NHS or Private? (was:English 'pull own teeth')

[brit]

http://news.bbc.co.uk/1/hi/health/7483182.stm
The latest BBC report covering the apparent shortcomings of the new contract in England - complex procedures have gone down whereas in Scotland (where it doesn't apply) they have gone up indicating dentists are not necessarily doing the most appropriate treatment.

 

[fluffyjo]

As much as i would like to get private dental treatment, i could not possibly afford it, i've looked into it and it is far to expensive for me. I'm on incapacity benefit and disability living allowance but because my husband works full time (although he is on minimum wage) i am not entitled to free Nhs treatment. Luckily i have found a nice Nhs dentist but i can imagine that there are alot of people out there in my position who cannot find a decent Nhs dentist.

 

[scaredinthechi]

I know this is an old topic, I hope nobody minds me adding my take on this.

Remember when we were kids and they did NHS glasses - those big ugly brown things? NHS dentistry kind of reminds me of that - the bare essentials, and if you want anything over and above that, you will have to pay for it. I suppose it's just not seen as being such an essential need that they will provide it for everyone and anyone, which is really a shame. Then again there are more than enough people wandering around with mouths full of rotten teeth that are managing to get by, so who knows.

When it comes to the NHS I always think of that saying 'you get what you pay for'.

 

[brit]

I know this is an old topic, I hope nobody minds me adding my take on this.

Remember when we were kids and they did NHS glasses - those big ugly brown things? NHS dentistry kind of reminds me of that - the bare essentials, and if you want anything over and above that, you will have to pay for it. I suppose it's just not seen as being such an essential need that they will provide it for everyone and anyone, which is really a shame. Then again there are more than enough people wandering around with mouths full of rotten teeth that are managing to get by, so who knows.
When it comes to the NHS I always think of that saying 'you get what you pay for'.

NHS Specs.....that's a very good analogy....I'm amazed no one has mentioned that before.....I am in favour of 'free at point of use' NHS hospital care...it's just the dentistry I'm happy to opt out of which is provided by private individuals (dentists) contracted to provide NHS care.

 

[scaredinthechi]

I've been out of the UK for a good decade so I don't know if they even do those anymore!

What gets me about the NHS is the way you can see the same doctor, in the same hospital, and get the same treatment, with the only difference being that paying for it gets you in there 10 times quicker. I don't really think that's right at all.

 

[Ingolduk]

Just to add my two pence worth to the NHS v private debate.......

I've recently converted to private treatment and feel aggrieved for in effect paying twice for treatment, if the NHS were to contribute to some of the cost of private treatment wouldn't this:

a - allow more people to afford private treatment

b - reduce the load on NHS practices


By me paying privately for dental care I'm reducing the load on NHS services, and the money I have already paid into the system should be returned to me as a discount against private treatment?

 

[Ingolduk]

I've been out of the UK for a good decade so I don't know if they even do those anymore!

What gets me about the NHS is the way you can see the same doctor, in the same hospital, and get the same treatment, with the only difference being that paying for it gets you in there 10 times quicker. I don't really think that's right at all.

Check up with NHS? 3 months......

Check up private? Next week.......

And that's with the same dentist, I know 'cos I tried it

 

[brit]

[broken link to Mirror article removed]

I love Miriam - she's genuine in her concern but you can bet your life she doesn't have an NHS dentist herself and why would she? Good advice for finding an NHS dentist in the article and strong recommendation to use private specialists as appropriate for things like root canals.

 

[brit]

Just to add my two pence worth to the NHS v private debate.......

I've recently converted to private treatment and feel aggrieved for in effect paying twice for treatment, if the NHS were to contribute to some of the cost of private treatment wouldn't this:

a - allow more people to afford private treatment

b - reduce the load on NHS practices


By me paying privately for dental care I'm reducing the load on NHS services, and the money I have already paid into the system should be returned to me as a discount against private treatment?

I think the bureaucratic nightmare and expense of organising such a rebate and guarding against fraud, would outweigh the benefit....the Tories did offer something similar years ago which you claimed as a tax rebate on your tax return to subsidise private medical insurance (e.g. BUPA) for retired people only - the ones private medical doesn't actually want to insure because they make claims lol.

I look at it that I am not necessarily paying twice...I am maybe paying back belatedly for my hospital GA for wisdom teeth which was 100% free at point of use...in USA it would cost you thousands of dollars...

Also if private dentists were somehow allowed to apply a discount on their fees to cover this 'rebate' from the Government, it would simply mean they'd up their prices.
You need the NHS system chugging there alongside providing some kind of competition as it forces prices in private sector to stay reasonable and for people to 'choose to pay twice' as you say, the private sector has to be adding significant added value such as less rushed appts, more experienced staff, sedation options, different treatment modalities.
The other benefit is you can opt in and out of both systems as you wish..no questions asked, no insurance company to keep happy, for young people with healthy teeth NHS care is maybe fine..it's just not for me anymore but I don't resent my taxes being used to provide it for other people...because I don't want a society where kids die of dental abcesses because their parents can't or won't afford dental care.

