Dentist Industry and NHS Backlogs

Nick Fletcher Excerpts

Monday 7th February 2022 Commons Chamber

[Andy Carter]

I absolutely agree with the hon. Gentleman. That is the purpose of this debate: to highlight to the Minister the concern that I and other Members around the country have that NHS dentistry is on the brink and that there has to be radical change.

As well as talking to dentists, I have spoken to constituents who have written to me, completed an online survey that I placed on my website or messaged me directly following publicity in local newspapers about this debate. This topic matters not only so that people can access urgent treatment for toothache. More and more studies are confirming what dentists have always argued: that tooth decay and gum disease are increasingly linked to a heightened risk of serious health problems such as stroke, heart disease and diabetes. A healthy mouth is the gateway to a healthy body. Neglecting oral health can sabotage our long-term overall health. As the hon. Gentleman indicated, this topic really does matter to many, many people.

One of the first issues I want to highlight is the challenge people face when they move house. Finding NHS treatment can be almost impossible as a new resident in a location. I wanted to say, “getting on to a surgery’s list,” but it is clear from speaking to dentists that the notion of getting on to a list does not exist anymore; there are no such things as dentists’ lists today.

In my quest to help residents, I have spoken to NHS England, Warrington clinical commissioning group and the regional dentists’ team. They have all pointed me to an NHS website that lists details of dentists who are accepting patients in my local area. The reality is that the website is massively out of date. In most cases, surgery information has not been updated for about two years. Despite being assured that there are dentists accepting new patients in Warrington, it is simply impossible to find them. As my hon. Friend the Member for Worthing West (Sir Peter Bottomley) indicated, it is like looking for a needle in a haystack.

On Friday, I had it confirmed by constituents I spoke to that NHS England could not provide them with the details of any dentist in Warrington, Cheshire or Merseyside who was accepting new NHS patients. They could provide details of emergency dental treatment services available in Manchester or Liverpool, but NHS England confirmed that no dentists are currently taking on new NHS patients across an area with a population of about 1.8 million people. I am afraid, Minister, that the signposting we are offering online is woeful and urgently needs to be updated.

In early January, I heard from many people living in Appleton, who had received notice from their local practice that after many years of providing NHS treatment, it would no longer be offering services through the NHS. On Friday last week, I met Paul and Paula Green, who have been patients at Appleton Park dentist surgery for many years. They are two of about 8,000 local people who received the notification that their provider was changing the way it offers services, and that the only way they could continue to get treatment at the local practice was to become part of a dental plan or to pay for their treatment. Mrs Green has been at the same surgery for about 50 years. In fact, the whole family are patients. They were suddenly informed that treatment provided by the NHS would no longer be available from the end of March. They will have to look further afield for a practice—there are no other practices in the village—and there is no guarantee that they will be taken on by any practice in Warrington, Cheshire or Merseyside.

Many of those 8,000 people will be left without an NHS dentist. Some could even be mid-treatment. They have paid their national insurance and their taxes, in many cases over many years, but now they cannot get NHS treatment. Understandably, they are pretty cross. They are cross with the dentist for making this change. They are cross with the regional NHS team. They are cross with me as their Member of Parliament. They are cross with the Government. They want to know what the Minister is going to do to help them find an NHS dentist who can look after their family’s oral health.

Myriad factors are driving practices across the country to make such moves, and I will cover a couple of the main issues that I hear when I talk to owners and senior dentists across my constituency. One of the first issues I want to discuss is the need—much like in many other sectors—to bolster and boost skills. Dental practices stand or fall based on the quality of their people, and if a dental practice cannot recruit enough good staff with the right level of training, that practice obviously has a serious problem. However, unfortunately, research suggests that this is a common problem for small and medium-sized dental practices right across the UK. Most dentists are SMEs: they are run by a senior dentist, receiving payment from the NHS to provide services through an annual contract, which I will discuss in more detail shortly.

The problem is that the UK does not seem to be producing sufficient numbers of dentists with the skills that those SMEs need. On top of that, the difficulty with dentistry is that when people graduate, they tend to work where they qualify or where they live, and they are not necessarily going to dental schools in the north of England—in fact, most of the dental schools in this country are in the south or the midlands. We are simply not training enough people in the regions who want to become dentists, who want to take on those NHS contracts, and it is not sufficient to say that we pay trained professionals well. We seem to have a lack of supply and over-demand.

What is the sector looking for? By widening access and participation in training, the Government need to create more flexible entry routes, including for overseas dentists, as well as develop training places for dental professionals right across the UK. This is not just about dentists: it is about upskilling dental technicians and dental associates by providing them with more training, so that they can provide a greater range of services. There are many vacancies for salaried dentists available in the UK—anyone who searches online can find details in pretty much every town around the country—but the problem is particularly bad in small towns and villages across the north of England, and the ability to track new entrants into NHS roles is limited, particularly when dentists working in the private sector can earn much more than they do in the NHS.

There is also an immediate need for dentists from outside the European economic area, and we should be making much more of our fantastic links to the Commonwealth countries, where there is often a surplus of trained dentists. Will the Minister look to extend the General Dental Council’s recognition of dental qualifications to schools outside the EEA? When needed, candidates could work in a provisional registration period with close supervision and training for a year before registration with the GDC is granted, a measure already used for overseas doctors by the General Medial Council, but not currently employed by dentists. I ask the Minister to look at recruitment, with a target to increase the number of UK dentist training places and incentives for NHS dentists to move to areas where there is less access to NHS provision.

I mentioned the NHS contract earlier, and I want to move on to that topic now. One of the main points that I have heard from dentists is that urgent attention needs to be paid to the 2006 NHS dental contract. Without fail, every dentist I have spoken to has said that the current system of renumerating dentists purely on activity is simply not fit for purpose. It has received criticism from dentists; from Governments of both political persuasions; from the Health and Social Care Committee; from the chief dental officer for England and Wales; from the British Dental Association; from patient groups; from all the major providers of dentistry in the UK; and, I think, from numerous Health Ministers who want to see changes. I suspect that my hon. Friend the Minister also wants changes to be made to the dental contract.

[Nick Fletcher (Don Valley) (Con)]

A dentist in my constituency, Matt Hooper, has contacted me several times regarding this matter. He says that morale in dentistry is extremely low at this moment in time, specifically due to the contracts that my hon. Friend is discussing. Does he agree that we really need to value our dentists? When most of us are going about our day-to-day business, we do not think twice about our dentists, but when we get toothache, all of a sudden they become our best friends. We need to make sure that they are there for us.

[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.