It’s time for dentists to sit in their own examination chair

by , Senior Health Researcher Consumer Rights 20 October 2011
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More than half the NHS and private dentists we visited in our undercover investigation were rated poor by our experts. Some even neglected to offer basic treatment. Sound familiar, or do you love your dentist?

Tooth examination cartoon

I don’t know about you, but I think my dentist is pretty fabulous. She’s clear about what she’s going to do, and I can honestly say she’s been a godsend for my poor, much-ground teeth. But I’m no clinician, and I’m relying on her to do a good job – if I’m honest, I’m not sure I’d be able to tell if she didn’t.

So it’s worrying to think that our undercover dentistry investigation might be any sort of reflection on the general state of UK dental practice.

Our dentistry diagnosis

Out of 20 visits across England rated by our panel of experts, 11 were rated poor, with evidence of poor case history-taking, clinical examination and a hotch-potch of inappropriate treatment offered to our undercover researchers.

All of our researchers had dental problems – from gum disease to decay and orthodontic need – and all should have been offered x-rays. So it was a real disappointment to see this didn’t happen in five out of 20 visits. Moreover, five visits lasted less than ten minutes, with two at just a shocking five minutes!

So what’s going wrong in an industry that has two regulators? Is it the NHS contract that’s the problem? Not necessarily – we also saw some poor private dentist visits. Are the standards dentists are working to too broad and woolly? Perhaps – these standards are currently under review by the General Dental Council (GDC).

Our four experts – who work at general dentist and consultant level, as well as having expertise in standard-setting and performance management – were surprised and disappointed by the picture they saw, with only three of the 20 visits rated good.

Improving NHS and private dentists

Sadly, it looks like some patients have been failed, which might leave them with a lifetime of dental problems that could have been prevented.

We want our findings to bring about positive change, so we’ve already shared our results with the British Dental Association (BDA) and the GDC. The latter is studying our findings closely to consider further action and told us:

‘We’re extremely concerned by any evidence of poor standards in the delivery of dental care. All dentists and dental care professionals are required to observe standards, and the findings of the Which? undercover research raise questions about adherence by some dentists.’

Do our dire dentistry findings strike a chord with you, or do you love your dentist?

107 comments

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Ray Steggles

Responding to Greg’s comments

You will get a range of fees, because the cost profile of practices differ. At one end you will have highly qualified staff, undertaking regular training, the most modern fully maintained equipment , wonderful surroundings, work guaranteed for several years, and so on. At the other you could have inexperienced staff, undertaking the minimum of training, basic equipment, no investment in the future, rapid throughput of patients.

To maintain these types of practices produces a very different hourly rate that they need to earn.

Which type of practice would you feel more confident of receiving a high quality crown? There are different types of crown, usually involving laboratory work, which is a cost additional to the required rate for the practice, or very expensive computer and milling equipment (Mine cost me £70,000.). There are other factors, which I won’t go into here, which are to do with treatment planning, which can have a significant effect on cost.

I think that should give you some idea of the background to the variation between practices. Of course the majority of practices come somewhere in between those ends of the spectrum, having to establish their costs by local market conditions. I think it becomes extortionate when a practice charges slightly below the local average rate, and at the same time offers a much lower quality of service, and cutting back by employing inexperienced staff, for example. To a patient this may seem like a bargain, because they think one crown is the same as any other.

People can have treatment abroad, because of the differentials in the cost of living. A person travelling from here to Poland pays very much less for treatment, but the dentist in Poland is receiving a fee which is high in their terms, and could be described as being extortionate, because it may be way above their normal earning level. It is also depriving local people of a service, by pricing them out of their local market, as ‘greedy’ dentists makes money from health tourists.

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Greg

Mine cost me £70,000? You are a dentist of course, so you can afford it.

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A worker

Daft comment Greg, he was explaining the high cost of equipment. This is to help you understand why dental charges are seen as high by you.

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Greg

Yes sorry I misunderstood.

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Donna Jackson

Dentistry in the uk is roughly 30 times more regulated than anywhere else in Europe. Our property , taxes, cost of living are higher than virtually the whole of Europe. The costs of this are reflected in how much it costs to employ people and how much it costs to run a business.

In eg Hungary the average wage is a third of the uk. So the technician who makes the crown, the nurse who assists the dentist, the receptionist, the cleaners , the decontamination nurse, the dentist are all paid less, the premises cost less , but do you think the price of a Hungarian crown will appear cheap to the average hungarian? No.

It will cost a uk dentist between £120 to over £200 or more an hour to run each surgery in a practice and that figure goes up at around 10% a year (far above inflation rate) and alot of that is to comply with uk regulations.

The uk technician that makes the crown has also seen a massive increase in overheads also partly due to having to be registered with the gdc. Many UK dental labs have gone to the wall because they cannot make a living in the current climate and introducing registration for some was the final straw.

Over 70% of dentists do not own a practice and these dentists average 72% of their earnings going in expenses. Private dentists have a higher percentage of their earnings go in expenses than nhs as private practices are so much more expensive to run.

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Greg

It would be good to have a Which report on your view and others posted here, to demystify this situation with dentistry in the UK. I cannot understand why dentistry fees have gone so high, or why there can’t be reasonable competition, unless the government is involved mucking things up as usual. Which please do this report, it is a major concern amongst at least older people in this country, but it is a concern for the younger generation too and also for dentists in terms of their livelihood and credibility.

Witness myself, reasonably affluent at 47 but struggling, no way I can go to the dentist for any more than an NHS filling, while I have other broken teeth requiring bridges or removal/implant as recommended by my dentist. But I won’t go because I can’t afford it and I certainly won’t pay for someone to remove a broken/decayed tooth that isn’t bothering me only to give me a huge quote to replace it.

