Dentist Industry and NHS Backlogs

Cherilyn Mackrory Excerpts

Monday 7th February 2022 Commons Chamber

[Andy Carter]

My hon. Friend is absolutely right: many of the dentists I have spoken to say that working with these activity targets is like being on a treadmill. It wrongly puts the focus on meeting targets, rather than delivering the sort of patient care we need to be delivered in our dentists’ surgeries.

On the back of receiving news from constituents who contacted me that a surgery in Appleton was to close, I went to see Dr Mansour Mirza, who runs Appleton Park dental surgery. He talked me through his decision to give notice to the NHS. He was handing back a contract worth hundreds of thousands of pounds which his practice had had for many years. I want to thank Dr Mirza for being so open and so frank with me about the decision that he had to take earlier this year. Providing the treatment that he is required to deliver under the contract just does not add up. It costs him more to provide the services than he is paid. No one can survive over the long term if that is the case, so it is hardly surprising that his contract, like many others around the United Kingdom, is being handed back to the NHS.

I am also grateful to David Flattery, a dentist who lives in Lymm and owns and manages a practice in Altrincham, for his insights. He says that the incentives to take on new NHS patients at his practice are slim to none, owing to the workload and the quotas that he has to meet under the “units of dental activity” system. When he explained how the system works, with units attributed to particular types of treatment, I came away scratching my head. Dentists are effectively paid the same for delivering a check-up as they are for root canal work, although one of those procedures involves a tremendous amount more work than the other. That makes little sense.

The Minister will know that UDAs simply do not work, and it is time to replace the contract with a more modern system which reflects dentistry in the 21st century. Dr Miraz told me that his private work had been subsidising the NHS contract for many years, and that despite wanting to continue, he simply could not afford to provide the NHS services that he had signed up to. Shockingly, the regional NHS team did not seem to want to find a solution: they have simply left people without access to any NHS dentist.

There is a real fear that NHS dentistry will disappear in the months and years to come. Dentists want to do the job of dentistry. It seems from what I have heard about the experience of dentists working through the pandemic that the likelihood of having payment clawed back by the NHS has grown. In the current quarter, dentists need to deliver 80% of their contracted UDAs, at a time when the prevalence of covid and the omicron variant is at its highest point in the entire pandemic, but the targets that have been set for dentists have risen during that period. If patients cancel or staff are sick and dentists cannot deliver that 80% of UDAs, the dentists lose funding, which means that they cannot pay the salaries of their staff, meet the rent, or provide future services for children or those with the lowest earnings. I believe that dentists are conscientious and caring healthcare professionals. They want to treat their patients, but they also want to be treated fairly by the NHS. Mr Flattery told me:

“If we really want to incentivise prevention, we need to see change urgently. ‘Incentives’ to just drill and fill is what the industry has been arguing against for many years.”

The latest NHS dental statistics show that in NHS Warrington clinical commissioning group, only 33.6% of child patients were seen by a dentist in the 12 months to June 2021, a fall from 54% patients the year before.

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

My hon. Friend is advancing a compelling argument, and much of what he is saying rings true in Cornwall as well. One of my passions relates to childhood dentistry, or the lack of it. When we question the authorities in Cornwall, we often find that they are not entirely aware of the scale of the problem that they have. Many Cornish Members are currently conducting their own online dentistry survey.

When I was a child—I do not know whether other Members had the same experience—we used to have dental checks at school, and our parents were told if there was a problem. When I investigated, I was told that it was not necessary for a dentist to carry out the checks; a dental professional could do them, and a letter would then go home to the child’s parents. Would my hon. Friend support piloting such schemes again, particularly in deprived areas, along with preventive medicine to stop children needing to go to the dentist with serious problems in the first place?

[Andy Carter]

My hon. Friend raises an interesting point. I spent Friday afternoon with a GP practice in Warrington South and heard from the doctor there about the work that is now undertaken by nurse practitioners in the surgery and in the community. It seems sensible to me to upskill dental nurses to become dental nurse practitioners who can work in the community, and in schools in particular, to try to give guidance to parents to support families and to ensure that children’s dental health is a priority.

My hon. Friend identifies issues in child oral health. If we are not careful, we will store up an incredible problem for the future. We need to see it as a priority. The notion of having a six-month check-up has gone, for many good reasons, but many children are not seeing a dentist over a 12 month or even two-year period. We need to think carefully about that, so I absolutely support her point.

According to the NHS workforce study, 147 fewer dentists are working in the NHS in the north-west than in the previous year. In Warrington, there are 64 dentists per 100,000 of the population and we are seeing considerable falls on previous years.

In the long term, root and branch reforms need to be instigated in the dentistry sector. I hope that the Minister can explain what steps the Government are taking to increase training places in the north of England. I ask her to instigate a national recruitment drive to increase the number of people going to university to study dentistry and to introduce incentives for dentists to relocate to areas such as Warrington and to work in smaller practices where they provide an incredible service to local communities.

I ask the Minister about the new dental contract too. As I mentioned, I think most of the underlying problems in NHS dentistry spring from the fact that the current contract, which dates back to 2006, is not fit for purpose. It is inadequate and does not reflect the needs of dentists and their patients today. I hope that she can explain what steps she will take to bring forward a new contract and how she can work with dentists, patient groups and other interested parties around the country to ensure that the contract reflects what dentists and their patients need for the next decade. Does the Minister agree that we must break the idea of units of dental activity and ensure that NHS dentistry is available to all those who need it, as well as prioritising preventive care?

Finally, what can she say to my constituents, such as Paul and Paula Green, who have paid their national insurance contributions and paid their taxes but who, because of where they live in Warrington, can no longer get access to NHS treatment because nobody wants to provide a service through an NHS contract? I thank the Minister and look forward to hearing her reply.