The state of the nation’s teeth isn’t really the sexiest topic, and oral health doesn’t make for front page headlines. But, as dentists, we are appalled that in 2017, tooth decay is still a massive problem we are fighting against, and that it is affecting some people more than others.
Do teeth really matter? Especially when there appear to be more pressing health issues on the Government’s agenda: diabetes, obesity, dementia, cancer, to name but a few.
A cursory glance at the statistics may show that dental health is improving over time in the UK, but this masks some serious underlying, structural, problems in dentistry as a profession, and in the way our patients are prioritising their oral health.
It irks me that this situation continues. Especially when as a dentist, I know that dental decay is, for the most, a preventable disease.
Failing oral health is more than just inconvenience and pain. It can affect your life chances, your job prospects, and things like oral cancer (which dentists are trained to detect), can actually kill you if it isn’t detected early on.
A lot of people don’t really care much for their dentist. We aren’t as ‘loved’ as our GP colleagues.
Hence, people don’t prioritise their oral health and take the time to ensure they are well informed, and follow a good oral hygiene routine, which would help prevent many dental problems.
NHS dentists are paid quite differently to GPs. Those who are practice owners, are technically small business owners; we pay for the costs of investment in our practices, the building, the infrastructure, the equipment, and all the overheads.
NHS dentists don’t get any ‘sweeteners’ from Government to provide services, we have to manage the books, plan for the future, ensure we can keep our businesses operating and pay our staff.
In England, to treat NHS patients, we have to bid for a contract, and we agree to do a defined number of ‘units of dental activity’ (UDAs) each year. This effectively sets quotas on the numbers of patients we can see and treat each year – and it’s not flexible. If we don’t fulfil the units, then we have to give money back, and if we run out of units, then patients have to go elsewhere, or wait until we get our new quota.
Does this sound like an effective way of providing healthcare to you?
Need for a new contract
Government knows there is a problem with the current system, and in 2011, announced a process to reform the dental contract.
Seven years later, we don’t really feel the process has actually moved forward much and we are still stuck with quotas. Activity is still being prioritised over quality, and treating disease over preventing it in the first place.
Government has been ‘testing’ different pathways and payment systems, but we’ve now been told that a new system that might be based on quality alongside activity, will not be seen any time before March 2020.
And we are sceptical about what this new system will look like, and how it will impact on the way we can run our small businesses, as quotas are likely to still be a feature.
Prevention is key
We’ve called for a focus on prevention for oral health, rather than quotas, as we feel this makes more sense – it would enable us to provide quality care for all those patients who need it, and the oral health inequality gap would be narrowed.
Oral health inequalities are a massive problem - all across the UK there are pockets of poor oral health, and this is correlated to levels of deprivation. A child born in Blackburn is nearly seven times more likely to experience decay than one born in the Surrey constituency of Health Secretary, Jeremy Hunt.
The elephant in the room, is of course, funding. In the context of spiralling NHS costs and funding being reduced, we know that Government is not going to sign-up to a system that potentially, in the short term, might appear to cost more.
Funding for NHS dentistry has been falling in real terms over recent years, despite the ever-growing need, as people live longer, keep their teeth for longer, and require more complex treatment.
The NHS dental budget is being increasingly subsidised by dental patient charges, which have been growing at an inflation-busting rate recently – they were increased by 5 per cent last year and another 5 per cent this year – but that is not enough to meet the rising need.
System not working
Government policy is often short-sighted, for a myriad of reasons.
But shouldn’t we be looking at a real preventative approach for oral health, backed up by real investment?
Tooth decay is the leading cause of hospital admissions among children aged 5-9 years old across the UK. An estimated 150 procedures to extract teeth are performed each day under general anaesthetic in hospitals across England, costing the NHS around £33 million a year.
Is this a good use of money, not to mention the pain and trauma being suffered by young children?
And the cost of treating dental patients who’ve ended up at A&E, rather than getting treatment earlier, could be costing a staggering £18 million a year.
We don’t think the current system is working.
We’re glad this QualityWatch briefing is highlighting the current state of NHS dentistry and the issues we as dentists face every day.
And we’d love to have a few more voices join us in calling for a better way, and improved outcomes for everyone’s oral health.