Also, I suspect that when I was a child and young adult, dentists did unnecessary procedures on my teeth in order to get money from the NHS. Why is it that my daughters, who devour chocolate and sweets, have not had a single filling in their young teeth or for that matter in their adult replacements, while my juvenile teeth were drilled to bits and filled to the hilt with fillings? Was that because I was undernourished as a child? What is the explanation?

I had one episode when the government introduced a £15 fee for initial consultation, in my early twenties I think (i.e. the 1980s) when my usual dentist was replaced because he was ill by a stand-in irritable dentist, where when I complained when she said I had to have the initial consultation and return a week later despite me having a bad tooth ache, she then proceeded to drill with a vengeance through the tooth to remove most of it and replace it with a filling that fell out on the same day.

I’ve never trusted dentists since then, alas.

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Ray Steggles

Responding to Greg.
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Demystifying dentistry would be a good idea from the point of view of patients and dentists alike. It would not sit well with the DOH because they prefer to obscure the situation and blame dentists for the mess they have created. For many, dentistry hasn’t been the best experience. Given knowledge, equipment, materials and the massive demand because of disease rates, dentists of the time were doing their best. Those who found their experiences unpleasant are easy targets to propagate perceptions of dentistry and pass them on to their children, friends, work colleagues and so on. The ‘Press’ play on these fears and create or repeat stories pandering and perpetuating these anxieties. As we can see, many are keen to add their negative perceptions on discussion boards. Modern dentistry is more to do with prevention and catching disease at its earlier stages. If people avoid us they only appear when disease is bad and treatment options limited. This feeds through to cost. Unlike older generations, many don’t want dentures, and the other options are expensive. The NHS will not cover more than basic, traditional types of treatment. There isn’t sufficient money in the system, even though everyones been paying ‘their stamp’ and feels entitled to any treatment they feel they need.

Do people really want to know about dentistry or are they happier to view it on the basis of their preconceptions?

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We can all choose how we spend our money. I have some patients, who elect to have private treatment, even though they could qualify for free NHS treatment. We all know there is a range of ability to pay and a range of desires to pay. What people would really like is to separate the desire from the payment. We all like a bargain. Bargain dentistry and other health care is not a good way to go. At what point does it change from being a bargain to dangerous or a rip off?

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35 years ago, when I qualified, there was so much disease we really couldn’t cope, and we didn’t need to do unnecessary fillings to earn a living. So if I had seen a 12 year old Greg, I would have been very pleased not to have to do any fillings. In all likelihood you were over nourished with the wrong things. What has changed is the use of fluoride containing toothpastes. Those who use them slow down the rate of decay, even if their diet isn’t particularly good. They still get holes, but later in life, when they can cope more easily with dental treatment.
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Does one poor experience make all dentists bad?
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That’s a shame.

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Ian

The bottom line with NHS dentistry is that the “service” is expected to be provided on a quarter of the European market value of dentistry. This was bad enough when the contract was fee per item but is far worse under the new contract. At least before if someone came in needing a full mouth reconstruction you got paid for what you did; a pittance admittedly but not a loss.

Another legacy of the NHS is the perception among the general public that dentistry is a cheap activity, leading to belief systems as instanced in one of the posts above where £400 was considered expensive for a root canal treatment and crown! The NHS has created a populace that expects to receive a very complex and very expensive service for next to nothing.

When the new contract was being formulated the main problem with fee per item was the money, which had led to whole new methods of providing high tech treatment on the cheap at high speed. In typical government fashion the new contract changed everything except the money. Now we have a situation where the same payment is received for ten fillings as for one, or for a root canal treatment taking, say, ninety minutes and an extraction taking ten minutes.

When I first arrived here from Australia I saw the fee levels and thought that someone was joking. Sadly it was not a joke. It was known that the drop from ivory tower academic standards to those of NHS practice was a big one but it was only this year, when I had the chance to speak to an undergraduate, that I realised that the university course content has now been corrupted by the need to provide NHS cannon fodder.

Dentists have differing opinions on what should be done about the NHS. My own feeling is that anyone who can pay should be private. The remainder in the benefit system should get First World treatment at private fee levels. What is happening, though, is that this situation is being arrived at by default, with dentists moving paying patients out of the NHS, but the fees for work on exempt groups remain at Third World levels.

All this is overseen by the GDC, a body which is supposed to look after the interests of patients, and which does indeed crack down hard on dentists who may have been faced with the choice between cutting corners and bankruptcy, but which cannot or will not address a system that makes it all but impossible to carry out First World dentistry. The GDC has always been politicised but, in recent times has become virtually a government quango. The ever increasing lay membership, imposed from above, is heavily stacked with lawyers; yes, the profession that is now making fortunes out of no win, no fee litigation, an activity whose worst manifestations border on fraud.

Which could have written a scarifying expose on the above but instead chose the tired old mystery patient routine, the first resort of junior journalists looking to make a name. Still, a proper treatment of all that is wrong at the heart of UK dentistry would have required some research and hard work.

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Greg

I agree Which should do a proper report on dentistry in the UK, rather than the rather shallow article against dentists that appeared in a recent report. I suppose that’s what I would like to see, and appreciate you and others for your comments here that are educating me out of a two dimensional naive position.

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Tim Moody

Average NHS payment per NHS dentist £98,000 pa. Average costs per NHS dentist £110,000 pa.
Average NHS payment per NHS GP £258,000 pa . Average costs per NHS GP £152,000 pa.
Can anyone see the problem yet, peeps? Anyone????

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Greg

So you are saying, I think, that a dentist has to make another £12,000 per year to cover their costs, and then make a wage on top of that? Once again I ask, where are these costs coming from? Forgive me if I am naive.

