Fourth NHS Confidence Monitor Survey- Simon Thackeray

Simon Thackeray’s views on the results of the fourth NHS Confidence Monitor Survey

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The lack of information and clarity as to what will be in any new contract is still not evident, and personally I think it never will be as this suits the Government. I think that’s one of the main reasons for the disillusion in the profession, and probably the reason confidence is at 25%. That’s not good when there are dentists who are basically supporting a flawed contract and will be expected to work under a new, unknown version.

Public perception

It’s interesting that one of the points made as to how confidence in dentistry could be improved, is a change in public perception. All too often we are given a bad press, and most recently The Times article in early August was yet another example of dentist bashing. Whilst much of that article actually pointed to the elephant in the room, that is an increase in extractions over root treatment that we all know has happened, once again as a profession we are given a good kicking without any particularly vocal defence from our representatives. The BDA response the following day was relatively strong for them, but unfortunately was only likely to have been published to the public somewhere like the Barnsley and District Cat Appreciation Society’s Annual Report. Morale is obviously at an all-time low in the profession, and it is the responsibility of our representative body to be proactive with the press and not reactive. Publishing a response that will be read by seven members of the public and a cat isn’t really going to make much impact on public perception of the profession.

“Morale is obviously at an all-time low in the profession, and it is the responsibility of our representative body to be proactive with the press and not reactive.”

Professional support

As for professional support – well, it’s there if you know where to look for it. But one of the problems is the worry that indemnifiers will load premiums (even though they say they don’t) or even drop members when they seek support. Other support is available but this often comes at a price, and there are many parasitic companies feeding off the profession at the moment who promise types of support at a cost, but are very often economical with their interpretation of recommendations, rules, etc, often misleading the busy dentist into buying a product that doesn’t meet expectations.

Bureaucracy

As for bureaucracy, I’m afraid I’m of the opinion that this is here to stay for the foreseeable future, so we just have to get on with that. It’s important to have efficient teams and management structures, and given the investment this takes then option four on that graph becomes more necessary – leaving the NHS and going private.

Career prospects

It’s still sad that approximately one third of the profession would probably choose a different career if they had their time again, and over two thirds wouldn’t recommend it as a profession to others. I personally think this is due to the perfect storm of increased bureaucracy, increased threat of the GDC, and a contract that to me looks as similar to playing a game of rugby where someone changes the rules every 20 minutes without telling you, the ball is on fire, you’re covered in petrol, and someone has forgotten to bring the fire extinguishers.

“With the inexorable rise of the faceless entity that are the corporates, and the increased skill sets needed in private dentistry that are often not provided routinely on the NHS, the younger practitioner has a much more challenging time ahead.”

Having 84% of the dentists not confident in their career prospects in the NHS is not particularly surprising, but a sad indictment of how the system is failing the younger practitioners. Whilst there has never been a formally defined pathway, at least in the past there has been the ability to develop skills within the system before then utilising these either in your own practice, or moving into the private sector.

With the inexorable rise of the faceless entity that are the corporates, and the increased skill sets needed in private dentistry that are often not provided routinely on the NHS, the younger practitioner has a much more challenging time ahead. We will begin to reap what we sow soon, and the risk of a largely deskilled dental workforce is looming, with only those who have the foresight to invest in their training to take them out of the NHS sector having anything like the career progression of old. There is the attempt to make some form of career pathway within the NHS by introducing the Tier 1, Tier 2 and Tier 3 levels of practitioner, but who in their right mind will invest years of training, for example in endodontics, to be rewarded with the princely sum of three  UDAs (or whatever the new currency will be)?

Treatment vs prevention

The Government can’t afford to pay for prevention. It might have the weasel words that suggest it can and is willing to, but fundamentally when it sees the reduction in output and access that a system focused on prevention brings, then there is usually a U-turn back to a system based on output. This is a stark fact of any third-party payment system that expects value for money, and only sees value as the production of a number of widgets. Once again, the lack of clarity as to what a new contract will involve, and the likelihood that the clarity won’t even be there when the new contract is live, will mean that the goalposts can be continually changed before the profession even realise what the goalposts were in the first place.

The future of NHS dentsitry

It does seem though from the results that the profession are growing wise to the future of NHS dentistry. We are in an era of austerity, and since dentistry seems to be a small part of the NHS overall, almost a bolted on afterthought, then it should come as no surprise that the funding for it will be at best similar to now, but more than likely less in the future, with expectations of more output required for this diminishing amount. The final results confirm that this is what the profession seem to think, and that there will be an increasing downward pressure on remuneration. The regulatory burden will not diminish either, and with the associates’ costs of this adding to the financial pressure, then it is quite clear that the majority of dentists will see a less appropriate level of remuneration.

The dental team

I’m not totally sure though that I agree with the last metric that only 1 in 10 dentists feel the team will be able to work effectively within the NHS framework. I feel personally that they will HAVE to, and adopt a different working practice and team dynamic in order to make it work. This won’t be for everyone; and certainly not necessarily the way we were trained at dental school to deliver care. However, I do think that those practices that will make a success of the NHS will be the ones who are geared up to adapt to a completely new form of team dentistry without the traditional structure we are all used to. Whether or not the right manpower structure is in place in the workforce is another thing.

I have said before that any new contract is going to be just as challenging as ones we have had previously, and with an ever-decreasing pot of money to deliver an ever increasingly expensive service then I personally feel that people HAVE to look at their Plan B to survive. Our representative body could be more vocal at promoting this, but their voice can be heard about as clearly as a farting mosquito at a rock concert.

“I have said before that any new contract is going to be just as challenging as ones we have had previously, and with an ever-decreasing pot of money to deliver an ever increasingly expensive service then I personally feel that people HAVE to look at their Plan B to survive.”

To me, continuing to rely on the Department of Health to provide a system that is both good for patients and good for the profession is a bit like going into the lion enclosure at the zoo wearing an outfit made entirely from meat and expecting not to get eaten.

To read the full results of the fourth NHS Confidence Monitor survey, click here.

About Simon

Simon has been a GDP since qualifying in 1991, initially in the NHS, and since 2005 in private practice in Nottinghamshire. Simon sits on the Gdpc committee of the BDA and is also a past BDA Branch President for South Yorkshire.



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