29 May 2012 / Health

Open wide please – the results of dentistry’s check-up are in

Charlotte Fitzgerald Engagement Strategy Manager

Comments 39

The ‘dentist’. Just that word can send you into meltdown – whether it’s fear of the pain or the cost of the treatment. Yet we also know that some of you love your dentist, and are very happy with the treatment you get.

There are three set cost bands for NHS dental treatment. But most high-street dentists in the UK provide both NHS and private treatment – so things can get confusing.

Our own research has found that people don’t really shop around for dentists – and that’s hardly surprising given that it’s hard to find private treatment prices that you can compare easily.

When my practice had a big shake up a few years ago, I was duly informed that to keep my dentist I had to go private. I obliged and made the switch.

After a painful bill a couple of months ago (£350 for two fillings to be replaced) I decided to get on the waiting list for an NHS dentist. I’d managed to get my boyfriend on it pretty easily last year. He was on the list and signed up in around three months. But it looks like I could be waiting much longer. In the meantime, how do I know what a reasonable price is?

The dental market

The Office of Fair Trading (OFT) has today called for changes to the UK dentistry market after it has found that it doesn’t always work in the best interest of patients. Echoing Which?, they found that patients don’t always have the right information at the right time to make informed decisions about their choice of treatment.

Amongst other things, the OFT also recommended that the process of complaining to your dentist should be simplified to make it easier for patients and dentists to resolve complaints.

I spoke to our dental expert, Rebecca Owen-Evans, to ask her view on the OFT’s report:

‘We’re pleased that the OFT has called for more clear, accurate and timely information for patients, and support moves to make this happen. Whether they’re going private, NHS or a mixture of both, all patients should know the facts about their treatment – including the cost – before it starts’

Dental treatment plans

Despite my desire to get on the NHS list, overall I’m happy with my dentist and the service she provides. She always gives me a printed price plan and I rather weirdly love the visual of my teeth and the relevant dental work sketched on the plan.

A few friends have looked bemused when I’ve mentioned this to them in the past and it’s got me wondering if all dentists actually provide their patients with a written treatment plan – does yours?

So, are you happy when you leave your dentist with a gleaming smile? Or do you feel like you’ve had little choice but to part with your cash?

Comments

susan taylor says:

29 May 2012

My dentist has changed dental chargers my last visit was to replace a filling, i was in the chair less than 2 minutes, no injection and was charged £46!!! I was mortified, I am unable to work and claim disability living allowance and they wanted half of it for 2 minutes work. They didnot inform me of the bands they now work on so now they wont see me till it is paid. I am petrified of dentists from being young, they were so caring i felt at ease with them, now i need treatment and dont know what to do. I would be gratefull for any advise.

Rebecca Owen-Evans says:

30 May 2012

Dear Susan

Thank you for your comment.

I’m not sure whether you had NHS or private treatment this time, but the standard NHS treatment cost for a filling in England is £48 at the moment. Charges differ elsewhere in the UK.

Lots of people are entitled to help with their healthcare costs. To find out if this applies to you, you can visit http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Dentalcosts.aspx

If you’re unhappy with the experience you’ve had, you can also complain about your dentist – please see our guide at http://www.which.co.uk/consumer-rights/making-a-complaint/how-to-complain-about-your-dentist/

I hope this is helpful for you.

Adentist says:

29 June 2012

People assume the patient charges on the NHS reflect the work done. The charges are tax collections and have been laid down by government. The dentist is required to collect this tax, irrespective of the time taken, complexity, or cost of materials. Dentists receive payment from government in a similarly crude way. There are some circumstances where the cost of providing treatment is less than that received, and others where costs often exceed payments.

The balancing act for dentists is making sure these even out, otherwise they will become bankrupt, and will be unable to provide any treatment. So those with high needs will tend to push the practice the wrong way. Those with high needs tend to be those who neglect their mouths, only attending when in pain. Those on lowish income just above the exemption level where treatment tax becomes payable, often leave treatment as long as possible. By this time the damage may be so great that the treatment tax collectable is over £200 (and the cost of treating several hundred pounds over that provided by government, and has to be found by the dentist).