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A worker

Greg, premises costs (rent or mortgage), gas, electric, staff salaries , staff training, Care Quality Commission bureaucracy and registration fee, General Dental Council registration fee, equipment purchases, equipment maintenance, stationery, postage, computer systems, unscientific cross infection measures, scientific cross infection measures, carpets, desks, storage facilities, lab fees, contents insurance, buildings insurance, public liability insurance, dental protection insurance ( for those no win no fee lawyer), council tax, security systems, loans interest and we haven’t even started doing any dentistry with customers yet. Materials needed to do dentistry, time spent with customers, referring customers to other professionals (ie. cancer suspicions), time spent educating customers who know better and do not listen, fees to trade associations, training courses which cost £500+ loss of days earning(£1000) many of which are mandatory. Plastic cups, paper tissues, minty mouth wash tablets, toilet rolls etc.
That’s not all,but I think gives you an idea.

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Carol

The point is that even £400 is a lot of money for most people to pay out. There should be a Dentist Ofsted – who go around ensuring dentists are up to scratch, and this should be funded by dentists but be independent. They must register.

My experience: a cap became very loose. I have a phobio of dentists, problems with things in my mouth and a hiatus hernia which gives dry mouth. I needed quick treatment and my dentist had moved. Local dentist fitted me in, then was too busy to see me leaving me in the chair, ran in and said Oh and make another appointmnt., Did this. Drilled a bit and stuck it back on. Charged me £200 + so I got her to examine my teeth as part of this. She said I needed work on virtually all my teeth. 10 days later the cap completely fell off. Very distressed I went back but they said they couldn’t see me for two weeks. I demanded money back as I would have to elsewhere and undergo all the trauma again. Finally agreed. Went to NHS dentist who stuck it on for £15 – it is stil stuck on some 2 years later. She examined my teeth and said nothing needed to be done!!!!!!! No wonder we patients are confused. Which one was right? Is the original dentist a complete incompetent fraud who is deliberately making unnecessary work to make money, or is the NHS one not being particulary thorough. We need help. Dentists charge a lot compared with what ordinary people earn which is probably why we are known as a nation with bad teeth. I appreciate that some treatments might cost a lot but if we can’t afford to get our teeth done that is no good for anyone. So there needs to be some compromise, which presumably is where the NHS should come in.
My experience shows there is a desperate need for a Dentist Ofsted inspection regularly, so at least if we are paying huge sums, we know the dentist is both competent and not a shyster.

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Greg

I had a similar experience a while back, where a dentist put in a “temporary dressing” to help with a tooth that seemed all but shot, for nothing, telling me that it had to come out. But months later it is still holding, there’s no pain and the temporary filling is solid. I am confused too, but I think this forum that Which has created is great because we are getting some valuable and considered responses back from dentists that are helping to create a clearer picture of why dentistry is like it is today in the UK.

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Donna Jackson

Dentists are registered and inspected. There are over 50 bodies who can and do visit dental practices to inspect them.

The latest batch in England is cqc for which the average surgery pays £800 a year to register yet they duplicate alot of the checks already made.

It is partly the cost of regulation which is up to 30 times more than anywhere else in Europe that makes it so expensive to run a dental practice in Britain. A room in a NHS practice will cost £130 an hour to run or more, a private practice has even higher overheads.

People in Britain have bad teeth for exactly the same reasons they are the most obese in Europe and have highest cardiac problems. We eat a poor ,high sugar diet, we eat on average 7 times a day snacking rather than just eating at meal times.We do not brush and floss effectively. A dentist only sees you for a short time each year, what happens the rest of the time is in your hands.

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Greg

This sounds like a bloated buorocracy that is incurring expense on dentists, though at £800 a year that doesn’t sound too bad, so is this really the main complaint.

It would be interesting to know more about the cost of regulation, to which you refer. What is this regulation that makes a room in an NHS practice cost £130 per hour to run, and even more in a private practice??? Such figures don’t add up for me, because in my understanding by that account the costs of ordinary dentistry climb to astronomical proportions.

Meantime I have got used to missing some parts of teeth, and the fact I have no money to go to dentists for repairs, extractions, replacements etc. But I will say always that we should push for a better way at least for our children.

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Ray Steggles

Greg

If you want cheap dentistry, we could all go in this direction

http://www.youtube.com/watch?v=WR8tIjTykbE

Whilst you are waiting for the decline of UK dentistry, perhaps you would like to become a ‘health’ tourist. :)

How would you like us to cut corners to keep prices affordable? Which regulations will HMG cut to help us? Most dental practices are run very efficiently, probably much more so than state run health services.

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a worker

Greg another analogy for you.
1* hotel £40 a night
3* hotel £100 a night
5* hotel £200 a night
so why the price differences? It’s only a bed for the night.

I think you will find government regulations are strangling the life blood out of every walk of life, just because the public always want to blame if anything goes wrong. We have brought it on ourselves as a society.

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wavechange

This helps put things in perspective, Ray. You might have warned us that this video is not for the squeamish. :-)

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Greg

Ray I watched the video and although you may be taking the mickey I had great respect for the Indian dentist and think he is doing a great job. Maybe there is an opportunity over here for “onshore” pavement dentists who can do tooth extractions and replacements and an affordable cost, and I would use them if I couldn’t afford better. After all, what use is all the better technology if no one can afford it in their moment of need?

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Greg

A worker, thanks for your analogy. But actually, me and most people I know can’t afford to go away even for one night for £40, so what are you talking about?

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Ray Steggles

Greg

I put the link to the video to indicate what really low cost dentistry means and how it is being achieved, i.e. by total lack of regulation.

I wonder how many others in the population would be prepared to accept that level of treatment? I suppose a lot, if the country goes totally to pot.

The existing level of regulation forces prices up (as well as overall standards). In a totally unregulated market, some of us would compete with the street dentists by offering much higher quality for those who wanted it and could afford it. The market would take over, and basic treatment would be available to all at affordable costs.

