OFT report - analysis

The Office of Fair Trading report says that evidence gathered from its market study suggests that dental patients are largely satisfied with the services provided by their dentist.  This useful fact appears in the executive summary, but not in the press release.

The latter majors on findings that patients have insufficient information to make informed decisions about their choice of dentist and the dental treatments they receive. Alongside they produce a headline grabbing statistic that each year around 500,000 patients may be provided with inaccurate information by dentists regarding their entitlement to receive particular dental treatments on the NHS, and as a result they may pay more to receive private dental treatment.


Dentists working in the NHS seem to worry them more: 39 per cent of NHS dental patients who had been to the dentist in the last two years reported that there were no leaflets or posters providing information on NHS charges at their dentist. 82 per cent of dental patients who recently received a course of dental treatment that incurred a charge did not receive a written treatment plan.

Consequently the OFT wants clear, accurate and timely information for patients. Additionally it wants NHS commissioning bodies, the General Dental Council and the Care Quality Commission to be proactive in enforcing existing rules which require dentists to provide timely, clear and accurate information to patients about prices and available dental treatments.

The report also raises concerns about continued restrictions preventing patients from directly accessing dental care professionals, such as hygienists, without a referral from a dentist. The OFT considers these restrictions to be unjustified and likely to reduce patient choice and dampen competition. The OFT points out that it called for the GDC to end restrictions on direct patient access to such dental care professionals in 2003. Despite this they say that ‘the GDC has provided no compelling explanation for the delay in implementing the requisite reforms’. The OFT considers this delay to be unjustified and calls on the GDC to act swiftly to address the concerns set out in this report.

The OFT also highlights concerns with the current NHS dental contracts in England. A core concern for the OFT is that the existing NHS dental contract in England acts as a barrier to entry and expansion in the dentistry market. Having a contract to provide NHS dental treatment is crucial to the commercial viability of most dental practices. In England, most NHS dental contracts were allocated to incumbent dental practices in 2006. The majority of these contracts are not time-limited and only a small volume of new contracts are put out to competitive tender each year.

The effect of these factors, the OFT says, has been to insulate dental practices with an NHS dental contract – which are profit-seeking businesses – from competition. Potential new, innovative dental practices trying to enter the dentistry market face limited opportunities, good practices offering higher quality services to patients face high barriers to expansion, and poor performing dental practices face more limited incentives to improve in order to retain and attract new patients. The Department of Health is already engaged in a process of reform of the current NHS dental contract, and the OFT hopes that the analysis and principles for reform set out in this report will assist the Department.

Other issues of concern highlighted in the report include the complexity of the complaints process for patients and instances of potential pressure selling by dentists of dental payment plans. On the former point the OFT calls on the GDC to expand their professional standards to provide that dentists must, with limited exceptions, remedy at no extra cost to the patient, any dental treatment, including private dental treatment, which they have provided and which fails within one year.

On the latter point the OFT found that 20% of dental patients who have joined a dental payment plan as a means of paying for private dental treatment stated that they felt that they were put under pressure by their dentist to sign up to the plan. The omitted to point oiut the obvious corollary that 80% found no pressure.

However they had discussions with the BDA, which has rather bizarrely some may feel, agreed to develop ‘a robust and effective code of practice covering the sale of dental payment plans’. Why this responsibility was not given to the plan providers themselves and why the BDA is undertaking this work is not immediately apparent.

John Fingleton, OFT Chief Executive said: ‘Our study has raised significant concerns about the UK dentistry market which need to be tackled quickly in the interest of patients’. No profession likes being put under the microscope, especially not twice in 10 years. But overall it could have been worse. If the object of the exercise was to show private practice in a poor light in comparison with the private sector, it has failed. Unfortunately some of the positive findings were hidden in the report and the media is likely to concentrate on the negative points that appear in the press release.


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