Anonymous Blog
There’s an old anecdote about a government official and a representative of a dental organisation sharing a journey on public transport. The government official jokingly says “How bad do we have to make NHS terms before you guys will leave’.
Although said in jest, maybe the position we’re in now, is the tipping point the government official speculated about.
Years of government indifference to growing problems within the profession, a failure to modernise the service, chronic under resourcing and a complete lack of concern for the wellbeing of dental workers are long standing problems. But now beleaguered NHS practice operators face further challenges:
- The ‘lucky ones’ are running their practices on 85% pre pandemic NHS income. But many are getting significantly less than this because they’ve fallen victim to flaws in the process used to calculate financial support. Two practices, each looking after the same number of registered patients, can be receiving vastly different levels of NHS support, simply because one practice has had the misfortune to have an associate retire or relocate. That the office of the CDO has not adequately addressed this issue, some 12 months after the introduction of financial support measures, demonstrates an alarming lack of concern for practice operators.
- NHS supplied PPE is limited
- We still don’t know how activity will be measured, even though this will affect future support payment
- We have no idea how long we’re to be stuck ‘treading water’ with the current arrangements
- We have no idea what the exit strategy is. Plans for the future of NHS dentistry are unclear, 1 year since the onset of the pandemic and 3 years since the publication of the OHIP.
- Secondary care support for NHS practitioners is falling away
- There’s a declining workforce
- Strategic planning is impossible in NHS practice with the current uncertainties
- And although the majority of NHS dental care is provided in general practice, the service is run by individuals with little or no practice or business experience. The appointment terms for CDO and deputy CDO positions make it almost impossible for GDPs to apply.
So perhaps the hypothetical threshold for an exodus from the service has been reached. Some practice owners have already converted to the private sector. Others are contingency planning, with independent plan providers reporting a surge in enquiries. Practice owners are preparing to protect their businesses if new NHS terms are not attractive or sustainable, or if the current ‘holding strategy’ is left in place for too long.
But what of the good ship NHS Dentistry? Perhaps the response to the government official quoted above should have been “Be careful what you wish for”.
If practice owners walk away from the NHS it will create a public health crisis to which there will be no ready solution. Accessible dental care in communities will fall away. The PDS do not have the resources to pick up the slack. Over worked GPs will not appreciate having to manage significant numbers of dental emergencies on a daily basis.
Have the government and the CDO given thought to the implications across society of the collapse of NHS dentistry?
The stakes are high, and time is limited. Practice owners will not tread water indefinitely.
The conditions are ripe for an exodus from NHS practice. The CDO and Scottish ministers need to decide if that’s really what they want.
The author of this article has preferred to remain anonymous.