NHS dentistry is supposed to do the same, without resorting to street dentists, and maintaining reasonable standards, but people still consider it expensive. As a dentist, knowing how much the service costs, I think people need a reality check. Unlike the street dentists, it is free for those who are exempt from charges, i.e tax payers are funding all their treatment, rather than subsidising part. All NHS treatment is subsidised out of taxes. As it turns out, the system is set up so that those who neglect their mouths most and require most treatment are subsidised by the dentist treating them. Unsurprisingly the system doesn’t work as set up, because it was forced onto dentists without agreement. They were given the option of signing or closing their practices.

Have you checked whether you qualify for free or reduced contribution? If you don’t , should we feel sorry for your plight? Have you made spending decisions which have affected your ability to get care for your mouth?

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Greg

Ray,

Interesting question:

Have you made spending decisions which have affected your ability to get care for your mouth?

Are you suggesting that all my financial decisions should be pivotal around how I care for my teeth and pay dentists?

I’m sure you are not, but your question indicates how disproportionate the expectation is in terms of spending for dentistry against other financial demands on our lives. In practice other demands are more imperative, for example in my life funding my daughters in their sixth form schooling, so what I might have spent on a tooth goes on a digital SLR camera for my daughter for her course (£250 second hand), or to pay for fines they have incurred through dodging train fares (£150 last month). Think on.

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Ray Steggles

I think it is helpful for understanding to put the current dental situation in historical context.
Following the second world war, the baby boomer generation was born. There was increasing refined carbohydrate in the diet. Within a few years, rates of dental decay increased rapidly, so remedial work increased. It was realised that dental services were becoming swamped and new dental schools were built to train more dentists. As these newly qualified dentists came through the system there was little more money to pay for them, so the remuneration per item of treatment was reduced in real terms virtually on an annual basis.
Probably through to the 1980′s, the amount of work was overwhelming. Many people were presenting in pain with 8 or 10 very damaged teeth. These were filled quickly, efficiently, and at relatively low cost. These fillings have lasted, in many instances, for 30 or 40 years. Lifespan has increased, and no planning was put into place to deal with the inevitable effects of wear and tear. On the contrary, as the effects of fluoride containing toothpastes reduced the incidence of decay in 5 and 12 year olds, projections were made to show that fewer dentists would be needed, so dental schools were shut.

Attitudes have changed. Pre-second world war, before the NHS, many accepted loss of teeth and dentures in their 20′s and 30′s. Free or low cost dental treatment within the NHS after the war, permitted people to keep their teeth, and the current baby-boomer generation and later cannot accept early loss of teeth. They have become more appearance conscious and want more natural looking repairs. New materials have been developed which are much more expensive than the original NHS materials. Placing those materials is more time consuming, so adds to the cost.

Leaps and bounds in cross-infection control have taken place with AIDS epidemics of the 1980′s and vCJD, so we can all feel more protected. This trend has probably now gone too far, because we now have in place procedures to prevent diseases that have never been shown to have been transmitted during dental treatment, and are unlikely to be. These recent changes have increased costs considerably. Ultimately, the person being treated must cover the cost of these.

Changes in cross-infection control, materials, skill levels to provide modern treatment, and increasing regulations, higher medico-legal costs of the growing blame culture, etc have increased costs. Against this successive governments have reduced, in real terms, the amount available for NHS dentistry. They have also sliced money off the budget for other initiatives, which have been costly mistakes.

So at the present time, we have people who received free and extensive treatment as children, now finding that their repairs and teeth are breaking. Most have not made any provision for this and expect to have them repaired for next to nothing on the NHS. They also want the replacements to be cosmetically good, unlike the original fillings.

There is a gradual rise in oral cancers, which, as dentists we monitor for at regular dental examinations. Against this the DOH are reducing frequency of attendance, so we will see people at a later stage of the disease. Early detection is vital for early treatment to prevent mortality.

Government planning over the period from the Second World war has turned out to be poor. They have listened to academics, who have suggested lower cost options will suffice, but their predictions have not been borne out. This process is continuing, without proper thought to the consequences. There is an air of distrust between the DOH and dentists. The former refuse to take advice from the profession, because it is believed any we give will be tainted by self-interest. In the middle of this is the patient or customer, whose perception is being actively distorted to lay blame on dentists and divert it from government. After all, all they care about are votes, and political courage is low on the agenda, when political expediency or pragmatism are the order of the day. Now they’ve run out of money, so even if they wanted to do something to improve the situation, they can’t!

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Greg

Thanks, your explanation helps me understand a lot more. Time for a considered survey by Which, I think?

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Ray Steggles

Greg

What kind of survey can uncover the complexities? Surveys can only look at minute areas, usually selected for an anticipated result, and based on some prejudice. Perhaps a full analysis and inquiry is required. Even this is likely to have terms of reference set, and if set up by HMG the parameters will exclude government action, I suspect. Can Which? afford to carry out such a thorough and unbiased investigation?

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Greg

Ray, to your comment “what kind of survey can uncover the complexities”. You are right, a proper review is different from a survey, by definition the former being deeper, more probing and conclusive hopefully than the latter, which can be done just for buzz and to sell itself. A review also investigates with the expectation of some action being taken, even if the reviewers may have no power to take that action.

I suppose, having read the recent superficial indictment of poor dental practice by Which recently, I was frustrated because I just saw rag mag material, that didn’t tell the whole story and so irritated me. I was pleased to find the forum here and having shouted my biases and listened to the views of dentists better informed than me, it has helped me start to get a better view of how things really are.

Regarding whether Which could take on such a challenge as this, that is another matter. This is a completely different realm to scoring consumer products. But it would be great if they could, as this could be a step change in their maturity as not just a consumer watchdog but also a (hopefully) balanced and independant judge of other services that take into account more complicated issues such as history, past and current legislation, mistakes made, challenges for the service provider (as in this case dentists), current state of affairs and what could be done about these.

