/ Health

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

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?

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?

Comments

Who addresses issues such as lack of NHS dentists in London & policy of no sedation if feel pain acutely even if you pay for it privately . Are they condemning many to no health care they have paid for ?

Dear Joanna,

Thankyou for your reply – adequate Quality (which needs adequate time to deliver it) is critically important, especially so in busy and over-stretched NHS systems.
Although the Pilots for NHS dentistry only officially started 1st Sept, already it is becoming clear that these Dentists are having to take 30 to 40 minutes to check everything well and communicate this with the patient properly!

Now if WHICH can support Dentists to be allowed this time to spend upon delivering this quality of care, you will see more Dentists (and patients) moving back to the NHS dental system in England by choice – however if the DH pulls it’s usual trick, the right noises will be made then at the last minute Targets will be changed, with the emphasis still on rushing through more patients in less time to meet Political Access targets, with NHS Dental Practices facing massive fines (called clawback) if they don’t meet productivity UDA targets on patients, which ironically would leave the Dental Practice with even less funding for NHS patients who need to be seen 🙁

Thus you have a not uncommon scenario of Dentists having to see more patients per hour to meet NHS productivity Targets, so less time is given per patient and then NHS NICE guidance on check-ups says send as many away as you can for 2 years to make room for more so DH can meet political Access targets WITHOUT spending any more money etc, etc.

This is then even more flawed because nobody has yet explained to me how you do Annual Oral Cancer checks on the NHS, if the NHS sends them away for 2 years!

Presumably if patients want this level of ‘Quality’, which your survey noted was an important dental check, they will presumably have to ask a Private Dentist to do this in the year between their 2 yearly NHS dental check-ups?

Given that November is Oral Cancer awareness month and Oral Cancer now kills more people annually than Cervical cancer and Testicular cancer in England combined, such poorly planned economic decisions in the NHS Dental system in England are far from ‘NICE’ and could even be contributing to the increases in Oral Cancer deaths we are now noticing.

So yes IF the new dental contract protects patient time needed to do everything properly on the NHS, it could be a great improvement Qualitatively, but will politics and cost-savings interfere yet again and compromise the delicate balance between Time/Quality ratio for patients???

Whilst Private Dentistry has suffered as generally paperwork increases and thus patient Frontline direct care decreases as a result, in general patients pay 100% direct to the Dentist for their time and expertise. Suddenly the reality then of how costly it is to pay for un-subsidised yet high-tech dental environments directly hits home and frankly patients notice what to them seems like ‘high-prices’, but remember Dentists have even higher overheads than GPs and they are paying for Dentist + Nurse + expensive materials, Xray machines, hospital level cleanliness and growing mountains of paperwork and audits they may never get to see, but which the CQC and other bodies now insist upon, driving costs up even further to patients.

Imagine if you went to Hospital and had to pay ALL the actual costs of your visit, Medics, Nurses, seterilisation, bandages, heating, lighting, Xrays, special tests etc. Basically it would be even more than Private Dental fees, but on the NHS the taxpayer pays it for you.

So yes Dentistry is a high-tech. high cost intensive and detailed medical speciality really, but if you want it to get better for patients, both NHS and Private, without the costs Spiraling ever higher, then reduce our wasteful paperwork burdens by 50%, free-up our hands to spend more protected-time on direct patient care and put pressure on government Systems to enable Professionals, rather than disabling Professionals, to do their best.

What is bad for Dentists and their Teams, is bad for patients too ultimately.

Please don’t get distracted in the petty politicised dogmas of NHS vs Private – the real truth is neither system can meet ALL the Nations needs by itself, so we should plan for synergy and a general raising of Quality in ALL systems.

But to come full circle, less Time = less Quality, so whilst some anxious people may want to get out of that Dental chair as quickly as they can, rushing things helps nobody, apart from NHS management tick-boxers who will tell NHS Dentists they are ‘under-performing’ if they take more time to relax the anxious patients and do everything properly too, I fear 🙁

I hope you’ll forgive my frankness, but it seems so easy to blame just the workers, when 80% of the fault lies in a poor-system that penalises time spent with patients – haven’t we learnt anything from the Mid-Staffordshire Hospital disaster where an additional 400-1200 people died, because medical staff were distracted chasing additional paperwork targets instead of providing more direct patient care?

