Hot Topics in Dentistry: MMIs- part 1

1. NHS
2. COVID
3. Brexit

NHS

Costs

Tell us about your understanding of dentistry in the NHS.Do you think dentistry should be performed by the NHS for freeWhy do you think NHS dentistry costs money?

• Costs are divided into 3 bands:

• You pay Band 1 for emergency treatment.
• ie dentistry is not free, unlike most other areas of healthcare in the NHS
• Dentures were actually the first areas of the NHS to cost money as by 1951 the NHS was running out of money.
• It’s pretty impressive if you know the 3 founding principles of the NHS (founded in 1948)
  • Available to everyone
  • Free at the point of delivery
  • Based on clinical need rather than wealth
• You could also mention about the importance of dentistry with regards to both physical and mental health and therefore should be more accessible?
  • Additionally the NHS does not provide cosmetic treatments despite its potential impact on mental health.
• However you could argue that maybe it is justified for dentistry to cost money since many dentists are going private so this could be a financial incentive for dentists to stay.
• Also dentistry is inherently expensive due to the advanced training dentists require, the costs of high quality materials as well as sterilisation and infection control

Contracts

Tell us about your understanding of UDAs.

Why do you think so many dentists are going private?

Tell us about your understanding of NHS dentistry

• UDAs or Units of Dental Activity is a measure of how productive dentists/practices are.
• Every NHS dentist/practice is given a certain number of UDAs to satisfy by the government- treatments will give a dentist a certain number of UDAs. A dentists or practices are financially penalised if they do not satisfy the UDAs.
• Problems:
  • Does not take into account education
  • Disincentivises preventative work
    • Extracting a tooth and conserving it would give the same number of UDAs but extraction is much easier
    • It’s higher ‘value’ to do more fillings and extractions
  • Incentivises dentists to take on patients who require shorter courses of treatments
    • Disincentivises taking on high need patients
  • One filling can have the same number of UDAs as five fillings, a root canal treatment and extraction (3 UDAs)
• In order to satisfy UDAs, appointments are required to be rushed to get through a huge backlog of cases.
  • Obviously this is sub optimal for various reasons
    • Best interests etc
• In 2016, a BDA survey showed that 93% dentists believed UDAs where standing in the way of treating patients in need
  • Also 70% feel that contracts are limiting their ability to take on new NHS patients
• Leads to a lot of pressure on NHS dentists
  • Recruitment crisis
  • NHS dentistryfails to see 55% of the population.
  • 30% decrease in income for dentists over a 10 year period
  • Charges of treatment over the past 5 years has increased 4x faster in England compared to Wales
  • 1/5 patients delayed treatment because of the cost
  • Many resort to DIY dentistry

COVID

How has the pandemic affected oral health and dental care?

• Link to how there is already a backlog of dental patients and problems with NHS dentistry/contracts
  • Even more pressure on NHS dentists
• Immediate consequences of increase in anxiety and uncertainty
  • Dentists had to close during first lockdown
    • How important is dentistry? Physical and mental health.
• ICU beds taken up
  • Oral cancer patients
  • OMFS
  • Patients in hospital at risk of COVID
• Outpatient consultation affected
  • Appointments cancelled due to pressures on practices but also uncertainty/anxiety
  • Lots of air powered tools in dentistry
    • Spread the virus
    • Close contact with mouth
  • Harder to do video consultations, unlike GPs
• Gingivitis, periodontitis, oral cancer asymptomatic in early changes so regularly check ups are important

Brexit

How has/will Brexit affect healthcare/dental care?

How has Brexit affected staffing?

Nurses

• Brexit may lead to a shortage of nurses
• Impact on patients:
  • Source of comfort and worries
  • Integral in patient care
  • Especially patients with COVID who can’t see their families
• Impact on doctors:
  • Obvious reasons
    • Like extra workload
• Significance of the aging population
  • High demand for healthcare
  • People keep teeth for longer
  • Age related diseases
  • But shows the NHS is doing well as people are living longer
• Solutions:
  • Outreach
  • Scholarships
  • Economic incentives

Other

• Medicine shortages
  • Border disruptions and delay
• Scientific research
  • EU funding
• Higher tuition fees for EU students

See part 2 for use of amalgam, fluoridation and the sugar tax.