Thread by @healthyopinion

Is #NHS #dentistry beyond crisis? Like rest of #primarycare, .@NHSEngland in its dominant position as market regulator has failed to manage the market. #NHS manages contracts, funding, nhs regulations, clinical policy, nhs #tech +entry & exit of workforce .@guardian 1/19

There will be those out there that’ll say but number of registrants has increased. That’ll suit nhs policy makers. Doesn’t account for people leaving NHS, working less hours for NHS, taking a career break or going into private practice or people taking up other careers 2/19

Certainly my experience in London is that many dentists don’t want stress of high needs #nhs practice. Are less likely to work full time & don’t want to work on abysmal NHS rates on offer in places like London. Many won’t be able to pay their rent /indemnity/ travel costs 3/19

For practices, rents have gone up & in many locations similar high rentals like any retailer. Again making it very difficult to run an NHS practice as NHS funding hasn’t kept up with actual operating costs. Electricity, Gas +water all cost significantly more 4/19

Only way of paying for the roof and the services is to supplement with private income if that’s an option but for some practices that’s not really an option given the location and population. Would be clumsy to assume that all practices can go private 5/19

Staffing is fragile. Dental nurses will switch practices for a few extra pence. Pipeline is non-existent &workforce from europe and elsewhere is drying up fast. Agency rates have gone up by way more than inflation and no longer makes sense to spend on agency for nhs services 6/19

It’s a workers market, NHs UDA pay rate expectations for associates have gone up out of necessity but UDA rates for many practices are not even close. Leading in access gaps and market failure. NHSE has failed to understand this or even address it. 7/19

Some people in NHSE may feel this is all dramatic as they personally aren’t affected by it. This is a very real problem. I know of good practices that are carrying more than 50% vacancy for dentists. Staff aren’t burnt out. Complaints are sky rocketing. It’s unsustainable 9/19

Patients have not been exposed to fragile state of #dentistry. ALL the risk of operating a practice is absorbed by the owners. The #NHS dental contract is entirely one sided in favour of @NHSEngland. Of course NHSE can balance this risk but it suits them not to bother 10/19

#NHS #generalpractice technically has two arms. #NHS General Dental Practice does NOT receive any rent reimbursement, contribution towards IT & non dentist staff cannot join the nhs pension. capital funding has been inaccessible since NHSE was created 11/19

Trying to get dentists onto NHS performers list is unnecessarily bureaucratic. Taken almost a year to set up 1 dentist for equivalence. Even then no recognition of 4yrs experience in private practice or 5yrs overseas. Anyone would think there isn’t a crisis 12/19

NHS patient charges are another barrier & cause of stress for all. Costly to administer. Staff & patients get into tense arguments. Patients find all the rules confusing. Practices suffer the cost of non-payment, State benefits either way. They are a barrier to access 13/19

There are a growing number of people that don’t qualify for #NHS charge exemption but can’t afford #NHS charges or private charges. A lazy commissioner & #dental #publichealth view that exemption means deprivation is misleading & erroneous. It’s much more complex than that 14/19

Yes, private charges may seem high for many. They’ll be broadly similar in any given geography. They reflect risk, operating costs, skill, complexity & regulatory cost. I can understand that people may not want to pay but doesn’t make it acceptable to blame profession 15/19

So is this #privatisation? It’s not privatisation in traditional sense but a collective set of policies that are driving market towards private delivery of care and therefore patients will have to pay for private care if they want to access it. #Inequalities will widen 16/19

Yes, we could solve everything through upstream #prevention, #waterfluoridation, patient health education & promoting healthy behaviour. That’ll take more than 20yrs. In the meantime in the real world oral diseases exist & need treatment now 17/19

There are many practices both #nhs and private who are trying to help patients. I know of #NHS practices open until 10pm 365 days a year including Xmas day. We need more than warm fuzzy vacuous word and claps from NHSE 18/19

Read some #dental colleagues claim that Government invested in #dentistry with a new £50m. It did not, this is false. It was one off, it was a fraction of the money taken back from practices in the same year. It actually cost the system to administer it. #PR stunt 19/19