Maybe only public-pressure from orgnisations like WHICH, can now help Professionals (Dental and Medical) get the protected time they need to put Patients before Paperwork targets!

Yours still realistically,

Anthony Kilcoyne.

Daniel says:
2 November 2011

As a practicing dentist I have some issues with this “research”.

1) I feel a short initial appointment is not necessarily an indicator of poor quality as I feel it is quite acceptable to use this initial appointment to initially assess a new patient and then allocate appropriate time at another visit to carry out necessary investigations or provide preventative advice. This is more an indication of practice efficiency rather than poor quality. It may be that the hygienist provides the preventative advice in the practice and so this would be done by them at another visit. It does not mean that the patient was not going to be offered preventative advice. Maybe the x-rays were to be done at a future visit? Perhaps this makes your conclusions flawed. I personally on a daily basis see patients initially to screen them so I can then allocate the appropriate amount of time at a future visit. There is too much to do and say in a single visit.

2) It cannot be disputed that there will be a number of suitable treatment plans for each patient. In reality if you go to ten different dentists with the same complex problem you will likely get ten different treatment plans. This does not necessarily mean that any one is better than another. In dentistry there is almost always more than one way to treat a problem and treatment planning decisions are based on personal philosophies which vary from dentist to dentist depending on training background and clinical experience. One treatment plan which would work well in one dentists hands may well not work for another. There are endless hundreds of dental materials and techniques that are used routinely by some and disliked by others. However, my point is that for your so called “dental experts” to criticise from their ivory towers when in all likelihood they are not wet fingered dentists working in general practice treating 30+ patients per day is very unfair. What exactly do you mean when you claim there was a “’a hotch-potch of inappropriate treatment’” can we have specifics? It is all too easy for a dental “expert” to criticize a treatment plan when they are not the one carrying out the treatment.

There are good and bad in every profession and dentistry is no different. However, the NHS system at present makes providing a top quality service difficult (not impossible but very difficult). The dentist is expected to carry the burden of ever increasing paper work and bureaucracy. A massive increase in practice expenses and no increase in funding over the last few years. This (despite popular belief) has resulted in reduced income and a number of incidents of bankruptcy and practice closures over the last few years. The NHS system requires a certain amount of activity from the dentist which penalises them for spending time with a high needs patient. If they don’t meet their targets because they have spent a disproportionate amount of time helping those high needs patients then their funding will be cut. The system awards the dentist the same number of units of activity if they do one filling or 10 fillings for a patient (in any industry this is an absurd system). So if a dentist takes on lots of patients who need a lot of work they will never meet their targets. If you want a preventative service then have the government pay for one because at present they don’t.

I see you have spoken to the GDC. In fact revalidation already exists and dentists are probably some of the most over regulated professionals in the UK at present.

So the bottom line: If you want to find a good dentist then shop around, get a second opinion if you are not sure and ask for personal recommendations. And the country needs to come to terms with the fact that the NHS cannot afford to provide a world class fully comprehensive dental service. It’s not fair to blame the front line clinician when they are being held back by a lack of funding. We need to come to terms with the fact that if we want top quality dentistry then we are going to have to pay for it. The department of health need to stop pretending that the service is fully inclusive and just be honest with us.

Alisdair Mckendrick says:
2 November 2011

There is nothing new in your report “Which”. You have taken a paltry 20 visits and drawn absolutely unjustifiable conclusions. I am so so disappointed with your sensationalist headlines and such very very poor research. You should be ashamed!
The NHS dental system is broken and flatters to decieve! It claims to provide everything but fails to deliver even adequate care in some cases.

