In this article, Practice Plan Sales and Marketing Director, Nigel Jones, discusses Labour’s plans to address the state of NHS dentistry.
To begin to answer the question of what a new government could mean for NHS dentistry, it is worth considering Labour’s manifesto and its rescue plan, which were discussed in the run up to the election.
Both the manifesto and rescue plan provide some clues as to how the party may try to tackle the current state of NHS dentistry. There were five points that particularly stood out, including: contract reform, access, workforce, prevention and investment in dental services.
Contract reform
When discussing contract reform, there are a few things to think about. We know that Wes Streeting met with the BDA shortly after the election to discuss the launch of Labour’s Rescue Plan, what a new dental contract might look like and how it will tackle the ‘dental deserts’.
One interesting observation on this point is the referencing in Labour’s manifesto that this will be fully funded. Fully funding something that has not yet been agreed seems a somewhat bold claim to make unless, perhaps, you are going into those negotiations with a fairly clear idea of what you are going to do.
There has been much talk about treatment for under-18s and urgent care for adults, but not a lot of talk about fee paying adults. This makes me wonder whether Labour are heeding the advice of the Nuffield Trust report and preparing to introduce some kind of core service. (The Nuffield Trust report essentially concluded that to save NHS dentistry, it needed to either be reduced to a core service, or to receive large amounts of additional funding).
Access
The provision of a core service would need to be quite creative if it were to achieve the second of the five points – that being, widening access to all.
This might be a combination of focussing scant resources on those most in need, such as children and vulnerable adults, while finding some way of allowing all members of the public access to some limited form of NHS care, such as urgent appointments, or perhaps offering one free appointment per year, to the entire population.
That would tick the access box in the manifesto points, however it does not address the third, critical point, which I would say is perhaps the biggest challenge - the workforce.
Workforce
We currently have a situation where there are not enough dentists, hygienists and therapists, and not enough clinical hours to be able to deliver any kind of contract reform.
There has been a noticeable move to part-time clinical work for a large proportion of the profession, and a loss of productivity within those reduced hours due to defensive dentistry (prompting more extensive notetaking than previous decades) and the lower levels of clinical experience on graduation.
That means standing still in terms of headcount is not enough as the Full Time Equivalent (FTE) count and productivity are going down.
Addressing the problem by allowing more graduates into dentistry - ‘to flood dental deserts with new dentistry graduates, with golden hellos of £20,000 for those who spend at least three years working in underserved areas” - will help, but we are years away from meaningful numbers being available as new dental schools and an expanded training team will be required...and is £20,000 enough?
Recruiting dentists from overseas is an option, but there is a lot that needs to be done in terms of supervising and mentoring. This will be expensive and time-consuming, further eroding the productivity of experienced dentists already in the UK. Loosening the requirements runs the risk of quality issues emerging, as well as compromises in patient safety - something neither the government nor the GDC want on their watch.
However, while the scarcity of clinicians persists, the competition for anyone available will intensify and inevitably favour private practices that can offer both pay and conditions that NHS practices will find hard to match.
Then there is the idea of increasing the number of dental school places, but this is also something that can’t happen quickly as they need trainers and infrastructure, so there is no quick fix there either. The NHS dentistry issue may well be a thorn in the side of this government for some time to come.
Prevention
The focus on prevention is absolutely the right thing to do, and the focus on children's health with plans for supervised tooth brushing in schools is a welcome measure.
However, we need a contractual framework that genuinely supports prevention, such as tackling the food industry over the sugar content in our food, in much the same way in which the Tony Blair government lobbied the food industry back in the 1990s to have the salt content of food reduced. This would be an important preventative measure - not just for dentistry but for all the wider health problems associated with excess sugar consumption.
Investment in dental services
This leads us to the last point, which is investment in dental services. At this stage I believe it is difficult to know what additional investment could be made into dental services, as the true financial position that the new Labour government finds itself in will, in part, dictate what level of investment is possible.
The Treasury seems to have been reluctant to put more money into dentistry. Indeed, there is the observation by the Nuffield Trust that additional money could end up being spent on people that can afford private dentistry and not those most in need, so investment needs to be considered in the context of contract reform and the potential introduction of a core service.
I believe there will be interesting times ahead of us over the next days and months for dentistry.
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