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

[brit]

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

Unfortunately it's not that no...although exposure to USA healthcare attitudes over the net, does jaundice one's view I agree.
I'm not saying they are all like this..just that it is a tendency. I think all healthcare professions should have empathy-screening probably at admittance stage. Teeth come with people attached and blocking a person's mouth makes it all the more important that you convey some empathy and establish rapport.
Although to be a good dentist technically you do have to be manually dextrous so it is legitimate to look for those skilled in crafts, modelmaking etc etc. By the way Pally, any dentist you are registered with and a regular attender with, should see you asap if you are in pain..it's triage isn't it? Most private dentists agree to see you same day if you are in pain and most areas have some sort of 'out of hours' system. A dentist who won't see you when you need them within reason is not worth staying with.

I also think that by the BDA's own admission on several occasions, dentists are driven to skew their behaviour unethically based on the NHS remuneration targets they are set (the current English ones seem to be extremely off). I remember years ago a BDA spokeperson saying in the media 'well if you do that, dentists will just extract kids teeth rather than restore them'. Hello why wouldn't you do what was best for the child in each case?

Maybe being salaried is the way for 'newbie' NHS dentists to go (the new contract does have some element of guaranteed income doesn't it but they then have to justify it by completing the units of dental activity) if NHS dentistry is mainly to be a basic service for dentists to acquire skills post-graduation before going into private practice which is what it is beginning to resemble.
Maybe it is wholly appropriate that you can't get implants on NHS since these need a high skill level.
Why is the UK profession not fighting its own corner better and pointing out the UDA activity levels for very different courses of treatment..instead they just said 'well most of us won't sign up to that' but sufficient just about did.

Ask most women if they'd have a problem having no control over who cuts their hair ....and their dentist? Would you go to an NHS hairdresser? (I would actually - hair grows back - so undermining my own argument - but most wouldn't lol)

It's a shame but I think primarily because of the advances dentistry has made, if you are likely to need treatment, it is less stressful to go private and pay for TLC and hopefully ethical appropriate treatment (no guarantees).

If primarily 'newbies' are going to be working on you in NHS then give them a decent salary, a few performance indicators such as patient satisfaction and let them take their time to do their 'best work' just as they could at dental school.

 

[annie778]

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.

The only way the nhs would do something like this is if the private treatment cost the same as its own tariffs. That's what has happened with hospital treatment. There is now a choice of private providers offered but those private providers have to match the nhs tariffs. In the case of dentistry there is a such a big disprarity in price betweeen private and nhs that I can't see it happening in practice.

NHS treatment is not really free, but as you say it's free at the point of delivery. The treatment costs a lot of money and it's taxpayer's money that is used.

Maybe something to recommend to the department of health review.

 

[brit]

Maybe something to recommend to the department of health review.

Which bit exactly? Feel free to do it. I didn't make the point about a decent NHS keeping private price levels reasonable.
Good point I hadn't thought of you made about the tax rebate not being viable because of the price disparity anyway.
I'm never a fan of two-tier systems and opting out/getting rebates for supposed non-use of services. Those people who think they should pay less tax because they haven't had kids yet/don't use taxpayer funded roads (lol) etc irritate me.
By keeping the universal entitlement (funded through taxes) to anything education, healthcare etc , you effectively keep up standards....even more so if the same practitioners work in both sectors (thinking hospital surgeons here) which is an argument for mixed NHS dental practices I suppose.

 

[letsconnect]

I didn't make any concrete (financial) suggestions myself, but it's good to take dental fear into the political realm
I don't envy Jimmy Steele...

 

[brit]

Daily Mail Article from January 2008 - throws some light on the long history of problems with how the NHS pays dentists.

QUOTE: Britain's teeth are supposed to be improving.
We have all become better at brushing and flossing, government spending on dentistry is soaring, and snaggle-toothed Tony Blair has been replaced by Gordon Brown, a gleaming advertisement for the dentist's art.
But it turns out we aren't smiling after all, because according to a MORI survey for Citizen's Advice, 7.4million of us have tried and failed to find an NHS dentist to treat us since April 2006.

