Frustrated, let down and angry — that’s how I felt reading the news this week that some NHS patients may have to wait for up to three years to see a dentist.
The NHS dental system was once something to be proud of, but now it is in full-scale crisis, a shadow of its former self.
This week’s report by Healthwatch England found that even emergency cases can face a six-week wait. Let’s not forget that these people may have pain arising from an abscess, an infection or a broken tooth — some of the most excruciating sources of pain it’s possible to have.
The result is that some patients are forced to go private, where a filling may cost more than £100, compared with about £65.20 on the NHS in England — or in some cases, even doing DIY fillings or pulling out their own teeth.
How did we come to this? It’s not because dentists stopped caring. The problem is there simply aren’t enough NHS dentists: they’ve left the health service in droves.
The NHS dental system was once something to be proud of, but now it is in full-scale crisis, a shadow of its former self. Stock image
The number of dental surgeries offering NHS treatment fell from 9,661 in 2014-2015 to 8,408 in 2019-2020 — and I was one of those who jumped ship.
After qualifying in 2000, I spent 14 years working in the NHS. But six years ago, I’d had enough. I was seeing more and more patients and getting more and more stressed.
Although the public may think we all want to move to the private sector to make money, this isn’t the main reason why most are going. Yes, it is harder to make a good living in the NHS. But for most, the key concern is that you rarely get the chance to do a good job.
The failings began in 2006 with the imposition of the targets-based payments system.
This meant dentists began to be paid per course of treatment — so if a patient needed four fillings or six teeth pulling, the dentist would receive a single payment, as if they had done just one procedure.
We shouldn’t be treating NHS dentistry as a Cinderella service — it’s a vital part of healthcare. Stock image
In many cases, such as root canal work, which can take between one and two hours, the dentist may be left out of pocket after paying for equipment, nurses, surgery space and overheads.
Dentists were also given targets of ‘units of activity’ to achieve. This means you have to undertake a certain number of treatments each year. If you don’t reach the target, you have to refund the Government the difference.
So it doesn’t matter how many patients I may have seen, or how many procedures I carried out. It was only completed courses of treatment that accrued points.
As a result, I was seeing up to 40 patients each day. By contrast, in private practice I may see between 15 and 20 people on a busy day. It felt like a production line, if I’m honest.
For those still in the NHS, Covid has made things worse because of all the extra costs involved with clinical hygiene and ‘fallow time’ between patients to allow for cleaning and air conditioning.
Even before this, NHS work could be upsetting. I remember one pensioner who needed new dentures but didn’t qualify for NHS treatment. Pensioners don’t get free dentistry and his income was slightly above the very low threshold.
He ended up spending his Winter Fuel Payment to get the dentures privately. I felt really bad for him but there was nothing I could do. The charges are set up by central government.
I know from colleagues in the NHS that this kind of thing still goes on. Patients can’t afford £282.80 to have a crown so they opt for a tooth extraction instead, which costs £65.20. It’s not right.
Children who in the past would have been given orthodontic treatment on the NHS to straighten their wonky teeth may not qualify under the new, stricter, points-based system. Unless a child scores above a three on the Index of Orthodontic Treatment Need, they won’t be eligible — and even if they are, they may have to wait two to three years for treatment.
Many parents don’t have thousands of pounds set aside for this, so their children go untreated. Yet your smile is one of the first things people see and it can really affect your self-confidence.
We shouldn’t be treating NHS dentistry as a Cinderella service — it’s a vital part of healthcare. Dental health can affect far more than your mouth — gum disease, for example, is linked to heart disease and other inflammatory issues.
Successive governments have starved NHS dentists of funds. They only allot money for 52 per cent of the population anyway, as they bank on the rest going private or not bothering to get treatment at all. It is the only part of the NHS operating on a lower budget than it was a decade ago.
If we made it a rewarding profession in which dentists were free to give patients the time and treatment they needed, we might just — just — be able to turn the tide. But my fear is that things will get worse before they get better.
n Paul Woodhouse is a dentist at the Grange Dental Practice in Norton, in the North East of England.