Are you NHS or private?
NewsPosted by: Dental Design 18th March 2022
Why do people still ask that question?
It is now twenty years since I left dental practice and moved to the Department of Health. Many things have changed in that time; oral health has continued to improve, the number of edentulous people has continued to fall, the techniques now available to treat oral disease have increased and we have guidance about what preventive measures work in the primary care environment. The scope of practice of DCPs has quite rightly been expanded and hopefully this will continue.
Access to NHS dentistry is now controlled by the NHS after the crisis created by the 1992 fee cut motivated the then government to finally do something about dental access. The extra investment that was made leading up to 2006 has sadly not been repeated to tackle the current access issues and the measures taken on workforce; creating two new dental schools and encouraging overseas recruitment have also not been revisited.
Some things, though, have not changed. Dentists dislike the current contract currency almost as much as they did not like the previous item of service system, although the growth of social media has meant it is talked about much more widely now. The thing that still surprises me is that people still insist on talking about NHS or private practice and some sadly talk down those working more in the NHS. I think people mean to talk down the system but a recent visit to a practice for some treatment made me realise how much some dentists working largely in the NHS resent this constant criticism. One particular comment complained about how the NHS is talked down by many members of staff at some of the dental schools and, more worryingly, by some people working with the post graduate dental deans.
The truth is that there are very few fully NHS practices. We were a largely NHS practice but still did some treatments on a private basis when patients wanted something provided, which was outside the scope of the NHS. With the improvement in oral health and the much greater interest in dental aesthetics, this has certainly increased.
So, the correct question should really be: “Are you in a wholly private practice or a mixed one?”
Being in fully private practice means that you have made your own business decision to have complete freedom in how you run your business and to opt out of the benefits of being part of the NHS – a pension to which the NHS also contributes, access to maternity and paternity pay, as well as the opportunity to treat children and about 30% of adults free of charge (this will clearly vary depending on the area you practice). The clear advantage of retaining an NHS contract, setting aside the payment of contracts in the early stages of the pandemic, is that if the NHS ever gets around to doing something about the current workforce crisis meaning practices with an NHS contract can recruit again, then you should be able to grow your business based on a contract rather than, in some areas, relying on a lack of NHS provision to support the growth of private provision.
I am sure that when people criticise the current NHS contract, they do not mean to criticise those working in it. In a recent interview on the BBC, a dental journalist said that dentists working in the NHS were being deskilled. I don’t know what the basis was for this statement, but it certainly grated with many clinicians.
After the fee cut in 1992, our LDC arranged an evening event with a private plan provider and every practice in the town attended. The spokesman for the plan provider told us that around 50% of our patients would be able to take up the alternative provision and that we would suffer no loss of income and have a more relaxing practicing life. We asked what would happen to our patients who could not afford this new offer and were told that this was “not our problem”.
Our practice had been established in the town since pre-war days and we were not willing to deny care to longstanding patients on the basis of whether they could afford to pay the fees associated with this new system.
We stayed in the NHS and, five years later, got involved with PDS piloting of alternative currencies. Our pilot currency was similar to that piloted and prototyped and, although it worked for us, our patients and the local NHS, it seems to have been dropped for now. I hope that is not a permanent situation.
About the author
Dr Barry Cockcroft CBE is the former Chief Dental Officer for England and current chair of the British Fluoridation Society
