Opening wide the Dental debate

Eric's response to an Evening News & Star article

Article which appeared in the Evening News & Star on 16.11.05

Carlisle dentists have spoken about how they have been forced to quit the NHS because they can't afford to stay. Liz Mather, of Eden Dental Surgery, is the latest Carlisle dentist to opt out of the NHS, claiming her practice would not survive if she continued. Her decision means 4,000 patients will lose their NHS dentist. She will keep just 2,000 as private patients. She is supported in her decision by fellow Carlisle dentist Richard Hellen, the North Cumbria Local Dental Committee spokesman. Mr. Hellen made his York Place practice private four years ago. He says financial pressures left him no choice. Decision Miss Mather's decision to quit the NHS on Friday came just days after Richard Wilson's practices in Carlisle and Penrith announced they were going private, resulting in 17,000 people losing their NHS service and 8,500 losing a place at the practice. Miss Mather and Mr. Hellen say that to break even, an NHS dentist in Cumbria has to treat one patient every three minutes. They earn a minimum of £7.30 for every patient they see but claim their practice costs are between £140 and £160 an hour. They believe this financial pressure is putting book balancing ahead of patient care, forcing an ever-increasing number of Cumbrian dentists to quit the strain of NHS.

Miss Mather told the News & Star that dentists would prefer to stay with the NHS but severe under-funding has forced them out.

"The practitioners that are leaving the NHS have no choice. It is a complete misconception if people believe we are making these changes on financial grounds alone. What it boils down to is that the Government hasn't got the financial resources to fund dental practices to a sufficient level. My practice is not financially viable."

The dental crisis is not just a Cumbrian problem * the whole of the UK is suffering. Extreme shortages of dentists, rising numbers moving into the private sector and huge waiting lists for appointments are all the result of inadequate NHS investment. At Mather's surgery the average waiting time is three to four months. She has twice as many patients on her books as she should because it brings her extra Government money.

There is an average of 64p per month for each registered patient, which has hiked up patient and waiting lists.

She said:

"Going private means I can halve my patient list, and I aim to be able to offer a treatment within four to six weeks. If all I wanted to do was cash in, I would keep the same number of patients and charge them more. But that's not why I'm doing this. I'm a caring practitioner who just wants to provide the best for my patients."

Mr. Hellen is frustrated that dentists are taking the blame for the problem, and believes the Government is using dentists to privatise the profession.

"The fundamental question is, why don't they want to fund dentistry? The only thing I can think of is that it's not a high political priority and they see it as a way of indirectly privatising it,"
he said.
"At the end of the day the responsibility for providing dentistry does not lie with dentists, it lies with the Department of Health. The latest wave of dentists turning to the private sector is a direct result of years of Government neglect of the NHS dental services. Going private is not an easy decision because dentists are aware of the impact it has, but many feel they have been left with no choice."

He accused Carlisle MP Eric Martlew who claimed dentists earn £65,000 a year of not being able to tell the difference between profit and turnover.

"Untrue comments like that don't help our situation. I have never earned anything like that. In fact principal dentists are often paid less then their associates, and the money they do earn usually goes straight back into the practice."

Higher Private dentists' rates are far higher than NHS patient charges. For a standard check-up, patients could see an increase from £5.84 to up to £30. This is the most contentious issue for patients being forced to seek private dental care, but Hellen claims all the extra money goes back into the practice to benefit patients. He said:

"It goes towards investment in the practice, investment in training and investment in salaries. Dentists become less stressed and appointments run on time. Waiting lists for appointments are also shorter."

Patients at Liz Mather's surgery will today (WED) have to re- register for a place. Half will be faced with the virtually impossible challenge of seeking dental care elsewhere. She says she is disappointed that it has come to this.

"If the Government came to me and said they would buy my practice and pay mine and my staff's salaries, I would agree tomorrow."

Eric's response to Evening News & Star article

I feel I must put the record straight following the comments made by local dentists (Evening News & Star 16.11.05), who have discarded their NHS patients to go totally private.