It is rare that the patient charge(tax) exceeds the cost of treatment, so generally NHS treatment is a good deal, even though it is unlike medical treatment, which is free at the point of delivery.

Mike Browninton says:

16 April 2015

£48 on NHS wow that’s a lot, why not free

wavechange says:

30 May 2012

Dentistry does seem expensive considering that NHS care of the rest of our bodies costs nothing for most people and the cost of prescription drugs is capped for anyone who takes advantage of prescription prepayment. Eye tests and glasses are relatively inexpensive unless expensive frames etc. are chosen.

Z stiles says:

30 May 2012

My husband was told he needed bridge work and was not advised that this work was available on the NHS (we are NHS patients). New to the NHS practice having finally been able to get in with an NHS dentist we were unclear on the way things worked. We assumed that complicated work such as this was only therefore available privately (unless you are on benefits or a low income and then qualified for NHS treatment). After seeing the OFT report we became concerned that we had been charged privately for work that could have been undertaken on the NHS had we but known. The upshot is we ended up paying £1260 for work which under the NHS fee bands would have cost us £209!!!! We are gutted and wish to seek compensation from our dentist.

Adentist says:

29 June 2012

I can understand how you feel.

There are several dilemmas for your dentist. As you are aware the cost of your treatment was around £1260, which means that your dentist would have to find in the region of £960 to subsidise your treatment after receiving the NHS contribution. Where is this to be found? He could provide less treatment for 10 to 20 other people and try to makeup the shortfall.

The dental contract expects that all necessary treatment be carried out, but you can probably work out that there wouldn’t need to be many high needs patients to destroy a practice. The real problem lies with government’s unworkable contract which pits patient against dentist, as the former understandably wants the best deal they can obtain, and the dentist trying to maintain a viable practice.

You will have to decide how you want to play it.

Andy says:

1 June 2012

I must be one of the lucky ones! I live in a small town where 2 dentist practices are advertising for NHS patients. My 3 children live in a larger town, no NHS dentists available. My children have been registered with my dentist. A round trip of 18miles for any appointments. Why is there such a difference in availability in such a small area? Is this the same across the UK?

Michael says:

2 June 2012

On retirement in 2010, relocated back to Yorkshire. Impossible to find an NHS dentist even operating a waiting list, within a 10 mile radius of my location. (Via NHS on line listing). No option but to go private, but I am seriously annoyed at the lack of NHS places. Why, when I and my wife have paid our NI contributions all our life do we have to resort to private treatment?

Fred says:

4 June 2012

As a practicing dentist, I completely understand the frustration felt by those unable to get the treatment they need on the NHS. As usual it’s the dentist who gets all the blame. It’s not just our fault! I am deeply unhappy with the current NHS contract. which was forced on us in 2006 by the then Labour government. I have been involved in the training of newly qualified dentists for the past 12 years. This year I was not selected to be an “educational supervisor”. This means that I will lose one third of my practice’s NHS activity over the next year as the foundation year funding comes from a different “pot”. I applied to my local Primary Care Trust for some replacement NHS Units Of Dental Activity so that I could keep my outgoing dentist on. I was told in no uncertain terms that there would be no more available. I will therefore be a dentist short, and will be unable to traeat all of my current NHS patents within the NHS. Many others are in similar situations, and young dentists are finding difficulties in finding new NHS jobs as the contract put a cap on the activity levels and the funding. New entrants cannot get a foot in the NHS dooras the number of dentists starts to rise following the opening of 2 new dental schools. Many UK graduates will have to look overseas for jobs and yet EU dentists not required to do the Foundation Year Training are choosing to do so, and taking up the places so badly needed by UK graduates who cannot work in the NHS until they have completed foundation training. The whole thing is a complete mess which was started by the government, so please don’t blame the dentists, we are as frustrated as you.

wavechange says:

5 June 2012

If practising dentists are being blamed for the cost of NHS treatment then it may be useful to publicise the NHS charges for dental work.

phr33kbob says:

