BDA

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.”

BDA: Charge hike a political choice that will hit millions on modest incomes

The British Dental Association has slammed moves to increase NHS dental charges during the cost-of-living crisis, accusing Ministers of prioritising lowering their own cash contributions to the service over tackling tangible barriers to access for those with both higher needs and lower incomes.

Charges in England will rise by 8.5% from 24 April 2023. This will mean the cost of a band 1 treatment like a check-up will increase from £23.80 to £25.80, a band 2 like a filling will increase from £65.20 to £70.70, and a band 3 like dentures will increase from £282.80 to £306.80, an increase of £24.

While a proportion of the adult population is exempt from NHS charges, the BDA stress that many on modest incomes will inevitably be forced to think twice about seeking care. Entitlements to free care are limited, with many Universal Credit recipients not being eligible. The government’s own data [1], indicates that around 1 million adults declined to see an NHS dentist for reasons of cost in 2022.

The BDA has underlined that the increase will not put a single penny of new investment into the cash strapped service, and appears to mark a return to a long term strategy in which charges are used 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 struck. 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. [2] The BDA believe this latest increase represents an attempt by the Treasury to return to a fatally flawed ‘business as usual’ model as far as funding is concerned.

The BDA has stressed in oral evidence to the current Health and Social Care Committee inquiry that NHS dentistry’s survival will hinge on 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 according to OECD data, with England spending the lowest amount per head of population of any UK nation.

The BDA is deeply concerned that this increase in charges – the largest since the current system for NHS dentistry was rolled out in 2006 – will have a disproportionate impact on higher needs patients, and fuel already widening oral health inequality. The professional body has requested the equality impact assessment that should have underpinned this latest increase.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “This is an utterly grotesque display of priorities from the Treasury. This hike won’t put a single penny into a struggling service. Our patients are being asked to pay more simply so ministers can pay less.

“The Government did not have to go down this path during a cost-of-living crisis. This is a cold, calculated political choice, that will hit millions on modest incomes. Ministers must know some face a choice between heating, eating and seeking NHS care. And they are carrying on regardless.”

[1] Analysis of the GP Surveys by Ipsos Mori, 2022.

* Base: all patients who have tried to get an NHS dental appointment more than 2 years ago, or have never tried, and answered the question

**Base: all patients who have tried to get an NHS dental appointment in the last 2 years and answered the question, excluding ‘can’t remember’ and failed to secure one.

 

 

 

 

 

 

 

[2] NHS General Dental Services budget (England) 

Source: Department of Health accounts 

Dentists tell MPs NHS dentistry is ‘sinking ship’

The British Dental Association has warned the service is reaching the end of the road in evidence to the Health and Social Care Committee inquiry into NHS dentistry today.

The Committee heard how a failed NHS contract and chronic underfunding have fuelled an exodus from the service, and that in place of reform government has delivered mere tweaks to the system without a penny of new investment.

Research undertaken by the BBC in 2022 revealed 9 in 10 practices were unable to take on new adult NHS patients. The latest BDA survey indicates over half of dentists in England (50.3%) have reduced their NHS commitment since the start of the pandemic. 74% now intend to reduce – or further reduce – the amount of NHS work they undertake this year.

Recent analysis of government data undertaken by the professional body indicates unmet need for dentistry in 2022 stood at over 11 million people, or almost one in four of England’s adult population. 

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, told the Committee: “Recent tweaks to a failed contract will not stop the exodus of dentists and their teams from the NHS. A fundamental barrier has been funding. There is only enough NHS dentistry commissioned in this country for 50% of the population. Can you imagine if this was general medical practice? There would be rioting. What Ministers are doing at the moment is rearranging the deck chairs on the Titanic, while the service slowly slips into the sea. Without fundamental reform this service will not meet the demands of the British people. This really isn’t rocket science. Improve the terms and conditions, increase commitment through sustainable funding, and we will have NHS dentists again.”

BDA: Care home residents baring brunt of access crisis

The British Dental Association has stressed Ministers must act on new research from the Care Quality Commission, which reveals a collapse in access to NHS dentistry among care home residents.

