When it comes to our teeth and oral health, getting the care you need is different to the rest the of the NHS, but why?

Recently a friend discovered that she had an abscess in her tooth. Her dentist started root canal treatment, but after inflicting several body-jerking shocks of pain, the dentist decided that the procedure needed a specialist. The wait on the NHS in her area was six months.

Her choice was either to wait, risk complications and endure the discomfort, or to go for a private slot by paying £600, seeing the same specialist. There was only one NHS option in the area for difficult cases and he was hugely over booked.

Reluctantly she chose to pay up, shocked that, effectively there was no NHS service to help her. An unusual story?

Not according to the British Dental Association who estimate that 135,000 dental patients a year go to A&E because they can’t access care for a problem.

It believes that a further 600,000 seek treatment from a GP, adding to the pressure on family doctor services.

Desperate measures
Some patients avoid steep charges by heading to the garden shed to have a go at DIY dentistry. It’s a wince inducing throwback to the Victorian age, but reaching for the pliers is not as rare as you might think, according to BDA chair of General Dental Practice, Henrik Overgaard-Nielsen,

‘Whenever Governments fail to invest in NHS dentistry, we find desperate patients opting for “DIY” alternatives,’

‘In a country with supposedly universal healthcare these access problems are man-made.
They’re borne of failed contracts and cut budgets’.

Many patients who can’t pay will be put off going to the dentist. Enduring pain, popping painkillers and hoping the problem goes away. According to official statistics, almost one in five patients have delayed treatment due to its cost.

If only more of us listened to the official advice and got our teeth checked more regularly, before the rot sets in. Actually, many of us are trying to do the right thing, but space on NHS dental lists is very hard to find. Figures show that one million patients were unable to register with an NHS dentist last year.

The poor are hit hardest. The British Dental Association point to the fact there has been a big decline in the number of visits to the dentist by people with low incomes, falling by 23% over four years, that’s two million fewer treatments.

The root cause?
NHS charges are going up, but the number of new NHS dentists is falling back. People are being driven towards the private dental market, but many can’t pay.

The NHS charging structure is a baffling arrangement, perhaps meant to distract us from the fact that it is a tax on health. Patients are being asked to contribute a much bigger share of the cost of treatment. According to the British Dental Association NHS patients will soon be contributing a third of NHS England’s dental budget in charges and this will rise to a half by 2032.

Patients are paying more, but the money going to practices for NHS work hasn’t risen nearly as fast, causing NHS contracts to be handed back and a decline in the number of NHS dentists that can make their businesses viable. Austerity has been felt. In the last five years government funding has fallen by 10%.

Dentists are also getting harder to recruit. A recent survey found that 68% of practices had difficulty in filling vacancies in the last year. Numbers have dropped to 2010 levels.

EU dental professionals are no longer applying to come. Brexit deters like halitosis. Of those already working in the UK a third are thinking of leaving and 80% blame Brexit.

We can’t afford to lose their support though, we already rely on it. Around 17% of the UK workforce consists of EU dentists and they deliver 22% of NHS dentistry.

Deprived areas stand to lose most from the Brexit fallout. EU dentists undertake 30% of the dental work in poorer areas, according to the dentistry website.

Mr Hancock’s Solution?
All the evidence points to a shrinking NHS service, underfunded and crying out for a boost in capacity. The obvious move is to invest heavily in a new body of NHS community dentists – that have no tie to the private sector, so all their time goes on NHS patients. Funding more urgent care dentistry would help to reduce the pressure on our overworked GPs and A&E services.

At first glance such a move would appear to be in tune with the new NHS long term plan. In it we are promised more community services, better primary care and more prevention – all cornerstones to improving oral health services. And yet there is virtually no mention of dentistry in the NHS plan.

Is this a sign? Many governments have been neglectful of NHS dentistry. Unlike the endless shakeups elsewhere in the NHS, dentistry policy has remained largely untouched. But is the government going further, driving down the NHS service and effectively reducing it to a safety net?

Dentistry is a mixed market, although most practices still provide NHS and private care, but the huge pressure on NHS funding has shifted the market towards private provision.

According to market analysts Laing and Buisson the number of NHS-only practices has dropped from 15% to 4% of the overall total.

Unsurprisingly demand for private work has risen by around 10% in just the last three years.

So far no reassurances over the future of NHS dentistry have come from health secretary, Matt Hancock. In fact the reverse could be said. He was recently seen endorsing a private company that makes money from the lack of NHS capacity. MyDentist targets areas with shortages of NHS practices and offers prices that are slightly higher than the NHS for basic work, but much higher for anything more complicated.

The health secretary was warm in his praise “Companies like MyDentist play a really important role in delivering a good service to keep our nation’s teeth strong.”

The fate of NHS dentistry offers an allegory for the NHS as a whole. Charges open the door for reduced funding, less public funding leads to private provision, a two-tier system quickly emerges and before you know it access to care then depends on your spending power, which is the very opposite of the NHS.

Charges for dentistry first appeared in 1951, an attempt to curb demand. They have now become deeply set in the system and dominate people’s decisions about when and if to access dental care.

Over the last 60 years our view of oral health has changed. It is now very much a field of healthcare. Dentists treat our decay, but they also monitor our health watching out for mouth and neck cancers and taking action against conditions like gum disease – which has recently been linked to Alzheimers.

Some of their work is cosmetic, but most should be housed within the NHS, as a crucial part of our healthcare and connected with our other health services.

Today a quarter of children start school with some tooth decay, record numbers of children are having teeth removed each year. A million of us cannot get access to NHS dentistry. This is the time to invest in public health and NHS dentistry provision. We must change the focus, to look at solutions that can improve the health of everyone in our society.

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Paul Evans

director of the NHS Support Federation

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