Stop slagging off the dentists and start to do some proper investigating.
Have a wee look at the statistics about private dentists’ earning as opposed to NHS dentists’ earnings..private dentists earn less!!!!!
Explain that to me. When our practice chose to leave the NHS it was because the 2006 contract was going to force us(the detists) into target driven DoH lead “smoke and mirrors”.
Dentistry has always sat on the sidelines of the NHS and never been fully embraced. NHS dentistry is not “Free at the point of delivery”. We are easy whipping boys.
Our practice left the NHS so that we could continue to provide time and care to our patients regardless of what the idiot politicians and the devious DoH planned for patients. AND guess what the patients are willing to pay for that.
Attack the system not the workers!
AND do some decent research.
The people let down by the current system are the patients and tax payers. Get on the case
Alisdair Mckendrick BDS

Barry says:
2 November 2011

The number of practices surveyed was to small to really give any indication of the state of UK dentistry . “Which” really needed to survey at least 50 or more NHS and the same number of private practices .
NHS dentists are paid by achieving a quota of units of dental activity the UDA, and they are given a target number of UDAs to achieve through the year to get their income . This target was set by the department of health based on what they assessed was the activity that dentists reached over a period of two years before the current system was introduced , even if the dentists feel that the targets are not attainable if they fail to reach their targets its possible that as well as having to refund money to the NHS ( which is acceptable ) they would forfeit these UDAs for any subsequent years even if they became busier or employed other dentists . ( which is not acceptable ) . Thus NHS dentists have pressure to complete a specific number of treatments per year which means that the time they are able to spend on patients can be limited . It also means that providing lots of fillings for a patient is a concern as the numbers of UDAs is the same for any number of fillings or crowns etc . Its a bit like getting in a cab and paying the same for a 5 mile trip as a 100 mile trip !!
NHS charges should be no more than either £17.00 or £47.00 or £204 depending on the complexity of treatment received i.e exam and clean with or without x rays / fillings and root canals / crowns , bridges or dentures and anyone paying different fees needs to query this at the practice .
Depending on a history a patient gives at the first visit it may not be appropriate to take x rays of teeth i.e if they have had some done recently elsewhere, but to maintain their UDA targets some dentists may not be able to spend more than 5 minutes with a patient during an examination .
Dentists are also struggling under the increased regulation and costs that are being forced on them by the DoH due to unproven and unsupported comcerns regarding health and safety and by the intrusion of the CQC which is the same for both NHS and private practices .
Some dentists feel that they are unable to maintain their standards when faced with the NHS , UDA scenariou and change to provide private dentistry , not necessarily to increase their income .
No dentist is perfect , dentistry is not a perfect science , its not like servicing a car but I would agree that a minimum standard should be met however dentistry is obtained . The fact that any dentist trained in the EEC can work in the UK with minimal checks on language and no checks on the standard of their dentistry does not help matters and the “Which” survey fails to investigate this aspect of dental practice .
The DoH runs a randomised questionaire which shows a 90% approx patient satisfaction with the dental treatment that they received so some patients appear to be happy .
Whilst the DoH is running pilot schemes of possible new dental contracts there is serious doubt among some dentists that this will improve matters .
Sending selected patients to an extremely small number of dentists is not the way to investigate the matter adequately .

A worker says:
2 November 2011

Whilst fully agreeing with the above comments regarding the failure of NHS and Dept. Of Health I would like to give an insight into the strangulation by the Care Quality Comission.
An analogy is probably easiest………..
As a home owner the government has decided it is necessary for you to be responsible for the safety and wellbeing of all residents ( staff) and all visitors (customers, tradespeople CQC inspectors etc.).
To do this you must identify all risks, write and record protocols and policies for each, keeping them updated at all times. To do this you will have to refer to all government legislation, employ experts where you do not have the skills (electrician, plumber, fire, gas etc) to ensure all facilities are safe and up to date.
You will identify all dangers and ensure all residents are properly and formally trained in the use of all equipment (cooker, fridge, freezer, hoover, fire, car, bike, lawnmower, hedge trimmer etc.) and hazardous materials (have a look at what you buy from the shops, if you don’t eat it it will have a hazard sign on it.
You will create checklists and use daily to ensure everything is perfect, you will keep all checklists, expert reports etc. for when an inspector calls. Should you deem certain things are not necessary you will have to write your reasoning down, so an inspector can decide if your reasoning is acceptable.
You will have different colour coded mops, dusters, buckets for cleaning different parts of your home. You will have notices over each sink to show how to wash hands correctly.
Every conversation or comment will be recorded to ensure you can show you are doing everything correctly. Don’t forget to have your policy to ensure the nutritional needs of all your residents are met.
You will also have to find time to go and do your job, but you will have to work longer/harder to pay for all those records, experts and to ensure the government has the money to check on you they will charge you an annual fee of £800.
There’s a lot more, but that gives you the gist.