Feedback from providers indicates that since 2019, and the onset of lockdown, the proportion of residents never accessing NHS dental care routinely has grown from 6% to 25%. Homes stating residents were always or mostly always able to access routine care fell from 67% to 35%.

Dentist leaders stress that the access gap here will far exceed the wider population, given the high needs and complex medical histories of residents, which includes the elderly and vulnerable adults. The BDA has long expressed concern over the postcode lottery of provision and the horrific cases that have emerged from the sector, with some patients reported as being unable to communicate their pain, to eat or to sleep. It has stressed that any solution requires national leadership on commissioning and funding services that must cover mainstream, urgent and domiciliary care.

In response to health watchdog’s first 2019 report the BDA had urged a revolution in the approach to oral health in care homes. It has applauded the leadership shown by the CQC which has shown a paradigm shift on awareness among leadership teams, and in care planning and staff training. The professional body has stressed the responsibility for providing anything resembling normal levels of access rests firmly with government. The report continues to underline the difficulties delivering care under the flawed 2006 NHS contract, with only 5% of contracts held in England including domiciliary care in 2021/22.

Following the 2019 Public Accounts Committee hearing into NHS patient fines, the BDA has applauded the CQC’s call to make care home residents automatically exempt from patient charges. A heavy-handed system has seen hundreds of thousands fined for attempting to access free NHS dental care, with many with complex needs facing penalties simply because their carers ticked the wrong box on a form.

Giten Dabhi, Chair of the British Dental Association’s England Community Dental Services Committee said: “The pandemic caused huge disruption to dental services, and sadly the worst impact is being felt by the most vulnerable in our society. “For years we’ve needed a revolution in oral health in our care homes. Now real progress risks being undone as access to care falls off a cliff. The Government must step up. Ministers have a moral duty to residents that can be left unable to eat, drink and communicate.”

Department of Health maintains support for dentists, but more certainty needed

With the Department of Health set to start the next financial year at a £300m deficit, the British Dental Association has acknowledged the efforts made to maintain vital financial support for the struggling service. 

The Department has confirmed that fee enhancements for high street NHS dentists will continue into the first quarter of the 2023/24 financial year. A further business case will be submitted for continuation of this funding for the remainder of the year.

An enhanced £14.30 fee to see unregistered children will also carry over into Q1 but will then cease.

Ciara Gallagher, Chair of the BDA’s Northern Ireland Dental Practice Committee said: “We recognise the concerted effort that has been put in to ensure this vital support will remain in place. Today’s announcement only covers the period to June, dentists will require continued support and certainty for the remainder of the financial year, and beyond, if we are to stem the flow away from Health Service dentistry.

“With patient care continuing to be severely impacted in the wake of COVID, we must find a way of measuring and addressing the costs of delivering NHS dental care, to make NHS dentistry financially viable for practitioners”. 

“Below-inflation uplifts which bear no resemblance to soaring costs of care will no longer cut it. We must use the next 3 months to put dentistry on a sustainable footing.”

BDA announces 2023 honour and awards recipients

The British Dental Association has proudly highlighted the work of those who have supported its causes and gone over and above for dentistry.

The BDA is looking to celebrate those who have shown a commitment to advancing dentistry and worked tirelessly for the profession. The Association strongly encourages nominations from all areas of the profession – so please do consider putting forward a colleague/s for the next round of awards.

You can find out more about the criteria and nominate for this year. The deadline for the next round of nominations is 26 May 2023. Nominations for the Joy Harrild Award for Young Dentists should be submitted by 28 April 2023.

Fellowship Medal: 

Honours outstanding and distinguished service to the profession and the BDA.

  • Katrina Clarke
  • Tim Harker
  • Ian Mills
  • Graham Stokes
  • Nick Stolls

John Tomes Medal: 

Honours outstanding scientific work or distinguished service in the medical or allied services.

  • Professor Mike Lewis

Life Membership: 

This honour is usually awarded after retirement and celebrates long and valuable service to the BDA, often at Branch, Group or local level.

