As Wes Streeting resigns as health secretary, how will his actions around dentistry be looked back on? Jaimie Kaffash warns that problems in other parts of the health service - including general medical practice - might leave his legacy in tatters
Wes Streeting’s resignation letter contained 987 words. Guess how many were about dentistry? If you said zero, then congrats – you win an NHS appointment for urgent treatment.
In fairness, there wasn’t a huge amount about healthcare at all. He talked about ambulance response times, A&E waiting times, recruiting more GPs and mental health nurses. And, in what was perhaps most relevant to dentists, having to balance the books.
In terms of a legacy around dentistry, it will probably be remembered as one of honesty about the state of NHS dentistry – which he frequently refers to as being ‘in crisis’ – alongside caveats that any changes had to come with no new money.
The British Dental Association are proud of stating that they were the first organisation to meet with the health secretary on his appointment. There has been a commitment to a new NHS contract that overhauls the UDA system in England. It was a Labour Party manifesto commitment that they would reform the contract – but what happens with this is at the mercy of the next health secretary.
BDA chair Dr Eddie Crouch greeted Mr Streeting’s decision with a touch of concern: ‘Wes Streeting sent a powerful signal by making us the first organisation he met after the election. Promises to fundamentally reform NHS dentistry have been made but are yet to be kept. Change at the top must not undermine progress to save a service millions depend on.’
It is not as though the Government has been blind to the issues around dentistry while Mr Streeting has been health secretary. In its 10-year plan, released last year, ‘many cannot get a GP or dental appointment’ was the very first bullet point of the executive summary. His way of rectifying this was through the controversial NHS contract this year, which mandated that dentists deliver 8.2% of their NHS contract value as urgent/unscheduled care
There were some concrete proposals that would affect all dentists, and not just those with an NHS contract. Most obviously was the requirement for newly qualified dentists to practice in the NHS for a minimum period of three years – with the justification that it costs £200,000 of taxpayers’ money to train a dentist.
Within Mr Streeting’s time as health secretary, there have been public health commitments too – for example, the 10-year plan promised to ‘expand community water fluoridation in the north east of England from 2028 so that it reaches 1.6 million more people by April 2030’, and refurbish schemes elsewhere in the country to benefit a ‘further 6 million people by 2030’. The Government has already introduced the supervised toothbrushing schemes, amid criticisms around the ‘nanny state’.
Dentists are also a part of his ‘Neighbourhood Health Service’ vision, which sees them working alongside other parts of the health service, including the promotion of skills mix.
But all these policies require money. Change might be unlocked by the new NHS contract, but this is by no means a certainty with Mr Streeting gone. No one knows who will take over as health secretary (we don’t even know who will take over as Prime Minister, after all). This is equally true of the primary care minister – Stephen Kinnock is well regarded by the BDA for providing continuity.
And perhaps, just as significantly for dentists, this funding envelope is not just an issue for them. Dentistry’s role as the Cinderella service of healthcare means it won’t be front of the queue for funding. And things are turning uglier for a sister service. Just today, the British Medical Association’s Local Medical Committees conference voted to explore the possibility of GMPs ‘doing a dentist’.
As GDPUK’s sister title Pulse has reported, LMC leaders agreed that general practice within the NHS is ‘no longer financially viable’ and called for ‘a move towards a hybrid NHS and private GP service’, which is ‘the only option for the future’.
At their conference in Belfast today, they voted in favour on a motion to ballot the profession on ‘a plan B option for general practice provision that includes consideration of a means-tested, subscription-based service, such as those being offered currently by NHS dentists’.
This is unlikely to happen soon, but does show how GMPs are feeling about the service, and are looking over the fence with the idea the grass is greener. Dentists may disagree with them, but they may be competing over the same limited funding.
If Mr Streeting’s legacy is to be more health professionals following the dentistry route, this has the potential to be problematic for the profession in the long run. Over to the next health secretary.