Edward Byrne says:
2 November 2011

I find it hard to believe ‘Which’ that dentistry in the U.K. is so so expensive.
I have several patients who return to me in England from France annually because they get a better service at less cost, even factoring in the airfares.
I also had a family return from Spain who informed me that they brought the children to the dentist regularly whilst there, but went without themselves because it was just so expensive they could not afford it for the whole family.
I also had a patient who flew back to the U.K. from working on Broadway to have her wisdom tooth out and fly back again because the New York dentist refused to take the infected wisdom tooth out, instead referring her to an oral surgeon who wanted a horrendous amount of money.
I had no problem taking the wisdom tooth out , I even ordered special resporbable sutures in for her because she couldn’t stay around to have them removed a week later.
My own nephew went to the dentist in Brisbane, Australia. He neeed four wisdom teeth removed.
$1800 Australian Dollars for a one hour appointment !
Here in the U.K. the N.H.S. would pay a dentist on average about £66 for this.
Where a specialist Oral Surgeon was needed, the N.H.S. would pay the specialist on average £150.
So, that is why I am at a loss to explain why ‘Which’ says the U.K. is so expensive !!!
Something doesn’t add up here.
Edward Byrne.
Dentist,
Bedford.

Peter Thomson MICQ says:
3 November 2011

I have a large amount of sympathy for dentists who have had a load of unnecessary paper work ‘dumped’ on them in the name of ‘quality / clinical governance’.

In the late 1990’s I and two friends had set up a company to make clinical governance simple and were working with the Eastman Dental Institute and J D Hull and Associates to create a simple computer based system based on a proven methodology (ISO 9000) that would meet the requirement of clinical governance and more importantly add value to the practice management and delivery of care.

Sadly, vested interests in dentistry ensured the Eastman Dental Institute pulled the plug on this concept in spite of a clear warning from us that what was proposed by the vested interests was simple tick boxing, would not achieve any improvement in dental practice and be seen by the practices as a burden because it was badly run by dentists who had little training in quality management audit.

The practices that took part in the initial trial of the Eastman projected were very positive with regards to how the practice audit operated, reported to them and helped resolve problems and simplify records and processes. This was because the two dentists and one doctor carrying out the audit were all ISO 9000, IRCA certificated quality system auditors. The lead auditor was a full ISO 9000 certification auditor for the health care sector who had worked for an internationally renowned ISO 9000 certification company.

The problem for dentistry whether private or NHS is the background regulatory system has been made more complex and inflexible than it needs to be. In following this rigid monolithic path common sense has gone out the window as Mr Byrne has so eloquently described.

This has happened because well meaning people within the dental profession created a regulatory system that was beyond their competence to do because they thought they knew best rather than developing a compliance system based on quality assurance best practice.

As for whether fillings have ‘failed’ or not a study carried out by the Eastman Dental Hospital on MSc students in restorative dentistry demonstrated that in a large number of the fillings replaced there were no clinical symptoms or signs that clinically indicated a need for replacement, the decision was wholly subjective. In 75% of the fillings replaced the same faults that had been ascribed for making the decision to replace the filling were still present.

The question I would pose is how many of those replacement fillings were necessary and to what extent an NHS system of reward fixated on volume of treatment delivered, drives this style of treatment in England.