Firstly I would like to take this opportunity to publicly thank those dentists who are keeping faith with the NHS in North Cumbria. They are doing a great job made more difficult by their colleagues opting out.

However, I would like to remind those who have opted-out that they should not abandon their duty of care to patients.

Every NHS patient must be given at least three months written notice and during that time the dentist has a responsibility to provide NHS treatment. Additionally, any course of NHS treatment which has commenced prior to the notice being sent must be completed.

Let's get one thing out of the way immediately. Dentists working in the NHS are not, by any standards, poorly paid. In fact they are considerably well paid, especially in a comparatively low wage area like Cumbria.

An independent dentist with an average NHS workload will make about £80,000 pa. But on top of this they will also receive a further £60,000 towards their practice costs.

An experienced salaried dentist working for the NHS will receive around £65,000 and has no practice costs.

Whilst the dentists have been critical of the Government, I have heard very little criticism of the former Tory Government, who in the late 80s closed two dental schools, reducing the number of dentists in training, and in the early 90s introduced a contract system that cut their fees and led to the high degree of resentment and mistrust which is manifesting itself today.

Whether they believe it or not this Labour Government has committed unprecedented levels of funding for NHS dentistry. Last July we announced an extra £368 million for improving dental services in England and this year funding is set to increase by nearly 20%.

The local difficulties brought about by certain dentists opting out of the NHS is also being tackled. They have taken advantage of the national shortage of dentists and although local initiatives have been implemented they have been insufficient in the short-term to redress these local problems.

Under existing arrangements dentists are classed as independent contractors to the NHS and are under no obligation to see and treat NHS patients. They can choose how many NHS patients to see and in what categories - with some seeing children or patients exempt from charges under the NHS, but not offering an NHS service to adults. The local Primary Care Trust (PCT) has no power to allocate patients for registration.

However, all this will change next April when the PCT, for the first time, will assume full control of the budget for Primary Care Dental Services and will have a clear responsibility to secure or provide dental services.

The new arrangements will be beneficial to both dentist and patient.

Dentists will be able to spend more time with patients and the charging system will be simplified into 3 bands, in contrast to the 400 separate charges made at present. The maximum charge will reduce and patients will see more clearly what treatment is proposed and how much it will cost.

The new contract will also ban the unacceptable practice of only allowing children as NHS patients if their parents agree to register as private patients.

The dentist will also get a guarantee that for the next 3 years their NHS contract will be worth at least the value of their current NHS earnings.

They will also benefit from a generous and secure NHS pension scheme and will continue to benefit from investment in high quality education and training regardless of how much NHS work they go on to do.

But however effective these measures are they will not solve the current problem which is caused by a shortage of dentists and although NHS registration rates in North Cumbria compare reasonably well to other areas the available supply is not meeting demand.

The obvious answer is to employ more dentists but recruitment at this present time is very difficult.

In the long-term the Government has invested heavily in funding more undergraduate places but this is planning for the future and does not help the current problem.

In the short-term the Primary Care Trust is actively recruiting from abroad and is agreeing contracts with local practices which are committed to working in the NHS.

The PCT plans to recruit 10 dentists per year over the next three years to provide replacements for those who leave and also to cope with the public demand.

Currently they are recruiting internationally with dentists from Poland and Spain being encouraged to come.

Newly qualified dentists are also being encouraged to North Cumbria with a bursary scheme and guarantee of high quality training opportunities. At present they have succeeded in recruiting 6 European dentists, 2 from the UK, 1 Orthodontic specialist and 1 from private practice who has a great commitment to the NHS.

These will be supplemented by a further 5 posts from recruitment in Spain in January.

So why are dentists leaving the NHS?

Various reasons have been given

These are some of the reasons given, but not them all. I'll leave you to draw your own conclusions.

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On behalf of Eric Martlew, 3 Chatsworth Square Carlisle Cumbria CA1 1HB