NHS dentistry

Dentistry provided by the National Health Service (NHS) in the United Kingdom was originally intended to ensure that dental treatment is available to the whole population. However, for dentistry it has been limited centrally for some time, struggling to even see 55% of the population in a two year period (HSCIC official stats http://www.gov.uk/government/statistics/nhs-dental-statistics-for-england-2015-16-annual-report ). Unlike medical care, charges are made to most people. In England, a new but experimental target system of UDAs was imposed by government on 1st April 2006, but by 2008 the Parliamentary Health Select Committee investigation found the UDAs were unfit for purpose. Sadly the Dept. Health have largely ignored that finding, introduced perpetual pilots but 90% of nhs dental practices are still limited and inhibited by UDA targets today, which everyone agrees is bad for patients. Dentists act as private contractors to the NHS, which simply put means the Dentists buy the building and equip the Surgery, hire all the staff and pay all of the running costs including wages, materials and insurarances, to provide an NHS dental service. So it's not surprising as the NHS dental system gets worse or more limited in nature and medical/dental costs rise, that practices look to the Private sector to grow or make progress. Many now believe the NHS dental system in England is unfit for purpose and are whistleblowing publicly, to warn and expose the centralised failings to develop a proper national dental health and prevention strategy. Spin and denial by Government are NO substitute for an overdue decent, if limited system (http://www.telegraph.co.uk/news/health/news/12079233/Third-World-dentistry-crisis-in-England.html).

Scope of the service

According to NHS Choices "All the treatment that your dentist believes is necessary to achieve and maintain good oral health is available on the NHS. This means that the NHS provides any treatment you need to keep your mouth, teeth and gums healthy and free of pain.[1]". This includes if clinically necessary: dentures, crowns and bridges, orthodontistry, root canal treatment, scaling and polishing, and white fillings.

Many dentists who provide NHS services also offer additional services, such as hygienists, for payment. A dentist is allowed to refuse to provide treatment under the NHS and then offer to perform the same treatment privately.[2] However, this practice is far from clear cut, as many dentists do not provide what they are contractually obliged to provide, and instead "upsell" in a process known as gaming.[3]

A revised contract is under discussion in 2013 with greater emphasis on oral health and quality indicators.[4] The British Dental Association is keen to see reform, having campaigned vigorously against the "flawed, target-driven arrangements" introduced in 2006 that are currently in place.[5]

Availability

Following the government's introduction of a new contract in April 2006, NHS dentistry is not as widely available as it once was,[6] with 900,000 fewer patients seeing an NHS dentist in 2008 and 300,000 losing their NHS dentist in a single month.[7] This has forced many patients to pay much higher sums for private treatment,[8] and has been criticised by the British Dental Association as having "failed to improve access to care for patients and failed to allow dentists to provide the modern, preventive care they want to deliver".[7]

Ben Bradshaw when Minister for Health was questioned on Radio 4 in 2007 about the shortfall in NHS dentistry leading to patients unable to access NHS dentists and even resorting to pulling their own teeth out. He suggested that those needing urgent treatment should go to see their GP,[9] prompting the British Medical Association to observe that a General Practitioner was no substitute for a qualified dentist.[10]

There are repeated stories of shortage of NHS dental services in 2013, especially in remote areas such as Skye[11] and Cornwall.[12] Lack of access to emergency dentistry is often seen as contributing to overcrowding in hospital casualty departments.[13]

Charges

Initially NHS dentistry was free at the time of use but charges to patients were introduced in 1951 and have been increased from time to time. Charges vary in different countries of the UK.

As of April 2016 there were three standard charges for all NHS dental treatments in England[14] and Wales,[15] with prices having increased in England by 5% to:

It was announced in March 2016 that charges in England would rise by 5% in April 2016 and a further 5% in April 2017. The British Dental Association complained: "This unprecedented hike in dental charges will only serve to discourage the patients that are most in need of care."[16]

Dentists are paid in "Units of Dental Activity". Typical values for UDAs are £20-35, and they are paid 1 UDA for a band 1 course of treatment, 3 for a band 2 course of treatment, and 12 for a band 3 course of treatment. Patient charges are deducted from these values. For many treatments, the rate of pay is below the cost of providing the treatment to a modern standard, and as a result, many dentists will refer patients for any unprofitable services.

In Scotland and Northern Ireland, the system works differently and relies upon a mix of capitation payments alongside Item of Service charges. An examination in Scotland is free of charge to the patient, but pays the dentist £8.10. For most other items of treatment, the patient charge is set at 80% of the total fee.[17] The fees paid are approximately one third to one half of what they were in 1948, once adjusted for inflation.

Exemptions

Some groups of people are exempt for charges for dental treatment:

From 2013 to 2015 632 patients in Oldham who were in receipt of Universal Credit and therefore entitled to free prescriptions were issued with penalty charge notices, totalling £71,000, because the NHS forms had not been updated to reflect the introduction of Universal Credit. [19]

History

School dental services provided by local authorities developed slowly after 1907 when the first service of this kind was set up in Cambridge. The Royal Commission on the National Health Service in 1979 reported that local authorities had a statutory duty to make comprehensive dental treatment available to pupils since 1953, but undermanning had prevented the school dental service from delivering it. In 1968 37% of the population of England and Wales over the age of 16 had no natural teeth. In Scotland 44% of the population over 15 in 1972 had none.