Donna Jackson says:
3 November 2011

We are a mixed practice who see both nhs and private patients. In seeing a nhs patient for a check up we have to potentially fill out seven different forms for the check up (medical history, record card, x ray report book, fp17 dc, nhs perio chart form, nhs prescription, referral letter). The amount that has to be recorded in the notes has increased exponentially in the time since I qualified and increases every year. Every patient nhs or private has at least two forms to sign and all of this is without actually discussing with the patient what they want, what problems they have and what their options are. All of this takes time and time has to be paid for. In a country where dentists are mire regulated than anywhere else in the world and more likely to face litigation , with some of the highest property and employment costs time is expensive.

In private practice you can adjust your fees to allow for the ever increasing time that complying with all the latest regulation and best practice allows. The reality of this is that overheads are much higher in private practice and dentists earnings are roughly the same working private as nhs despite increased cost to the patient.

In nhs no matter what it costs you to adopt best practice, no matter where you practice in a cheap or expensive part if the country, no matter that ever increasing costs of regulation, or that dental inflation (cost of materials etc) far exceeds headline inflation rates, the uda fee structure cannot be adjusted, if you do not do a set amount of dental units of activity each day you are penalised.

Medicine is very expensive to provide but the nhs system prizes access and quantity and unfortunately it is difficult to see that changing.

One final point British dentistry is NOT the most expensive in Europe. That came from a 2008 study on the cost of providing a filling for an 11 year old child with special needs. This was more expensive in the uk than anywhere else (but not for the child who doesn’t pay in the uk) because this was in a special dedicated community clinic set up to treat people with disabilities, a system which either does not exist in many countries and is run very differently for normal dental practice. The increased cost accurately portrayed as there is no profit made in community practice, how much more expensive it is to provide dentistry in the UK.

After seeing the patient at least 5 items must be disposed of and the rest decontaminated , sterilised, logged, and all surfaces, chair etc wiped down. It takes a minimum of 5 minutes to clear and clean and prepare without sterilisation etc.

Donna Jackson says:
3 November 2011

Recent research indicates that uk dentists are 34 times more regulated than elsewhere.

Regulation costs money. In England CQC regulation alone costs £800, the three day nhs and private inspection we had recently cost us alot more than that in terms of paper work to be gathered and surgeries shut down and dentist time lost. That is roughly 40 patient check ups to pay for cqc box ticking or more for the practice inspection. Over 50 bodies are entitled to inspect dental pracices and each has regulations that have to be paid for to enforce, comply with and validate. Does any of this increase the quality of care? Very debatable. But the increased expense to comply means each minute of time spent becomes more expensive to provide in a time when quality care needs much more time.

Are we democratic or not ? Why has this happened ? Greed ? Otherwise why didn’t dentists unite & stop this happening in first place . Why did government too allow this to happen ? Deregulation ? Nobody is satisfied but some of us can’t get appropriate treatment at any cost ?And this is with Dentists knowing this is happening ? As for regulation ? A call centre with those directed by accountants on remits maladministrating ? What is going on?

a worker says:
3 November 2011

Julie it’s called divide, conquer and ignore.
The Dept of Health (full time civil servants) makes decisions and rolls out the system.
The British Dental Association (sort of trade union) negotiates with DoH. The DoH picks comments from BDA and uses what suits them. The DoH has no fear of the BDA because, over the years, the public has been happy to accept that dentists are butchers, greedy etc. The public also have no idea of the complications of dentistry and do not want to know.
So the only course of action dentists have been able to use is to write to their MP’s, who in turn pass those concerns to the Health Secretary, who in turn contacts the DoH (you know, the ones who instigated the system in the first place). Not surprisingly the DoH tell the Secretary all is well with the world. Health Secretary replies to MP’s saying concerns have been looked into and are not a problem. MP’s reply to dentists that their concerns are unfounded/being looked into and nothing happens.
Sir Humphrey is alive and well and living in Whitehall.

Stuart Allan says:
3 November 2011

I will not repeat the comments from the dentists (with which I agree) but would like to address the issue of access to NHS dentistry which several have raised.