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jools

Thanks Ray Steggles for v. helpful historic context for this.

Obviously, there needs to be a proper government or independent investigation of dentistry provision in the UK. For whatever reason, justifiable or not, it is obvious by the number of postings on this site, that many patients (or clients) perceive a problem and distrust their dentist/dental treatment, and justifiable or not, dentists have issues with the way they are forced to work.

However, I am still concerned about the number of cases mentioned, both by the WHICH survey and by postings here, in which inconsistent or inadequate treatment has been given.

The explanation that dentists are at full stretch and receiving inadequate funds for their work, is surely not being used as a justification for lack of professional care – a response of “what do you expect for the money you pay”? Or maybe it does. Perhaps we have lost sight of the fact that good treatment is not totally measured by money, the amount of technical equipment used, or even the amount of time given. It is that intangible feeling that one is being dealt with to the best of the professional ability, given the time and money restraints. That seems somehow to be missing when lack of good treatment is blamed upon financial considerations i.e “if you paid me more, I’d do a good job.”
Perhaps part of dealing with this distrust of dentists is for them to run seminars occasionally, where they explain to their patients the difficulties they are working under and deal with any issues within that practice the patients wish to discuss.

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Greg

I gather from what you are saying that you don’t feeled adequate care is given for by your dentist because your dentist is lacking in funds. But then you say he/she could make up for it by a smile, and maybe a seminar to explain their problems? I would suggest that you are too polite and a national enquiry is needed. Or perhaps Which could lead the way on this survey…?

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Anthony Kilcoyne

Dear Greg, Carol and many others,

Thank you for your comments – it is becoming clear to me that the MAIN issues for you as patients, is the fact that you have to pay for Dentistry, not just Privately by choice but also on the NHS too.

I have sat in hospitals kept waiting, had a simple X-ray, been made to wait again, then gone somewhere else to have a simple dressing afterwards – not a great service but FREE to me on the NHS, so I can hardly moan, can I?

Of course they have experienced high overheads, specialised equipment, staff wages and all the background training required, from Medical updating, handling emergencies, H&S and of course numerous bureaucratic inspectors who expect some 14 forms per patient to be completed too – cost to the Taxpayer of that visit probably £1000 to £2000 but hey, I’m not paying it so I don’t mind.

Now if I was billed the REAL cost of that visit at say £1500, then I would suddenly be asking all kinds of questions about whether that was ‘value’ or ‘good service’ and suddenly I would care a LOT when I’m paying for everything, building, equipment, staff, training, paperwork tasks plus materials etc.

All proper medical care is very costly, with Dentistry becoming particularly high-tech and very much based upon keyhole surgery techniques. The buildings, the equipment, the staff and the materials have to pass rigorous standards and cost a fortune to maintain and check and those in their own businesses bemoaning the massive increase in H&S, well in medical and dental care you can at least quadruple that, it’s getting (needlessly) worse and dental treatment and knowledge is bespoke and unique for every patient – in over 25 years of working I have never even done two identical restorations (fillings) and I know THE biggest factor for Quality is TIME, we simply need the time to care better, but more time = more expense = a larger bill for someone!

So come on WHICH, don’t just have a dig at an easy target like Dentists that nobody (I hate dentists is a regular comment) likes allegedly, ask the REALLY important questions, like why don’t we have a National Dental Strategy that makes plans for Treatments/Prevention over the next 20 years? Why isn’t time spent with patients ( instead of paperwork ) THE biggest indicator of Quality? Why do patients have to pay anything if any Dentistry is really NHS? Why have you added extra burdens and costs to Private Dentistry who have to pass these onto patients directly? Why don’t you now run a National Dental Prevention campaign, when dental problems are 99% preventable?
Why do Dentists have one of the highest suicide rates amongst all Jobs? Who would want to be a Dentist in a hostile system?

Yours also questioningly,

Anthony Kilcoyne

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Carole

Sorry if I appear unsympathetic, but my dentist told me the only treatment he could offer me for a cracked tooth was extraction and replacement with an implant at a cost of 3,000 British pounds. All this with a big grin on his face and a large picture of his very luxurious yacht moored in Salcombe harbour behind him on the wall. Salcombe is about as posh as it gets, he went on to talk about his very expensive house, car and the boat – just tactless. He is extremely wealthy and most of us could not afford to spend all that money on the grossly overpriced treatment he offered to keep him living in the lap of luxury. Perhaps the dentists who are milking the system would feel less suicidal if they offered value for money and didn’t foster resentment from poor saps like us who line their pockets. I am sure not all are the same and I have met some that are honest and caring, but lets just say you never meet a poor one do you.

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jools

If it is so bad here for dentists, why do they come to Britain to work from all over the world?.

Dentists come to base practices here, (NHS and Private) who originate from Australia, the Middle East, Sweden, Poland, Spain, China, South Africa etc. Or are they literally “practising” on the Britains before returning to wherever they are from? Is this particularly the case here, or is it the same throughout Europe? Perhaps this is part of the problem – that dentists are trained in many different countries and colleges, which means you get different approaches.

According to the BBC site, vets have twice the suicide rates of doctors or dentists. The correlation between occupation and suicide is at any rate, fragile.

I have been to 2 private practices in the last couple of years or so – the first who was Swedish and carried out quite a number of crowns and the second from South Africa who said he couldn’t understand why so much work had been done on my teeth. (the Swedish one who was in her early 50s has now retired) If you don’t have a throbbing or loose tooth, you don’t know what is going on, if there is silent decay of some sort. One has to rely upon a dentists advice, as you don’t want to wait until in pain and you risk losing the tooth, but so much seems to be a matter of individual professional opinion, and that is where it is difficult to trust what they are saying. That is why earlier I suggested seminars to give what the professional approach is of that particular practice i.e pre-emptive intervention, or waiting until there are signs of problems, or continuing education about dental health or whatever else that will answer client’s queries.

