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A year of small steps, rather than giant leaps

Nigel Jones NHS Dental Landscape Leave a Comment

Nigel Jones looks back at the developments in dentistry over the past year and what 2018 might hold…

As we’re reaching the end of another 12 months I find myself looking back and reflecting on the past year. The news coming out of the wider NHS picked up where 2016 left off with a seemingly non-stop train of damning headlines.

In the past three months alone, Professor Ted Baker, Chief Inspector for Hospitals, has declared the service unfit for the 21st Century and in need of radical reform, and The Times recently reported the number of people flying abroad for medical treatment, including dentistry, has tripled in three years due to the longest waiting times for operations in almost a decade.

The NHS is being squeezed on all sides, and it is against this backdrop that dentistry finds itself fighting for its share of the funding.

In regards to funding, I found it particularly interesting to learn at a briefing held by the CDO – the first time such an event has been held – that it appears there is no ring-fenced budget for dentistry. I, and I suspect many others within the profession, had previously thought that whilst there may be no magic money tree for dentists, there was a protected pot of funds.

“The NHS is being squeezed on all sides, and it is against this backdrop that dentistry finds itself fighting for its share of the funding.”

However, this was clarified at the briefing, and makes me fear that dentists’ funding fight is in that case even harder. As, whilst theoretically no ring-fencing means no limit, I think in reality what this does is enable the budget to be easily shrunk if money needs to be diverted elsewhere in the NHS.

No major changes for dentists

Within dentistry, what we have seen throughout 2017 for many aspects of the profession is a series of small incremental changes, rather than any singular big bang that’s dramatically changed the landscape.

Some English dentists may have been hoping for some such announcement around the progress or rollout of the contract reform programme, however I think the majority will have been unsurprised at the lack of movement. But whilst we continue to wait for the results of the evaluation reports to be revealed, the unofficial news coming out from the prototypes about the business models they use has been largely negative, even if feedback on the pathway and oral health assessment remains positive.

“Whilst we continue to wait for the results of the evaluation reports to be revealed, the unofficial news coming out from the prototypes about the business models they use has been largely negative…”

The subject of prototypes was discussed at Practice Plan’s NHS Insights Panel in October. A panel of experts were brought together to discuss the results of our latest NHS Confidence Monitor survey, which were revealed in September. At the panel, Paul Worskett, a prototype practice owner, revealed his challenge with the business model in its current structure. Eddie Crouch, also said that it was estimated that a third of practices involved in the pilot scheme were struggling.

In these circumstances one can’t help but feel that there are some major issues with the models being tested by the prototypes and that the powers that be are buying time to ponder the art of the possible given budget constraints, rather than just fine tuning something they expect to be a finished product.

Unfortunately, this negativity is not confined to the issue of prototypes. The Confidence Monitor survey, which for the first time looked at happiness levels in dentistry, also revealed deep levels of unhappiness across the NHS, in contrast to private dentists who reported feeling much happier about their professional lives, compared to when they were in the NHS. Respondents to that survey and research carried out by the BDA showed that a majority of the profession are considering leaving the NHS within five years.

A more pragmatic GDC?

In terms of the profession’s regulator, I think this year has shown some improvement in the GDC’s willingness to engage with dentists. It seems like there has been a shift towards the GDC thinking more pragmatically and taking into account the circumstances dentists work in, and what is acceptable within that situation – rather than whether or not they are achieving the gold standard.

There was a hint at the CDO briefing from Jonathan Green, Executive Director overseeing Fitness to Practise at the GDC, that things are moving in this direction. He said, “When I sit in and observe FTP hearings, very often part of a registrant’s defence is that their record-keeping struggled because they were up against it in terms of time. We and our panels are sympathetic to that, but obviously it’s something that needs to be addressed as part of the regulatory picture.”

“There remains much fear, worry and anxiety about complaints and litigation, which was highlighted in the Confidence Monitor results – 95% of NHS dentists, and 67% of private dentists said they were anxious in this area.”

I found it fairly significant that the GDC was now talking in terms of being ‘sympathetic’ to dentists, and it could be the beginning of a more understanding relationship between them and the profession. However, I think whilst the words may well be appreciated, what many are still waiting for is evidence of positive action.

There remains much fear, worry and anxiety about complaints and litigation, which was highlighted in the Confidence Monitor results – 95% of NHS dentists, and 67% of private dentists said they were anxious in this area. It is perhaps unsurprising then that this year I feel I have been hearing the term ‘defensive dentistry’ more and more.

It is understandable that given these levels of anxiety, some dentists are preferring to err on the side of caution and avoid the more complex clinical work. However, that also presents an interesting challenge in terms of whether, in line with standards around informed consent, they are giving their patients all the options, even if it would be provided by another practitioner.

An important mitigation of the risk of being litigated against is building rapport and relationships with patients, but this is easier said than done within the time pressures of an NHS contract.

The year ahead

Looking ahead to 2018 it is unlikely that these pressures will be alleviated by any significant progress in the contract reform programme. I don’t think we will see any fundamental changes in this area, rather we will continue going slowly down the road that began almost two years ago with the rollout of the prototypes.

The question hanging over the self-employed status of associates may also become more of a focal point.  Not only could this impact the liability of principals and practice owners, but it could also affect the corporates, where there is already some tension around the status of associates.

“In the NHS, I fear there is not much light ahead in terms of the challenges it faces.”

2018 should be an interesting year for the corporates as BUPA continue to integrate with Oasis following their acquisition and we should start to see the BUPA brand becoming more commonplace. This is the first time a big, well-loved brand is entering practice ownership – except, perhaps, Boots’ ill-fated attempt to open practices within their store – so it will be interesting to watch. The major difference here is that BUPA have bought a business that is already very successful within the market that they can apply their brand to.

Meanwhile Portman are following an accelerated growth programme, while {my}dentist appear to be taking stock of their current portfolio of practices.

In the NHS, I fear there is not much light ahead in terms of the challenges it faces. The winter we’re entering will no doubt be as challenging as ever, and I don’t think the following change in seasons will bring any relief to the funding, resource and morale crisis facing the service. And once again, dentistry will continue to struggle to fight for its fair share.

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