I have been in practice for 30 years, over 90% of my work in through the NHS. I have three colleagues working with me and though we have a steady stream of phone calls from potential patients we have exceeded the number of treatments (UDAs) we are contracted to do each year since this system started.

The NHS will not contract more as this would cost more thus access is denied; please do not blame the dentists though. The 2006 dental contract effectively allowed the NHS administrators to limit NHS dentistry and this is the result.

Ray Steggles says:
3 November 2011

Generally dentists accept that improvements in dental care are needed, and as individuals, we strive to achieve this. The flies in the ointment are those in the Department of Health, sometimes acting to meet Treasury guidelines, who introduce harebrained ideas which impact adversely on our collective ability to care for our patients. We know these won’t work, and has been said previously, many of us have written to our MPs, and in my case I have had a meeting to discuss it.

Unfortunately, the remit of the General Dental Council, which exists to protect patients, does not include assessing the effect of proposed government policies on patient care. It is limited to dealing with transgressions by individuals who are registered as dental professionals

With a few exceptions, all family dentists are private, many contracting all or some of their time to the NHS (they are known as NHS dentists, even though they fund their own practice). A sizeable number decided not to take up such contracts. Now it is extremely difficult to obtain an NHS contract. Every practice must be financially viable or, like any other business, it will have to close. To remain viable it must obtain funding from the NHS, as a result of providing the amount of work set out in the contract, and/or direct funding from patients. To continue to attract and keep patients the practice must be able to reinvest and improve.

Over recent years there have been great advances in knowledge of disease, with the ability to identify it at a much earlier stage, and improvements in materials and techniques. Many of these are very expensive, and although in the best interests of patients, the NHS will not fund them. So it is left to individual dentists to fund these and offer treatment on a private basis. The policy of the Department of Health appears to be to hound private practices out of business, so the valuable service they offer will be lost.

In theory, most dental disease is preventable and by concentrating on this should result in lower expenditure and more time for those who fall through the preventive net. Unfortunately, most people don’t attend before disease sets in, so that they can be assessed for risk and given specific advice. Instead, they attend with a whole range of established problems, overwhelming the available resources.

The current UDA system penalises NHS dentists for seeing a large number of these late attenders. Caring dentists will be drawn into helping such people, because they can’t leave them to suffer. By taking the time to do so, they risk failing to reach their NHS targets, and find ‘clawback’ of earnings, risking bankruptcy.

Is it right that a system encourages dentists to be less caring?

Like many others who could see the implications of this system before it was imposed, I left the NHS so that I could care for my patients in the same way as I would for my family. At the time, I was hoping that many more dentists would do the same, forcing the Department of Health to have a major rethink before it was too late. The DOH pushed it through, despite all the criticism from the profession. We all know why it was done – to cap spending on NHS dentistry. It has achieved this, so the Treasury is pleased, but a different price is now being paid.

Ray Steggles BDS MBA MSc

Mary says:
3 November 2011

I work in a mainly private dental practice which has a small NHS contract used for children and adults on benefits. The PCT are threatening to remove our contract this year. This is because once again we have not met our targets. In past years they have taken money back but are no longer willing to do this. Why can’t we meet our targets? It is because a.) we spend the necessary time with the patients, b) A number of them require multiple treatment which takes time. We do not get extra targets for providing large amounts of treatment for a patient when they need it. If we see 10 patients who each require a filling taking half an hour we will receive 30 points towards our targets. If however we see one new high needs patient who requires 10 fillings we only get 3 points towards our target, even though it will take just as long. NHS practices are still independent business. A business cannot remain solvent in such circumstances. An NHS practice which has large numbers of healthy patients needing only a check up or perhaps a small filling which can both be carried out quickly, will meet their targets and enough enough resources left to provide more complex treatment for a few patients. However if they are in a practice where all the patients have high needs they will be in trouble. It is harder for some than others as NHS funding varies widely now from practice to practice. One may receive twice what another does for the same target. A purely NHS practice with low funding and high needs has 3 options, they go bankrupt, they go private, or sadly turn a blind eye to, or do not spend long enough to diagnose all the patients problems because finding acknowledging these problems leads them back to the first option!
We survive because we are mainly private. The recent huge administrative burdens mentioned in other posts make it difficult to provide care at the same level as before. For example a dental nurse assisting a dentist is not able to give his/her full attention to the patient and the procedure because of the date stamping, box ticking and extra filing she is having to do at the same time . This is despite having employed extra staff to cope with the admin.

