has recently announced mass closures and over 300 patients queued outside a Kings Lynn practice last Tuesday from 4am to secure access, a sight not seen in England for a generation.

In January he told Lancaster and Fleetwood’s Cat Smith MP: “as a result of the new reformed NHS dentistry contract there are now more NHS dentists across the UK with more funding making sure people can get the treatment they need.”

The discredited NHS contract, which is fuelling an exodus from NHS dentistry and has been dubbed ‘not fit for purpose’ by Parliament’s Health Committee underwent only minor tweaks in October 2022. In March the BDA warned the Committee, which is currently holding in inquiry into the crisis in the service, that Ministers are just “rearranging the deck chairs on the Titanic, while the service slowly slips into the sea.”

The PM has repeatedly cited workforce data from the financial year ending 2021/22, which clearly has no relationship to these changes. In March he told Bradford’s Judith Cummins: “There are 500 more dentists in the NHS today.” England has fewer NHS dentists in 2021/22 than it did in 2017/18, and thousands are cutting back their NHS work, a shift going unseen in official data. BDA surveys suggest over half of dentists in England (50.3%) have reduced their NHS commitment since the start of the pandemic – by 27% on average. The proportion of dentists now reporting their intention to reduce – or further reduce – the amount of NHS work they undertake this year stands at 74%.

On funding the PM has repeatedly cited the £3bn NHS budget. This budget has remained effectively static for a decade, subject to savage real terms cuts. In cash terms government contributions into NHS dentistry in England were lower as the nation headed into the pandemic than they a decade ago (£2.2bn in 2010/11 vs £2.1bn in 2019/20), with patients paying an ever-larger share via inflation-busting charge increases. The share of the gross NHS budget coming from charges rose from 21.8% in 2010/11 to a high of 30.7% in 2018/19. During the access crisis over £400m of the budget is set to be lost from the frontline, from practices who failed to hit their NHS contractual targets. Many of these ‘underperforming’ practice simply cannot fill vacancies.

The Prime Minister unveiled a 5-point plan to end the access crisis during the Conservative leadership election last summer. No element of it has been taken forward.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “While ministers rearrange the deckchairs on the Titanic, their captain refuses to accept this service has even hit the iceberg. This ‘crisis, what crisis?’ attitude flies in the face of the facts. The reality is mass closures, the return of queues outside practices, and millions unable to secure the care they need. Until the PM recognises this, we won’t see progress.”

BDA: Government sitting on side-lines as child oral health gap widens

The British Dental Association has warned oral health inequality among the young is set to widen, as new research commissioned by the Liberal Democrats indicates 6.5 million children in England have not been seen by an NHS dentist for at least a year.

The BDA warn the lack of access will disproportionately impact on lower income, higher needs families, widening the UK’s oral health gap. Data obtained by the professional body under Freedom of Information indicates over 15 million appointments for children have been lost since lockdown, well over a year’s worth of dentistry in normal times.

In March the first oral health survey of 5-year-olds published since lockdown showed once again no improvements in decay levels and a widening gap between rich and poor. 23.7% of 5-year-old children in England had experience of obvious dentinal decay. This was a marginal increase on the previous survey of 5-year-olds in 2019, where figures stood at 23.4%. 

The report concluded that while absolute inequalities in tooth decay prevalence in 5-year-olds reduced from 2008 to 2015, there have been no further reductions in inequalities since then.

In the 2019 survey the prevalence of dental decay was higher in children from more deprived areas (34.3%) than in children from less deprived areas (13.7%) – an oral health gap of 20.6 percentage points. In 2022 data that gap has widened. In 2022 the prevalence of dental decay in more deprived areas was 35.1% compared to 13.5% in the more affluent – an oral health gap of over 21.6 percentage points.

Last week the UK government pledged to develop a ‘recovery plan’ just minutes ahead of the Department of Health and NHS England giving evidence to the Health and Social Care Committee inquiry into the crisis in NHS dentistry. The BDA described the last-minute announcement as ‘reeking of desperation.’ Dentist leaders have called on the Committee to set out a clear roadmap to reform for government, following evasive answers and poorly defined commitments to rescue the struggling service.

The BDA has slammed failure by government to take forward longstanding pledges to consult on expansion of supervised brushing programmes in schools and nurseries, and to act on pledges to expand water fluoridation. Both policies pay for themselves owing to reduction in treatment need among children. 

BDA Chair Eddie Crouch said: “Access to dentistry has fallen off a cliff. We’re losing the ability to nip problems in the bud, and the results are frankly devastating. A preventable disease remains the number one reason for hospital admissions among young children, and things are set to go from bad to worse. Kids in our most deprived communities will be hit the hardest while government sits on the side-lines.”

