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

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.

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.

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.