Are NHS charges masking cuts and driving patients to GPs?

16 September 2016
News
01 January 0001
Volume 31 · Issue 6

NHS charges are driving patients with dental problems to overstretched GPs, and could soon overtake government funding as the principle source of revenue for NHS dentistry, according to new analysis from the British Dental Association (BDA).

Patient charges were first introduced in 1951, to lower demand for NHS dental services. The BDA has dubbed the charges a “tax on health” that mask real cuts in the service and discourages the patients most in need of care.

Nearly one in five patients has delayed treatment for reasons of cost according to official statistics.

Recent academic studies show 600,000 patients – over 11,000 per week – are choosing to head to their GPs, who are not subject to charges but are unequipped to provide dental treatment. The BDA estimates these appointments cost the NHS over £26m a year. 

Dental charges in England increased by five per cent this year, and are set to rise by a further five per cent in 2017, alongside further falls in state funding for NHS dentistry. BDA projections show that unless ministers change course, patients will be contributing a full third of England’s NHS dental budget through charges within the lifetime of this parliament – and are on course to exceed government spending by 2032.

Patients in England already pay far higher charges for basic care and contribute a larger share of the dental budget through charges than their counterparts in the devolved nations – whose systems have become less reliant on charge income over the last decade. The BDA is now sending information posters to over 8,000 NHS dentists across England to help canvas feedback from patients on the future of the charge. 

Henrik Overgaard-Nielsen, chair of the general dental practice committee at the BDA, said:
“Ministers insist the NHS will remain free at the point of use, but keepramping up England’s dental charges. Increasingly they look like a tax on health, a substitute for adequate government investment which drives down demand from the patients who need us most. These increases aren’t putting an extra penny into the service; they are just a winning formula for cuts by stealth.

“We’re told our patients should make a ‘contribution' toward the cost of NHS dentistry. Well unless ministers change course, our patients will end up paying more into the service than the state within a generation. The term ‘NHS dentistry’ ceases to have much meaning if patients are expected to pay the lion’s share of their treatment costs at the point of delivery.

“Already these inflated charges are pushing those who can’t pay towards overstretched GPs, who aren’t equipped to treat them. It’s bad for our patients and it’s bad for the NHS.

“Dentists are health professionals not tax collectors. Our patients need an adequately funded service and they deserve some honest answers on how that service will be paid for.”

Facts and figures: Paying for dental treatment in the UK

  • England now leads the field for basic treatment charges, with a £19.70 charge for an examination, compared to £13.50 in Wales. In Scotland, check ups are free of charge, with £4.72 charged for X-rays, £6.76 for extraction of one tooth or £10.76 for simple gum treatment. In Northern Ireland examinations charges start at £6.68.
  • Many patients on low to moderate incomes are offered no exemptions from these charges by government. 
  • Direct government investment in the service in England has fallen by £170m since 2010, while the gross budget has been topped up by inflated patient charges. The BDA has estimated a likely continuation of the five per cent uplift in in patient charge income, alongside a one per cent annual increase in the gross budget (comprised of both patient charges and direct government spending). Based on current trends, patient charges in England are on course to contribute one third of the total dental budget within the next four years – and are on track to exceed funding from government by 2031/32.
  • Patients in England are expected to pay a far greater share of the budget than those in all other devolved nations. The share of the NHS dental budget paid by patients through charges in England has risen from 18.6 per cent in 2006, to 26.1 per cent in 2015, while in Scotland it has fallen from 26.3 per cent to just 16.9 per cent.
  • The last Adult Dental Health Survey reports that just over a quarter of adults (26 per cent) say that the type of dental treatment they opted for has been affected by cost – and almost one fifth (19 per cent) say that they have delayed dental treatment for the same reason.
  • A study of over 280,000 dental consultations published in the British Journal of General Practice in May 2016, indicated a rate of dental consultations of 6.06 consultations per 1,000 patient-years among GPs. This equates to approximately 600,000 consultations for patients with dental problems at GP practices every year. Patients with emergency dental problems (including toothache and abscesses) typically require some form of operative intervention, which GPs are not trained or equipped to provide. Patients requiring operative interventions are usually referred on to a dentist.
  • The Personal Social Services Research Unit has calculated the unit cost for GP services as £44 for 11.7 minutes of patient contact. This would suggest a minimum added cost to the NHS of dental problems being handled by GPs at around £26.4m per year.