NHS dentistry

NHS dentistry in the United Kingdom is intended to ensure that dental treatment is available to the whole population. However, unlike medical care, charges are made to most people. Most dentists in the UK, unlike most doctors, do private work and many don't do NHS work. On average, dentists who work within the NHS earn more money than those who work in private practice,^[1] with many dentists opting out of what they perceive to be an unethical and compromised system.

Scope of the service

According to NHS Choices "All the treatment that your dentist believes is necessary to achieve and maintain good oral health is available on the NHS. This means that the NHS provides any treatment you need to keep your mouth, teeth and gums healthy and free of pain.^[2]". This includes if clinically necessary: dentures, crowns and bridges, orthodontistry, root canal treatment, scaling and polishing, and white fillings.

Many dentists who provide NHS services also offer additional services, such as hygienists, for payment. A dentist is allowed to refuse to provide treatment under the NHS and then offer to perform the same treatment privately.^[3]

A revised contract is under discussion in 2013 with greater emphasis on oral health and quality indicators.^[4] The British Dental Association is keen to see reform, having campaigned vigorously against the "flawed, target-driven arrangements" introduced in 2006 that are currently in place.^[5]

Availability

Following the government's introduction of a new contract in April 2006, NHS dentistry is not as widely available as it once was,^[6] with 900,000 fewer patients seeing an NHS dentist in 2008 and 300,000 losing their NHS dentist in a single month.^[7] This has forced many patients to pay much higher sums for private treatment,^[8] and has been criticised by the British Dental Association as having "failed to improve access to care for patients and failed to allow dentists to provide the modern, preventive care they want to deliver".^[7]

Ben Bradshaw when Minister for Health was questioned on Radio 4 in 2007 about the shortfall in NHS dentistry leading to patients unable to access NHS dentists and even resorting to pulling their own teeth out. He suggested that those needing urgent treatment should go to see their GP,^[9] prompting the British Medical Association to observe that a General Practitioner was no substitute for a qualified dentist.^[10]

There are repeated stories of shortage of NHS dental services in 2013, especially in remote areas such as Skye^[11] and Cornwall.^[12] Lack of access to emergency dentistry is often seen as contributing to overcrowding in hospital casualty departments.^[13]

Charges

There are three standard charges for all NHS dental treatments:

• Band 1 course of treatment – £18.80 covers an examination, diagnosis (including X-rays), advice on how to prevent future problems, a scale and polish if needed, and application of fluoride varnish or fissure sealant. Band 1 also covers emergency care such as stopping bleeding, trauma, teeth knocked out, severe pain or swelling, even if more than one visit is required.
• Band 2 course of treatment – £51.30 covers everything listed in Band 1, plus fillings, root canal work or removal of teeth.
• Band 3 course of treatment – £222.50 covers everything listed in Bands 1 and 2, plus crowns, dentures and bridges.

Exemption from Charges

• children under 18,
• people under 19 and in full-time education,
• people who get some Means-tested benefits,
• women who are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx) when they start a course of treatment
• People in custody
• people who have a certificate (HC2) entitling them to help under the NHS Low Income Scheme. An HC3 certificate gives some help but not exemption from charges. The effect is that a patient is only asked to pay three times the amount their income exceeds the free treatment level. Any charges paid within three weeks are added together and count as one charge.^[14]

History

At the inception of the NHS in 1948 there were 3 branches of dental service,^[15] and these 3 branches still exist today, although the organisation of services in England has changed much more than in the rest of the UK:

• A local health authority dental service - now chiefly Special needs dentistry. These were transferred to the NHS in the 1974 reorganisation and were repeatedly reorganised, like other community services. Most were run by Primary Care Trusts until they were abolished in April 2013.
• A general practitioner service. Proposals for whole time salaried service at health centres came to nothing and almost all General Dental Practitioners are in private practice. Contracts were originally held by Local Executive Councils, and then by their successors Family Practitioner Committees, Family Health Services Authorities and Primary Care Trusts. They are now held by NHS England
• A hospital dental service, with access to specialist maxillo-facial and oral surgeons. Managed originally by Regional Health Authorities they became part of NHS Trusts, mostly in teaching hospitals.

See also

Special needs dentistry

References