11 June 2012

Are dentists always practising, or at some stage do they become qualified?
Now to serious stuff. I saw my dentist today as an emergency visit. She is a young Greek girl (not a British citizen). She looked at my painful tooth and swollen gland; I said I had a bad headache too. She had a quick look and said ‘It has to come out’. Oh not another one I thought; and suggested maybe we could try anti-biotics. Eventually she agreed.
When I asked her about other possible treatments, she explained that my tooth was too bad to replace / have bridge work etc. (What is bridge work?). I do not understand this. Also I do not know what treatment, as being in receipt of Pension Credit, I am entitled to.
Are there any publications or web sites that explain ALL the ins and outs. Getting any comprehensive information nowadays is like pulling a tooth. Ouch!

joyk says:

14 June 2012

I went to an NHS dentist today for a check up and was asked if I would agree to pay independentely. I queried this as I wished to remain on the NHS. I was told the treatment and the cost would be the same, even if I needed other treatment at a later stage but that it would let them treat more people within the NHS if I agreed. I repeated that I didn’t understand why I was being asked to use a different system if everything was the same. Was told they could treat more people who couldn’t afford treatment if I agreed. I said I was on my pension too and wanted everthing even if I may need other treatment on the NHS. Not completely sure of the outcome. How do I know why he was offering this and if what he was offering was correct I really felt under pressure to do as he asked. Surely this can’t be right.

Dentist X says:

26 June 2012

I feel in many ways that today’s dentistry is part of another era. We saw it with most of the products available out there; there used to be little shops, and now it is all streamlined and centralised in big shops.
There are practices out there which are badly organised and a lot of time is waisted, that time is then paid for by the patient. I believe that we will see clinics where the whole patient journey will be streamlined, each stage of the treatment would be done as efficiently as possible, and by doing this the cost of private treatment could be pushed right down without any compromise in quality.
Clinics like this do exist accross the world already. It will only be a question of time before large clinic take over, just like supermarkets took over the small shops.
Patients do struggle to fund private dental care, and one way or another the costs will need to come down.
Please let me know your comments.

Worker says:

27 June 2012

I tend to agree with your sentiments, but dentistry is a highly individual and customer focused profession. Production line type process is exactly what is causing confusion and dissatisfaction currently. A filling is not the same to each individual, it is easier and cheaper to place a filling in a customer who is relaxed, compliant, does not gag and produces little saliva than one who is the opposite. If you are the compliant type why should you pay the same as someone whose needs are more demanding and time consuming?
This thought process is the same for every treatment, hence each individual treatment cannot be judged in a simple price list.

Worker says:

27 June 2012

Having just read the July issue of Which, I was intrigued to read that you do not intend to test hearing aids as there are so many types and degrees of hearing loss. So, why do you feel 60million different mouths can be fitted into a simple range of costs and circumstances?

Alan says:

27 June 2012

My wife and I have subscribed to Denplan for a number of years. Both of us have regularly had our six monthly check-up under the scheme and any required treatment has been minimal. We moved home and enquired to register with a local dentist and upon doing so we advised that we subscribe to Denplan. We were most surprised that the new dentist stated that we are expected to pay £120 (£60 each) for examination before accepting us under the Denplan scheme. This was despite the fact that each of us had had a routine check-up just 10 days earlier. Enquiries with alternative dental practices resulted in the same requests for payment. The reason given to us was “Denplan only acts as a collector of payment on behalf of the practice”. We’ve now decided to stay with the same dentist which is about a two hour drive, a journey we need to make just twice a year.

Worker says:

27 June 2012

This is where more confusion arises. As stated Denplan is a collector of premiums on behalf of individual dentists. A dentist will work out their overheads and decide on a fee necessary for varying levels of risk. Their fee maybe £10 per month for low risk patients to maybe £40 or more for high risk patients. Denplan collects the fees, take their admin fee and pass the rest onto the dentist.
If you move to another dentist (who is also a Denplan scheme) this dentist needs to assess you on their own risk scale. Their monthly fees may also differ from the previous dentist.
Now for the cynical bit……..if you are paying me £20 (less Denplan admin fees) per month why should I notice any minor problems which may or may not be growing. A new dentist would, sensibly, wish to assess that you have not been neglected.
So a second opinion is not necessarily a bad thing, especially with the cost of fuel for 2 hour journey.
VERY VERY FEW DENTISTS WOULD BE GUILTY OF NEGLECT, BUT IT IS A POSSIBILITY.

