10 minutes reading time (2057 words)

Making Sense of NHS Mathematics

Making Sense of NHS Mathematics

Making Sense of NHS Mathematics

Making Sense of NHS Mathematics


It will all become clear.

I once got a Grade 5 for CSE maths.  In the 60’s and 70’s the Certificate in Secondary Education was in the tier below ‘O’ levels.  It was primarily taken by kids who didn’t pass the 11 Plus to go on to grammar school, and I was one of them.  CSE’s generally, and the exams in mathematics in particular, were a bit…basic to say the least. “John has two apples, and Susan then gives him one apple.  How many apples does John have? Please show your working out.” After I got Grade 5, I steeled myself to retake it.  At the resit, I failed completely and was even ungraded.

I always struggled with maths and so when I decided in about 1979 to go into dentistry, the prospect of entering the dark art of differentiating was more than a little daunting.  I mean, how on Earth was I going to get through all that ‘A’ level physics and chemistry when I was still struggling to cope with the decimalisation of our proper money?

Since I was working full time, the only way of taking ‘A’ level sciences was at evening classes.  I was so diffident at my ability to cope with maths, I wasn’t prepared to chance leaving my job to study full-time, just in case it all went a bit pear.

When my fears were borne out when I struggled with some of the mathematical concepts lurking in the ‘A’ level physics syllabus, I mentioned it to a friend of mine, who casually announced that her dad might be able to help.  I had never really paid much attention to her father’s occupation.  He never brought it up at his frequent house parties and always changed the subject when the subject of work entered the conversation.  It turned out he was a physicist at a top-secret government research facility.  It was an open secret locally, that this establishment was involved with the military and the peculiar flashing lights that were frequently emitted from a nearby disused airfield it owned, bore out suspicions that it was developing laser weapons.

Anyway, my friend’s dad didn’t offer to tutor me directly, but introduced me to one of his superiors, who offered to teach me maths privately, over a few evenings.  The senior physicist gave up after one session, realising that bringing a Russian satellite down with a modified intercontinental ballistic missile, was child’s play compared to trying to teach me trigonometry. Embarrassingly, I found out many years later, that the physicist was an internationally renowned scientist. Nice bloke, but he wasn’t at all fussed on the mathematically inept.

A few days later, I saw an avert in the small ads column of the local evening newspaper – the one I worked for.  A man was offering private tuition in mathematics.  I rang him and set up my first session.  Malcolm was a quietly spoken Scottish chartered accountant and liked teaching as a hobby.  He struggled.  I had no idea why sin x cos x would equal tan x, no matter how much he tried to explain.  At the end of the second lesson, he asked “Are you SURE you want to go into dentistry?”  His remark was clear.  He thought I hadn’t got a hope.

Fortunately, apathy helped me out.  The ‘A’ level courses in physics and chemistry at the local technical college that I was enrolled in, were closed down because people dropped out in such numbers, they became unviable to run and were closed down.  

Panicking, I approached the dental school I wanted to go to, and they advised me that I could get entry to the course via 1st BDS – for that I needed to have one science ‘A’ level and two non-science ‘A’ levels.  The drawback was an extra year of basic sciences at university before I got on to the ‘real’ course, but such was my desperation to become a dentist, I was prepared to do it.  I haven’t a clue why I thought I would manage university level maths.  I suppose I must have thought that once I got my foot in the door, they would struggle to eject me.

Fast forward to 1983 and I find myself taking remedial maths for science students on Friday lunchtimes, with all the other numerical dunces.

Somehow, I managed to pass 1st BDS despite my mathematical ineptitude, and all through my career I wondered why physics and maths was necessary for a dentist.  Yes, it might be useful to be able to calculate the velocity of a crown and rate of descent when it snaps off during an extraction so you could position onlookers out of the firing line, but otherwise?  It was a few years after qualification when I had a psychometric test during my recovery from viral encephalitis, that it was discovered I have dyscalculia, the numerical equivalent of dyslexia.  That’s my excuse and I’m sticking to it.  I mean, I even struggled with the ISO tooth numbering system and the universal numbering system was mind-blowing. Give me Palmer any day. To this day, I can’t dial a telephone number without trying at least a couple of times, because I get the digits all mixed up.


Making Sense of NHS Mathematics


So, you can imagine how out of my depth I was when I entered practice in 1988 and couldn’t work out mathematically how I was supposed to make a living when I was taking half an hour to do an occlusal filling on a fractious child for the (then) fee of only £6.80.  It took a bit of doing and the help of a receptionist to figure out that my 50% associate cut of that fee was £3.40.  It was a few months later when I had my first meeting with my first accountant, that it was patiently explained to me that I would have made a better living had I trained to be a physicist. 

