Less than half of the adult population in England saw an NHS dentist in the 2 years to March 2024, and, despite a growing population, there are nearly 500 fewer dentists providing any NHS care in England in 2023-24 compared with 2019-20. Such is the urgency of the issue that the Government has announced 700,000 new appointments to try to combat the crisis.
Which raises an obvious question – how have we got to this stage? There is no single reason for this. Rather, it is the result of several factors which must all be addressed if we are to resolve this crisis.
At the beginning of the year, the Public Accounts Committee launched a new inquiry titled “Fixing NHS Dentistry”, which aims to explore the situation and what more could be done to address this. The Dental Defence Union (DDU), the specialist dental division of the Medical Defence Union (MDU), submitted evidence outlining what we believe can and should be done to help fix NHS dentistry.
Address clinical negligence and fixed recoverable costs
Patients found to have been harmed as a result of clinical negligence must receive appropriate compensation. However, a long-standing issue within the field of dentistry is the disproportionate legal costs incurred in clinical negligence claims, with legal fees often far outstripping the amount paid to claimants themselves.
The DDU’s evidence is testament to this. In recent years, we have settled claims where the claimant received £1,400, while their legal costs came to £60,000. In another case, the claimant received £5,725 and their legal costs were £99,529. These are not anomalous results.
This is an issue that the Government has been aware of for a number of years. In January 2022, the Department of Health and Social Care (DHSC) launched a consultation on introducing a system of fixed recoverable costs (FRC) for clinical negligence claims valued up to £25,000. This would bring the system for clinical negligence claims in line with those of most other personal injury claims.
However, despite DHSC confirming it would introduce an FRC system, progress has stalled. It is nearly a year since the system was to come into force, but this has been delayed multiple times. In response to a written parliamentary question, DHSC refused to provide a timeframe for the implementation. Clarity on this would help immensely.
Reform fitness to practice
If concerns are raised about a dental professional’s conduct or competence, the GDC has the power to launch a fitness to practice investigation. However, the DDU has significant and long-held concerns about the timeliness of these investigations, which can have a devastating impact on both the individual practitioner and the provision of NHS dental services.
The Professional Standards Authority 2022-23 monitoring report for the GDC, found that it was typically taking over 140 weeks to process a fitness to practice case from receipt to final hearing.
Where serious concerns about a dental professional are raised, they should not be properly investigated with appropriate measures put in place to protect the public. But far too many talented, compassionate and effective dentists are being subjected to needlessly long and distressing investigations by the regulator.
Dentists are already under immense pressure, including having to juggle a large number of patients, manage their expectations, and rising practice costs. Extended fitness to practice investigations result in a further strain on practitioners’ mental and physical wellbeing. It also limits the ability of dental professionals to practice, placing further demands on other dentists to provide NHS services. This is bad for practitioners and for patients.
Reform has long been promised but has never materialised. We are calling on the Government to issue a Section 60 Order to reform the GDC, and allow dentists a fairer, timelier fitness to practice process – ultimately relieving strain on NHS dental services.
Prioritise the welfare of dentists
The DDU regularly conducts surveys of our members. Sadly, these findings indicate a significant number of dental professionals are planning to either reduce their hours or retire early. If borne out, this would have a devastating impact on the ability of the NHS to deliver dental services, with fewer dental professionals available and a significant amount of experience being lost.
When we have asked why, members have been clear – it is the stress that they are under. In a 2021 survey, 86% of respondents stated that they had experienced an increase in workplace pressures within the past two to three years. 91% said they felt worn out at the end of the working day, and 84% said they felt burned out.
Tackling these issues is key. That is why the DDU is calling for steps to be taken to ensure the long-term funding of services that help dentists at risk of burnout. We are pleased that one such scheme, NHS Practitioner Health, has had funding guaranteed until March 2026. However, funding after those 12 months is not guaranteed. We believe that this service, and others like it, must be guaranteed long-term funding if we are to prevent professional burnout and ensure that staff providing invaluable NHS dentistry services are maintained.
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