linda says:

30 June 2012

charging money to put amalgam flllings and lead in ur mouth which are poison need i say more

Alison says:

2 July 2012

Some prices were given on our dentist’s website – so you could compare charges if you did or did not belong to his insurance scheme. However I now notice this comparison has disappeared, and the only charges posted are for the insurance scheme – which we do not consider value for money, since we would not make use of all that’s covered. If you ask for prices for treatment, he merely says that he will tell you the cost before you proceed – not exactly making it easy to make comparisons with other dentists. (However, having had bad dentists in the past, we are reluctant to change.)

John says:

5 July 2012

Is this where comments are to be made about dentists NOT showing their NHS prices? At our dentist there are no prices shown nor do we ever get an itemised receipt. From time to time I get asked about payment when I’ve already paid so always keep my receipts. Where else would they get away with this? Imagine going into Asda & never getting an itemised receipt !! And they call themselves a “profession” !

miss Gruntled says:

7 July 2012

I moved to Surrey from Scotland. In Scotland I had NHS dentist and there didn’t seem to be the difficulties in paying for treatment as here, is it organised differently?
in England I thought I was lucky to find NHS dentist. They had pay bands advertised on the desk so I knew I would pay for an initial checkup. no work done and if I want a scale and polish it has to be via a private dental hygienist at £50 please !
3 days later I returned in an emergency in acute pain. They found an abscess and said I needed root canal work. I had to pay for the examination , same price as 3days ago, and they said they didn’t do root canal work on the NHS and it might be £700 to have it done privately.
it seems to me dentists advertise as taking NHS patients then only do check ups on the NHS and basic fillings. No one knows if patients can demand a scale and polish as part of this NHS checkup or if we have to accept costly private version. As a patient, and I am not completely thick, I find it impossible to know if my NHS dentist will treat work needed on the NHS rate or simply refuse to do it and only offer the private treatment rates. This would not be acceptable practice in any other service would it ? I understand that the way dentists get paid have contributed to this situation so pleas e can it be reformed in a way that is fair for patients and fair for dentists in a way that no one rips off the NHS ie all us tax payers!

Adentist says:

7 July 2012

There is a difference between Scotland and England, and I’ve heard that there are less problems for people requesting NHS treatment. I don’t work in Scotland so can’t comment further about that.

Unfortunately, patients often get a raw deal in England, because the way dentists are paid, under the new contract introduced in 2006, was appallingly conceived by the Department of Health. It is having repercussions through the growing antagonism between dentists and patients, and the neglect that appears to be occurring leading to a steady decline in the nation’s health. This is exacerbated by the economic climate, where everyone is trying to cut expenditure, and watching every penny.

Prior to 2006 the ideas for the new dental contract were leaking out, and it was obvious that there were going to be great problems. Some of us were in a position that we could refuse to accept the contract, but others accepted the reassurances, from a variety of influential sources, that it wouldn’t be as bad as they thought, and of course it would be tweaked if necessary. It turned out worse. Some had no option, but to accept the contract, because like many they had taken on large loans to buy their practices, they had staff who relied on them for employment, and they had to keep a roof over their own heads and support their families. They had no choice, but to sign the contract, in the hope it would be sorted out rapidly. It hasn’t been, and now we are beginning to see the fallout, with consumer groups taking increasing interest.

Unfairly the wrath of such groups and patients is directed at dentists, whilst the instigators of this debacle, the Department of Health sits in the background stirring the pot, encouraging the press, Which, and OFT to place all the blame on dentists.

The current expenditure on NHS dentistry, including taxpayers contribution and patient charges is roughly £3 billion, out of a total spend of £8 Billion on all dentistry in England. If everyone were to be provided with all the dentistry they need on the NHS, the government would need to buy up all dental practices costing perhaps £20 Billion and put all dentists and their staff on salaries costing around £8 Billion pounds annually. Can you see that the government couldn’t do that? They won’t say so, though. For political reasons, i.e. votes to put them out of office, they make out that a quart may be extracted from a pint pot. Dentists are left to try to make the figures work and keep some level of NHS provision in existence.