• 1,000 dentists have quit since botched NHS shake-up...TWICE official estimates, latest figures reveal

This latest poll bears out all the other evidence over the last few years, that for many people, their so-called right to access NHS dental treatment is a myth.
In many parts of Britain, there are no NHS dentists accepting new adult patients.
Another survey before Christmas found a number of people who had resorted to pulling out their own teeth.
So what has gone so catastrophically wrong?
The problems began in the Seventies, when fluoride was added to toothpaste, and many experts concluded that dental decay would become a thing of the past.
In fact, we have more money to spend on sweets and soft drinks, so we get just as many fillings.
But meanwhile the number of places at dental schools had been drastically cut back.
The result is that in 2004 we had only 3.7 dentists per 10,000 Britons; half the U.S. figure.
The next problem is that more dentists do more private work.
In 1990, 6 per cent of dentists' income came from the private sector. By 2000, it had risen to 42 per cent.
Now it's 58 per cent. At this rate, there soon won't be any dentistry left on the NHS.
There's no question that Labour inherited problems.
In 1992, the Tories drastically cut back on the rates the NHS paid to dentists, encouraging many to go private.
But for years after coming to power, Labour did nothing, despite Tony Blair promising in 1999 that everyone would have access to NHS dental care.
Then in 2006, they introduced a new dental contract, and the result - like the new contracts for GPs and hospital consultants - was a disaster.
Under the old system, dentists were paid for the work that they did.
Under the new one, they are paid a fixed fee of around £80,000 a year for achieving so many Units of Dental Activity.
This Stalinist approach has failed completely.
The energetic dentists run through all their NHS "units" early in the year and then can't treat any more public patients.
The lazy ones haven't managed to complete all the units that they promised and have had to pay back nearly £100million to the primary care trusts.
None of them is happy.
There's also a fundamental flaw in the way that these "units" are designed.
There's no doubt the old system was too complicated; 400 different treatments and 400 different fees.
But now it is over-simplified. Dentists receive the same amount of money for one filling on a patient as they do for six.
So anyone with complex dental work needed gets turned away; it's not worth the dentist's while to do it on the NHS.
At the same time, the costs of having NHS dental work have risen sharply.
Unless you are a child or on benefits, you have to pay 80 per cent of the cost of your treatment.
Before the reforms, a filling would cost £14; now it's £43.
So the gap between NHS and private has narrowed for many patients.
The new system has also introduced a new layer of bureaucracy.
In the old days, the NHS contracted directly with dentists. Now the money goes to primary care trusts, who pass it on to dentists.
This was meant to ensure the PCTs would find a dentist for everyone - but it hasn't worked like that.
Instead, dentists suspect that much of the new money - spending up a third in three years and another 11 per cent this year - has been wasted on PCT bureaucracy.
And from 2009, the dental budget will no longer be ring-fenced, so primary-care trusts can cut it back to fund more urgent priorities.
All this has persuaded many dentists - who pay for their premises and equipment themselves - that staying in the public sector is an unacceptable financial risk.
So what can the Government do about the mess that it has largely created?
It should redraw the dental contract, getting rid of the ridiculous units of activity.
It should pay dentists for the work they do.
And it could find ways of preventing dentists - whose training costs the taxpayer £175,000 each - from immediately deserting the NHS.
Perhaps they could be banned from working privately for a number of years after graduating..... END OF QUOTE

 

[annie778]

I agree newly qualified dentists should work a minimum period in the NHS before being able to practice privately. Alternatively, all private dentists should only be allowed to practice if they put in say a day into nhs work.

Also I think that nhs dentists should be employed directly by the nhs rather than being independent contractors. This is the only way to eradicate the temptation to play the system. Any independent contract will have it's drawbacks and loopholes encouraging foul play. Having a piecemeal contract only encourages unnecessary work (proof being 1970s abundance of fillings in my mouth & in many others)

 

[letsconnect]

I agree newly qualified dentists should work a minimum period in the NHS before being able to practice privately.

Would that be enforceable under EU law (freedom of movement and all that)? I don't believe restricting freedom of movement would be desirable at all ...
Also, you'd end up with a situation where NHS patients may not receive the same quality of dentistry as private patients yet again (just from the level of experience and clinical skills which dentists accumulate over the years). Any such system would have to ensure that the recently qualified dentists working in the NHS can allocate more time to each patient (I'd imagine that, on average, it takes longer for a more recently qualified dentist to do a procedure than it would take a more skilled practitioner). In any event, I would think that most newly graduated dentists start out doing NHS work to gather experience for private practice anyway. I suppose the advantage of such a system would be that the general public would be fully aware that when availing of NHS services, their dentists may lack experience.

