Since the publication of the recent Office of Fair Trading (OFT) report, it seemed like dentistry was taking a real beating from the media. In particular the media's portrayal of the OFT's findings seemed to focus on alleged miss-selling of private treatment. If it were not for the prospect of industrial action from doctors, dentistry would probably have dominated the health news a little longer.
The OFT seems to be suggesting that NHS contracts should be time limited in order to increase competition. This idea seems to be fundamentally flawed, or perhaps just very poorly thought out, when applied to the current model of dentistry. The dental market currently benefits from relatively better access to loans when compared with other markets. This is in part due to the fact that dental businesses have some certainty of income from NHS dental contracts. As soon as that certainty diminishes, the risk exposure increases and the availability of loans will become more difficult and more expensive. This in turn will drive up the cost of running a dental practice. The long-term implication is that dental providers will find it more difficult to provide low cost services; private charges will start to increase and NHS services will then become less available or providers will move away from providing NHS services.
It is surprising that the OFT has focused on dentistry but steered clear of primary care medicine or any other hospital services. Arguably all the statements the OFT have made about dentistry could be applied to each and every part of the UK healthcare system. Given that NHS contracts for primary care medicine and primary care dentistry are extremely similar, the issues relating to lack of time limitation could apply equally to GPs. The OFT report is possibly more political than they may wish to admit. The recommendations seem to be biased towards the NHS and partly come across as being opposed to private dentistry.
The OFT may have overlooked the education and training systems that sit behind the NHS. It seems to have ignored the issue of 'vocational training'. At present vocational training in the NHS remains the only mechanism for UK graduates to enter the NHS in primary care. The OFT has made no recommendations to de-regulate this training process and allow any qualified provider to compete for the right to offer their own scheme. If it was really serious about competition then it may have considered this issue. Education and training funds are not in infinite supply, yet the number of UK graduates has continued to increase rapidly. The implication is that there will be insufficient vocational training places for the number of UK graduates and these highly skilled individuals will not be able to enter the NHS, yet their non-UK counterparts will still retain a route of entry.
The OFT has been unrelenting in its push for direct access to dental care professionals. Direct access coupled with the potential for expanding skill mix in the NHS, could actually mean that some dentists are 'competed' out of the market. If we look forward by another 20 years, it is entirely possible that the same issues may apply to Dental Care Professional (DCP) groups whereby dental nurses and dental hygienists are competing for the same overlapping duties and once again the OFT or its successor will wade in and remove a barrier.
In my view it seems like the OFT has ignored the complexity of healthcare and has taken a very simplistic view of dentistry, similar to an unregulated market. The fact remains that dentistry is a regulated market with barriers to entry and exit. It would be unrealistic to treat dentistry like other perfectly competitive markets.