I have now gone NHS as on a pension, and can’t afford to pay the full amount anymore.

People don’t hate dentists, but they hate having to visit them – it is not a comfortable experience and unlike the GP or other professionals, it takes place on a regular basis throughout your life. If people don’t like the visits, the ball is in the dentists’ court to do something about it, to make it high profile and get support from their clients and make a fuss with government.

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Anthony Kilcoyne

Dear Jools – you make some interesting points not least your last one which is it is up to Dentists to kick up a fuss! When we do, we are quickly put down with accusations of being Greedy or Selfish or Resistant to change etc – the systems we have now in England were imposed DESPITE warnings from the Dental Profession this would be bad for patients and we were given the ultimatum of Like it or Lump it, we can always ‘import’ Dentists from other ‘poorer’ countries to replace you if you don’t tow the line whatever the consequences for patients and if more of you go Private to spend more time on average, we will damn you for that too :(

UDA capped-funding dentistry in England and Wales has been a disaster for patients and the public in terms of dental health, more extractions and less advanced options being offered to save teeth on a National scale, which is what the English DH designed it to do by mainly/only providing ‘simpler’ courses of treatment. Thus IF a Dentist spends more time and more care with each individual patient, they face fines and clawbacks from the WHOLE practice as punishment, for not meeting ‘volume’ targets to rush through people to meet centralised targets of Access so the Politicians can say dental access has been improved, but what they don’t say is at what price – that price is less time per patient and thus less ‘care’ and treatment options than used to be offered on the NHS before this was imposed in 2006.

Coming full circle to this story from WHICH, saying how examinations didn’t tick all the quality checks that ideally should be done – this is quite clearly DIRECTLY related to the time spent with the patient and at the risk of repeating myself and stating the very obvious point that Less Time = Less Quality overall for something as intracate and detailed as a dental examination and treatment planning for the short, medium and longer term too.

If WHICH is willing or unable to make this point publically, that government targets are too biased towards rushing higher volumes of people through a clinic as a measure of quality ‘performance’, rather than the time spent with each individual as a better qualitative measure, then nothing will change frankly and we will head straight into another Mid-Staffordshire disaster where an EXTRA 400-1200 people died in Hospital because Medical Staff were forced to chase Paperwork/Volume Management targets and inevitably spend less time with the patient – this mentality is spreading to the Private sector too as it becomes dangerously ‘normalised’ by the Department of Health for England and Political rules that regulate Professionals.

Yes Time = money too, but who thinks rushing people through a healthcare system (Dentistry or Hospitals) and putting paperwork before direct care is a good idea or value for money overall?

The answer is not you or I, but the Politicans and their Civil Servants at the Department of Health and their Agents do, they think it’s clever saving money using cheaper Breast Implants to save the NHS money too and worst of all, the Private sector start getting told if it’s good enough for the NHS then their managers say let’s copy this ‘established’ World-Class system, so everything gets ‘dumbed-down’ over time in the name of ‘Quality’, when it’s really Quantity measures which MUST impact upon quality negatively at some point.

I agree the Profession AND the public together, including bodies that claim to Champion the public interest like WHICH, need the Courage to say actually, this Emperor is Naked, time with patients is THE most important Qualitative target and if you compromise this you compromise everything else !

It really is as simple as that, but of course it isn’t simple, it requires a cultural change and pressure to be put upon Politicians and the DH to act, not just spout out the usual sound-bites but continue with the same failed approaches to dumbing-down care by relabelling quantity as quality just to look good on paper :(

I’m not sure I would recommend anyone to have a career in Medicine or Dentistry in England under the current DH regieme now, where their Professionalism is so restricted or even penalised for spending extra time to care for patients individually – how sad is it that I and many others who actually like our Profession and helping patients, are made to feel like this?

Yours genuinely concerned,

Anthony Kilcoyne.

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jools

So WHICH…are you going to take this issue further? I think everything that could be said has been, by both dentist professionals and receivers of the service. Some whistle blowing, media launching, government embarrassing action is needed.

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Greg

Agreed. It would be great if WHICH, as an apparent Ombudsman of public interests, could take up this challenge rather than leave it in their chat area. I don’t think that everything has been said though, all of this needs go through a proper evaluation and I suspect WHICH is not competent enough for this challenge, as I have said before in this forum, and as is corroborated by their silence.

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Joanna Pearl

Thank you for all your posts.
I would like to make two points:

1) Our article (and mystery-shopping) was about testing the experience of the consumer: for us that’s fundamental and the right place to start. I think that the expert view column (titled ‘time for change’, in fact) does put the issue into some perspective, although I accept that this could be broader..

2) I do understand the depth of feeling expressed and the issues with the wider system around the patient experience, and there is a depth of debate that I have found very interesting. While this is not an area that Which? is campaigning on, I will start by collating the views and debate expressed here so I can report back to DH and regulators but will also see what we can do to also reflect the issues behind what was presented in the magazine. We have also engaged with the GDC around their standard-setting, so there is work going on behind the scenes.

Your comments are not going unheeded. We do think quite hard about the methods we use, and how we present issues, and I can honestly say that we’ll be thinking about future health content and its presentation.

Please do continue to suggest constructive ways we could engage, bearing in mind that this is not an area we’re currently campaigning on.

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wavechange

I appreciate that introductory articles on Which? Conversation are provocative to stimulate discussion, but apart from your personal experience this is rather negative and tarnishes the reputation of those dentists who are doing their best.

If an organisation published a brief report that was highly critical of consumers’ organisations, I am sure that Which? would be rather annoyed. :-)

What we need is more constructive criticism and less journalism.