  • Eric Battison
  • Jenny Godson
  • Margaret Wilson

Roll of Distinction: 

This award honours outstanding services to UK dentistry and non-dentists can be nominated.

  • Rory O’Connor

Certificate of Merit for Services to the Association: 

This award recognises special service to dentistry at any level and can be awarded to earlier career dentists for their commitment to the BDA.

  • Ian Douglas
  • Robin MacDougall
  • Andrew Sadler}

Certificate of Merit for Services to the Profession:

This award recognises special service to dentistry at any level and can be awarded to earlier career dentists for their commitment to the profession.

  • Melanie Catleugh
  • Russell Gidney
  • Paul Grugan
  • Simon Hearnshaw
  • Mandy Heller
  • Anna Hunt

Dentist juniors to join 72-hour walkout

The British Dental Association has announced that dentists working in hospitals employed under the junior contract will join their medical colleagues in a 72-hour walkout from 13 March.

These dentists will be withdrawing their labour in 19 employing trusts. 100% of voters backed industrial action in 18 of the 19 trusts.

British Dental Association Chair Eddie Crouch said: “This small but important group of dentists are working to the same contracts as their medical colleagues, and like them are not worth a penny less than they were 15 years ago. Our members will down drills until the government comes back to the table with a serious offer.”

Hospital dentists based in the following trusts are set for action:

  1. Cambridge University Hospitals NHS Foundation Trust
  2. Countess Of Chester Hospital NHS Foundation Trust
  3. Dorset County Hospital NHS Foundation Trust
  4. East Suffolk and North Essex NHS Foundation Trust
  5. George Eliot Hospital NHS Trust
  6. Kingston Hospital NHS Foundation Trust
  7. Norfolk and Norwich University Hospitals NHS Foundation Trust
  8. Northern Lincolnshire and Goole NHS Foundation Trust
  9. Portsmouth Hospitals NHS Trust
  10. Somerset NHS Foundation Trust
  11. University Hospitals Plymouth NHS Trust
  12. Guy’s and St Thomas’ NHS Foundation Trust
  13. Manchester University NHS Foundation Trust
  14. Sheffield Teaching Hospitals NHS Foundation Trust
  15. South Tyneside And Sunderland NHS Foundation Trust
  16. Bedfordshire Hospitals NHS Foundation Trust
  17. Northumbria Healthcare NHS Foundation Trust
  18. St Helens and Knowsley Teaching Hospitals NHS Trust
  19. Barts Health NHS Trust

Soaring debt risks cutting off pipeline for next generation of dentists

The British Dental Association warn debt among dental students has more than doubled from 2013 to 2022, risking escalating severe workforce problems, while shutting off access to the profession to those from more modest backgrounds. 

Research published today (24 February 2023) in the British Dental Journal shows: 

  • The total debt of final year dental students and recent dental graduates surveyed increased substantially, more than doubling from £24,734 in 2013 to £52,922.12 in 2022. Increased student fees in 2010 and then in 2016, plus the removal of student grants in 2016 have played a large part in the increase.
  • Commercial and informal borrowing from family and friends almost doubled between 2013 and 2022, with the average value of commercial debt among dental students / recent graduates in 2022, £2,268 and £2,976 average for informal debt in 2022.
  • Three in five (60.2%) respondents experienced financial difficulties during their studies and over a quarter (28.2%) nearly did not come to university because they were concerned about the debts they would accumulate – roughly a 10% increase in both proportions compared to 2013.
  • Over a third (37.9%) of respondents had thought about dropping out of university, with significant differences found between different socioeconomic groups (students whose parents attended university or college of higher education vs. those who didn’t).

With NHS dentistry currently experiencing unprecedented workforce problems and an access crisis the BDA stress sufficient support must be available to meet the needs of current and future dental students, as part of any fully funded, long term workforce plan. 

The professional body stresses that the level of maintenance support within the financial package available to students must be adequate. It says all dental students should be entitled to an NHS bursary, and that all UK governments must jointly produce information resources which allow prospective students to easily find out what support is available to them. It believes interest should not be applied to student loans during studies.