NHS dentistry: Ministers and officials try to defend the indefensible, says BDA

The British Dental Association has urged the Health and Social Care Committee to set out a clear roadmap to reform for government, following evasive answers and poorly defined commitments to rescue the struggling service.

It has disputed data cited by Minister O’Brien on the supposed ‘recovery’ in NHS dentistry. The Minister repeatedly spoke of NHS activity rising by ‘a fifth’ in the last year. Dentist leaders stress this ‘growth’ is based on comparing 2021/22 figures with the depths activity fell to during the height of the pandemic.

Levels of activity are so low that in the last financial year over £400m of the service’s budget is expected to be clawed back. Contrary to claims from NHS England on contract, the BDA has seen official data suggesting just 75% of contracted UDA activity was delivered in the eleven months to the end of February. This compares with activity levels before that pandemic, which, the BDA understands, were normally well in excess of 95% of contracted levels.

The BDA said the government’s pledge to develop a recovery plan for dentistry just ahead of the evidence session as ‘reeking of desperation.’

British Dental Association Chair Eddie Crouch said: “Witnesses tried to defend the indefensible, attempting to put a gloss on the government’s record. It won’t wash. NHS dentistry needs urgent reform, it’s got tweaks. It requires sustainable funding, instead we’ve got a charge hike that’s hit the patients who need us most. An exodus of dentists is still in motion, and millions remain unable to secure the care they need. The Committee can draw a line under this and set an urgent ‘to do list’ for government.”

BDA demands Barclay drops plans for further NHS charge hike

The British Dental Association has demanded that the Secretary of State for Health, Steve Barclay MP, drop plans for a further 4% increase in NHS charges in England next year.

In an open letter the professional body has warned millions are avoiding or delaying needed care, numbers which will only grow during the cost-of-living crisis.

The BDA has urged the Department to abandon its long-term strategy of using charge revenue as a substitute for state investment, an approach no other UK nation has followed. The letter states: “Crowns or dentures now cost £306.80 in England compared to £203.00 in Wales. You have a duty to explain to the public why patients in England must pay over £100 more for exactly the same NHS care.”

Today’s 8.5% increase is the largest on record, and greater than those recently set for both prescriptions (3.2%) and eye tests (4.5%). The letter notes “at any time, such vast patient charge increases would be unacceptable. During a cost-of-living crisis we consider them utterly outrageous. They are well beyond the increases set for optics or pharmacy, and we must ask why our patients are being singled out.”

Last month The Times reported Whitehall sources suggesting that a further 4% increase is set for 2024. The BDA say this plan must be abandoned. Dentist leaders say they can see no evidence of any meaningful equality impact assessment being undertaken, given the material impact this policy is set to have on millions on modest incomes. It has stressed pledges to develop a new framework must be brought forward with urgency, and that a sustainable funding settlement must be in place to underpin the rebuild of a service whose future is no longer guaranteed.

The access crisis in NHS dentistry is currently the focus of a Health and Social Care Committee inquiry, which is set to hear tomorrow from Sara Hurley, Chief Dental Officer for England and Neil O’Brien MP, Minister for Primary Care and Public Health. The BDA has referred the record increase in charges to the chairs of both the Health and Public Accounts Committees.

NHS dentistry: Costs leave quarter of patients delaying or avoiding treatment

With NHS dental charges in England set to jump by an historic high of 8.5% today (Monday April 24), the British Dental Association has warned government that costs are now shaping the clinical choices made by millions of patients.

The professional body has urged Ministers to follow the lead of public opinion and break with its long-term strategy of using charge increases as cover for cuts in government spending on NHS dentistry.

A new survey by YouGov of adults in England shows:

  • Nearly a quarter (23%) report delaying or going without NHS dental treatment for reasons of cost.
  • 45% say the price shapes the choice of treatment patients opt for, more than those following the clinical recommendations of their dentist (36%)
  • An overwhelming majority support a break from the government’s current model of ramping up charges while reducing government spending. 38% say dentistry should be fully funded by government through general taxation, effectively free at the point of delivery. 29% say funding from government should increase, while maintaining some patient charges. Similar levels of support are clear among all political allegiances [2], social classes, and regions.  A further 16% say charge levels should remain unchanged.
  • There is strong support for extension of free NHS dentistry to groups not currently covered, with 82% saying exemptions should cover cancer patients, whose treatments can cause severe dental problems.

