Sunday, 28 June 2009

NHS Dentistry a report

A while back we did a post about the fact that the Party thought there might just be a tad of a problem with NHS dentistry as after their new Party NHS dentistry contract came in at least a 1 million fewer people were registered with NHS dentists. This isn’t usually a problem if you are a caring Party (as it costs less and is therefore prudent) until pictures of people queuing to register with newly imported (from the EU) NHS dentists were a little embarrassing given their successful dentistry policy and a certain Mr Blair’s pledge of NHS dentistry for all within 2 years in 1999. We are still waiting 8 years later.

Unusually for the Party we noted that rather than employ an Armenian born Irish trained surgeon to reform NHS General Practice they would employ a UK born and trained dentist (albeit Scottish trained?) to tell them what they had done wrong. Professor Jimmy Steele has now published his report.

We are sure that like most GPs who used to see a couple of dental emergencies a year pre Party reforms but now we see anything between 2 a month to 2 a week all saying they cannot get to see a (free) NHS dentist or asking us to refer them to the hospital for (free) NHS dentistry because they cannot see a (free) NHS dentist.

If patients are to be believed no NHS dentists are taking patients on and there is even a waiting list to see private dentists. If you get on a private dentists’ list you have to take out a monthly private dental insurance to stay registered so local golf club car parks here in Northern shire are now filled by NHS and private dentists rather than industrialists.

(An aside dear reader. If the same happened in general practice and we kept our current list size and you were charged £100 a year for registration we would earn as much as we do now without doing any work. Charge for treatment on top and we would be doing a dentist and earn more than we do now! It has worked so well in dentistry why not do it for general practice? Then we could join a golf club and find out where all the missing dentists are!).

However the Party has provided a new free accessible NHS Dentistry service called NHS General Practice. In the same way that they can replace real doctors with nurses at NHS (re)Direct they can replace real dentists with GPs.

This is done in the same way that witches were condemned to death in the Middle Ages using the sink or swim principle.

If you chuck a witch into a pond and she sinks she is innocent. If she floats to the surface she is guilty and is therefore burnt at the stake for surviving. Either way she is dead.

The Party applies the same principle to NHS dentists. If you cannot see a dentist you approach your local PCT who are responsible for providing NHS dentists which they don’t. They cannot do so and so they send you to NHS (re)Direct who will tell you to see your GP.

If your GP fails to treat you then they can be penalized for failing to give immediate emergency treatment even though GPs are not qualified dentists. If they decide to treat you, based on their lack of a 5 year dental course and dental qualification, and something goes wrong they can be sued. Either way you are stuffed as a GP like the medieval witches were.

Let us look at some bits of the report as heard on the BBC while we drove home through the now pleasantly warm but thundery Northernshire.

The main thrust of the report seems to be a move away from a payment for completed treatments towards a payment based on registered patients. One of the big flaws of the current contract was that payment was made only when a treatment was finished. A filling is quick to do but corrective orthodontics for children may take years before it is finished and you get paid. So a lot of dentists doing this treatment had no choice but to go private. A lot of dentists did corrective and cosmetic dentistry which took time and so went private as for some reason people like white teeth.

Hence quick and many = money. Long and slow = waiting ages for money.

Furthermore the number of treatments was fixed by the Party and it managers who are so good at predicting illness while they work 09.00-17.00 Mon-Fri and 11.00-13.00 Fri so once you had done your Politburo quota no more money which meant some dentists stopped working for a few weeks/months in a year when they had done all the treatment they were going to be paid for. If you are doing nothing for the NHS you may as well go and do a little private work in that down time and get paid for it. Central planning at work again?

The report suggests piloting change before implementing it. Now that sounds sensible as long as the pilots are real dentists and not heavily subsidised Party stooges. Not entirely in keeping with current NHS top down Soviet centrally managed one idea suits all. Of course the report is accepted in principle by the current health secretary which means it may not be turned into practice or ignored by any future Government which actually started the rot of NHS dentistry.

More worrying is the fact that administration may get more complicated as instead of 3 bands of payment there would now be 10. No prizes for guessing what that means in practice? More administrators to manage a more complex payment system?

Interestingly there is a guarantee that any dental work that fails within 3 years would be replaced for free. It would appear that the current system encouraged second rate workmanship presumably because failures could be charged to repair the “fault”.

Praise be the Party for succeeding in increasing NHS dental provision for all those who can afford it and for its report which shows how well it has succeeded and the way forward?

We shall see but meantime we will continue with NHS GP Dental care = antibiotics and painkillers, try and see a dentist and we’ll keep our fingers crossed nothing bad happens to you.


Mancman said...

Love the "stooge" reference.

The biggest stooge of all is of course Jimmy Steele.

The bottom line is, good dentistry, like all good medical care, cost money to implement.

I think they missed out that page of the report.

A (Once NHS now Private) Dentist


Northern Doc said...

Thank you for commenting on our blog. You are quite right that quality costs. Unfortunately the NHS is a very sacred cow which politicians slaughter at their peril even though quality might improve. Hope your move to the "dark" side has not inconvienced your wallet and reduced the quality of your practice too much!!!!!!!

Remember an elderly patient here in Northernshire recalling that her local GP that her family had to pay for pre NHS drove a Rolls Royce to see the family. She said "you don't do to bad?" One of us had walked to see her because we are not allowed to park our Fiesta on her estate.

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