Even if the Government say gave you a rebate through your tax code with the Inland Revenue for not using NHS dentistry - how would they check that? It would encourage people to claim the rebate but not spend the money on a private dentist maybe but on nicer things...I don't think the Inland Revenue wants to be going through taxpayers' dental check-up receipts as part of Tax Return processing.

So I kinda don't accept the principle personally but if I did, I still think it is logistically too difficult to be viable.

 

[brit]

Check up with NHS? 3 months......

Check up private? Next week.......

And that's with the same dentist, I know 'cos I tried it

Interesting that that's with the same dentist...I'd be inclined to go privately elsewhere (tit for tat) .
I suppose that's a 'mixed practice' then....sometimes the most experienced dentist will just do 'private' patients and the Associates will provide the NHS care...do you think you are seeing the same dentist or that it's just the same practice but a different dentist. I think you will find a lot of variation from area to area and practice to practice in terms of how they organise their appointment book.
I've even read of problems in England with the new contract and the funding for the year having been used up in Units of Dental Activity - originally when it was brought in I think they wanted to force dentists to be either NHS or private but I think this was dropped, which is actually good as it means there will at least be some more experienced dentists working on NHS patients and not just the newly qualified ones.

There was also a move to stop private dentists treating adults privately at the same time as treating the kids of registered patients on NHS - not sure what happened on this one?

It always was the case that an NHS dentist could offer private care..it was just that there was no discernible difference in quality in those days for a simple filling or a tooth extraction - so why would you pay more...it's the technological advances which have meant that what the NHS covers for dentistry is now quite basic in comparison.

 

[brewer734]

hi just thought i would add to this thread which is very interesting by the way. In my area there are no nhs dentists avalable and certainly none who treat phobics or who offer iv sedation which i will definately need! As i am a full time carer for my 8 yr old daughter who has a disibility i would get free treatment which they always say when i fill out forms for my daughters benefit and my carers allowance don't forget yr entitled to free dental treatment oh yeah where exactly would that be then ? i would be totally totally stuck with no options what so ever i checked with nhs direct and the nearest place with an nhs dentist is about 20 miles away and they definately dont do sedation. luckily for me my parents who have worked hard all their lives and have also had to pay for a private dentist have said they will pay for me to go private i cant tell you how much that means to me because otherwise there would be just no way out its just a terrible joke it really is.

emma

 

[letsconnect]

There's a review of the current contract ongoing at the moment, and as far as I can see, everyone (including members of the public) can comment. You can find out where to add your comments and suggestions here:

[link removed as it no longer exists]

Professor Jimmy Steele seems to be a good guy, so if you decide to e-mail with your grievances about the NHS, please complain about the NHS system rather than the people who are now trying to make it better ! In other words, be nice

 

[brewer734]

thanks letsconnect i have sent an e-mail in reply to this not sure what good it will do but worth a try !!
emma

 

[AngelStar]

I think this whole NHS dentistry thing is a sham (sorry to say this, we have one unlike you guys in the states). I was told if I wanted sedation through the NHS I would have to wait 9 months! It was a bad experience with an NHS dentist that gave me this phobia in the first place! I am not that well off and have only just got back into employment within the last couple of months (still not even on a perm contract yet either) and so private is very expensive for me but it is the only way I can do it, as NHS have no time of day for phobics and as a result I could not subject myself to that level of care again, if I did im pretty certain it would have made me even worse and would have made it even more impossible for me to go anywhere to get treatment and to start trusting the entire dental profession.

 

[AngelStar]

Since posting my last comment I emailed the above link-
(moderators' note: link removed as it has ceased working)

Hi
I am a dental phobic. As a child I was subjected to a nasty NHS dentist, this is where my problems started. I have recently had to seek some dental care and due to a bad experience I have avoided NHS. Not only because there is a shortage of practices taking on NHS patients, but because the level of care is poor. The whole policy seems to be cram in as many appointments as possible, this is where care is compromised. As a phobic this attitude is unacceptable. The reason why so many phobics, who may have avoided seeing a dentist for long durations of time, is because they cannot physically handle being rushed and "abused" by this style of treatment, however cost effective it may be and also many are unable to afford private care (many phobics I have spoken to can sometimes tolerate treatment, by having time taken with them to address their phobias). If I wanted to have sedation done through the NHS I was told I would have to wait 9 months for it-that is totally abysmal. If a person is in a lot of pain 9 months is totally unacceptable for a patient to wait to enable them to get treatment under sedation, as that is the only way many phobics will have their treatment done. If the level of care in NHS dentistry hadn't been so poor in the first place I would imagine there would be a lot less people with a dental phobia. More has to be done within the NHS to help people with dental phobias, by helping them practices will be helping themselves by not having to give as much treatment if that patient had attended sooner.