There were about 14,000 general dental practitioners doing NHS work in the UK in 1977, employing about 20,000 dental surgery assistants, and 1145 dental hygienists. 46% of adults with some of their own teeth in England and Wales regularly attended a dentist in 1978 compared with 40% in 1968. In 1979 there were about 400 dental consultants in hospital services, mostly based in the 17 undergraduate dental hospitals and one post-graduate institute.[20]

At the inception of the NHS in 1948 there were 3 branches of dental service,[21] and these 3 branches still exist today, although the organisation of services in England has changed much more than in the rest of the UK:

Contract

The contract between the NHS and dentists determines what work is provided for under the NHS, payments to dentists, and charges to patients. The contract has been revised several times, covering more than just charges and prices. A contract introduced in 2006 was said by the British Dental Association in 2016 to be not fit for purpose, rewarding dentists for meeting government targets for treatment and repair, but not for improving patients' oral health.[22]

Performance

In June 2015 The consumer group Which? contacted 500 dental surgeries listed on the official NHS Choices website and found that 31% of them were refusing to take on any new NHS patients. They called for the Competition and Markets Authority to intervene to ensure dentists were complying with rules. The British Dental Health Foundation. HealthWatch England said that in some parts of England only a fifth of surgeries were accepting new NHS patients. The chair of the British Dental Association, said the “byzantine system” had failed dentists and patients.[23]

The BDA said that the 2006 contract did not meet its purpose of improving access to NHS dentistry and concentrating on prevention, and had been criticised by patient groups, government, the Health Select Committee and the Chief Dental Officers for England and Wales.[22]

See also

Special needs dentistry

References

  1. ↑ "NHS dental charges". NHS Choices. Retrieved 29 December 2013.
  2. ↑ "What can I expect from my NHS dentist?". NHS. Retrieved 12 April 2015.
  3. ↑ Holden, A.C.L. (12 April 2013). "Justice and NHS dental treatment - is injustice rife in NHS dentistry?". British Dental Journal. 214: 335–337. doi:10.1038/sj.bdj.2013.323.
  4. ↑ "General Dental Practice Committee". British Dental Association. Retrieved 29 December 2013.
  5. ↑ "HSJ Live: 06.12.13 Hunt writes of 'long term challenges' in letter to NHS staff". Health Service Journal. 6 December 2013. Retrieved 29 December 2013.
  6. ↑ "Dentist shortage hits 'millions'". BBC. 2008-01-16. Retrieved 2008-02-28.
  7. 1 2 "NHS dental access 'falls further'". BBC. 2008-06-05. Retrieved 2008-06-05.
  8. ↑ "NHS dentistry 'set back 20 years'". BBC. 2008-02-19. Retrieved 2008-02-28.
  9. ↑ "Patients turn to DIY dentistry as the crisis in NHS care deepens". London: The Daily Mail. 2007-10-15. Retrieved 2008-07-03.
  10. ↑ "GPs Cannot Fill The Gaps In The NHS Dental Service, Says BMA, UK". 2007-10-17. Retrieved 2008-07-03.
  11. ↑ "Skye residents facing 200-mile trip to NHS dentist". The Scotsman. 11 December 2013. Retrieved 29 December 2013.
  12. ↑ "7,000 waiting in county for NHS dentist". Western Morning News. 30 November 2013. Retrieved 29 December 2013.
  13. ↑ "Brighton and Hove residents using A&E instead of more appropriate services". The Argus. 28 December 2013. Retrieved 29 December 2013.
  14. ↑ "How much will I pay for NHS dental treatment? - Health questions - NHS Choices". Nhs.uk. 6 May 2014. Retrieved 6 June 2016.
  15. ↑ "Health in Wales". Wales.nhs.uk. Retrieved 6 June 2016.
  16. ↑ "Dentist charges to rise 5% in England". BBC News. 11 March 2016. Retrieved 11 March 2016.
  17. ↑ "Statement of Dental Remuneration" (PDF). Statement of Dental Remuneration. PSD Scotland. Retrieved 2 June 15. Check date values in: |access-date= (help)
  18. ↑ "Help with dental treatment". Adviceguide. Citizens Advice. Retrieved 29 December 2013.
  19. ↑ "£71,000 in fines for free NHS treatment claims were wrongly issued". Oldham Chronicle. 6 October 2016. Retrieved 2 November 2016.
  20. 1 2 Royal Commission on the NHS Chapter 9. HMSO. July 1979. ISBN 0101761503. Retrieved 19 May 2015.
  21. ↑ "Dentistry and National Health Service Act A SOCIALIST MEDICAL ASSOCIATION MEMORANDUM 1947". Socialist Medical Association. Retrieved 29 December 2013.
  22. 1 2 "The NHS contract: 10 years on". British Dental Association. March 2016. Retrieved 6 June 2016.
  23. ↑ "Dentists say government has 'failed' NHS patients with overcomplicated regulations". Independent. 16 June 2015. Retrieved 16 June 2015.
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