Agree that if such a system was put in place, they should ideally be paid directly by the NHS (without that silly UDA system).

 

[brit]

I doubt there would be anything illegal about linking it to 'student loan debt' repayment.
You need 'blue sky' thinking...why not create attractive well-remunerated salaried positions within NHS without the UDAs? GPs don't seem to have a problem with being 'effectively salaried' plus bonuses.
How is that necessarily worse than being a lowly Associate who has to keep moving on....and then incur major debt to set up their own practice, thereby running a major business risk probably at just the same time they want to settle down and take out a mortage.
Once the newly qualified have gained experience in NHS, they need to consolidate and actually offer a few years of 'excellence' before moving on.....why not simply create a salaried force of NHS dentists for those new dentists who prefer this and think that running their own business would be an unwelcome challenge. At least it would get some continuity for long-suffering NHS patients whose Associate changes every other time they go along.

 

[letsconnect]

Today on the BBC news website (http://news.bbc.co.uk/2/hi/health/8109679.stm ):

NHS dentistry 'facing overhaul'


By Nick Triggle
Health reporter, BBC News

Ministers have agreed to an overhaul of NHS dentistry - just three years after the last shake-up of the system.
They have acted after heavy criticism of the 2006 dental contract, which has led to fewer patients accessing care.
The government said it would accept "in principle" the recommendations of an independent review of NHS care.
Unions welcomed the move which will see income determined by three factors - patient list size, quality of care and the number of courses of treatment.
It represents a return to patient registration - as called for by the Tories - which was scrapped under the 2006 changes.
Both the opposition parties said reform of the system was vital with the Tories branding the 2006 changes a failure and the Lib Dems saying NHS dentistry was a "national disgrace".

This review is a vision of a better deal for both patients and dentists

Professor Jimmy Steele, review author

Over the last three years dentists have been working in a system where they were given a set number of courses of NHS treatment to provide to any patient that asked for care.
It was structured so that they were effectively paid the same amount of money to see slightly fewer patients.
The deal was introduced in a bid to end the so-called "drill and fill" culture.
It was hoped that the changes would make NHS work more attractive to the profession - dentists also carry out a significant amount of private practice.
But instead of improving access, official statistics show that more than 1m fewer patients have been treated in the two years since it was introduced than the two years before.
One of the key problems was that some dentists had used up all their allocation of courses before the end of the year, meaning they had to turn away patients.
Rows broke out between the government and profession over whether this was due to the contract failing or dentists "playing the system".
'Unfinished business'
Health Secretary Andy Burnham rejected claims that the 2006 contract had been an outright failure.
But he added: "I recognise this is an area of unfinished business. We have to make sure the NHS is on the right path."
The proposals put forward by the review, which was led by Newcastle University expert Professor Jimmy Steele, will now be piloted in the autumn.


As well as the changes to the contractual arrangements, the report said patients needed to be provided with better information.
Local helplines are to be set up and NHS Direct given information about which dentists have spaces on their books for NHS patients.
It also suggested the three bands of patient fees - NHS patients contribute towards the cost of their care - should be widened to up to 10 bands as the current arrangements were overly simplistic.
The changes will also need a clear set of targets to be produced so that the quality element of dental income can be determined.
Nonetheless, Professor Steele said he was confident the proposals would work.
"This review is a vision of a better deal for both patients and dentists. I think there is a will to change."
John Milne, of the British Dental Association, which was highly critical of the 2006 changes, said the measures offered an opportunity to improve care.
But he said: "Clearly, the detail of how that approach will be delivered will be vital."
Anthony Halperin, of the Patients Association, said the changes were much needed because the current arrangements had "fundamental flaws".
He said the re-introduction of registration was particularly welcome as it would help to build a relationship between dentist and patient.
"We look forward to a system where the patient is assured of quality care."


----
More information about the Dentistry Review can be found here: [outdated link removed] and here: [outdated link removed]
Thanks to everyone on this forum who sent their thoughts and comments to Professor Jimmy Steel

 

[terrified_patient]

Sorry, I REALLY don't want to get political so I will be brief...I totally disagree..and the idea that everyone on benefits etc should get free treatment while those that work are punished financially, I find quite obscene..

