Opinion - dentists leaving the NHS and the new contract of April 2006

Historical funding:
Funding in the NHS has risen 75% over the past 15 years, over the same period it has risen a mere 9% in NHS dentistry. Many dentists suspect the Department of Health is actively squeezing dental care out of the NHS and into the private sector to save money. Dentists don't want to go private, they are being forced to go private.

Priorities vs. discrimination:
As progressive chronic NHS under funding bites, dentists respond by reducing their NHS commitment. This means prioritising children and exempt patients to receive NHS care which is subsidised by the dentist. Dentists are concerned they may not be able to prioritise care this way after April 2006 because of a non discrimination clause in the new contract. Dentists ethical prioritisation is termed discrimination by government. This is yet another push on NHS dentists into the private sector. It is infuriating to hear government officials claim that the new contract will encourage NHS dentists back into the NHS when it blatantly does the reverse.

The new contract:
The new contract to be imposed upon the profession in April 2006 is seen by many as the final straw, it will strike the death blow for NHS dentistry as we know it. It has been described by government as 'a new way of working'. Patients are going to find out the hard way what this means, indeed they will suffer 'a new way of being treated' which will include increased fees, and probably longer waiting times for routine care. The concept of registration with a particular dentist will cease completely. NHS dentists meanwhile will have to struggle to achieve performance targets based on volume of certain types of dental treatments or face cuts in funding.

Targets:
I am totally against targets in healthcare. Dental treatment should be appropriate and high quality, it should not be target driven.

Government spin and misinformation on 'the new way of working':
The British Dental Association commented "Three years ago the Government published its Options for Change vision for the future of NHS dentistry. Options for Change described a new system for dentistry that would enable a more preventive approach to care and remove dentists from the fee-per-item treadmill. This vision is now dead. The new contractual arrangements proposed for dentists will give no encouragement to prevention and fail to address quality improvement"

The government claim the 'new way of working' will allow dentists to take a more preventive approach and improve quality, they claim they have consulted dentists and tailored the contract to suit us and patients alike. They claim it to be a huge success already because many dentists have successfully moved to the 'new way of working' voluntarily through PDS schemes. They are of course referring to the vision of dental care referred to above which "..is now dead", indeed, it is the OLD 'new way of working'.

The new contract in April 2006 refers to a NEW 'new way of working' that is un-tested, un-piloted, non negotiated and many dentist believe ill conceived. All those voluntary PDS schemes the government triumphantly refer to, piloting and testing the OLD 'new way of working' have to convert to the NEW 'new way of working' in April 2006. This is the message dentists are getting from the BDA, is it a surprise they are leaving the NHS.

Government claims about "negotiating the new contract with the BDA"
Government claim the new contract has been negotiated with dentists from the BDA. The BDA negotiated with the government for some time over the OLD, new contract. The BDA walked out of negotiations due to government intransigence. To date (October 2006)The BDA deny contact, let alone 'negotiating' over the NEW, new contract.

19.10.05 Update: The BDA and the DoH appear to have started talking again. Here is a memo from Lester Ellman

Government veiled threats:
Following his claim in 1999 that everybody would have access to NHS dentistry within 2 years, Mr. Blair has now U-turned and claims he is powerless to increase access to NHS dental care. This is totally unbelievable, and alarmingly, he appears to purposefully categorize dentists as a law unto themselves for turning to the private sector after he forced them into it!

Moral and ethical dilemma's:
The new way of working delegates responsibility for providing dental care to the LHA's, Politicians postbags have been full of letters complaining about the lack of access to NHS dentistry and these letters cause our elected representatives concern. To eliminate these letters, ease their concerns and create 'access' to NHS dental care, the new contract will put dentists under pressure to provide an NHS "toothache service", much like dental access centre's.

Whilst this is a much needed service, it isn't comprehensive. Government advertising, and GDC regulations state that a comprehensive dental service is available on the NHS and dentists must provide this, and work to high standards of patient care.

NHS dentists will feel torn apart, the funding body will be pushing for a third World "toothache" service whilst the regulatory body will be pushing for a modern "comprehensive" service. If the dentist tends to one side he risks loosing funding, if he tends to the other he risks being sued by patients. The middle ground involves walking a tightrope. Why would a dentist accept these unworkable conditions?