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Greg

Well said wavechange, my point entirely.

Joanna I thought the whole ethos of Which was to campaign on matters of interest to the consumer, and not to engage itself in tittle-tattle journalism that does not give a fair representation but sells your magazine. I am suspicious of the real value of Which as a result, unless there is a follow up, if you really want to get into this territory.

I think we will soon be seeing “onshore” street dentists (or at least the equivalent behind closed doors) in the near future, imported from India because less and less people can afford the dentists here. Mark my words. Even the cheaper solution, to go for a trip to Hungary or wherever, is beyond the reach of most people of a certain age.

Meantime some people I know with teeth problems are finding their own solution. I am one of them :)

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wavechange

I think part of the problem is the difference between NHS dentistry and general medical care. Visiting a GP or hospital costs nothing and many people get free prescriptions. Those that pay for prescriptions can purchase a pre-payment certificate that will cover any number of items for £104 per year. It is not so long since I spent around £500 pounds on a single tooth, which eventually had to be removed. I am glad that I have always been able to afford dental care and feel sorry for those who are faced with large bills.

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DevonDeb

I’m grateful for the Which? report as it does indeed show the difference in experience of us as consumers. It helps to show that there is a need to improve the experience for most people. I don’t think that the good dentists and professionals in this field need feel defensive, for we all know that there are outstanding dentists working in both private and NHS practices who deserve high praise.
What is needed though is a way for consumers to feel confident that the advice and treatment given to them will be within a similar margin no matter who they visit, and that they are receiving good value for money whether they pay directly for it or not.
I have personally received great treatment, good treatment and appalling treatment from different practices both as an NHS patient and as a private patient. I have had dental treatment in the USA which I had to pay handsomely for but was treated in a vastly different way. Their whole ethos is in a higher league to what I have witnessed here so far. There the customer/patient is king.
Education for personal responsibility toward good diet and dental health, along with an attitude towards financially preparing for such expense in the form of insurance perhaps, will help to improve the situation.
I have awful teeth due to irresponsible and selfish parents who couldn’t be bothered to teach their children to brush their teeth, and who provided sweets/chocolates before bedtime.
However, I educated myself and my own children have had regular checks and none of them had fillings during childhood.
I believe that I get better service and attention if I pay for treatment even though it feels expensive, but I look at it like this….If my car goes wrong I pay for that despite it being expensive and I am more important than a car. I don’t have Sky TV, don’t drink or smoke etc, and money is tight for our family but I do budget for our dental care and if we cannot afford it, we do revert to NHS as a ‘safetynet’.
I am grateful for the good dentists, the ones who really are awesome in very difficult circumstances, but I want to see the many poor ones brought to light and made to improve.

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a.paris

Dr. Steggles. I have some questions i would like to ask you but don’t want to ask on this forum page. Am i able to email them to you? If so what is the email address? I have looked on every site with your name and practice on the web but couldn’t see an email address to do this. Thanks.

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Adentist

a.paris

If you put up a contact email address, or if Which are prepared to forward your email address, I’ll contact you. I don’t want to put mine on the list with the possibility of being bombarded.

Ray Steggles

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a.paris

I have replied to the email sent to me by Which? Hopefully they will send you my email address. If you don’t receive it please let me know via this site. Thanks.

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Adentist

a.paris

Just to let you know that I’ve received no response, so far.

Ray Steggles

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julieshrive

I suspect a lot of this is to do with poor restructuring by NHS originally [before Thatcher ] which made many dentists opt out .
I have often been without access due to a need for sedation that is not done on NHS .
Anaethetists refuse even hospital ones , as don’t want the risk as have had cardiac arrest due to system negligence ,

This has left me having to access corporate Europe with same problem taking money then refusing on assessment . Calling the restoratve cosmetic . The only way round the problem was to find a dentist who was an anaethist who has proceeded carefully over a year saying I am his most complex patient.Had I had it done I probably would have not been coming home alive as pulse fluctuates on eating & sedation.

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tim eley

I went to my dentist recently and had a check up descale and teeth clean he then informed me that from 2014 they would only do fillings tooth check and descale as cleaning of teeth would now be classed as cosmetic and in future i would have to have it done by the hygienist minimum cost £50.00 is any body else aware of this change that this government has slipped in on its health reforms and will this lead to more bad dental health,as less people will go to the dentist because of these measures, as usual they take your contributions off you for over 40 years and then cut back on on your health as you get older

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lucy Saxon

I went for a check up and despite explaining my phobia. Medical history and disabilities the new dentist, who has taken over my old one, said she wanted to start treatment and I couldn’t have sedation. And she only did white fillings which I had to pay for despite being entitled to free dental care. She didn’t care about my phobia or botched dental treatment at the same practice for which I was compensated for. I was told I needed all my fillings replaced with white ones, an inlay and none would be free. She said my teeth were ok as I didn’t smoke. I said I do smoke and she said my teeth were in dire need of cleaning and she would do them immediately. I said no way as I couldn’t cope with the drill unless sedated with valium. She was a foreign lady with poor English. In the end I said no way could I afford private and left. A second opinion said I had perfect teeth. My phobia is worse now!! I can’t trust a dentist full stop!!

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Anthony Kilcoyne

Dear Which,

I must say I find it strange how quick your organisation is to attack Dentists, but very slow to criticise an NHS Dentistry system in England that is simply UNFIT for purpose – can you explain why that is ???

Anyway at least the daily Telegraph is willing to publish our dental professional concerns about BAD systems being BAD for patients and the public generally.

Can WHICH start asking some pertinent questions of the English DH, without accepting the usual Spin at face value ???

The public need you to act in THEIR interests – good people stuck in a BAD target-system cannot do their best, surely Mid-Staffordshire disaster has proven that?

