Mission Impossible: Solving the morale crisis in NHS primary care dental services…?
By Henry Clover, Chief Dental Officer at Simplyhealth Professionals
There are many issues to be resolved within the current crisis in NHS primary dental care services. Can the NHS budget for primary dental care support a high quality comprehensive service available to all? And if so, how could the NHS primary dental care services be reconfigured to meet the needs of patients and professionals? We all know there isn’t an easy solution to any of this. It’s not helped by the fact that, 12 years down the line we are still no closer to definitive NHS dental contract reform, while we await yet further prototype testing and no new contract reform now due until at least 2022.

One major issue that plays into the current crisis in NHS dentistry is that of the regulatory and litigation threats continually facing dentists and how this is impacting patient care and morale in the profession. Sadly, it’s become a statement of fact that low morale and fear are becoming endemic in dentistry. Practitioners often feel like they remain one step away from losing their livelihood. The threat of complaints, and the fear of regulatory sanction and litigation can inhibit dentists from making the right decisions – it’s not unreasonable to suggest, it can lead dentists to behave more defensively, because they can feel like they are drowning in what they feel is an over regulated profession. Previous figures from NHS Digital* have shown that complaints made about NHS dentistry in England almost doubled from 7,664 in 2015-16 to 13,493 in 2016/17. 
Previous figures from NHS Digital* have shown that complaints made about NHS dentistry in England almost doubled from 7,664 in 2015-16 to 13,493 in 2016/17.
Morale is low in the profession, as the levels of NHS commitments continually puts dentists under strain, namely the pressures of unrealistic UDA targets which can force true patient centred care to play second fiddle, and then there is the threat of clawback.  BDA Chief Executive Peter Ward estimates that through clawback of over-performance fees, the NHS has benefited, at dentists’ expense, from £165 million worth of dental care and treatment. £15 million of clawback a year, over 11 years, in other words**. Or in other words, £41 thousand a day of your money, your time, your patients.  All of this is also impacting recruitment within NHS dentistry as was highlighted by the BDA’s Evidence to the Review Body of Doctor’s and Dentists Remuneration for 2018/19.  The report warns of ‘a looming and fast approaching crisis in recruitment and retention of NHS primary care dentists in the UK’. It further highlighted the impact of morale and motivation is vital to recruitment and retention and in stemming the rates of attrition. Ongoing work is needed to ensure that we attract new members to the profession but we also need to make sure that those currently working in the NHS are valued and want to stay. The NHS is losing valuable dentists as they reduce their NHS commitment and seek to retire or leave the profession and this situation is causing a recruitment issue in general dental practice and the community dental services in many geographic areas.’    Perhaps, BDA Vice Chair Eddie Crouch summarised it best when he said “When patients are struggling to get access government should not be punishing dentists for commitment to the NHS. It is a damning indictment of current policy that the dentists who go over and above with NHS care are now paying the price in low morale. The constant treadmill of targets and pay cuts mean something has to give, and services cannot be maintained when practices are unable to fill vacancies.”
The constant treadmill of targets and pay cuts mean something has to give, and services cannot be maintained when practices are unable to fill vacancies.
Simplyhealth Professionals recently conducted research*** to discover dentists’ attitudes towards the NHS, potential contract changes and private dentistry. It revealed that around a third of practices may not be offering NHS services anymore in the next five years. The ability to provide a better level of care is the most often mentioned driver for dentists potentially leaving the NHS (63%), closely followed by the expectation of more job satisfaction outside the NHS and a better work life balance (54%). A large percentage (52%) also cited falling income and falling dental budgets (47%) as reasons for making them want to leave the NHS.  If these are real concerns for you as a dentist, and you’re considering a move towards independence from NHS dentistry towards private practice we would happily come and talk to you about the benefits of introducing payment plans into your practice. Our recent survey showed that improved finances, earnings and being in more control of their business were the main reasons for introducing a payment plan in practice, with 45% of mainly private/fully private practices noticing a reduction in their stress levels***. We offer a range of options for practices, so you can be free to practise the skills you’re proud of and the balance of treatment offerings that suits your practice’s needs. Simplyhealth Professionals ‘Principal-only’ transition option allows you to make incremental change without reducing your current NHS offering. We understand that it’s a big step into the unknown but we have a proven track record of making dentist transitions work smoothly whilst helping you to make the most of your practice. We can help you discuss the potential changes and make sure your patients understand the benefits of your decision. You’ll also receive free dedicated local consultant support and access to our range of professional guidance, regulatory advice and business planning.   For further information call us on 0800169 9962 or visit www.denplan.co.uk/dentists/moving-to-denplan/nhs-if * Data on Written Complaints in the NHS 2016-17 Published 14 September 2017 ** Article published in British Dental Journal, Volume 222 No 6. 24 March 2017 ***Simplyhealth Professionals NHS Survey Sept 2017, Base: 206 dentists
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