A child receives dental care

Hundreds of people queued in the St Pauls area of Bristol due to the demand for NHS dental care. Dressed for the cold, they formed an orderly line that stretched around the corner and into surrounding roads. For three days last week, queues formed because locals heard that a new dental practice was opening—and it said it would treat NHS patients.

“There’s not a single dentist in St Pauls that isn’t private-only. And this is a poor area where people are struggling,” says local activist Anne. She was part of a battle to bring in a new NHS practice. For months campaigners held a Friday night vigil outside the old Bupa one that recently shut its doors.

The private health firm said it wouldn’t maintain its contract because it could not attract dentists to do NHS work, and because of a general shortage of dentists. There are currently more than 5,000 dental vacancies across Britain.

“The problem isn’t just in St Pauls,” Anne adds. “There are 52 dental practices in Bristol—and not one is taking NHS patients. We had to fight hard to get this one to re-open.” It’s a situation repeated across the country. 

According to the House of Commons Health and Social Care Committee, 90 percent of dentists are not taking on new NHS adult patients. That has terrible consequences for those needing treatment. The price of NHS band 2 root canal surgery, for example, is £70.70. Private treatment starts at £350.

When there are no NHS dentists those that can go private. Those that can’t, go without.

Claudette was one of the first in the queue in St Pauls last Wednesday. She told reporters that she’d spent £600 on treatment in the last two years but couldn’t afford to again.

“I am waiting for a tooth extraction. I have got a temporary filling at the moment. I looked at the prices and I am looking at hundreds of pounds, so I was desperate to join.”

But by the afternoon, the dental surgery was pleading with queuers to go home, saying it had reached its quota. “It’s heartbreaking that we will have to say no to some people,” says Dr Gauri Pradhan, director of the practice. The problems in Bristol, and across Britain, can be traced back to Tory austerity.

According to the Nuffield Trust health think tank, dental funding has fallen by £525 million since 2014-15 once inflation is considered. And, it says, the number of dental treatments done each year is now six million lower than it was before the pandemic.

That drop is having a catastrophic effect as people’s dental problems worsen and treatment becomes more complicated and expensive. As the disappointed drift away from the queue for Bristol’s only NHS dentist, the painful consequences of NHS decline are only too clear.

No free market solutions to ongoing dental crisis   

  The Tories responded to the growing dental crisis in their traditional way—by offering too little, too late. Dentists that set up practices in areas of England with poor access to NHS care will be offered a £20,000 bonus, they proclaimed last Wednesday. This extra payment will be available to up to 240 dentists. That’s just 1 percent of the workforce.

The government has also announced higher payments for those dentists that take on new patients and teeth-cleaning in schools. Ministers hope the offer of higher standard payments for dentists carrying out NHS work will tempt them away from the private sector. But there are no free market solutions to the problem.

That’s because even the increased NHS payment comes nowhere near what dentists can make privately. And, the crisis in dental care means there is a huge, lucrative pool of people that will pay over the odds. The British Dental Association is arguing for a new contract that pays dentists a lot more for doing NHS work. 

This, it says, will end the crisis. But they are arguing as a trade body, representing private contractors, rather than an organisation committed to decent dental care for all. The real solution is to bring all dental care into the NHS, and to turn dentists into normal NHS employees, just like other doctors. Such a move would be transformative for those currently going without care—especially children.

Tooth decay is the primary cause of NHS hospital admissions for people aged between five and 17-years-old in England. Yet some 40 percent of children no longer have access to regular dental appointments.

A history of dodgy deals

When the NHS was founded in 1948 dentists were among the most resistant to joining it. Dentists signed a contract that kept them as independent provides, outside of the NHS. This means dentists are private contractors and ordinary people have to pay.

They buy the building, equip the surgery, hire staff and pay wages, to providers an NHS dental service. Many dentists still refused to sign the contract until the last moment. These professionals feared their status and independence would be under threat if they became “state employees”.

The Labour government worried that doctors and dentists could derail the plans for the NHS and offered both lucrative rewards. And, rather than fight, ministers made deals. The initial contract agreed in 1947 meant that local authorities paid dentists for each filling and extraction. The rates were set deliberately high to win over opposition.

This compromise held for nearly 50 years until 1990 when the Tory government brought in a new NHS dentists’ contract. The new contract cut funding for NHS dentistry, reducing payments for NHS treatments. This pushed dentists to provide more and more private care.

The Tories also doubled patient charges—the amount you pay for dental treatment—between 1980 and 1985. The result was a sudden expansion in the numbers of private patients—and huge growth in the number of private providers. This marked the beginning of the end of NHS dentistry.

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