Dentist Issue

[Swango1980]

This is - believe it or not - correct. The government/NHS (not your dentist) has defined mouth guards for tooth grinding as being in Band 3 for payment (same band as crowns and dentures - around £350).

They are nothing like as complex or time consuming as a crown/denture to make and £150 is a fair price privately - so yes you are better off having it done as a private item rather than on the NHS.

The mad payment banding system was dreamed up and imposed by the government in 2006 and has been hated by the profession ever since. It means that the cost of having 20 fillings in one go is the same as the cost of having one filling. Dentist gets paid the same fixed amount for doing 20 as for doing 1 too (i.e. they take a thumping loss on the 20 filling patient). Ponder how mad that is for a second (if you wanted beans then Tesco was forced to give you 20 tins for the same price as one!?!) and ponder whether you’d ever run a business if forced to run that way. No wonder dentists are leaving and NHS dentistry is dying.

Apparently the pre-2006 system (each individual treatment having its own set cost on a price list) was “too complex” according to the government. Yet they couldn’t explain how everyone seems to cope with understanding that same pricing system just fine in Tesco and every other business on earth…

Perhaps some new manager, or management team, felt they needed to justify their salary by dreaming up a completely new payment structure? Whether it is better or not is not as relevant, they just want to be seen to be doing something ground breaking.

That is the cynic in me talking anyway.

 

[Don Barzini]

This is - believe it or not - correct. The government/NHS (not your dentist) has defined mouth guards for tooth grinding as being in Band 3 for payment (same band as crowns and dentures - around £350).

They are nothing like as complex or time consuming as a crown/denture to make and £150 is a fair price privately - so yes you are better off having it done as a private item rather than on the NHS.

The mad payment banding system was dreamed up and imposed by the government in 2006 and has been hated by the profession ever since. It means that the cost of having 20 fillings in one go is the same as the cost of having one filling. Dentist gets paid the same fixed amount for doing 20 as for doing 1 too (i.e. they take a thumping loss on the 20 filling patient). Ponder how mad that is for a second (if you wanted beans then Tesco was forced to give you 20 tins for the same price as one!?!) and ponder whether you’d ever run a business if forced to run that way. No wonder dentists are leaving and NHS dentistry is dying.

Apparently the pre-2006 system (each individual treatment having its own set cost on a price list) was “too complex” according to the government. Yet they couldn’t explain how everyone seems to cope with understanding that same pricing system just fine in Tesco and every other business on earth…

Mate of mine who is a dentist explained this to me once. I didn’t believe him at first! Genuinely thought he was on the wind up!

He himself is NHS still but hates the job and can’t wait to retire.

 

[Lord Tyrion]

When something is so clearly not working for both parties, why do the powers that be not look again at it?. Get the govt, the dentists and a patients group together and sort this out. Continuing on in the same way is not the smart thing to do.

 

[The Squirrel]

When something is so clearly not working for both parties, why do the powers that be not look again at it?. Get the govt, the dentists and a patients group together and sort this out. Continuing on in the same way is not the smart thing to do.

It is working for one party.

It does not work for a lot of patients.
It does not work for a lot of dentists.

It does work for the government. The dental budget now has a fixed maximum (it didn’t pre 2006 - the whole contract reform at that stage was driven by the treasury wanting a capped budget). Pre 2006 if you wanted to provide MORE NHS care then you worked harder - now each practice has an annual cap which means that if you use up all your allocated NHS funding then you cannot provide further funded NHS care that financial year even if perfectly willing and eager to do so. The total cap is capped at about enough to provide NHS dental care for around 40% of the population (remember that when they next mention NHS care being available to everyone).

If dentists leave then the funding allocated returns to the NHS pot to plug holes elsewhere - and there are certainly plenty of those. A dentist going private is a big win for the government- the business will still provide dental care to many people but now at zero taxpayer cost; (in fact it will now be a healthy contributor to the taxpayer pot in the same ways as any other business).

A move towards sensibly priced private dental care for most is not necessarily a bad thing (given that it involves greater choice and easier access to care; and even difficult/restricted access to NHS care involves paying a proportion of the cost) but there is a dishonesty at government level that they are trying to prevent or discourage this shift when in reality they are trying to speed up the process….then of course blame dentists when it happens.

