NHS dentistry is facing a “twin crisis of access and affordability”, according to the watchdog Healthwatch England, which means in reality for many people NHS dentistry no longer exists.
The latest data from Healthwatch has found some patients being told they have to wait up to three years for appointments, although if they go private they can be seen within a week, with other patients unable to find a dentist that will do NHS work.
Healthwatch England has been monitoring how dentistry has fared during the Covid-19 pandemic. Over many months the organisation has documented a catalogue of problems with accessibility and affordability with the two groups suffering the most – those on low incomes and ethnic minorities.
This latest report collates the experiences of 1,375 people from January to March 2021, plus a Healthwatch commissioned poll of 2,019 adults that looked at people’s experiences of NHS dentistry during the pandemic. The report also pulls in data and people’s experiences from earlier in 2021 and in 2020.
Of the 1,375 reports from local teams, it was found that 80% of people found it difficult to access timely care and 59% reported a negative experience of care, with just 3% of people telling them about a positive experience.
The problem of access includes difficulties in finding an NHS dentist to register with and then long waiting times. Being unable to access care or having it delayed has left people with pain, swellings, and broken teeth, fillings and dentures. Other patients have had appointments cancelled in the middle of a course of treatment, such as root canal surgery. Others have found that when they have tried to book a dentist appointment, they have been removed from their practice list.
The Healthwatch poll on the public’s attitude to access and affordability of dentistry found that most people (61%) feel that NHS dental treatment charges are expensive, with over a quarter (27%) of respondents saying they either struggled to pay or avoid dental treatments altogether because they cannot afford the costs.
The poll also backed up the reports that Healthwatch has received from its local teams – many people feel pressured into paying private fees to get all the dental treatment they need, difficulties booking an appointment, and in finding information on treatment fees.
For those requiring emergency dental treatment there are some truly shocking reports, with many people being told to self-medicate whilst they wait for an appointment or try to register with a dentist. Being left in pain and told to self-medicate can have serious consequences – Suffolk Healthwatch reported that after unsuccessfully trying to find a dentist for three years, one patient ended up in hospital for three days after taking too many painkillers to relieve severe tooth pain when their condition worsened and no emergency dentist could be found. The patient still does not have a dentist and is still in pain.
Healthwatch has been told that when rung by people with a dental emergency NHS 111 has advised people to gargle with salt-water and just to continue trying to get an appointment.
Experiences reported by Healthwatch teams in late 2020 include some people calling over 40 practices to find an NHS dentist, and pulling their own teeth out when they couldn’t bear the pain.
Patients have been told by practices to use DIY filling kits while they wait for an appointment and there has been an increase in reports of being repeatedly prescribed antibiotics to deal with the pain, but with no prospect of an appointment to actually fix the problem.
Healthwatch England has called for major changes to NHS dentistry, including a radical reform of the way NHS dentistry is commissioned and provided.
Imelda Redmond, national director of Healthwatch England, told PA: “The twin crisis of access and affordability hitting NHS dentistry means many people are not able to access timely care – and the poorest are hardest hit….Reform of dental contracts needs to be a matter of urgency for this government. New arrangements should include making access to NHS dental services equal and affordable for everyone, regardless of where people live, their income and ethnicity.”
The failure of dentistry now will lead to long-term harm to thousands of people – the result will be further pressure on the NHS in the future.
The government’s new guidance introduced in January 2021 and revised 1 April 2021 on how dentists will be paid and what targets they have to reach has led to dentists choosing to do straightforward work, such as check-ups, rather than difficult time-consuming urgent work.
This came to light as soon as the targets were announced in January 2021, via a leaked email from a leading UK dental chain, in which its dentists were instructed to limit urgent care in order to meet the targets. The system means it is easier to achieve the targets and escape financial penalties via simple routine check-ups rather than time-consuming urgent care.
Practices that don’t meet the targets have to return two thirds or more of their NHS funding for that quarter, leaving practices under severe financial pressure, which in turn threatens patient access. In order to meet the targets, dentists would have to increase visits to the surgery and this in turn will make effective social distancing very difficult to achieve and at odds with clinical guidance.
NHS dentistry is struggling to survive – with a combination of the government targets that have to be met, whilst working with the Covid restrictions potentially leading to an exodus of dentists from the NHS service, according to the BDA. A survey conducted by the BDA shows that nearly half (47%) of dentists indicate they are now likely to change career or seek early retirement in the next 12 months should current COVID restrictions remain in place with the same proportion saying they are likely to reduce their NHS commitment.
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