What is going to happen next in the profession that I entered 26 years ago this year?
As I write this in November 2020 much of NHS dentistry is not working and certainly not working to any sort of capacity that it was in February 2020.
It looks very much from my vantage point outside of NHS dentistry now that it won’t be doing anything of any great capacity before April 2021.
The difficulty we will have with that is that the government will be able to look backwards and wonder how much capacity they actually need to fund in NHS dentistry in order to provide ‘the basic level of health’.
Part of the big extended down time period for many NHS dental practitioners came at the cost of giving data to the government which will allow them to potentially hang the system that previously existed.
That may not be the agenda at all but it would certainly be hard for it not to be my agenda were I in a position of authority within the National Health Service.
We can argue that this and argue that but in the end the NHS is responsible for providing the level of care that it states for the most value and that might be a lot less value than it was providing in February 2020.
Imagine we were starting again (and we may well be to some extent in April 2021), what would that look like for NHS dentistry?
In a world that was fair, in a basic level of dentistry providing good health and good value for patients who required it in a means tested and socially agreed way would be the most reasonable.
That would be the most vulnerable parts of society who needed dentistry to be provided for them and for it to be provided in the best possible way.
For the rest of the population who are able to afford Sky TV and to run a car and to buy alcohol and Dominos pizzas, they will have to find some way of funding their own dentistry beyond very basic care to keep their health maintained.
Funding middle class orthodontics in the UK must surely be a thing of the past and even funding anything which constitutes aesthetic dentistry is probably beyond the reach of the ‘new NHS’.
Ever since I was a Chairman of a local dental committee in the early 2000’s we have been discussing the concept of ‘core service’ and now surely seems the time that the core service will arrive.
And so, what would that core service look like?
This was scored about 3 years ago when I approached the commissioners in my local area with the prospect of providing them with a brand new dental ‘supercenter’ next door to the new practice that I was building.
This was a genuine offer to try to do something fantastic and not in any way to buy me a yacht or an airplane.
I had already gone through the pain of designing a state-of-the-art dental practice over 7,000 square feet of real estate, from scratch and felt it was only reasonable to start to discuss with the NHS what that might look like if they used it themselves in a creative way for the people of South Nottinghamshire.
Having had experience of setting up an NHS specialist service before in North Derbyshire and also an oral surgery service in South Derbyshire, I felt I was in a reasonable position to put together some sort of proposal to discuss.
I had the opportunity to put a 7,000 square foot building right beside my 7,000 square foot building and to have shared parking of 62 car parking spaces (or potentially more) and to provide NHS core service dentistry, oral surgery, orthodontics, endodontics and periodontics if required but also tie in with community service, educating children in local schools, educating the workforce including dental nurses, therapists, technicians and dentists and tying it all up with data collection to show how effective it was.
The sad part of that was that there was absolutely no political means in order to achieve it.
All that was available was tendered contracts, some of them at zero value and it’s quite tricky to build a 3 million pound building and staff it on a promise of nothing unless somebody walks through the door.
I still believe though it’s the best model and the best option.
It relies on building relationships with honest and ethical providers (so that might well rule out many of the corporate organisations) but you could build a template McDonalds style and you could start to drop them into areas of high need.
It is revolutionary and undoubtedly almost impossible due to the barriers of red tape and empire building that exist but ‘beacon centers’ where NHS patients can access their care in facilities of high quality with motivated, educated teams would provide, in my opinion, the best value for money.
It would allow us to train DFT’s and dental nurses and technicians and therapists and hygienists and the economy of scale would make it the most effective way to provide dentistry.
Each building would cost something ranging from 3-3.5 million to put in the ground including the dental equipment depending upon the services that wanted to be provided. It might cost the same again to run it on a yearly basis and so I’d need to do some math’s on how that split around the population that needed to access it against how many centers would be required.
It might be possible to repurpose existing places to keep the costs lower but the strategy to appoint and develop changes within these centers would be able to be written and nailed down.
This is not a new idea. We explored and tried to develop the idea in the late 2000’s and we were almost there with South Derbyshire Health Authority before the world fell out of the financial markets.
Fashion comes round again and so will this. There is definitely an opportunity here for someone to do an extraordinary amount of good within dental healthcare in the UK.
Grab it if you can, it would make a huge difference.
Blog Post Number - 2554