This is not a political point by the way - the position has not changed between 2006 and today, which covers governments of all the main cross-border parties. What has changed in the last 2-3 years I think is much better public understanding of how unworkable the contract is and why this process is occurring.

 

[KenL]

This is - believe it or not - correct. The government/NHS (not your dentist) has defined mouth guards for tooth grinding as being in Band 3 for payment (same band as crowns and dentures - around £350).

They are nothing like as complex or time consuming as a crown/denture to make and £150 is a fair price privately - so yes you are better off having it done as a private item rather than on the NHS.

The mad payment banding system was dreamed up and imposed by the government in 2006 and has been hated by the profession ever since. It means that the cost of having 20 fillings in one go is the same as the cost of having one filling. Dentist gets paid the same fixed amount for doing 20 as for doing 1 too (i.e. they take a thumping loss on the 20 filling patient). Ponder how mad that is for a second (if you wanted beans then Tesco was forced to give you 20 tins for the same price as one!?!) and ponder whether you’d ever run a business if forced to run that way. No wonder dentists are leaving and NHS dentistry is dying.

Apparently the pre-2006 system (each individual treatment having its own set cost on a price list) was “too complex” according to the government. Yet they couldn’t explain how everyone seems to cope with understanding that same pricing system just fine in Tesco and every other business on earth…

Just curious, are you a dentist
@The Squirrel ?
How do you know this if you are not?

 

[The Squirrel]

Just curious, are you a dentist
@The Squirrel ?
How do you know this if you are not?

Guilty as charged.

Other thing I should mention relevant to many is that none of the above applies to Scotland who never implemented the 2006 contract so still work under the old (more sensible) fee per item system. Norn Iron has its own system too.

 

[SocketRocket]

If it's considered ok to make any form of charge for dental surgery then why not for all medical treatment. Surely dental treatment is no different to getting a hip, knee, heart, (all medical procedures). Our NHS should cover all of it, OK people should be free to go private if they want but that should be optional.
Trying not to be political here.

 

[Swango1980]

If it's considered ok to make any form of charge for dental surgery then why not for all medical treatment. Surely dental treatment is no different to getting a hip, knee, heart, (all medical procedures). Our NHS should cover all of it, OK people should be free to go private if they want but that should be optional.
Trying not to be political here.

Is it because technically everyone should go for a check up twice a year, and will probably need treatment fairly regularly.

Whereas with doctors, many people can go years, maybe even decades without seeing a doctor.

No idea, but I imagine free dental care would be a huge cost for NHS. And they are struggling enough as it is

 

[SocketRocket]

Is it because technically everyone should go for a check up twice a year, and will probably need treatment fairly regularly.

Whereas with doctors, many people can go years, maybe even decades without seeing a doctor.

No idea, but I imagine free dental care would be a huge cost for NHS. And they are struggling enough as it is

It used to be free on the NHS.
I guess the answer to your final point is to ask the question whether spending money on peoples health should be a priority.

 

[The Squirrel]

If it's considered ok to make any form of charge for dental surgery then why not for all medical treatment. Surely dental treatment is no different to getting a hip, knee, heart, (all medical procedures). Our NHS should cover all of it, OK people should be free to go private if they want but that should be optional.
Trying not to be political here.

Dental was free when introduced.

That didn’t last long- a couple of years - there have then been charges for (adult) dental treatment for well over 70 years now.

The NHS is often described as “free at the point of delivery” but this is pure nonsense and always has been - prescriptions, optical and dental are most peoples’ most frequent point of contact with the NHS and all have attracted charges for the whole of living memory. Yet the “free” NHS is still somehow embedded as an article of national faith.

There is an interesting debate as to whether a small non-prohibitive appointment charge would greatly ease the GP access crisis (with suitable exemptions). A large proportion of appointments are taken up by a tiny fraction of worried well, in with every cold, and the GPs have no way to manage or prevent this currently. It would be initially unpopular (everyone would rather have something for ‘free’ after all, the GPs like being seen as ‘good guys’ because they don’t charge, and wouldn’t like that service expectations go up as soon as direct payment of money is involved) but works perfectly well in most other countries.