Think Tank Weighs in on NHS Dentistry

Think Tank Weighs in on NHS Dentistry

Faced with intractable problems, such as sorting out NHS dentistry, some politicians recognise that they might need expert advice. That raises the question of where to seek such enlightenment. Often, they gravitate to people like themselves, who speak their language and often share their limited experience of life outside politics. 

Which may also describe the recruitment pool for many think tanks. Now, one of these has focussed its thoughts on dentistry. Smiles-All-Round.pdf (ukonward.com)

Think tanks come in a variety of political flavours, so a little about Onward, the providers of this latest dental wisdom. It is described as a British centre-right think tank producing research on economic and social issues. While aligned to the Conservative party, the Labour think tank associated with leader Keir Starmer, Labour together is said to be modelled on Onward. Despite the upcoming election this gives their dental report some importance. Not entirely tribal, previous Onward reports have been jointly authored by Labour and Conservative MPs.

Described as a research note it has the title “Smiles All Round” with the secondary title, “Liberalising dentistry to improve access and cut costs.” Its author is Tim Leunig, whose main political affiliation appears to be with the LibDems. The executive summary gives a good flavour of Onward’s bright ideas.

Onward appears to see the access problem primarily as one of a shortage of dentists. After covering some of the current horrors in areas such as access and child dental health it gets into its stride, “Thankfully few of us need to ever see a dentist - check-ups, polishes and filling can all be performed by dental therapists.” Indeed, Tim has a plan: “Liberalising dentistry can solve the problems. We should all, as a matter of course, see dental therapists for our routine appointments.”

According to Tim: “This is not dumbing down, or a reduction in quality. Dental therapists are highly trained and skilled. They have a three year degree in dentistry. They can do this job. Such a move would immediately increase the size of the workforce, as it would allow dental therapists to work on their own, running their own practices.”

In the body of the report there are more simplistic observations. The author may have speed read the NICE guidance on recalls, hence: “Taking into account that adults only need to see a dentist every other year that means an extra 12 million more visits a year.”

It is always entertaining to see those who claim to stand for ‘liberalising’ complaining about pesky market forces and individual choice. Tim does not disappoint: “The ability of a dental clinic to offer both NHS and private work and to up-sell private treatment to all patients means that dentists will typically have an incentive to move to affluent areas, where people are more likely to want to pay for private treatment.” There is even a section about Invisalign which because it, to summarise the argument used, appeals to wealthier people and so will have more uptake in wealthier areas, has sucked dentists away from less prosperous areas.

The analysis then turns to the government’s recovery plan and the policy paper, “Faster, simpler and fairer: our plan to recover and reform NHS dentistry.” The recommendations whilst welcomed are “extremely limited.” The “best bits” of the plan include bringing forward “legislation early this year to enable dental care professionals to work to their full scope of practice,” and further water fluoridation.

Tim does spot the weaknesses in the new patient premium and golden hellos for dental deserts, and notes that a more effective ring fence will reduce money available to other needy parts of the NHS. He observes that, “for every winner there will be a loser.” Widespread use of dental vans is also dismissed for the familiar reasons.

When it comes to forced NHS service, Tim rediscovers his liberalism: “The proposal that we mandate dentists to work in the NHS recurs frequently. We do not mandate that doctors work in the NHS.” He concludes that, “There is no reason to single out dentistry students because we as a society do not train enough of them.”

To support his case for Therapist led care, Tim provides a case study. That the subject could be a typical think tank employee (He attends a practice at the London School of Economics, has always brushed his teeth regularly, and followed the practices advice to stop putting sugar in his tea) may not be accidental, or may reveal the breadth of Tim’s wider experience.

There is more about how the system would work. Therapists, “could found their own practices and bill the NHS directly.” For out of scope needs, “they would refer the patient to a dentist. That dentist would then remove, straighten or realign teeth, as required. They would also produce bridges and similar. This approach is akin to seeing a GP and being referred to a consultant when a specialist is needed.” In Tim’s world, “This proposal is unlikely to cause any additional inconvenience to the patient.”

Tim is also a fan of the ‘dentistry as an add-on to a therapy degree’ approach to training, which appears to be gaining ground.

Towards the end of the document there is discussion of “a new contract for dentists.” It is not straightforward, but the following paragraph offers an insight into Tim’s thinking: “In the short run the government will have to continue to pay current dentists for regular consultations at rates appropriate for people with five years of university training. In the medium term, however, it will be able to offer lower rates of pay for general check-ups once they can be undertaken by dental therapists with three years of specialist training rather than five. That rate would be higher than the rates currently paid to dental therapists, to reflect the fact that they would now run their own practices and work under their own authority. In other words, the rate would be somewhere between the rates paid to (current) dentist therapists and (current) dentists.”

Timing is everything in politics. As the concerns about physician and anaesthetic associates begin to spread outside of the medical community, the coming years may not be the best time to tell the public that they do not need to see a dentist anymore.

Dental therapists have a many decades long history of being misunderstood and under used. It may be their dual misfortune that now is the time that their full potential is being reconsidered, along with the motivation of those planning the changes.

The BDA  were not impressed by Onward’s efforts.  Chair Eddie Crouch dismissed the report in less than 50 words on X:

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