 

[pally]

Call me cynical if you want but surely a large part of this situation has been brought about by large numbers of dentists putting personal greed ahead of patient care. I work in healthcare and know how often doctors, pharmacists and other staff go above and beyond requirements for no extra pay to help their patients. Dentists are higher paid than almost all other health professions and yet my dentist told me recently I had to wait 3 weeks for an appointment despite my being in pain and begging for help sooner. Dental surgeries in my area are open basic office hours, no weekends or evenings (unlike the rest of us in healthcare) and the emergency service is swamped by the sheer numbers needing out-of-hours help. I know there are some great, helpful and caring dentists out there but surely the service in this country would not be in this state if there were more like them.
PS. All of you nice dentists taking the time and trouble to help people via services like this one are automatically not included in this whinge! You are clearly not the problem!

 

[letsconnect]

Call me cynical if you want but surely a large part of this situation has been brought about by large numbers of dentists putting personal greed ahead of patient care.

I don't really feel it's as simple as that - the "new" contract in England and Wales has a lot to answer for... if dentists get paid the same for a small filling as they do for 6 fillings plus 2 root canals, can we really put the blame on dentists being greedy? Both situations above count as 3 units of dental activity (UDAs), and with productivity targets to be met, it's quite understandable that many NHS dentists would prefer not to take on people with more complex dental needs. Of course, you'll find saints in every profession - but really, the system needs changing?

 

[pally]

I do agree with you "lets connect". The system does need changing and I would not be happy with the situation you describe re payment either but, please do correct me if I'm wrong here, dentists are now the highest paid professionals in the healthcare sector and dentistry is the healthcare area with the most obvious problems of access, hours of service, etc. I think there's some fault on both sides here. The system is clearly wrong but there do seem to be plenty of people willing to milk it for every penny with not much concern for their patients.

Can I also admit openly though, my opinions are clearly coloured by a recent episode of stunningly poor service I have personally experienced and, as I work as a healthcare professional in a deprived area of the UK, I see regularly the pain and distress that patients are suffering. Meanwhile we see our local dentists more on the "Society" pages of the local paper than we do in their surgeries!

 

[brit]

I do agree with you "lets connect". The system does need changing and I would not be happy with the situation you describe re payment either but, please do correct me if I'm wrong here, dentists are now the highest paid professionals in the healthcare sector and dentistry is the healthcare area with the most obvious problems of access, hours of service, etc. I think there's some fault on both sides here. The system is clearly wrong but there do seem to be plenty of people willing to milk it for every penny with not much concern for their patients.

Can I also admit openly though, my opinions are clearly coloured by a recent episode of stunningly poor service I have personally experienced and, as I work as a healthcare professional in a deprived area of the UK, I see regularly the pain and distress that patients are suffering. Meanwhile we see our local dentists more on the "Society" pages of the local paper than we do in their surgeries!

Pally
I think you have a point. I agree with you and Letsconnect on this. Dentists have always been the most obviously money-motivated of the healthcare professions in the UK based on people I have known socially and my personal experience of UK dentists.
For instance back in the 1970s my favourite NHS dentist (I really liked him - was always nice as pie to me) got shirty with my Mum for giving her NHS appointment to my Dad who had a toothache...said 'it was an abuse' and that my Dad should just sit and wait to be seen. There is no way my current private dentist would take such a ridiculous attitude...in fact I did send my OH along to a hygiene appt which I couldn't make recently and they were delighted to have him instead of me.
I think UK dentistry attracts money-motivated types more than medicine and the other allied health professions....it is attractive because you don't have to be on call in the same way as a doctor and the training is slightly shorter. I think it has always paid more simply to attract people to the 'most feared profession'..even on this website it is a minority of posters who also fear medical doctors. It does have its downsides at 'cocktail parties' I'm sure -although this has undoubtedly lessened as painfree techniques have become a reality.
The problems with NHS remuneration (and I agree with Letsconnect the situation is ridiculous in England) date back long before the current contract..the piece rate had its problems as well.

The real problem is the NHS remuneration system coupled with cutbacks in the number of student places which go back many years...such that the current shortfall has to be filled with non-UK trained and inexperienced personnel.
Also in the 1970s (when treatment options were much more basic) only 40% of population attended regularly, so it was possible for NHS dentists to not seem to be as rushed as they seem now (I think checkups were 15 mins back then on NHS)...yes they were busy but thesedays as fear has diminished, most people seem to want to be registered somewhere and if the majority of the population want regular hygiene/ check up and treatment visits then we probably do need more dentists to meet that demand.
The NHS has recognised this and as a result started saying that 6 months is no longer the gold standard and has reduced the emphasis on scale and polish as part of a check-up etc etc.
Dentistry is a unique healthcare area which will always tend to attract a 'different personality type' (techy model airplane-making boy type - low empathy/low social conscience) to the other healthcare professions so I think extreme remuneration reform is the way to go.
Hope I haven't offended all my dentist friends in cyberspace....my real dentist is of course an exception to this rule .

 

[letsconnect]

Dentistry is a unique healthcare area which will always tend to attract a 'different personality type' (techy model airplane-making boy type - low empathy/low social conscience)

Are you sure you're not reading too much DentalTown, Brit ?