Will NHS dentistry survive the COVID pandemic? Neel Kothari explores whether the contract is worthwhile for dental practices anymore.
For over a decade now, we have been told that a new contract is on the horizon. Despite numerous pilots and prototypes, little is known about what this will entail. But one certainty remains: there is little additional funding for NHS dentistry.
During the pandemic, the continued funding for NHS dentistry has been a lifeline for many practices. But the temporary removal of targets is slowly being reversed. The NHS does not seem to have answers for alternative ways that NHS dentistry can operate.
Dentistry has always proved a conundrum for the NHS. It has used targets and incentives as far back as 1951 to control output, when the first ever patient charge was introduced for dentures.
Almost eclipsed by COVID, but nevertheless acting in tandem, is the effect of Brexit and the impact this may have on the sizeable contribution to the NHS dental workforce by our European colleagues.
We may not realise the vulnerabilities resulting from both COVID and Brexit for some time. Particularly given the government support packages helping businesses to stay afloat. But many are already reporting increased pricing for dental stock and materials. As well as delays on orders arriving because of Brexit.
It is entirely predictable that staffing issues are looming in the future.
Staying in NHS dentistry
Let me be clear, in a post pandemic world there is a realistic possibility that some things may never go back to how they were.
The imposition of higher targets may work for some, but are wholly unrealistic for others.
When I first started my dental career, it was not unusual to hear colleagues questioning whether they could afford to leave the NHS and convert to private. Now many colleagues are openly questioning whether they can afford to stay in it.
Why is this? Well, the answer is complex.
Simply put, funding issues and high levels of administrative bureaucracy are making NHS dentistry less attractive.
Sure, it has a degree of security, but is it workable in a post pandemic world? For many with high UDA values the answer is probably yes. For the rest of us, the margins are too close to call.
In addition, not knowing when targets will change, what percentages will apply, when a new system will come to the fore or where we will get staff from leads to a great deal of uncertainty.
At the best of times this makes running a business challenging; in a post COVID/Brexit world, this is mentally and financially crippling for many.
Leaping to private dentistry
If this was not enough, let us consider the impact of rising patient charges.
For some, rightly or wrongly, NHS dentistry is becoming a choice between feeding their families or fixing a tooth.
With an economic disaster looming, it is probable that increasing numbers will put off dentistry due to affordability. This will compound future oral health issues as well as make it harder to claim UDAs.
This raises the question: at what point do patient charges begin to frustrate performing the NHS dental contract?
So, can NHS dentistry survive in a post pandemic world?
Well, I do not expect every contract holder to hand back their contract. So, in a sense, yes it will survive. But, just like patients have a choice to have NHS or private care, it is wholly foreseeable that dentists who can afford to do so, may choose to jump ship and make the leap to private care.
This may be a scary prospect for some. But for others it is akin to leaving a sinking ship and landing on a lifeboat.
You can watch the full Dentistry Question Time debate here, where a panel discusses whether there is a future for NHS dentistry.
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