Sorry, but there it is...

Jools
xJools, I don't really understand your point, but guess you are saying that you feel a large proportion of people on benefits should be working instead and then there'd maybe be more money in the system to subsidise working people's NHS dentistry....as Harper says most everyone living in UK is entitled to NHS treatment whether they work or not but you can upgrade if you choose to.... I don't see that removing that universality of entitlement - is that what you would like?, would help those who really do need help.
It's one thing to discuss on a forum alternative ways of funding dental healthcare but maybe (?) beyond the scope of this Board to encompass who should and shouldn't be entitled to welfare benefits within a particular country.
__________________

I agree with Jools, im a full time worker, I work my ass out 6 days a week earning pittance, and for a root canal its costing me £50.........if I was to be a lazy ass and claim benefits for all sorts of bloody reasons then Id get it for free..........

Im a debt collector and income support, incapacity benefit, child support, child tax, tax credits, DLA .......... take into consideration the amount of immigrants that come here with a decent sob story and they get ALL the FREEEEE health care they need.

Its a bloody disgrace, but I wont scrounge off benefits because thankfully I have some dignity. But I sure as hell know where Jools is coming from. If you dont work you get everything free, if you work and need help you get a massive bill at the end of the day!!! No justice whatsoever!!!!!!!!!!

 

[letsconnect]

The problem is that the per capita spending on primary dental care service in England for 2008-2009 was 2081 million (https://www.theyworkforyou.com/wrans/?id=2009-07-13d.285890.h ). With a population of 51 million, this works out at £40.80 per person (I hope I calculated that right, lol - maths is not one of my strengths). While this is not taking into account the dental charges collected from patients, this amount is a long way off being able to provide comprehensive 21st century care for everyone in the audience . Add to this the fact that those at the lower end of the socio-economic spectrum tend to have higher treatment needs, while being unable to afford private treatment, and it's a bit of a recipe for disaster.
I think only something like 3% of NHS spending is allocated on dental, so I suppose one could cut down on other medical spending/administration, but cutting down on medical spending wouldn't go down well with the public, either. The other way would be to raise taxes, and again, this doesn't go down well. Hard to know what the solution might be.

 

[Dentist hater]

I am quite disgusted about what pertrified_patient said because a lot of people claim benefits for reasons out of their control, like people who are sick, would you really want people who are sick living on the streets, starving to death and poor health care just because you want to prove a point and slag them off. Also mothers with children who are living on their own struggling to bring them up, would you want them starving and living on the streets. You could say "oh why dont they work" Well the answer is affording childcare, have you seen the expense and some people who do work cant afford the childcare and also think of the concerns of mothers who dont want to put children in nurseries because of all the abuse that goes in them places you see all over the news. I do understand that there are many peoole who are not ill, who dont have children who can work and choose not too, i can understand thats wrong. And even people on benefits get very little money and find it difficult to live, they done live a high luxuary life, they just have the basics to live. Go and live whith a family on benefits and look at their life stly, dont judge when you dont know what you are talking about. Yeah you work but what if you got sick (wouldnt want that to happen) but you would be entitled to benefit cos no matter how cinical you are or how much pride you have you couldnt work and the YOU would get everything for free wouldnt you.You wouldnt be moaning then. Also not everyone can afford private care no matter what they do. Yeah the NHS dentistry is not a high standard and in a lot of cases as I have exprerienced myself its below the standard but its there and a lot of people need to reply on it, the system needs to change so people can use the NHS and maybe create more access centres and dental hospitals so more people can access it and these should provide all treatments needed as i went to an access centre and had anti-biotic put in my tooth as there was an absess giving me so much pain and they said you have to go back to your dentist what if i had no dentist? and even if i did they may want to just pull it out because they wouldnt get paid as much for doing a root canal. Am still in this situation and its very depressing but i didn have £1000 just to go to a private dentist and pay for it and i cant get credit either, dont have a rich family or rich husband so its ok for some of you to say why dont people stop spending and go private, well i dont go on holidays abroad (never been abroad in my whole life i am 21) i dont by desighner clothes, dont have car, dont go for expensive meals ect ect but i do have 2 children to look after so any money i do have goes on basics (i do by them a ice cream as a treat) but people dont just go and spend all their money on expensive things when they should be spending it on dentistry, THEY JUST CANT AFFORD IT OR CANNOT GET LOANS ITS AS SIMPLE AS THAT why cant people see the other side and not just one.

