It's the middle of February, and we're heading towards the start of March. The government have decided that there will be a new dental contract by the end of this parliament to rescue NHS dentistry, to change it for the better, to ‘make it work’.
In the meantime, there is a rescue plan which provides incentives to provide access to people who are in an emergency situation, because they have no ability to access care in many parts of the country.
Why is it like this?
How did we get here?
When I qualified in 1994 at Glasgow Dental Hospital and School, my aim and objective for my career was quite clear, with the arrogance and exuberance of youth, I declared to people, ‘I want to save the NHS single-handedly’.
What a d**k!
That said, I went straight into the hospital service and not into practice. I sat more exams, and I worked crazy hours as a junior house officer, senior house officer, and senior house officer again. Even in my VT (DFT here), I negotiated with my boss to continue to provide day-case surgery at the hospital where I've been in SHO one session per week.
Ultimately, that ran out, and I became an NHS associate in 1998, and I worked within the NHS and dentistry as a general dentist and then as someone providing oral surgery, up until around 2015.
That's 21 years of NHS service.
Watching what happened throughout that time, I watched the contract changes, the ‘year of high trust’ around 2006 or so, when people were ‘allowed to do what they wanted’ and just paid the money.
The big turning point came for me with the oral surgery contract that I had in North Derbyshire, after my whole practice had been sold by my boss to Integrated Dental Holdings (IDH) some years before.
After I had ‘been sold’ and left at short notice, I was given the opportunity to run a different IMOS contract than the one I previously had, which covered the whole of North Derbyshire. It turned out to be quite successful, particularly due to the fact that we managed to reduce the cost of individual oral surgery procedures to the NHS by 66%.
That is some efficiency saving.
I'm going to tell you that the quality was much better too, and all the outcomes were measured and delivered monthly to the then PCT (Primary Care Trust) without even asking.
We ran this for some years, and it was devastatingly successful. We were even at the place where anyone who had complaints related to this came to be sorted out, and we did favours for the commissioners all the time.
And then they returned back for a new contract, and told us that they had to reduce our contract value by 50%. At that point, the conversation went, ‘Would you like us to do half the number, or would you like us just to do it half as well?’
The answer was neither. Same number, same quality, half the price. Just to be clear, that's utterly unsustainable.
Ange, my partner and I had built the most extraordinary team of people. We were able to do that because we were able to invest in the service to pay them, to look after them as best we could. It would not be possible to work in the same way under those arrangements, and it was at that point that I decided to leave the NHS.
It's always been a problem, a little horcrux of mine, part of my soul that I left behind, but since then, in 2015 and in these intervening 10 or 11 years, that story has been repeated time and time again.
You cannot make a silk purse out of a sow's ear.
It's time for a revolution, not evolution.
Blog Post Number - 4447
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