I have experienced the highs and lows of NHS and private dentistry, but I have generally been very happy.

My worst experience was I had a crown fitted privately, which cost over £400 including root canal treatment. The new crown was too large so the dentist carved away part of an existing crown which had been perfect for over 30 years, and left it very rough. Soon after, part of the vandalised crown broke off. The practice closed down before I could complain. Had it been an NHS practice it would have been easier to take action.

Hi Wavechange,

Sorry to hear of your problem but complaints can still be made whether you are NHS or Private or Hospital treated etc.

Likewise I hope the above posts demonstrate a sincere and deep unhappiness from dentists and their teams with the state of Dentistry planning too and even when they have complained to their MPs, the DH and government directly, they feel even more ignored and helpless than you have.

As I said in my above postings, maybe Consumer Organisations like WHICH can put public pressure upon MPs and bring some accountability to England’s Department of Health for the consequences of THEIR imposed systems that bias Targets before Patients and paperwork burdens before time, for frontline care too!

Just blaming Dentists, Nurses, Medics and other Frontline Healthcare workers whilst easy to do, is misguided and lets the REAL culprits completely of the hook for their poor Centralised planning over a number of years.

It is now no suprise to us that Dentistry is in a National mess given such centralised bad planning, likewise it may be no suprise to you that our Economy is in a National mess given their centralised bad planning too.

As just one dental example, guess what is the third most common medical reason for any child in England to occupy a Hospital bed – is it Asthma, broken bones, Tonsillitis, tummy problems, Accidents, burns etc, etc? No, it’s Rotten Teeth !!!

In 1911 that might have been acceptable, but in 2011 this is just one example of how ‘sick’ our Dental systems are, putting paperwork before children, targets before prevention and completely frustrating (rather than enabling) Dental Professionals to do there best.

If you asked the Dental Profession today do you feel like you can work to the starndards you were taught at Dental School and put patients’ best interests first every time, I would guess 90% of our Profession would say NO and that they DREAM one day of being free to do that!

Again I say, what is BAD for Dentists and their teams is BAD for patients too ultimately.

I hope WHICH can start being part of the Solution and focus upon holding the English DH to account, as they have the power, write the rules and impose additional paperwork burdens upon us all.

Yours sincerely,

Anthony Kilcoyne.

Thanks Tony. I will make a complaint if I have problems in future. I am very happy with my current NHS dentist, and I have been happy with private dentistry apart from the one problem.

We obviously need a new website like Tripadvisor [Teethadvisor?] to enable people to report on dental practices and practises. I have never found it easy to find a good dentist. Unfortunately a recent one who gave excellent treatment and support and ran a very good surgery retired and sold the practice to a very unsympathetic dentist who was only interested in doing the high cost work and was constantly pushing for such treatments. I left and haven’t seen a dentist since. My teeth are deteriorating and I have some cavities but I am so put off going to another dentist I wish I could have the whole lot out on the NHS and a set of dentures fitted. Sorry this isn’t very coherent – my teeth make it difficult to say things properly.

Tim Moody says:
14 November 2011

John Ward. Dentures are 10% as good as natural teeth. Cavities don’t ‘just happen’ , you cause them by lack of care/ too much sugar. Why are you blaming dentists when you haven’t seen one?

steve says:
3 November 2011

i was appointed a new nhs dentist in the same practice i had been going to for 40 years. for the 1st time in my life i was told i needed 4 fillings. amazed at this and not being able to comprehend this i went to a private dentist who told me i needed no fillings and it was perhaps that i had white fillings already that that is why i was being told i needed 4. i went back to the nhs dentist several months later who again told me i needed 4 fillings and was aggressive when i told him the private dentists advice and told me that i could not produce a dentist who would not say i needed 4 fillings . i then went to a new nhs practice and was told that although i did not need any fillings it would be advisable to have an old 1 filled but that is all. as you can imagine, i am never going back to someone who obviously wants to make money out of me for his own profit. he should be dismissed from practicing

A worker says:
3 November 2011

Have you not read the previous postings which clearly point out that a NHS dentist is paid the same for 1 filling or 10. So your 4 fillings would have been a loss for that dentist. How does he/she appear to be wanting to make money out of you?

