Not Just Dentistry: The Scale Of The Problem Confronting The New Government

Not Just Dentistry: The Scale Of The Problem Confronting The New Government

Over recent years, the news and forum pages of GDPUK have chronicled the perilous state of NHS dentistry across many regions of the UK. Week in, week out, we’ve heard of practices returning their contracts, of patients resorting to going abroad, not for whitening and veneers, but for the ’basics’. Of practices closing because they can’t recruit the clinicians and staff they need. And in some cases, closing because their income simply does not cover their expenditure. 

So repetitive became the stories, our publisher signalled they would only constitute ’news’ if, and when, they added a new twist.  

We were not short of leads: Bristol patients queuing up the road and round the block through the night to register a family at that rarity, a practice taking on new NHS patients, just one of many variations on a theme.

Not surprisingly, our ’insider’s reporting’ of dental woes was dwarfed by the coverage dentistry received in the mainstream media.  

Newspapers, who for years only engaged with dentistry in order to ’out’ a ’greedy dentist’ here or a ’fraudulent’ one there,  cottoned on to the growing shortage of practices and the emergence, especially post-pandemic, of ’dental deserts’. 

Concurrent with this media coverage, MP mailbags delivered an increasing number of letters and e-mails from constituents unable to find a dentist to care for their family. 

Angry and desperate patients told their MPs that they were unable to access even an emergency dental service and, to the irritation and embarrassment of the government, popped up on news bulletins recounting how they had resorted to pulling their own teeth with pliers in a garden shed.  

It has not been a good look.  For the patients it’s meant enduring pain and discomfort  for which there is no excuse.  For the NHS Dental Service, given the toxicity of the UDA based contract it is forced to work with, it has meant impotence.  And for the government, dentistry has been yet another example of failure - failure to offer the citizens of the State the basic services which taxes are supposed to provide.  

Dentistry consequently has become a political football, and one that in recent weeks has been kicked around on a ’premier league’ pitch of voter concerns. 

For its part, the British Dental Association (BDA) has met with a succession of ’here today, gone tomorrow’ ministers, each time patiently resetting the clock to zero as it endeavours to educate a new incumbent about the modus operandi of an essential service.  

Diligently and robustly, it has represented the profession at numerous ’inquiries’ and concerned ’committees’, steadily turning up the volume and assisted by an ever increasing flow of statistics to ram home its message. Its Chair, Eddie Crouch, is to be called out for his devotion to the cause.

As opinion polls increasingly pointed to a Labour victory, the BDA and Crouch have rightly cosied-up to Wes Streeting and his team to impress them of the need for immediate and decisive action. Mr Streeting has promised to meet with the BDA to start addressing dentistry on the ’first Monday after the election’.

(This promise should be treated with caution: until Keir Starmer confirms his Cabinet, Mr Streeting doesn’t know if he will even be Health Secretary and can’t possibly know from his seat on the opposition benches, precisely what his diary secretary may already have inked in for the new incumbent on Monday 8th July.)

So far, so good. But Mr Streeting, having onboarded the BDA’s concerns and warnings, is going to have a tough battle on his hands.  Because the problems faced by dentistry are common across all public services.  

Take policing.  Policing is facing a looming staffing crisis as figures reveal more than 22% of officers are poised to quit the service over the next two years. 2000 dentists quit NHS dentistry in 2021. But 9200 police left the service in 2023, many citing low pay, long hours and abuse from the public.

Our schools too have issues that mirror those of dentistry. Recruitment targets are not being met.  Recruitment of physics teachers was 83% below target in 2023/24. The number of children in classes of over 36 has trebled over the last five years. According to the National Education Union, teachers are £5000 worse off than they were in 2010.

Teachers work an average 53 hours a week. Not surprisingly, they complain of being bogged down by their workload. 53% told a YouGov poll recently that they were thinking of quitting the profession.  In 2022 a record 40,000 9% of the total - state teachers did quit the profession whilst another 4000 retired.

The British Medical Journal reported in 2022 that a third of junior doctors planned to leave the NHS to work abroad citing poor pay and working conditions.  Two years later, their dispute has still not been settled. 

Dentists occasionally encounter ’bad behaviour’ from rude or aggressive patients but it plagues teaching.  In prisons - perhaps to be expected - it’s always been a problem but today it’s so bad it’s driving prison officers out of the profession. 47% of officers who left the service last year had under three years’ service. Low pay, gruesome conditions and the omnipresent danger of violence impedes all efforts to recruit.  

Put in this wider context, NHS dentistry suddenly becomes just another piece of a 1000 piece jigsaw. Few, if any, of its problems are unique.  Nor can it claim supremacy over policing, teaching or a secure prison service. The public needs them all.  In the words of David Cameron "We are all in this together".

So wherever the new government turns its gaze, there will be a familiar refrain.  Insufficient funding, staff recruitment and retention problems, impossible workloads, low morale.

How dentistry argues that it is any more deserving of special treatment than other public services will be a nigh on insurmountable challenge. The scale of the problems facing the new government is without precedent, 1945 perhaps comparable.

We wish the BDA, Mr Streeting (if, as likely, he’s appointed) and the new government every best wish for grappling with it. We were promised change. 

To date, however, nobody, not the BDA, the various ’colleges’, and certainly not the politicians, have identified what that change can and should be.  Talk about an ’NHS dentist for everyone’, ’700,000 urgent appointments’, ’golden hellos’ or ’children’s tooth brushing’  is an aspirational twaddle.  

What everyone agrees upon is the need for a new NHS dental contract. But nobody has defined one that would work given current and project funding and staffing levels.  Diagnosis is easy, prescription, alas, continues to elude.

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