NHS Dentistry At 'Most Perilous Point For 75 Years' Says Think Tank
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- Published: Wednesday, 20 December 2023 08:40
- Written by Guy Tuggle
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Another day, another headline. And once again, it’s the failings of NHS dentistry provision that’s sounding alarm bells.
Leading the coverage was the BBC’s attention grabbing, but hardly sensationalist headline ’NHS dentistry as we know it ’gone for good’. A touch hyperbolic perhaps, but for many citizens, their daily experience.
The stimulus for the headlines was the publication by independent health think tank the Nuffield Trust, of a 52 page report Bold Action or Slow Decay? The state of NHS dentistry and future policy actions,
’NHS dentistry in England is at its most perilous point in its 75-year history’ declares the comprehensive Report which ’seeks to understand how things have changed and what choice we face if we want a sustainable future for a publicly funded dental service that meets the needs of the population’.
Citing cutbacks which, allowing for inflation, translate into a £525m drop in funding for NHS dentistry since 2014-15, the Report notes that treatment numbers are now running six million below the pre-pandemic figures.
Treading where few have dared to tread before - ’thinking the unthinkable’ as Tony Blair used to say - the Report is concerned that the cost of repairing the broken service is now likely to be so high that the very nature of what is delivered and how - the ’NHS Offer’ - has become a question that must be confronted. And that debate could mean the end of NHS dentistry as many adults know it.
Media coverage has focussed on the ’NHS offer’ and how it may need to be trimmed or replaced with a different model of dentistry that’s radically different. The Report, however, is far more wide ranging.
It advocates contract reform to include weighted capitation and goes into considerable detail of how this could work. It heralds the return of patient registration, some fee-for-service and a return to ’dental reference officers’ to monitor delivery. Commissioning needs to be local and flexible.
The workforce needs strengthening, there needs to be wider use of skills mix and the announcement of additional training places is welcomed. And dental professionals will be delighted to learn that there’s no enthusiasm for ’lock-ins’: ’it is not clear that the NHS will benefit from the forced service of people who would rather be elsewhere - an incentivised approach may be more impactful’ the Report correctly concludes.
But it is the Report’s confrontation of the ’NHS Offer’ that sets it apart from previous analyses and NHS Offer reform goes way beyond making annual as opposed to six-monthly check-ups the norm, although this is a qualified recommendation.
That NHS dentistry is unlikely to be granted additional funds, let alone the ones necessary to cement its future in a guise that resembles its past is a given.
’The question, then, is how to make best use of the limited resources in a way that is fair, targets need most effectively and supports the growth and retention of the workforce’.
Chief Executive of the Nuffield Trust Thea Stein, said: "Difficult and frankly unpalatable policy choices will need to be made. If, as it seems, the original model of NHS dentistry is gone for good, then surely the imperative is to provide enough access for a basic core service for those most in need.
Whichever way we go, I’m afraid that NHS dentistry cannot continue without some kind of evaluation of the offer, even if there are some major improvements to the way services are contracted and commissioned."
Proposals include flexible commissioning to better target funding and, if budgets are not increased, restricting the NHS service to ’emergency care and pain relief plus check-ups for all’ with most adults other than the exempt then paying the full cost of any necessary treatments.
Children, the elderly and poorest members of society would continue to receive free care.
’There are a number of long-term actions which fall into two categories: reforming and strengthening the current model, or more radically looking at what the NHS can offer in terms of dentistry. The question for policy makers ... is to decide which unsatisfactory and problematic solution they dislike the least.
Speaking on BBC Breakfast BDA Chairman Eddie Crouch said dentists were losing money on some NHS courses of treatment which was unsustainable and therefore "unless they (the government) abolish the contract I agree with the Nuffield Report. I think we are seeing the demise of NHS dentistry".
Pressed on what will become of NHS dentistry if more money is not allocated to it Mr Crouch signalled that the recommendations of the Nuffield Report "that funds are targeted on that proportion of the population who can’t afford to go private" might come to pass. "That’s not what I would want but it’s their report" he added.
Background:
Nuffield Trust is an independent health think tank. It aims to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
Compilation of the Report included a round table discussion at the offices of the British Dental Association in July 2023. Participants included amongst others the GDC, BDA, CQC, College of General Dentistry, Royal College of Paediatrics and Child Health, Association of Dental Groups.
Extensive stakeholder interviews were carried out between June and October 2022 involving Policy makers and senior NHS executives (7), Regulators (2), Patient representatives (2), Academics/educators (4), Journalists/lobbyists/policy advisers (3), Professional representatives (3), Public health specialists (2), Local Government officials (3), Dental professionals (10)
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