Dentists extracting too many teeth reports The Times
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- Published: Saturday, 06 August 2016 09:12
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In advance of the D’Mello case at the GDC, The Times has claimed that ‘thousands of teeth’ are needlessly extracted as surgeries are accused of ‘putting profit before patients’. Regulators said that dentists were extracting teeth to avoid offering complex treatment, for which they are paid the same by the NHS and that some dentists earn almost £500,000 a year in a system that rewards them ‘for cramming in as many patients as they can.’
The story published by The Times on August 6, 2016 (click Here) claims that thousands of people are losing teeth needlessly because it is more lucrative for NHS dentists to take them out than try to save them. Dozens of dentists are claiming for the equivalent of more than 60 check-ups a day, in what has been condemned as an unethical conveyor-belt approach to patients. The upper limit is considered to be 30 a day for one dentist.
NHS figures seen by The Times show that 30 dentists were paid for more than 15,000 UDAs last year — the equivalent of about 60 simple appointments a day over a standard working week. Ten dentists were paid for more than 18,000 UDAs, equivalent to about £450,000.
Alex Wild, of the TaxPayers’ Alliance, a public spending watchdog, said: “The amount of work dentists do will obviously vary significantly, but the figures at the top end appear totally implausible . . . an urgent review is essential.” Dentists routinely weigh up how much time and treatment a patient needs against a desire to maximise earnings, say professional leaders who concede that the payment system is causing an “ethical compromise”.
Mike Waplington, president of the British Endodontic Society told The Times that extractions had jumped by a fifth and root canal treatment had fallen by almost half after the contract that paid the same for both was introduced in 2006. Root canal treatment could take three times as long as an extraction. “There is an incentive from the system and some dentists may say to patients ‘I can take this tooth out simply’.” More than two million teeth were taken out on the NHS last year, but Mr Waplington said that many could have been saved, estimating “over the lifetime of the contract it would have affected tens of thousands of teeth”.
At least 2,000 dentists claimed for more than 8,000 UDAs, equivalent to the upper limit of about 30 check-ups a day. Neel Kothari, a Cambridgeshire dentist seeking reforms, told The Times that it was difficult to do more “in any ethical sense”, with 60 patients a day impossible without cutting corners. He warned that dentists intent on maximising income might skimp on treatment as well as hygiene. “It’s as if you went to a top restaurant and they served you a Big Mac disguised as a gourmet burger,” he said.
Nigel Carter, chief executive of the Oral Health Foundation, told The Times: “To do a proper assessment of the patient would probably take 20 minutes. But that hasn’t been what the health service has been paying for. There is a bit of an ethical compromise.”
The General Dental Council says that it cannot act because a lack of professional guidance allows dentists to claim that extraction is a legitimate option. “I’m sure that if patients had a full understanding they’d be quite appalled,” Bill Moyes, the council chairman, said.
A spokesman for the Department of Health said that a new contract was being tested, adding: “If a dentist was found to be needlessly removing teeth this would be a matter for the General Dental Council.”
In a separate article (click here) Chris Smyth refers to the 2006 contract as a ‘quick fix’ that created new set of expensive problems for patients. He analyses how it started and quotes Henrik Overgaard-Nielsen, chairman of the BDA’s GDPC, who demanded the scrapping of a “crude, target-driven system”, insisting: “Dentistry is not car assembly work: it is about the relationship between an individual patient and their dentist.”
In a leading article (click here) The Times says that the Department of Health ‘needs to step in’. It continues: “A new sort of contract is clearly required to iron out perverse incentives. It could be modelled on the arrangement for GPs, who are paid according to the number of patients on their roster. The government should also consider capping the amount of appointments that dentists can heap into a day, to prevent such “conveyor-belt” dentistry. Regulators should also take responsibility for keeping dentists in check, not point the finger at each other.”
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