The Tipping Point for NHS Dentistry
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- Published: Wednesday, 08 February 2023 07:46
- Written by Peter Ingle
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Tipping points, turning points, points of no return, are just some of the expressions used to describe that moment when the old order breaks down, and there is no going back. Often identified with the benefit of hindsight, they are not always recognised at the time. Looking back over a recent webinar followed by GDPUK, it may be that NHS dentistry really has run out of road.
Eddie Crouch has worked tirelessly over many years, trying to making NHS dentistry work for the public and the profession. Even now, with his role as BDA Chair of the Principal Executive Committee, he speaks directly about the challenges dentists and their teams face.
Interviewed by Nigel Jones, Sales and Marketing director of the Practice Plan group, Eddie began by expressing his relief that the current minister had at least outlasted his predecessor. Turning to the forthcoming Health Select Committee inquiry into dental services, he recalled the previous 2008 Health Select committee that led to the Steele Review. That had led to the dead end of the abandoned prototypes and pilots. 16 years after that inquiry, there had been no significant progress on contract reform.
Eddie revealed that he had been invited to a meeting with Steve Barclay, Minister of State for Health and Social Care, making him the first BDA Chair to receive such an invite for many years. It was clear that dentistry was at the forefront in politics presently, which combined with such a meeting was encouraging. However the profession needed more than just listening to, it required action, and on that he was less optimistic.
Eddie did feel that there was better understanding of the problems facing dentistry, “I think every single politician that I’ve spoken to, and I’ve probably spoken to about 120 politicians since I’ve been chair of the BDA, every one of them recognises that the service is really falling apart. The population understands where the blame lies, and it’s firmly at Westminster.”
Nigel recognised that the shift in the media’s narrative from the previous “greedy dentists” line was very much to the credit of the BDA. When it came to the recently announced pay uplift though the picture was bleak.
Referring to the review body report, Eddie commented, “one of the things that they said in that recommendation was that to they wanted dentists to actually get a 4.5% uplift in pay. That’s what they said in their report. What they then went on to say was that the Department of Health had to have serious negotiations with the BDA about expenses, to actually make sure that the expenses element of contract uplift was sufficient to deliver a 4.5% uplift in pay. And that hasn’t happened.” When he had tackled Steve Barclay on this omission he had replied, "Well, we’ve honoured the pay review body," just as he has been saying to the media at every opportunity. Eddie’s response was that he had not honoured the pay review body, because there had been no purposeful discussion about expenses. He had told the minister that it was “disgraceful.”
There was some discussion about the failings of the review body, and as reported on GDPUK, the joint efforts of the BMA and BDA to demand reforms that would return it to its original role.
The bleak prospects for NHS dentistry were outlined by Eddie, "In general practise, we’re not taking industrial action. What we’re actually doing is moving away from the NHS at a rapid rate of knots. What we are doing is not chasing any targets this year. Because I think from the figures that we’ve seen from NHS England, the average delivery at the moment is somewhere around 80% to 85%. Which is going to present the ICSs in the future with probably a record amount of clawback next year because contracts are not on track to deliver. “
He felt that that many practices had decided, "Let’s not bother about chasing a unit of dental activity. Let’s work on the fact that we’re actually looking to perhaps convert over a staged period of time." He thought that, “practises are actually looking on it as an interest free loan that they’re going to give back. I really do think that.”
When it came to the workforce situation, the golden days of overseas dentists being eager to work in the NHS were gone, and increasing numbers of new UK graduates were not bothering with foundation training as they did not see a future for themselves in the NHS.
Looking to the future Eddie considered the herd of elephants in the room, “Am I confident that we’re going to get an above inflation pay rise next year? No. Every conversation I have with a minister, the opening gambit is, "There’s no more money." So if there is no more money, then I’ve been saying for a long time, we have to have an honest and frank conversation about what they want from dental practises as a basic, urgent or emergency care service for the patients, because that’s all the money will buy at the moment. It’s certainly not buying a comprehensive dental service. And we knew that it wasn’t even sufficient for 50% of the population when actual funding for dentistry was better a decade ago, in real terms.”
Despite this, the conversation closed with a positive thought for the profession, from Nigel Jones. He felt it was, “a fundamental truth,” that, “the NHS needs the dental profession more than the dental profession needs the NHS. And the sooner they realise that, the sooner that they’ll start doing proper change."
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