Sorry for the ramble but its not right people are giving bad name to people who dont work when most have reasons.

 

[Poppy36]

[/quote] Im a debt collector and income support, incapacity benefit, child support, child tax, tax credits, DLA .......... take into consideration the amount of immigrants that come here with a decent sob story and they get ALL the FREEEEE health care they need.

Its a bloody disgrace, but I wont scrounge off benefits because thankfully I have some dignity. But I sure as hell know where Jools is coming from. If you dont work you get everything free, if you work and need help you get a massive bill at the end of the day!!! No justice whatsoever!!!!!!!!!![/quote]

Well, that's all very well, but have you ever lived in a war torn country fearing for yourself or your children? Have you ever been a young abused single mother? I guess not.

I'm writing this as at 19 I was on benefits, had a baby, no partner, had been beaten up a good few times and had a nervous breakdown. Now at 37 said child is off to university and I run my own business. I just worked a 7 day week to pay my private dental bill. You can't judge. Every situation is different, and has a human being at the heart of it.

Dentist hater, hugs to you. You're doing a good job. xx

 

[Dentist hater]

Thank you poppy36, its good to know people understand and i am sorry to hear what you have been through but you have come through it and are now being what you want to be. Your strong. I want to succeed like that too when my children are in school full time. Hugs back to you lol.

 

[brewer734]

hey
not to go off topic but this made me so mad. I have just had all my treatment private because I couldnt find an nhs dentist even though im entitled to free treatment. I get benefits because im a full time carer to my disabled daughter who has a range of health problems if i could work i would but there is no way i could leave my daughter who's 9. It makes me so mad that we are tarred with one brush my job is caring for my daughter 24 hours a day 7 days a week and i have done this since she was born. So terrified_patient try my job stay up all night watching over a child with health problems then talk about dignity and benefits ive never had a day off in 9 yrs and its the hardest job in the whole world.
Think before you make suggestions about things you know nothing about yes there are people who live off the state getting money for nothing but then there are people who get help because they have sick children or an illness so be careful what you say and enjoy yr bloody dignity terrified_patient wont you.
sorry but that needed to be said !!
Anyway there are no nhs places where i live for anyone im entitled to free care but ive just had my treatment private with my very kind parents footing the bill. If they hadnt i'd still be in agony. Yes its wrong that people who work dont get more help too especially those struggling on low wages my sister falls into that trap and i know how hard it is for her too.
dentist hater i know where yr at and anytime you need a friend im here too i have the upmost respect for you enjoy yr lovely children and dont be put off by opinionated people !!!
Love Emma

 

[Dentist hater]

Aww thank you brewer, they were kind words and everything you said is very true and i think you are incredible sitting over your daughter watching her because of her health condition, you deserve all the help you can get. I think you are doing a wonderful job and you make sure all your time is focused on your daughter, And all the dentist problems to on top of that but i am happy for you that you are getting them sorted with private care, everyone says thats the best and we all need a little help from our parents lol.

 

[exdent]

OK well as you can probably guess by the username I have been there and done that. Basically as a dental associate you spend your time stuck between patients you want to do your best for and a boss who judges you primarily by turnover/profitability. Introduce into this mix a contract that pays you NOT for what you actually do but for the first item in the category of treatment. I guess you can see where I am going with this... Historically as a contracts change payment methods the type and extend of work done by dentists changes to reflect this.

Until this is honestly and openly up for discussion including the fact that the proportion of tax you pay towards dentistry in not sufficient to fund a service for all people/treatments we will get nowhere. Sadly no politician wants to hold their hand up and admit to this. Dentists are not listened to (as far as I am aware the BDA walked out on talks for this current contract as they found they were talking to a brick wall).

Some of you may find the House of Commons Health Committee report (Dental Services 5th report of session 2007-8) an interesting read. Particularly as the official government retoric is that everything is fine. The situation is also made worse by the fact now that individual PCTs are responsible for commissioning dental services for people in their areas, hence national politics can brush aside the question to be one of local decisionmaking. They are legally required to provide a service without being given a sufficient budget to pay for one.