Paul Blaylock, Chair of the British Dental Association’s Student Committee said: “As millions of patients struggle to access care, debt is leaving many students thinking twice about their future in the dental profession. Successive governments have tightened the screws. Ministers cannot rely on the Bank of Mum and Dad to ensure this country has the health professionals it needs. We need the brightest and the best on the frontline, and eye-watering levels of debt should not be a barrier. The next generation of dentists and patients deserve better.”

Decay going unchallenged as no.1 reason for child hospital admissions

The British Dental Association warns that new data on hospital tooth extractions among 0-to-19 year olds understates the level of demand, given huge backlogs and only partial recovery of elective services.

While numbers remain well below pre-COVID levels for now, the data confirms that tooth decay remains the most common reason for hospital admissions in children aged between 6 and 10 years – and that rates for children and young people living in the most deprived communities are nearly 3.5 times that of those living in the most affluent.

The BBC reported in August that 91% of dental practices in England were unable to take on new adult NHS patients, with 79% unable to take on new child patients.  The BDA remains deeply concerned that ongoing and severe access problems, together with disruption to public health programmes and lockdown diets will widen these deep oral health inequalities. Nearly 50m NHS dental appointments have been lost in England since lockdown, with dentists now reporting typical patients presenting with higher levels of need.

The Health and Social Care Committee is set to begin receiving oral evidence next month on the crisis in NHS dentistry in England. The BDA has accused government of failing to deliver needed reform and investment. This week it was revealed that during this unprecedented access crisis over 10% of the service’s already inadequate £3bn budget is set to be handed back, as struggling practices are unable to hit government targets owing to widespread recruitment problems. 

BDA Chair Eddie Crouch said: “Tooth decay is still going unchallenged as the number one reason for hospital admissions among young children. Decay and deprivation are going hand in hand, and this inequality is set to widen. None of this is inevitable. This government needs to be willing to take off the gloves when it comes to fighting a wholly preventable disease.”

BDA: Government set to take 100s of millions from NHS dentistry during access crisis

The British Dental Association has warned that hundreds of millions are set to be taken away from NHS dentistry during an unprecedented access crisis, on track to amount to over a tenth of the service’s £3 billion budget.

The Health Service Journal report that senior leaders in NHS England have major concerns that the service is set for record ‘underspends’ in 2022/23. The BDA stress this ‘clawback’ does not reflect a lack of demand for dentistry, but the reality of a recruitment crisis across the frontline which is leaving practices unable to fulfil their contractual commitments.

Practices face financial sanctions for failure to hit the widely discredited targets set in their contracts. Freedom of information data acquired by the BDA shows no sustained recovery in dentistry delivered in the first 9 months of this financial year. With activity – measured in Units of Dental Activity (UDAs) – delivered monthly averaging a little over three quarters of pre COVID levels up to January 2023, the BDA stress this all but rules out a full recovery, even if practices pull out all the stops, given ongoing workforce problems.

Given this performance the BDA estimate this will translate into losses of well over 10% of dentistry’s gross budget, potentially as high as £400m, given current trends. This funding is not ring fenced, and the vast majority will simply plug holes in other NHS England budget lines.

The BDA warn record breaking clawback levels will push some practices to bankruptcy or speed moves to the private sector. This reflects long-term issues with the failing and under-funded NHS dental system, with a contractual framework in which many dentists are no longer prepared to work. Clawback increased by 310% between 2014-20.

BBC research in August 2022 showed 9 in 10 practices in England were unable to take on new adult NHS patients. The House of Commons Health and Social Care Committee is currently holding a dedicated inquiry into dentistry.

British Dental Association Chair Eddie Crouch said: “Patients will struggle to comprehend why this Government is about to take hundreds of millions from the frontline during an access crisis. This cash will end up plugging holes in other NHS budget lines. It’s not because there’s any lack of demand for dentistry, it’s simply that practices are working to a failed contract and can’t fill vacancies. Any progress requires reform and investment, but instead dentists are getting kicked while they’re down. This will push dedicated NHS practices to the wall or to the private sector and leave whole communities with no options.”