/ Health

Patrick and John get their teeth into dentistry

What are your experiences with getting NHS and private dental treatment? I had a chat with community member John Ward to see if our experiences matched.

I was keen to find out whether experiences with private dental treatment and the NHS were similar to my own, so I had a chat with John Ward, one of our long-term community members. Here’s what happened.

Patrick: Thanks for joining me John – I’ve been thinking about dentistry. Not because my teeth are in any particular disorder (yet), but because of some of the poor experiences I’ve had in the past.

When I was with an NHS dentist, I knew that when I walked through the door, I was also entering a private clinic.

When I sat in the chair for my first NHS consultation and check up, there was basically a refusal to do anything with my teeth until I had booked an £80 appointment with the private hygienist. That type of upselling unfortunately doesn’t seem to be uncommon – do you have any similar experiences to this?

John: Firstly, I’d just like to emphasise that I’m extremely satisfied with my present dentist and the treatment I receive!

I’ve not been able to have dental treatment on the NHS for some years, ever since I left London in 2005. I was not in a priority category for NHS dentistry and the practices in our area were not taking on any new NHS patients.

I did have regular check-ups and treatment as necessary and this was covered under an insurance scheme for a monthly payment.

The dentist would assess the likely requirement each year and it seemed to be going up routinely irrespective of the amount of dental work actually performed.

If more advanced work was required then the premium was raised thereafter despite the fact that the dental work usually lessened the need for further intervention. When that dentist retired I decided to leave her practice and use a dentist in Norwich.

Patrick: So you’ve been with a private dentist for more than 10 years?

John: Yes, I have been having private treatment, some of it quite extensive since, due to previous problems, I had to have some reconstructive work and a partial denture. 

I do occasionally talk to people who have an NHS dentist and compare the treatment I receive relative to their experience. There seems to be no doubt that NHS patients receive a second rate – albeit competent – service.

Whether they are subject to upselling I do not know but, judging by what I see while I’m waiting, I do seem to get a superior service.

I wonder if NHS dentistry is an economy service possibly designed to encourage patients to ‘go private’.

Patrick: It’s interesting what you say about NHS dentists being “designed to make people move private”. As well as the hygienist service, I have had all my fillings done privately due to the fact that white fillings are rarely offered on the NHS.

I don’t have a particular criticism of this, only that NHS and private dentistry seems to be completely entwined.

I have one experience that makes the situation more complex. I had discovered that my teeth were sensitive and informed my NHS dentist – he told me that two of my teeth had worn down, likely from grinding my teeth during the night.

The solution? A mouth guard. I asked him whether I could get a standard one from the shop, but he advised (correctly, I believe) that a bespoke mouth guard fitted to my teeth would be best. I agreed.

After my normal check up and a little Xray, he handed me a piece of paper to sign. ‘Band 3: £269.30’ was ticked on this document – quite pricey I thought for a mouth guard. I asked him why it cost so much and he said that this type of treatment could only fit in Band 3, and not the others.

I said I would like to think about it and not sign. He told me that was OK, but I would have to pay £22.70 for today’s check up and then, if I decided I wanted the mouth guard at a later date, I’d have to pay the full £269.30 on top of this.

Despite this, I still wanted to go away and do some research on costing in my own time. I paid £22.70 and left.

I later found that a mouth guard could cost anywhere from £80-200. Still less than £269 I thought. I decided to do something a bit cheeky – call the dentist I had just left. I asked the receptionist: “Please could you tell me how much a mouth guard moulded to my teeth would cost if done privately?”.

“Yes, let me check with the dentist quickly.” The dentist she spoke to was the same dentist who had tried me to sign for a Band 3 payment on the NHS moments before. She returned to the phone: “Hello, it would cost you £80 if done privately.”… Thoughts on that John?

John: That sounds quite opportunistic and, basically, sharp practice. 

Leaving aside NHS work, dentists are acting commercially and can set their prices at any level they like according to what they think the market can bear. An existing patient might be charged more than a new one because the practice considers the existing ones are captive. With a new one they hope to gradually ratchet their income up over time, little by little. 

The profession has never felt the full blast of consumer inquiry or been transparent on its prices. 

Patrick: It’s funny you should say that, John. You may not know it, but Which?’s very first super-complaint was on dentistry.

We found issues with dentists not displaying price lists or giving people the proper option between private and NHS treatment – the Office for Fair Trading responded by demanding action from the dentistry industry and the government.