OK political rant over, but as you can see it is not going to be easy to overhaul NHS dentistry in the UK.

BTW for the poster who believed that dentistry is filled with model-making obsessed people who have no empathy; how is it that dentistry has one of the highest drug/alcohol/suicide risk of all the professions??? we would not suffer stress if were able to be detached. Please do not judge the majority based on a few bad examples.

 

[UKDentist]

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!

I've just found this forum this evening and am more than a little horrified at the views some people have of dentists! I am a UK trained and qualified dentist - I qualified from Liverpool University in 1998 with my BDS under my belt and entered a whole world of hurt and it wasn't dental pain!

I have to say I have found working in the profession the most disappointing and hardest thing I have ever done and suspect I ever will do! Passing the degree was just the start!

The vast majority of my career has been spent working in the NHS and indeed I am still working in the NHS. But hopefully not for much longer! Before you gasp and think that I want to defect to the 'Private Side' I can assure you that I have been there and done that and don't wish to do that either!

What has finished me off? The new NHS contract! I have never been a conveyor belt dentist - I like to know my patients and develop a good understanding and relationship with them but the new system is even worse that the previous one!

For the last two and a half years I have worked for the same practice group as an associate in two of their practices. The practice in which I work now is relatively new. At the previous practice my NHS contract was set at £19k and with a few private upgrades (whitening etc) my income was less than £30k.

Now don't get me wrong, that is not an inconsiderable sum and I appreciate that it is considerably more than some people earn, but please wait to hear my point. For that NHS contract, I saw patients that were only exempt from paying their charges - an agreement we had with the PCT to enable access to the more dental needy members of society. The level of care that my patients needed was extremely high and I can remember one patient in his teens that required nearly 30 fillings. He was not an exception, rather the rule! For that I got awarded 3 UDA's for all that treatment and it took me over 6 hours of appointment time. My UDA 'value' was £19.40 so the NHS awarded me the grand total of £58.20 for 6 hours work. Add on top of that the arrangement that most associates, by way of their agreement with the practice owners, pay 50% of that to the practice to cover costs etc and I was left with £29.10 for over 6 hours work. Out of that £29.10 I then had to pay national insurance and tax before I was left with my pay (we're all self-employed)! I do believe I could earn more working at a Supermarket but that was not my choice of career!

On top of that despite my best efforts, because of patients failing to attend, cancelling at the last minute and generally treating the practice as a convenience with little regard to their fellow patients that might actually appreciate the appointment, I always failed to meet my UDA target with the resultant clawback of money by the PCT.

I find it nigh on impossible to work out how much money is actually mine and how much I might have to pay back every few months if for whatever reason I fail to make my targets, for whatever reason. The fact is, I go to work every day but if a patient doesn't show I earn nothing and neither does the practice but the staff and bills still have to be paid! Also bear in mind, there is no sick pay nor holiday pay to take care of those times when you cannot be at the practice. In the last two and a half years I have had five weeks off... the statutory holiday for employed staff is at least four weeks per year if not more now. If I'm off from work I don't earn a bean and my UDA targets move further away - hence no annual leave!

Factor in the practice owner having to pay for materials, electricity, gas, equipment, upkeep of premises not to mention an obligatory qualified and GDC registered nurse and you can see why dentists end up worrying about money!

So why don't I want to defect to the 'Private Side' instead. Why indeed! Simply because it has it's own problems, and the one I simply could not deal with any longer was the never ending stream of patients that felt it appropriate to comment on my earnings every time they walked through the door! They of course had no clue what my actual income was, merely at what level the practice had set their fees. Again, it is normal for an associate to pay a 50% (in my case it was 55%) fee split to the practice owner for use of the surgery and staff etc so from the very get go my income was not what they thought it was! It is very soul destroying to be constantly and snidely derided by a never ending stream of people regarding your perceived income, how much luckier you are then them and that they have obviously paid for a nice house or a nice car or even your last holiday! This was despite not knowing what car I drove, where I spent my hioliday nor where I lived... All assumptions! They always seem to forget that what they actually paid for was a high level of care and attention to their dental needs and whatever time was needed to achieve that care!

