Is it still worth being an NHS dentist by John Grant

28th November 2011 - Cohen Cramer
Posted in: Services for Dentists
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I am sure this is a question many NHS dentists will have asked themselves, particularly since the introduction of the odious UDA in 2006.

To be fair, looking at things from an outsiders perspective (and while I spend most of my working life dealing with dentists, I am lawyer and have no idea of what it must be like staring into the mouths of people who would generally rather be anywhere than in the dentist chair – other perhaps than in a lawyer’s office!) the idea of knowing, to the penny, what my income for the year ahead is going to be seems like a huge benefit.

It has however been the case since the introduction of the latest contracts in 2006, that many practices have really struggled to fulfil their UDA targets – even those which were keeping up to speed could suddenly find their income severely under threat if they were prevented from working for even a brief period due to for example an accident, ill health or even bad weather.

If one accepts therefore, things were difficult at the outset; it appears that things have actually become considerably worse over the course of the last year or so.

There are a number of major reasons for this:

• Since the announcement of the abolition of PCT’s many experienced people with at least a working knowledge of the regulations have left PCTs to be replaced by those with ,to be charitable , little more than a flimsy knowledge , resulting in more and more perverse decisions and the inclusion of wholly unenforceable terms in NHS contracts
• Until recently, over 50% of PCT’s had taken no action to recoup overpayments, where there had been underperformance of UDA’s – this year by contrast, not only do they want their pound of flesh but they want it all and they want it now – or else
• The fact that whilst owners of  private practices are able to enjoy the potential tax and other advantages of incorporation , unreasonable PCT attitudes coupled with recent changes to NHS pension legislation mean that this is simply not an option which is open to NHS practitioners
• Changes to and the removal of seniority payments to those who have loyally served the NHS for their entire working lives
• Increasing uncertainty over the form of the proposed new NHS contracts –other than the reasonable assumption that the government will undoubtedly want more work for less pay

This combination of factors leads me to believe that any sensible practitioner would seek to look for an alternative way forward – such as joining one of the major scheme providers such as Practice plan and only those with no choice whatsoever would maintain wholly NHS practices. It is of course possible to run profitable nhs practices but that increasingly requires a level of  efficiency and investment in systems and processes which  many practices would struggle to implement due to  a lack of knowledge ,support and funds available to implement the necessary changes.

One would hope that ordinary folk will always be able to access an NHS dentist – on the other hand most I would hope would agree that in any civilised society, there would be fair access to justice for all – but in my profession it is becoming such access is increasingly only available to the very rich – let us hope that in five years, we are not saying the same about dentistry!

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