As someone who worked for and supported the NHS for 30 years, and only since 2006 when I saw what was happening, left, I am very sad that so much harm has been caused by a handful of people who thought they knew what they were doing. They will be living very comfortably on large pensions, despite the enormity of their failed experiment.

No one in government has the integrity to be truthful with the public, and accept responsibility, rather than push blame onto everyone else. We won’t make real progress until this happens. We will go in cycles of fudge and deception as the dental health of the nation continues to decline.

Malc.Moore says:

10 August 2012

I have a great young Dentist she is excellent my only complaint is the high cost of a proper clean.I think it is now £56.00 and Private only.I have always looked after my teeth since a child so its not often i have to have any work done even now i am a Senior.Cleaning your teeth should be a more reasonable price done by a NHS Qualified Assistant at present Private.

malcvolm says:

22 September 2012

My dentist practice has changed ownership. I am an NHS patient and for a check up I was presented with a bill for £37 – £20 more than the NHS cost for a check up – Band 1 treatment. I asked about this and was told that the hygienist was better qualified than required and provided a better service – but it was the same hygienist as I had normally seen and the treatment was similar. I was also told that this happened all over the country – hygienists were be coming self employed and having to charge.

I did not pay as I had not been told about the costs before I had the treatment – but its clear that I would be expected to pay the additional cost in the future. So can I only be an NHS patient if I pay for a private hygienist?

I was given the NHS leaflet that says a scale and polish is covered ‘if needed’ in the Band 1 treatment costs.

Adentist says:

22 September 2012

Where a dentist has signed up to the NHS contract, NHS dentistry should be provided where it is clinically necessary. Whether something is clinically necessary is open to interpretation, and this provides wriggle-room to get round the regulations and provide treatment on a private basis.

When is scaling and polishing of benefit to health, and when is it purely cosmetic, i.e merely improves appearance? That’s very difficult to answer, because it is necessary to consider whether ‘clinically necessary’ includes preventing disease, and this leads us to an individual’s risk of developing gum diseases. Surveys tend to show that established gum disease is widespread, silently progressing, and in reality there are few people where clinical signs are absent, and therefore, it could be argued that treatment should be available on the NHS.

Then there is the reality check. If all gum disease were treated properly on the NHS, there would be no resources to treat any other aspect of dental disease. So where do we go? Does everyone fight for their rights and force the system to a grinding halt, or allow some form of service to be provided, albeit not ideal?

You should only be required to pay privately for scaling, if you elect to have it for cosmetic reasons. So you will need to have a discussion with your dentist at each check-up to find out his/her view on your clinical condition and the reasons for the scale.

Wasim says:

15 November 2012

I am a practising dentist in London and have followed this thread with great interest. Unfortunately, I like many other dentists believe that the public has been firmly let down by the government.
In addition, I believe that no dentist should ever have signed up to this contract.
Any system which relies on a “swings in roundabouts” finance, a comment made by the CDO representing the government has to be laughable at best.
Ultimately, the consumer wants the best deal, which is understandable. Dentists are required (and rightly so) to spend adequate time treating and helping patients prevent dental disease, yet the net spend on NHS dentistry has remained the same since 2006.
The government needs to desperately increase funding in to NHS dentistry if it is to survive, otherwise I foresee a complete end to NHS dentistry very soon.
I do sympathise with dentists who have financial constraints in offering all treatment that are “technically available” under the banded treatment. However, I have always found that having an open and transparent relationship with your patient and explaining the constraints to them often results in a positive outcome.
Please email your MP, fight in your forums, do what you can but please do not shoot the messengers. Most dentists are fair and decent, and really want to help but are unable to do so due to this ridiculous contract in place

UncleMax says:

19 April 2013

I would like to see which? conduct a review of services that (private) dentists provide. eg. invisalign – massive variations in fee structures, tooth whitening – just what works and what doesn’t etc. etc.

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