Overall, I would say that NHS patients are far far more appreciative of the care they receive from their dentist (I remember very few private patients actually using the words 'Thank you') so I am stuck between a rock and hard place:

Better income - Low self-esteem OR
More job satisfaction - Financial worries and higher workload!

Neither are good for your health as has been alluded to by a previous poster commenting on the level of suicide in the profession - Actually the level of suicide among dentists is the highest of any job! Do we really stand an earthly?

Trying to compare the dental profession to other medical professionals is also a little fraught with problems when trying to compare incomes. The contract the NHS unilaterally 'agreed' with the dental profession is very very different from that agreed with the medical profession and in particular GP's.
For a start, GP's get considerable funding allocations for practice set-up and maintenance. A GP's staff are also entitled to an NHS pension whereas staff in an NHS dental practice do not get the same rights to an NHS pension. I am personally aware of a local medical practice that consistently get all their practice computer systems paid for by the local PCT. Staff training is funded by the NHS and even their equipment is sterilised at the local hospital and funded by the PCT. NHS dental practices on the other hand are paid for entirely by the dentist that owns the practice - the bricks and mortar, the fixtures and fittings, the equipment, the materials, you name it, the dentist has to pay for it out of their roughly 20 quid per UDA! Am I getting my point across here...? The government have and have ALWAYS had a very different view on dentistry and in my years as a member of the dental profession I am convinced that dentistry just isn't important enough to the government for them to take it seriously!

Regarding the views on dentists not caring for their patients outside of office hours... blame the government and NHS. Before the new contract, dentists were wholly responsible for the out-of-hours care of their patients and on many a cold night I answered the telephone to a crying patient, pulled on some clothes and made my way to a dark surgery in the middle of the night and spent as long as necessary easing their pain. The new contract removed that care and made it the realm of the Access Centre and NHS Direct so you only have them to blame! I might also point out that the same out-of-hours responsibility has also been removed from GP's and GP Out-Of-Hours clinics have been set up all over the country so when little Johnny is crying with tummy ache in the middle of the night, you have to pull your clothes on and bundle him in the car and drive him to them for care! And what is more the GP's still get paid for it!

I hope none of you find my comments a rant and do find it more enlightening regarding the NHS and the way that it can shape a dentist and his/her view of the world and perhaps it has even gone some way to explaining why dental practices, the staff and the dentists themselves behave the way they do!

And before you jump on me, I am well aware that there are some dentists (if they can be called that) that simply should not be practicing for whatever reason... you get them in all walks but please don't tar us all with the same brush!

To finish off... a comment to the poster that referred to us in a rather derogatory manner as model-makers or some-such...

I know whom I would choose to restore my teeth or operate in my mouth... the guy or girl with the keen eye for detail and a very steady hand!

Nuff said!

 

[Dentist hater]

Hello uk Dentist, sorry for the username dont take it personally, was just due to a bad experience i had with an NHS dentist, i am a mother with two children who cannot afford private care so i have to rely on the NHS, one dentist i visited a while ago looked at my teeth, didnt x ray them (i hadnt been to the Dentist in a while, my fault i know but was also due to access of it) so i would presume this is supposed to be done After a long absence from the dentist. He never cleaned my teeth, found out later i had a lot of build up on my teeth, and i beleive this is the most important thing a dentist needs to do to a patients too to prevent losing further teeth. I had two particular teeth, that needed treatment and when i went in there he just put this fillling mater over the teeth, never cleaned the teeth never drilled the teeth or anything, i didnt have a high level knowledge on dental procedures so i assumed its all that was needed. It got to the point were the fillling kept coming out several times, was going back at least 4/5 times and he still did the same thing, eventually it got so worse the pain, really extremt they both developed absesses and as the filling was coming off more of my natural came off with it too. I went back for the finally time after a big chunk came of it, really upset and he said sorry cant treat you anymore due to me going completely private. I also had a chipped front tooth and he didnt clean or drill that just filled it with the same old material and it kept coming off and then he tried a veneer! That came off too and i started to blame myself but then had the tooth simply cleaned drilled and filled by another NHS dentist and that has styared on, the other two teeth i was told i need taking out as no root canal will be done its pointless, 3 NHS dentist told me that, one of them was an emeergency dentist (which i can understand) but why two other ones i registered with wernt prepared to save the teeth which is due to the money aspect tht you mentioned and it has given me more knowledge to the situation now and what you must go through as dentists but the first dentist i saw is obviously imcompent because he didnt actually do anything to my teeth really well apart from make them worse so i am disgusted at some dentists who are very imoral to do this, even though money was an issue, the first dentist i saw shouldnt have under treated me that way. Yeah thre are some bad dentists out there but also there are some good ones who really wish they could treat their patients well and to the highest standard on the NHS but cant due to the funds, as regards to private care, which i would love to have is expensive so thats why patients do say them things to you because they see how much fees they have to pay and think that you must earn a lot if your charging all them fees, its not because they are being nasty really, and i am very appreciative of the NHS care i have recieved,even if some is bad, i have always said thank you at the end of the visit, and i know what you meant by your statment, (''Overall, I would say that NHS patients are far far more appreciative of the care they receive from their dentist (I remember very few private patients actually using the words 'Thank you') so I am stuck between a rock and hard place'') We need good dentists on the NHS and caring ones to help people who are in need but its always the payment/wage/salary issue, i mena i suppose manydentist would work within the NHS if the money was fair and that needs to change, the dentist need to be paid more morally and fairly before any would even consider and if this changed many people will have access and not sit in pain and have bad teeth. Thank you for your post uk dentist it certainly has made me think!