My mathematical abilities also didn’t stretch to working out how dental nurses actually survived on the appallingly low wages they were getting in some of the practices I worked at as an associate.  I’m sure I’m right that in one practice I worked at as an associate, the nurses were on about £3.20 an hour. 

I don’t suppose I’m alone in finding the accounting methods of some principals ‘other-worldly’ when working out associate wages.

At one practice, the bosses told me and the other associate that they were considering introducing a ‘sliding scale.’  This was in the fee-per-item days where income was flexible and UDA targets hadn’t yet been dreamed up by Beelzebub, who was at that time a junior minister in the Department of Agriculture and Fisheries before being promoted to the Health Department. Having said that, the ‘sliding-scale’ was pure evil genius and on a par with the UDA system.  If you earned (say) under £2,000 per month, then your cut of the income would only be 25%.  If you earned £3,000 to £4,000 then you would keep 40%.  Any income over £4,000 would be then distributed at 50%.  As you can imaging, this broke my little brain.  It was my logic that if you were earning a low figure, you really needed to be given a bigger percentage, just to keep your head above water.  But no.  We were told it was just ‘business’ and we both left the practice shortly before the new pay scheme was introduced.

But that wasn’t as odd as the accounting method of one crook who ran a group of a few practices in Birmingham.  He asked me to fill in part-time at one of his NHS practices in the last quarter.  One of the associates had gone off sick and the practice had lost out on UDA’s and was well short of its target. The loose arrangement was that I’d be paid 50% of the UDA rate for those UDA’s I completed, and I’d work for eight Saturday mornings, depending on ‘how it goes.’

Well, it was a nightmare. It was a busy practice and I worked flat out, despite the fact that hardly anything in the surgery worked.  I couldn’t use the ultrasonic because there was absolutely no water or pressure in the unit and when using the turbine, the nurse had to dribble triple-syringe water on the tip.  Despite raising my concerns with the group’s practice manager and the owner every week, nothing was ever repaired.  Towards the end of the period, I discovered that another associate, a senior dentist not far-off retirement, had left after not being paid for two months because the group of practices had ‘underperformed.’ I had only one Saturday left to do, and I noted only one patient had been booked in the appointment book. I decided that I would finish with the practice early and gave my reasons.

After a couple of months, I hadn’t been paid and when I approached the owner, he said that the lab fees I owed exceeded my earnings and he didn’t owe me anything. My only lab bill was for a single NHS crown. When pressed, he said I had ‘left him in the lurch’ and that if I pursued him for the money, he would report me to the GDC for breaking my ‘contract.’  I don’t think even a deep understanding of maths would have helped me figure his reasoning. He certainly didn’t show his working out. I was sufficiently scared of going through the hassle of receiving a GDC letter, that I let it slide.

The change from the NHS fee-per-item system to the UDA debacle occurred while I was still a practice owner and to this day, I feel it was developed by a governmental evil genius, who by that time had been promoted from the Ministry of Ag and Fish.  The whole concept behind UDA’s was completely over my head and it was only because I had an associate who knew her onions and spent time patiently explaining the system, that I vaguely grasped it.  But I don’t think you really need a grasp of the finer nuances of advanced mathematics to realise that the system makes no sense and is a complete stitch-up of the profession.

So, when the 45% activity target was recently imposed on NHS dentists in the last quarter of the financial year, I felt like I was hurtling through space at hypersonic velocity towards a dying star.  I didn’t understand it, or even vaguely grasp how it was all going to work.

This week, a young corporate ex-colleague of mine phoned me to ask how her pay was being worked out. She couldn’t fathom either the change in the UDA rate that had been imposed, or the change in laboratory fee charges. She reported that her lab fees were going up to 2.2% after a certain amount of activity.  I couldn’t make head nor tail of it, so I asked Twitter. I received a few replies and one extremely helpful direct message, which I passed on to my colleague.  At least SHE seemed to understand it.

I freely admit that the current dilemma facing dentists in Q4 is completely over my head.  The only thing I do understand, is that the situation is dire.  The MP’s who took part in the COVID and Dental Services parliamentary debate last week seemed to have a well-informed grasp of the financial problems facing dental practices and were incredibly supportive.

The only one who didn’t seem to have a handle on the problem was Health and Social Care Minister, Jo Churchill.

Perhaps, like me, Jo is really bad at maths.

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