Read more here and if you want to do a serious expose of the failings of the English DH, in the public interest, just let us know.

Yours exposingly,

Anthony Kilcoyne

http://www.telegraph.co.uk/comment/letters/10546044/The-public-should-know-of-the-dangerous-decay-of-NHS-dentistry-in-England.html?fb

and ……..

http://www.telegraph.co.uk/health/healthnews/10545878/NHS-dentistry-is-unfit-for-purpose-professionals-warn.html

Dear Anthony.
Rather than seeing it as Which? attacking dentists, are we not approaching the same issue from different directions? We took a consumer-focused look at the clinical treatment the patient receives (via a mystery-shopping investigation in 2011, when we were also doing policy work looking at the NHS dentistry system). You are looking at the endemic reasons why the system might be failing patients.

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Anthony Kilcoyne

Dear joanna,

Thanks for your response.

The unpalatable truth remains, when you put GOOD people to work in BAD systems, it has bad outcomes for patients.

In one Hospital, Mid-Staffordshire, that resulted in 1200+ additional DEATHS and goodness knows how much other avoidable harm !!!

Your report noted that many examinations of new patients were 10mins or less = wholly inadequate to do a thorough and proper examination. ABSOLUTELY agreed !!!

However as you’ve seen from the English Dental DH response, they brush such genuine concerns aside and simply say there has been an additional 1.2million people seen on the NHS since 2010, AS IF THAT’s A GOOD THING :o

Rushing even more people through a compromised system where there already isn’t enough TIME to CARE properly, gets even more pressure and targets put upon it to rush through even MORE people (1.2million more!) so the Politicians can mis-prepresent what these Statistics actually mean qualitatively!

Can you believe that NHS practices get told if they don’t meet these ‘volume’ targets imposed centrally, even if they’ve spent more time helping anxious new patients get dentally fit and fix their many problems to a high quality etc, the Mis-managed system still says SO WHAT, you will lose or get reduce resources for patients next year if you don’t rush people through regardless, because it’s ALL about TARGETS not PEOPLE :(

Come on WHICH, we need YOU to HELP us Professionals have protected TIME to care for EVERYONE properly, not attack us for such chronic limitations and increased pressures.

Expose The Big Lie publicly – to quote from the recent articles in the Daily Telegraph ,start with publicising this in the wider public (and consumers) interests:

“The Government continues to promise the public that all dental clinical health needs for the population of England are met under the NHS dentistry system, to the highest standards. Yet, with compromises on a national scale, it is frankly impossible for dental professionals to deliver this.”

If you want help or the references that back up such genuine concerns in the public interest, I and many others would be delighted to help.

The Francis report into the Mid-Staffordshire disaster and even the recent CQC Chairman’s statement are quite clear, the NHS system doesn’t tolerate criticism (so how can it change/learn from serious faults) and even when Professionals are powerless to change centrally imposed Bad systems and Bad Targets, we need to warn the Public at least.

My apologies if I assumed that WHICH were also prone to never criticising the NHS system flaws but just the struggling workers within it’s imposed limitations = bad for everyone :(

The best protection the Public has is our Professionalism – please help us expose how centrally, this is being limited and eroded against the Public interest overall.

Yours still deeply concerned,

Anthony Kilcoyne.

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Keith Hayes

I want to thank Tony for telling the Public what all dentists know privately to be true.
I hope that patients and consumer groups now get behind us and start asking the Department of Health some of these difficult questions which they have avoided until now.
We spend £3.7 Billion on NHS dentistry and still we end up with a system which is not fit for purpose and pretends that it can deliver everything to everybody.
It’s high time that we had some honesty here.

I wrote to Which recently in an attempt to get them to look seriously at the bigger picture and listen to what the dentists are saying. So far I’ve heard nothing and I am wondering why that is?

Is it because its a lot easier to trash a few dentists than to really understand the problem.

Is it because they believe that they are serving the public who buy Which magazine better by doing this rather than asking the people that continue to inflict this awful system on the innocent public?
Joanna said “We took a consumer-focused look at the clinical treatment the patient receives”
and you weren’t impressed were you?
Isn’t it about time you ask why this happens and stop playing to the gallery.

I hope Which are better than this and recognise that a large group of health professionals are genuinely asking for their help to improve the services that are offered to patients.

We’re not selling beans and you can’t pile it high and sell it cheap. We are caring professionals and we want your help. We need to have sufficient time with each of our patients to ensure they receive the type of care that we can all be proud of. Is that too much to ask of a consumer publication? Show us you care as much as we do.

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Carole

During my root canal treatment, my dentist only offered plain tap water to wash out my mouth between stages of the surgery. Should he have offered antiseptic mouthwash.

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wavechange

I assume that the main purpose of dental mouthwash is to mask unpleasant tastes. Most chemicals that are harmful to bacteria are not that good for humans. I believe my dentist has stopped using mouthwash, though I have not had any major work done recently.

It’s an interesting question, so let’s wait to see what the current recommendation is.

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John

My wife and I started to lose confidence in private dentistry when her Denplan contract was increased by substantial sums annually and yet all she required was an annual check-up.I appreciate that Denplan is a different organisation from my dentist’s business nevertheless her dentist was the only point of contact and he could not explain the increases.
We both now pay for treatment directly. About 2-3 years ago our dentist started suggesting that we both required six monthly check-ups when in the past annual check-ups seemed to suffice. This was followed up by frequent chaser phone calls from the dental surgery.
Recently after my check-up I was advised that I needed a scrape and polish from the dentist and eight weeks later a visit to the hygenist. I was given an estimate for the treatment which I am happy to pay but there is doubt now in my mind about whether I need any or all of this treatment.
My dentist is now part of a large national group and I am wondering if each dentist now has to meet an annual income per patient target.

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