At a recent Westminster Health Forum meeting in London, the Chief Dental
Officer (England) was challenged by audience members to state clearly, in a reformed NHS dental contract, what was ‘in’ and what was ‘out’ in terms of NHS dental provision.
For what I’m sure he felt were obvious reasons, no such clarity about the NHS ‘offer’ was forthcoming and in response, he determined that what mattered was the quality of communication by the individual clinician.
In this way, he continued, a patient without a (therapeutic) need for a scale and polish should be told so, and where appropriate, a layered composite restoration should be provided on the NHS.
One would have to ask NHS England for their definition of ‘need’ and ‘appropriate’ to avoid featuring in some forthcoming Channel 4 documentary, though. But in fact, what is ‘in’ and what is ‘out’ is slightly more clearly defined online by NHS Choices Live Well website.
Thus: “Bridges are available on the NHS”, as are ‘crowns’, however in addition to your dentist or a DwSI: “...your dentist can also refer you for private wisdom teeth treatment if you wish”.
“Root canal treatment is available on the NHS and costs £50 (Band 2)”. However, wisdom teeth are: “...£50.50” so a slight discount for RCT perhaps?
Fillings are a bit more ‘iffy’, since amalgam fillings and: “some white fillings” are available on the NHS, and a scale and polish is available only “depending on your clinical need”.
Implants are “usually only available privately” although they are “sometimes available on the NHS for patients who can’t wear dentures” or who have facial or dental disfigurement following cancer or avulsion following an accident.
In fact, accidents are the best way forward since, if you have knocked a tooth out: “Treatment of whatever type can be provided by an NHS dentist and the cost covered on the NHS.” With no mention, as elsewhere, of any patient fee, this may come as something of a surprise to (independent) practitioners with a GDS contract (and to those unfortunate enough to have a dental injury).
Teeth whitening is “cosmetic and therefore generally only available privately” but, like veneers, it’s occasionally available on the NHS “if you have a clinical need”.
Just a little summary, but you do feel almost more confused after reading it than before starting.
Most of the comments left on this web page are from patients who either cannot afford private or NHS dentistry or who are intensely critical of the costs of either service. After centuries of bad press the profession has a mountain to climb in terms of valuing the service it provides.
This does not seem, in my experience, to be an issue in other European countries where co-payment or social insurance is a way of life, thereby possibly confirming the views of the founder of the John Lewis Partnership who asked his staff to pay a small sum (it started at 1p) for the in-house magazine, as without a cost, he felt it would also be considered of no value.
Perhaps instead of selfjustification, the professions should give more thought to promoting intelligent (and intelligible) messages around the skills and training of dentists, therapists, hygienists and technicians. Like many, I hate the popular view that ‘pulling a tooth out’ is the easy option, and I still find the term ‘check-up’ derisory.
Given that between us we see more than a million patients a week, a one-to-one messaging campaign could be considered ‘do-able’ if only we could all agree on the wording (there’s always a catch).
As always, there are those who would not countenance the restriction of NHS dental care, either in scope of treatment or eligibility, this despite the fact that ‘the System’, 2006 style (and the rationale behind it), is so radically different from what was envisaged and enacted in 1948.
Others would, equally unrealistically, call for the untrammelled (it’s Shakespearean, look it up!) expansion of the budget to accommodate the advanced technology of dentistry, again unforeseen 66 years ago. It’s the same old unsolvable dilemma.
We need again to remind ourselves of a few things, such as that, beyond a basic level, healthcare is regarded by most economists as a luxury good. Why? Because when you plot total spend on healthcare against a nation’s gross domestic product (GDP) the relationship is linear. Essentially, this means that there is no ceiling to healthcare expenditure.
Secondly, we are still a heavily indebted nation, and no amount of economic growth now will solve the problem of NHS finance over the next 10 years. Finally, if the ring-fence around NHS funding were to be lifted, other central
services would decline to the point of mass unacceptability (even assuming that ministers of any ilk would approve it).
One cannot argue against the NHS as a ‘floor through which none shall fall’. But to expect that it will provide for the majority of our professional incomes over the next decade and beyond is, to my mind, nothing short of foolish.