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Where are we going?
In the early ‘80s I was heading for an LDC meeting, ready for trouble. There was an agenda item that evening with a request from our optician colleagues. They were seeking help to support them in their fight to stay fully in the NHS.
I found myself in a minority of one arguing that we shouldn’t do this as it would make no difference to the outcome. My view was that we should focus our energy on fighting our own battle, although it wasn’t apparent to me that my colleagues were aware then that we were even in a battle.
Not long after that meeting, The Opticians Act 1989 ‘allowed’ optometrists and dispensing opticians to set up their own practices and work privately. And we know what happened. They were unceremoniously shot along that path to the world of private practice. Go into a major optician now and the NHS frames – all four of them – are tucked in a corner, while all the vast array of ‘private’ frames sell like hotcakes.
Oh, how I wished they had done that to dentistry then.
Fast forward to today, and I think we are about to receive that push – and it might all be thanks to Tony Blair! During his tenure as Prime Minister, the NHS Ombudsman’s in-tray was stuffed with complaints about access to dental care (this is nothing new). But what TB discovered was that, by opening salaried walk-in centres strategically placed around the country, the vast majority of ombudsman complaints about dentistry disappeared. Which must have got politicians thinking that the country didn’t have to spend all this money on dental services to stop getting beaten up about access to dental services. And government is very patient.
Now, if you still think that politicians give a toss about ‘quality dental services’ (except for themselves), then it’s time to wake up and look around. What they care about is getting re-elected. No parliamentary seat = no power, simple.
Today, lack of access is rearing its ugly head again. And now we hear rumours that the office of the CDO is seeking to fast track Indian dentists direct into the UK to support NHS services. And, again, there may be a major dental corporate body thinking about doing the same?
So, here’s what I think is brewing. First, you can bet that, for those foreign dentists recruited, the major condition of their work visa will be that the continuation of their visa is contingent on them working in the NHS. If not, their visa will be rescinded – and back home they go.
And they will be in salaried positions which will be such that the cost is much less than all these self-employed bods that they have now to fund.
Similarly, for the corporate body thought to be doing the same, it is very unlikely that they can make headway with such a scheme without full government backing.
The government will then expand the existing walk-in centre network, or even, surprise, surprise, partner with the suspected corporate body. This allows them to create a larger network of strategically placed practices and walk-in centres which are much cheaper to run and that solve their access problems.
Of course, patients might have to travel some distance to receive care. But, there is precedence in medicine with ‘centres of excellence’ being formed in many medical specialities, which mean that patients in need of that expertise have to travel considerable distances to receive it. No escape there, then.
If more manpower is needed in these clinics, government will bring forward their plans to require all dental graduates to work in this new NHS network for a period of two to five years. Given that it shouldn’t be too difficult to persuade the general public that this is an entirely reasonable thing to do, I think the longer end of this sentence is more likely to happen.
Over the decades, the BDA and other stakeholders have urged government to accept a core range of treatment under then NHS and fund it at a level that ensures quality care. This has always been rejected, with government claiming that they are funding a ‘comprehensive care system’ (I refer you back to our optician friends).
What will happen now, of course, is that our newly employed, salaried Indian colleagues will be offering a restricted range of treatments, ‘that are appropriate to the maintenance of general health’, as defined by the DofH. That’s the ‘comprehensive care system’ out of the window, then.
Why should we be preparing for this to happen now? Well, ask yourselves, do we really believe that all the years of experiments with dental contracts was done to ensure the provision of quality treatment and the security of the dental profession? Do we really think that Whitehall has not been measuring very carefully just how much inexcusable and intolerable pressure the dental profession was prepared to live with? Or that all the little tinkerings with DWSIs was for out ennoblement and status?
There is now a huge network of dentists working in the private sphere in this country, and government know that any marketplace differentiates its offering of services to different sectors.
Think of restaurants; everything from The Savoy Grill to Greasy Pete’s operate to feed the population without support from government. This too will happen in dentistry.
The Food Standards Agency (FSA) is government’s arm to control that industry. In the same way that you will never hear the general population voting to disband the FSA, which of course is there to ‘protect’ them, so too, the CQC is going nowhere.
So, courtesy of this QUANGO, we are not a liability to government, the cost to the Treasury associated with dentistry will be lowered, plannable and predictable, and the majority of complaints from the public will disappear. Central control of this new NHS network will enable the DofH to produce ‘convincing’ statistics to demonstrate to the public that they are doing a great job and meeting their healthcare obligations to the electorate.
The government will have achieved its long term goals. Privatisation of an expensive profession, a predictable and plannable expenditure model, regulatory control of said professional and an ignorable level of complaints about the public provision of dental care.
Job done!
Dr John Willmott
Holly Tree House Dental Practice
334 Mansfield Road
Mapperley Park
Nottingham NG5 2EF
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