But when we investigated this same issue 10 years later – not much had changed. It just shows how long change can take.

John: That’s interesting. Personally I would like to see a scale of charges for the NHS work displayed in every practice and on their website with a priced explanation of enhancements that could be procured as a private patient.

If a private patient is content with an NHS treatment or service then they should pay the NHS rate, not a higher rate. Any higher price should be justified by a higher quality of service, more sophisticated treatment, and more time in the chair.

Unless that is done, and dentists still refuse to accept new NHS patients on their lists, the growing number of people with no choice will be discriminated against.

Patrick: So what do you feel the main problem is?

John: In my view the main deficiency is the lack of a clearly visible scale of charges. My practice gives me a treatment plan if the regular check-up reveals that specific non-routine treatment is necessary but the out-turn price can differ from the plan price if complications arise, which is fair enough but by that point it is too late to do anything else.

You can’t take the treatment plan to a different dentist for the work to be done and there is a general belief that a lower price will lead to an inferior treatment or more pain and suffering. Our dentist is one of those people we hesitate to get on the wrong side of.

Patrick: Let’s put that to the community – have you had a bad experience with an NHS or private dentist? Have you ever felt like you were being upsold private treatment, or the most expensive on offer? 

Let us know if your experiences are anything like mine and John’s in the comments. Over to you.

Comments

My dental practice, along with all the others in the district, went “private” at much the same time. Being a busy carer, I didn’t have time or motivation to travel and search for a new dentist. The result was that my NHS dentist retired and I was taken on in the same building with the same equipment as a private patient on a Denplan contract. The surgery has smartened up its surroundings but I notice no difference between the NHS dentistry I received and the private treatment I now get. It is important to me to have a dentist I can go to, though emergencies have lessened considerably as my teeth have finally succumbed and I now have just a few to be supplemented by dentures. Thus the work to be done is now quite minimal. I remember considerable payments for NHS work and wondered at the time how these fitted in to my free NHS at the point of need. My practice didn’t like Denplan and has changed to another management company. As with John, my monthly payments increase each year by a pound or two and, though, like John, I’m band C, they won’t decrease as my demand gets less. I get a regular check up and a filling now and then which probably amounts to about two hours at the dentist in a year. For this I currently pay about £25 a month. My appointments are always late by up to half an hour. Like other subscription services, the premium goes up for the captive clients and the only alternative is to do without. They know that.

I joined a new NHS dental practice almost ten years ago after the practice I used for years had closed. Several years ago the practice started offering private dentistry and the place is festooned with posters and leaflets advertising the service.

I have twice discussed the possibility of implants with my dentist at this practice because I have a several back teeth missing (mainly the result of private dentistry, but that’s another story), but she has twice discouraged me on the basis the gaps can’t be seen and I’m getting on fine without them. The reason that prices are not quoted is because the costs depend on various factors.

I strongly agree that fixed prices should be quoted for more straightforward jobs done privately, possibly using the NHS bands for easy comparison.

Thanks for the Convo.

Patrick says:
3 August 2019

The scenario in the article ref bite guards. The patient was NHS, any item requiring lab work is Band 3 and the dentist applied the correct NHS charge. If that NHS patient had instead required two root canals and five fillings do you think be would have been complaining that the NHS charge, around £65, was too cheap. The Banding system is madness, and really is swings and roundabouts, for both patient and dentist.

What you might find interesting to look at is, with the increasing patient charge per band, and the more or less static (uda) payment fee to the dentist, which remember is net of patient charge, how NHS is there in NHS dentistry?

I left the last practice I was at because of their rubbish admin. I got fed up with turning up for appts that had been cancelled because the “computer was down last week” or similar excuse I never believed. Maybe they wanted to get rid of me. Yet I had regular private appts with the hygienist and very little treatment needed to be done by the NHS dentists I saw. I also got ged up with the high turn over of staff, which is never a good sign in my view. I always wonder what pushes staff away. I also hated the fact that I saw the hygienist at the plush premises and the NHS dentist at the crummy premises a couple of doors away. It made me feel like an intermittent second-rate customer.

Previously I was at a very good practice and got very good treatment through Denplan. I was with them for years. I had to leave them because I moved, and also because later I changed jobs after being temporariyly unemployed and I couldn’t afford Denplan anymore. I still can’t.

I have been with my current NHS practice for a couple of years now, and so far so good, although I haven’t had to have anything done, so I can’t judge what they’re like when it comes to the crunch.