The impact will be even greater on dental care as incomes will be reduced, sparking fears more dentists will leave the NHS
Dentists may have to pay back millions of pounds to the NHS because they have failed to reach their targets in the first year of a new contract.
Some dentists face repayments of tens of thousands of pounds, and in a few cases more than Â£100,000. The impact on dental practices will be even greater because their income next year will be reduced, and it is feared that the problems may lead to even more dentists leaving the NHS.
The problem is the latest to hit the troubled NHS dental contract, which rewards dentists for the â€œunits of dental activityâ€ (UDAs) that they complete. Many dentists â€“ nobody yet knows how many â€“ have failed to achieve the UDA targets that were set by primary care trusts, and for which they have already been paid.
One dentist said that the contract had turned him into â€œa UDA factoryâ€, working flat-out to achieve the targets. Others said that the only way to reach the targets was to take on quick jobs such as extracting teeth, rather than root-canal surgery to save the tooth, which earns the same UDA score.
The NHS Dental system in the United Kingdom has gotten much worse not better with increased government scrutiny and involvement. Should this be surprising?
If my colleagues in Britain want to fix their system, they must privaitize their dentistry health care delivery system. After all, even other former Commonwealth countries, Canada, South Africa, New Zealand and Australia have primarily private dental systems.
Or they could model their system on the American private system.
What the NHS provides their dentists and patients today is the worst of all worlds: a government run system with bureucratic HMO targeted contracts where the provider is at financial risk.
Why would any dentist wish to participate in this system? Why should the individual dentist be held financially responsible for the health and health care decisions of individual citizens?
As my fellow blogger, Dr. John Crippen says:
â€œThe overwhelming majority of British dentists are decent, caring, and hard-working.â€
Government targets have pushed them towards working unethically. Towards working unprofessionally. They will not do that. The Times quotes a dentist who says:
â€œI a patient comes in and needs more than two crowns, it costs me more to do the work than I get paid. So there is a temptation not to do the things that need doing. There is a huge potential for supervised neglect.”
This government has done it to the doctors; it has done it to the teachers (see : â€œLife after the job from hell” ); it has done it to the lawyers (see : “Half the Cost of a no frills meal“); so I suppose it is only fair that it does it to the dentists.
But ask yourself this. How many of these NHS dentists, faced with financial disaster, will still be working in the NHS next year?
Answers on a post-card to Patricia Hewitt.
And what adds insult to injury are the high tax rates in the United Kingdom to pay for these “government” benefits.
Perhaps the British Dental Association should consider an orderly phase into a private system so as to minimize a dislocation of patient care. If not, the individual dentists will chose privitization with their feet by walking out of the NHS entirely.
50% Amount of average dentistâ€™s income from private work. Fifteen years ago it was 6%
20,887 Number of NHS dentists at end of 2006. On March 31 last year it was 21,111
Â£100,000 Estimated income of one in ten dentists before the new contract system
46% Percentage of adults registered with a dentist (children 62.9%)
Let’s look at some of the comments:
From the Times:
Means my local NHS Dentist might have to get rid of one of their 2 brand new Porsche Boxters and might have to downgrade the new Range Rover Sport as well.
Hard times ahead indeed.
Bry Barnes, Somerset, Uk
Another “Target debacle” ruled over by this government! “Targets, targets, targets” should have been Blair’s sound-bite when he came to government, not “education, education, education”. This is why the NHS is not making headway when it has money pouring into it – there is a whole industry in government (and the NHS etc) just to set and measure targets.
B. Cox, cambridge, uk
GPs met the targets set by their new contract and saw their pay being cut in the form of a reduction in pension.
If dentists had hit their targets one wonders if the government would have clawed back the pay in other ways on the grounds of ‘affordability’
john phillips, edinburgh
Couldn’t have said it better myself.
And to add insult to injury we now have to throw away a large number of precision instruments after one use; which isn’t necessarily a problem, except that the government isn’t giving the dentists any more money to pay for this non-evidence based dictat.
student dentist | 30.04.07 – 5:15 pm | #
The Guardian today hints that Gordon Brown will give the NHS political independence in his first 100 days as PM rather like he did with the Bank of England in his few few days as chancellor. Given the incredible amount of incompetence the Government has shown over its management of the NHS, is it high time this happened or just another smoke screen? You guys who actually work in the NHS would know best…
I would really like to hear your views on this Dr Crippen. You describe the NHS as bowing to government control freakery – is this where the heart of the NHS’s problems really lie?
JG | Homepage | 30.04.07 – 5:58 pm | #
Who are you (or anyone else) to say the Harley Street docs, or the dentists, SHOULD be in their NHS clinics?
The mentality that physicians (and dentists) are somehow “owned” by the people, hence by the government……almost a public utility……that’s how we got into this trouble in the first place.
I say “we” ’cause we’re not that much different in the USA.
Given what you describe of the NHS, I daresay the dentists are behaving rationally.
arf | 30.04.07 – 6:41 pm | #
What a picture. At least he won’t eat swans again.
dearieme | 30.04.07 – 7:08 pm | #
ideological preferences aside, arf, these dentists agreed a contract and have been paid (in advance) for work they have not done. The real unfairness here is that private surgical clinics paid by the government on the same basis (per units) have been paid even though they did not do all the contracted work (I assume the contracts differed, still, it is unfair).
jayann | 30.04.07 – 8:10 pm | #
Ah, different story, of course.
We had a similar problem with Medicaid dentistry in our area. Medicaid is a state/government program for the poor.
They got a sum of money from the government to provide dental services to a population of indigent people in our area. Yet I was repeatedly being called after-hours for pain medicines, etc., for dental pain. It’s a problem, as most people calling in that scenario are really seeking narcotics (in my area at least).
One time I got so fed up with it. Someone called seeking analgesics, and the person had just had dental work a few days earlier. “Why aren’t you calling your dentist?”. “The answering service says there’s no one on-call”. So they call me, ’cause I answer the phone. Sometimes I think I’m the only one who answers the phone.
I took the person’s name, all the relevant numbers, called the dental service myself. What do you know, the person was right. No one was listed as being on-call for emergencies, contrary to their contract. They took the money and didn’t provide the service.
And to add insult to injury, the work we physicians did….work the dentists were supposed to do but didn’t…..that work came out of our own Medicaid budget, so we look that more spendthrft in our services, and the dentists look that much more “efficient”.
I took that story, named names, and made a big stink.
They cleaned up their act, at least for the time being.
arf | 30.04.07 – 8:25 pm | #
John, you forgot one profession that has also been stuffed by the government and that is the profession of Nursing.
doctorno | 30.04.07 – 8:58 pm | #
In my profession’s defence, Most dentists work an on call rota between a few practices in the area so real emergencies shouldn’t slip through the net.
Some practice’s haven’t met their targets, from what i understand this is often because they are in an area of high need. i.e. people who require 12 fillings, three molar root canals and a course of perio treatment. This could take up to 10 hours, for which the dentist ‘earns’ 3 UDA’s and as an example my trainer next year has a target of 11’000. There are also incidences of the work completed in the ‘test period’ being overestimated by as much as 10%.
Of course the other side of the story (and the one i hear more often) is dentists meeting their targets early, applying for more funding to meet the needs of the population from the PCT and being refused. In this instance the only option is to close the practice until the new financial year.
I really believe in the NHS but i’m not sure how i will manage to work in this system and provide the treatment i want to.
student dentist | 30.04.07 – 9:20 pm | #
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