Robert Donald highlights the main issues raised from the recent LDC Committee conferences.
It’s Local Dental Committee conference season again with the Scottish and UK events taking place in Stirling and Birmingham, respectively. Both events were dominated by the main issues facing dentists throughout the UK – increased bureaucracy, heavy touch regulation and chronic underfunding, along with the increasing medicolegal awareness of patients. All of the above are driving the unprecedented levels of stress and low morale in the profession. Add into the mix the uncertainties over future contracts and commissioning both north and south of the border and you can see why all is not well with my GDP colleagues.
Running a dental business is difficult enough without all of this going on at the same time.
Apart from the usual suspects mentioned above there were common themes running through both conferences. There was outrage expressed at the outcome of this year’s recommendations by the Doctors’ and Dentists’ Pay Review Body (DDRB).
While Scotland unanimously passed a motion proposed by Greater Glasgow and Clyde calling for ‘a review of the mechanism by which the profession negotiates on NHS fees’, the UK conference went one step further. Birmingham LDC managed to convince its conference to back a motion to snub DDRB completely. ‘That until the limits of the Treasury on public sector pay are lifted, there should be non-engagement with the DDRB, which is clearly not independent. Instead, the BDA should negotiate directly with NHS England/DH and ballot the workforce on the offer made from these negotiations.’
An end to the 1% pay cap
A couple of weeks earlier, Scotland’s First Minister announced she was going to end the unsustainable 1% public sector pay cap in Scotland during a televised election debate.
At the time of writing, there is no detail available, but I wonder how this is going to pan out? What are the chances of it addressing the 35% drop in income that Scottish GDPs have suffered over the last five years?
Another recurring theme focused on young dentists. The Scottish CDO expressed her disappointment at the lack of engagement by young dentists at the various roadshows/ workshops held around the country on the future of Scotland’s oral health. She wanted ideas on how the government could better engage with that cohort since the new action plan will affect their future working lives. The Scottish conference had invited vocational dental practitioners for a third year following the positive feedback from those who attended previously and welcomed four to the event. This theme was further developed during a question and answer session in Birmingham where Nicki Patel, a young dentist, gave her views on why her colleagues appeared disinterested and apathetic in advancing within the profession.
She said that young dentists want different things from their profession compared to older colleagues and she felt young dentists were immersed in a more stressful environment. They graduate into an environment where litigation, GDC fees, and indemnity fees are at their highest and they are scared to practise and scared to upskill. Younger dentists want a better work/life balance, variety, and support in education and ongoing mentoring in places where they work.
She also said there was no career structure/progression in general dental practice – you either had to upskill, go private or go into specialist training and the current high-risk environment is not conducive to the way young dentists want to work. Another young colleague bemoaned the increase in no win no fee adverts from local radio stations with solicitors advertising their services for complaints about the NHS. Who can disagree? It’s no wonder then that many of our younger colleagues take a very jaundiced view of the future of their profession. There are obvious implications for my older colleagues. Apart from the corporates, whom are we going to sell our practices to when we retire?
Claire Stevens, consultant in paediatric dentistry at Manchester, lamented the fact that 45,000 children in England had general anaesthetic to remove decayed teeth in 2013/14 and that it was still the most common reason for a child to be admitted to a hospital in England. It cost the NHS £35 million a year. Eighty per cent of one- and two-year-olds, and 60% of children aged one to four in England, did not visit an NHS dentist last year.
This is despite the fact that NHS dental care for children is free. Claire confirmed that she was a big fan of the Childsmile scheme in Scotland and wanted a similar scheme set up in England, but due to the different legislative structures it was difficult to do it.
Clawback in Scotland
The other hot topic in Birmingham was the disturbing increase in clawback from contract values of dental practices in England and Wales last year. A whopping £54 million was clawed back and instead of being invested back into dentistry, the money went straight into the primary care ‘pot’, which includes pharmacy, ophthalmic and general medical practice. The main losers were those dental practices that treat high needs patients and exemplifies why the discredited UDA system has to go. We all know about clawback in Scotland and many of us still bear the scars.
Whilst the dental healthcare systems north and south of the border continue to diverge, the underlying problems we face are just the same. Many of my senior colleagues will remember Sir Kenneth Bloomfield’s report published in July 1994 on Improving NHS Dentistry (if you get a chance, why don’t you read it – you can still download it from the internet). This followed the disastrous fee cut and clawback for the profession in 1992.
Sir Kenneth got it absolutely right when he stated that we ‘need an NHS dental service that has the confidence of all of the interested parties, not least the public and the dental profession.’
Whilst systems north and south of the border may appear on the face of it to work for patients and the government, it certainly doesn’t work for UK dentists, and hasn’t done so for some considerable time.
The opinions and views expressed here are personal to the author and do not reflect the policy of any organisation with which he is associated.