In light of this evidence the BDA has urged the government to reject plans broadcast by Whitehall sources for a further 4% increase in charges next year, and to fully appreciate the impact charges have on lower income, higher needs patients. While some adult patients are exempt from charges, many on modest incomes still have to pay, including many recipients of low-income benefits such as Universal Credit. Dentist leaders warn that any repeat of these choices from government will inevitably widen already significant oral health inequalities.

The BDA has rejected claims from Minister Neil O’Brien that the increase “will raise important revenue for pressurised NHS budgets” stressing funds raised will simply become a substitute for state investment. NHS dentistry’s effectively static budget has remained at around £3bn for the best part of a decade, with patient charges forming an ever-greater share of the total pot. Direct Government spend on dentistry was lower as the country headed into the pandemic than it was in 2010.

The BDA told the Health and Social Care Committee inquiry last month that saving NHS dentistry will require a sustainable funding settlement. Since 2010 Spending on dentistry has failed to keep pace with both inflation and population growth. The UK now spends the lowest share of its health budget on dentistry of any European nation, with England spending the lowest amount per head of population of any UK nation. 

The BDA stress no other UK nation has followed this model, with the latest hike following a decade of inflation busting rises. A band 1 treatment like a check-up will now cost £25.80 in England, but just £14.70 in Wales. A band 3 treatment like dentures will now cost £306.80 in England and just £203.00 in Wales.

BDA Chair Eddie Crouch said: “This hike won’t put a penny into NHS dentistry, it will just force millions to think twice about needed care. Sadly, widening health inequality is a price this government seems willing to pay to cover for cuts. This is not a partisan issue. The public recognise this is not the way to fund a core part of our health service.”

BDA: Hundreds of dentists doing 1 NHS check-up a year

The British Dental Association has responded to new analysis commissioned by the Liberal Democrats, warning that the picture is far worse owing to the paucity of official data.

The Commons Library research shows how the rise in “dental deserts” has left people struggling to get an appointment, with some areas now having over 3,000 people for every NHS dentist. 65 of 104 local areas in England have seen the number of people per dentist rise since 2019, the figures show.

However, the professional body stresses that official data is a work of fiction, given the government has never attempted to collect data on how much NHS work these dentists perform. Most dentists combine NHS and private work, and officials have no estimate of the whole time equivalent NHS workforce. The BDA’s analysis of official data shows hundreds of dentists are doing the equivalent of a single NHS check-up a year.

The number of dentists delivering a single unit of dental activity (UDA) in 2021/22 was over 500. The Prime Minister has been criticised for repeatedly claiming there are 500 ‘new’ dentists practicing in the NHS as a result of government reforms. The BDA says this data underlines the emptiness of these claims. Recent polls by the professional body indicate over half of dentists in England (50.3%) report having reduced their NHS commitment since the start of the pandemic – by 27% on average. This movement is not tracked in official workforce data, which counts heads not commitment, and where dentists doing one NHS check-up a year carry the same weight as an NHS full timer. There are fewer dentists performing higher volumes of NHS dentistry in 2021/22 than in 2019/20, with the proportion performing over 5000 UDAs falling by more than half.

Recent analysis undertaken by the BDA indicates unmet need for dentistry in 2022 stood at over 11 million people, or almost one in four of England’s adult population. The professional body warned the Health and Social Care Committee last month that government was just “rearranging the deck chairs on the Titanic while the service slowly slips into the sea”. 

British Dental Association Chair Eddie Crouch said: “Dental deserts are on the rise, but the true scale of the exodus from the NHS is going untracked in official data. The Prime Minister keeps boasting of 500 ‘new’ dentists in the NHS. The reality is we have 500 doing a single check-up a year. We need a reality check from government, together with honesty, ambition and investment.”

NHS Dentists issue open letter to new Scottish First Minister

Following the election of Humza Yousaf as SNP leader and his swearing in as First Minister, dentist leaders in Scotland have called for immediate action to ensure the beleaguered service has a future.

The leadership election has delayed the timetable for reform of the low margin/high volume system dentists work to, that has left providers facing the risk of delivering NHS care at a financial loss. In an open letter, the British Dental Association has stressed that without immediate action the exodus from NHS dentistry will accelerate.

A recent survey of high street dentists across Scotland showed over half (59%) have reduced the amount of NHS work they do since lockdown, and four in five (83%) say they plan to reduce or further reduce their NHS commitment in the year ahead.

In the letter BDA’s Scottish leadership state: “In 2021 the SNP made a promise to the Scottish electorate: free NHS dentistry for all. The decisions you take in your first 100 days will effectively determine if that promise is going to be kept.”