Britain is fiercely proud of its NHS – and rightly so. But one part of the health service is not only underfunded but under-recognised. It’s time for us to get serious about the nation’s oral health, and support dentistry. Many dentists feel that they are simply too low in the NHS pecking order, and this can only be achieved through a separate National Dental Service, or NDS.
Many dentists are experiencing a backlog of demand from COVID-19 which could see some patients waiting for up to three years to get an appointment. In many parts of the country, there is no funding for new NHS dental services.
This puts huge pressure on dentists who want to see everyone who needs oral healthcare and to give them the best care possible. A recent survey from Healthwatch revealed that only 10 per cent of respondents have relayed a positive experience of their dental appointment, compared with 58 per cent who have had negative experiences.
The report also found that access to dentistry is difficult for 72 per cent of people – something that we wouldn’t expect from an NHS that is “the envy of the world”. This state of affairs cannot go on.
Dentists are increasingly vocal about the pressures they are under when providing care to patients. In a letter to the government in January 2020, signed by hundreds of industry professionals, it is mentioned that the most common reason a child is admitted to hospital is due to rotten teeth which they point out is an entirely fixable problem.
Many dentists feel that dental services are not seen in the minds of the government as an integral part of the health service, even though poor oral hygiene leads to so many adverse health issues. Half of all adults suffer from gum disease, which has a proven link to heart disease. We know that throughout the pandemic, poor oral hygiene has exacerbated the symptoms and transmission of COVID-19. Dentistry is as important a part of the health service as any other specialism. But the funders seem to disagree.
This situation is dire enough that In 2017, the charity Dentaid – that normally helps to care for people’s teeth in developing countries, set up clinics in the UK specifically in order to help low income families, homeless people and migrants get the dental care they need.
How did we get here? By creating a status quo where it makes very little economic sense for dentists to do work under the current NHS funding scheme. The NHS compensates dentists for each individual sitting, as opposed to the volume of work carried out.
This means that a dentist gets compensated the same amount for a routine checkup and a single small filling as they would for multiple root canals. This is the same, flat fee structure that the NHS issues to GPs, who keep their consultations to 10 minutes.
But the model does not and cannot translate to dentistry. It creates a situation where the more serious the case, the less financially viable it is for a dental practice, which is, after all, a privately owned business with rent, bills and payroll commitments.
What this has created is a two-tier public healthcare service. In reality, dental healthcare is often only free at the point of use in the UK if you have a perfect set of teeth which, unfortunately, most Brits don’t.
So what’s the solution? We first need to be willing to accept that dental care is not a “nice to have”, aesthetic add-on to the rest of the health service, it’s an integral part of it. We then need to bring this urgency to the top level of government. Boris Johnson and Matt Hancock need to recognise that there is a gaping hole at the root of the NHS. It’s up to them to fill it.
Filling it may mean accepting that the monolithic NHS is too cumbersome an organisation to also manage the delicate needs of the nation’s teeth. We need a National Dental Service that is funded properly, grants important dental care to every citizen, and helps train new dentists effectively.
Training is key: as it stands, there is a colossal recruitment crisis within dentistry, a high depression rate in the profession and an increasing brain drain with many British dentists going overseas where they can be compensated properly for their skills.
Brits should not have to accept three year wait times (even if those are exceptional cases) when we pride ourselves on our National Health Service. A National Dental Service could do better.
Dr Nilesh Parmar is a co-founder of Parmar Dental. Shaz Memon is founder of Digimax Dental.