Iain Martin says:
4 November 2011

The study provided by Which is poor and unscientific, as a result no conclusion can be drawn from its findings. But I as a dentist do feel as a profession we have to improve our standards and communicate more with the public. Although I do feel that standards are improving despite the meddling of the department of health.

Several factors have contributed to this situation; an ineffective response from dentists in England when an unethical new contract was forced opon them by the DOH was perhaps the biggest. This lack of response was driven by a fear amoungst dentists that the public would not support them and see us as greedy money grabers for going private. Clearly there are many members of the public that do feel that way you only have to read the comments on a daily mail online article when the word dentist is mentioned to see that.

To compound matters changes to the law ( introduced by the last government) have introduced big buisness and venture capital to the dentistry, the intention was to create competition amoungst dentists but in my mind has undermined the profession and changed dentistry from a professional service to a commodity. This again is reflected in the contract imposed by the NHS in England and its target driven culture.

The only way to change this situation is for Which and other such groups is to work with the profession rather than produce sensationalist headlines.

Try contacting the BDA first or MFGDP and get them to campaign to improve standards rather than alienating dentists further.

Iain Martin BDS , MSc

Ray Steggles says:
7 November 2011

Greg mentioned reasonable and extortionate prices. The distinction is generally in the mind of the person who has asked for the quote, based on their knowledge and prejudices. Few patients have the knowledge to assess, and certainly are provided with inaccurate and biased impressions via the press, whose job is to make money, too often by creating sensationalist headlines to sell their wares.

As a dentist, I would say that a reasonable fee covers the full cost of the treatment, (including staff pay for the time taken, materials, equipment costs, cross-infection procedures ) and makes a contribution to the continuation of the practice by allowing continuing investment in the service provided, costs of regulation, insurances, rent, rates, electricity, gas, repairs, staff training and so on. If a knock down fee is offered to one person that doesn’t cover those costs, it must be found elsewhere, or the practice slides to bankruptcy.

There has been general underfunding for NHS dentistry for many years, and the only way I could make it work, so that I provided adequate time with my patients, was to cross-subsidise from my private patients. This is unfair, because they have already paid their taxes, so that is another dilemma, artificially inflating private fees.

In truth, and you would never get any government to admit it, there is insufficient funding to provide for a comprehensive NHS dental service for the UK population. The population has been brought up with an NHS service and doesn’t realise the true costs, and baulk at fees which are adequate to provide and maintain it. The Department of Health tries to get a quart out of a pint pot, and tries to give the illusion all is being sorted by introducing all kinds of initiatives. The basic problem is the ‘time and quality vs cost’ conundrum.

It’s not possible to get high quality with insufficient resources, at least in a sustained way. A dentist who consistently undercharges will go bankrupt. A dentist who consistently overcharges will be highly scrutinised by every patient, and without some extraordinary added value or service, will rapidly lose patients and go bankrupt.

Greg mentions going to Poland to be treated.

I think you will find the cost of living, in Poland and other Eastern European countries is considerably less than the UK, and unsurprisingly they can offer treatment at a lower cost. If the standard of living drops across the board in this country, we can do the same, but in relative terms you would still find costs high, because your salary would have dropped also.

Ray Steggles BDS MBA MSc

Greg says:
8 November 2011

Thank you for an extremely thoughtful reply that gives insight to me that dentists probably do (as I must say was no doubt in my mind anyway) have a pride in their profession. BUT what about the extortionate fees for crowns etc. that make people have to leave this country for treatement. It is absurd. What the hell is going on?