 

[brit]

Sorry to have offended Exdent and UKdentist with my 'modelmaking' comment......and as dentists, I really welcome your input on the topic to this thread....I don't disagree with anything you have said about how crap the current English NHS contract is...you have confirmed what I have long suspected.... I think we largely agree on this...I submitted comments to the recent Steele review. You are actually rather preaching to the converted.

Obviously there are some valid concerns over treatment ethics....we had one poster recently who has now been successfully restored by a private dentist who was told by NHS dentist to go to hospital for GA for full removal and dentures at age 23!!!! I tend to read mainly negative posts on this board particularly about past experiences so my view will be slightly jaundiced...if you sign up for Dentaltown and see how the Yanks do stuff you might start to feel better as well, as Letsconnect inferred earlier in the thread.

If you review my posts in the support area, I think you will see that I have done a great deal over the last 3 years to convince dentally anxious/phobic people from all over the English speaking world that many many 'kind and caring dentists do exist' and they just have to find them, be polite to them (joke) and be prepared to pay a fair rate for the time they need.

My current dentist is a joy to visit...I always thank him and wouldn't dream of ever adversely commenting on his charges....and I frequently recommend him to other people.

The absolute irony here in you singling out my modelmaking comment (on a dental phobia board which you chose to stray into) is that I am the greatest fan of UK trained private dentists of any moderator on this board; since most of my bad experiences have been at the hands of non-UK trained dentists whether in UK in 1970s NHS (piece rate) or more recently as an adult in various EU countries (NB as an Expat not a dental tourist lol).

On your analysis which I don't disagree with, why doesn't the BDA lobby for a system more like the GP Medical one?

To Ukdentist who eschews working in the private sector too - I am amazed that you would have the misfortune to attract such ungrateful rude private patients...maybe it was your geographical area which was the problem...have you heard of Paddy Lund in Oz at all?
As I said I personally wouldn't dream of treating my dentist with anything other than respect (this is how I deal with all people in practice in real life) and I think you'll find that this would be true of the majority of posters on this board....with very few exceptions you will find that 'assertive' is the last thing they feel when attending dental appointments.
I agree that salary/contract terms you quote are unacceptable/uneconomic...I have nowhere said the present NHS contract is a good thing...quite the reverse.
Maybe you could consider working with dentally-anxious private patients - so long as you hone your comfortable injection technique, a more grateful bunch you are unlikely to find. Also a CDS career would get you out of the UDA nonsense (I think).

Your contributions are welcome....feel free to post replies all over...we do not in general actually hate dentists here at all..we just advise people to find themselves a kind and caring one with sufficient time to treat them respectfully in whatever system/country they happen to find themselves.

Thank Goodness for the internet's anonimity don't want to get myself blacklisted by all the best UK private dentists for when I return to UK (not a joke).
Also Exdent I agree you do need someone with manual dexterity working in the confines of the mouth....empathy is needed as well though....we are only ever talking about tendencies/personal observations/experiences and never saying all conform to a particular pattern.