Recent announcements around funding uplifts and GDC fee increases demonstrate that health authorities are happy for dentists to be their own businesses when it suits, but expect a public sector ethos when it doesn’t, argues GDPUK editor Jaimie Kaffash
I’m no economist. In fact, I’m barely economically literate. So when I see headlines about inflation and interest rates, I haven’t a clue whether it going down/up is good or bad depending on savings or debt or what have you. But one thing I have noticed is that inflation rates - when used by the health authorities - always seem to work against dentists.
For example, let’s take the government’s DDRB evidence. It has recommended a 2.4% pay uplift to keep it in line with inflation. Yet a mere week later, the GDC announces that its fees are going up with inflation - which is apparently 3.1%. Martin Lewis, help me out here! Meanwhile, Chancellor John Healey seems to suggest that inflation is at 0% - that’s the only possible reason he would have for freezing tax bands, which has led to de facto tax increases for everyone.
It’s hardly news that, in this never-ending age of austerity, ministers tend to cut public spending at the same time as introducing stealth tax increases on ordinary taxpayers (but will absolutely draw the line at tax increases on the super wealthy).
But the particular problem for dentistry is highlighted by this inconsistent approach to inflation: that they are treated as public sector organisations when the government is pleading austerity, but still have to deal with the real-world problems of being private sector businesses without the protection afforded to other public services.
Like any other business, they are subject to the vagaries of the market. They pay for all their own costs – and, in the real world, we don’t really need Mr Lewis to tell us that we are in a cost-of-living crisis. Costs are increasing, and this is solely the burden of the practice owners. If they are unable to keep up with payments, they can no longer continue as a business. This is fair enough. Business is a risk, and when things are going well, they reap the rewards.
But the problem is, they are also completely enmeshed in the public sector world and subject to the vagaries of government austerity. Unlike other businesses, they don’t have complete freedom to follow market forces. Most obviously, their biggest single customer remains the NHS and - while the BDA still retains some negotiating power - realistically ministers get to dictate the contract, which won’t be following the market.
Dental practices can – and most do – focus on their private sector work, which gives them more freedom to increase income to match costs. But even then, they are not free from the pressures of public services. The reputation of the profession takes a battering when they don’t offer NHS services. (This in itself makes no sense - arguably, housing is as much a societal issue, yet Taylor Wimpey are not held responsible for the housing crisis, which is rightly seen as a government issue.)
When they do set fees allied to costs, there are mechanisms to clip them beyond normal free market forces. The ongoing Competition and Markets Authority review into the private dental market is demonstrating this by its focus on fees. As the BDA has pointed out, there is no evidence that fees have been outstripping inflation (again, I really need Martin Lewis’s help on this subject).
Furthermore, all dentists are subject to compulsory regulatory fees. While other private sector professions are self-regulated through membership organisations (lawyers, architects, accountants, etc), dentists’ regulators are public sector bodies in the form of the GDC and CQC, who have no need to listen to the profession when setting their fees.
It would be remiss to claim that dentists are much worse off than other public sector employees, and I am in no way trying to claim that. Public sector employees rarely receive inflationary pay rises, which affects them profoundly in terms of personal finance (which, for the record, is scandalous).
But dentists do hold this unique position as businesses in a public sector environment. The only similar profession I can think of is general medical practitioners (an area I know well as editor-in-chief of the GDPUK’s sister GP magazine Pulse). They have their own issues with their relationship with health authorities, and they are completely at the mercy of the NHS contract, with very little freedom to choose a different path. But they at least this is acknowledged by the fact they receive NHS support for premises, infrastructure and a number of other major expenditures.
This space uniquely occupied by dentists is exploited by health authorities, who are happy to let dentists deal with spiralling costs themselves at the same time as pinning the blame of access issues onto the profession while retaining a substandard contract, reviewing private fees when voters start to complain, and allowing 3.1% fee increases (on what are already the highest fees in healthcare) without acknowledging this in their funding increases.
I don’t need Martin Lewis to tell me that none of this makes financial sense for the profession.