Monthly Archives: August 2015

Heart disease death rate drops by 45% in a decade

Ben Spencer in the Mail reports some “good news”: (and for once the GP is not being pilloried)

Heart disease death rate drops by 45% in a decade: Healthier lifestyles, statins and better medical practices responsible for huge reduction

  • Scientists say there has been a huge reduction in heart attacks and stroke
  • Add it is down to statins, healthier lifestyles and better medical practices 
  • Experts say Britain has become far better at treating and preventing heart disease 

Counting the cost of clinical negligence. £350m to lawyers in 2014!

NHS reality has always felt that there will have to be a “no fault compensation” bill at some time or other. But the same denial persists about the legal bills as for the need to ration…

Frances Gibb in The Times 27th August 2015 reports: Lawyers v doctors: counting the cost of clinical negligence

A third of the £1.1 billion paid out by the NHS in compensation last year went to lawyers. Next year the cost to the taxpayer is expected to rise to £1.4 billion with the NHS warning of its “increasingly difficult task” in managing the level of payouts.

Ministers are concerned that costs are too high and divert money from patient care. Costs in lower value claims, says the Department of Health, are “particularly disproportionate to the value of damages paid to claimants”. In 2013/14, legal costs paid to claimants amounted to 273 per cent of damages awarded in claims of £1,000 to £10,000; 153 per cent in claims of 10,000 to £25,000; 107 per cent in claims of £25,000 to £50,000; 74 per cent in claims of £50,000 to £100,000 and 54 per cent in claims of £100,000 to £250,000.

In its recent annual report, the NHS Litigation Authority (NHS LA), which handles claims, also expressed concern about the size of some bills and what it says is a large number of unjustified claims.It was “impossible to justify” the increasing number of cases where significantly more money was billed by claimant solicitors for costs than was paid in compensation, it says.

Hence government plans announced in July to cap costs charged by lawyers in clinical negligence claims. There is some judicial support for the move, including from Lord Justice Jackson and Lord Dyson, Master of the Rolls. The authority estimates that £80 million a year could be saved if costs are fixed on claims up to £100,000.

At the same time, the authority is taking a tougher line, challenging more claims and — it says — saving more than £1.2 billion for the NHS by rejecting claims that have no merit. Ian Dilks, chairman of the NHS LA, said: “The costs of litigation are placing a burden on NHS finances of a magnitude that was never imagined when the NHS LA was established.”

Despite legislation curbing legal aid and no win no fee deals, the NHSLA is seeing “an increasing number of plainly excessive and disproportionate costs bills, the presentation of which coincides with the banning of success fees [in which solicitors could charge up to 100 per cent of their normal rates] and the reduction of the recoverability of the full cost of after-the-event (ATE) insurance against the defendant.”

The findings seem to run counter to original warnings by judges and lawyers that if legal aid was withdrawn, access to justice would be denied. Dr Anthony Barton, solicitor, of consultancy Medical Negligence Team, said: “Latest government figures show an increased number of clinical negligence cases funded by no-win, no-fee agreements — successfully replacing legal aid. This demonstrates the success of privatising access to justice.”

Success or not, costs have inexorably risen. The plan now is to introduce “fixed recoverable costs” for claims of up to £100,000 and possibly also up to £250,000. A consultation is planned for this autumn. Catherine Dixon, chief executive of the Law Society, has already hit back at the proposals. Dixon is a former CEO of the NHSLA so speaks with some knowledge. Of the £1,169,506,598 spent last year by the NHSLA on clinical negligence claims, she points out in the Law Society Gazette that some 41 per cent — almost half a billion pounds — was for obstetric claims, mainly paid to brain-damaged children for life-long support.

At the end of March 2015 the NHSLA had £12.5 billion of claims on its books. It has also calculated the cost of claims from negligent care yet to be reported. In all, the total cost of known claims, costs of ongoing care and amount of claims incurred but not yet reported is £28.6 billion .”I am all too familiar with these figures,” Dixon says. “To put them in perspective, clinical negligence provisions on the government’s balance sheet are the second highest behind the cost of nuclear decommissioning.”

No wonder officials want to reduce costs. Details have yet to come but Dixon warns that the proposals could damage access to specialist advice, driving out experienced solicitors and ushering in claims management companies and spurious cases. “It is perhaps easy to forget when faced with balance sheets that clinical negligence claims are brought by people who have been injured through no fault of their own as a result of negligent NHS care and need specialist advice from a solicitor to help them get the compensation they are entitled to in law.”

As for fixed fees on claims of up to £250,000, she dismisses this as “truly shocking”, saying it would include claimsfrom those seriously harmed. “When I was the CEO of the NHSLA I saw inappropriately high cost claims, which are damaging to our profession and should never be condoned. But the reality is that the vast majority of costs submitted were appropriate for the work done. This is reflected in the fact that most costs are settled by the NHSLA and not taken to detailed assessment at court.”

Rather than focussing on claimant solicitors’ costs, she argues this should be on “reducing the amount of negligent care harming patients in the NHS”. The focus is certain to be both.

Litigation – The rising tsunami is swamping us all.. NHSreality lists all the posts on litigation in the two years of existence. NFC (No fault compensation) is essential.

NHS faces crisis in litigation as well as A&E. Introduce no fault compensation (NFC)?

Medical legal costs ‘excessive and should be capped’ – but no-fault compensation ignored…

The politics of health.. The Lemmings of the left leave a vacuum where Mr Stevens’ debate will not happen… Are we all lemmings as far as our health system is concerned?

Litigation – NHS creates three ‘compensation millionaires’ EACH week

The rising costs of failure: Worst hospitals cost NHS £300m

Having a “rant” at General Practice – it’s hard for some to see the opportunity ahead. A letter in The Times reveals the same for A&E..

Become a GP – a personal entry from NHSManagers.net. A “rant” at General Practice – it’s hard to see the opportunity ahead (Unreal manpower planning. It’s too late for a decade. GP services face ‘retirement crisis’. It’s the shape of the job silly.) The future appears to be a disparate system (England, Wales, Scotland and N.Ireland) with disingenuous methods of covertly restricting what services are available. The social divide in a country with an increasing Gini coefficient will get worse. General Practice and A&E are the heart of the Health Services. Their effectiveness is what replaced fear in 1948…

Ok, I know; I’ve got this on-off thing going on with primary care. I admit it; I love the idea of family practice. Localness, knowing me and mine, someone who shouts out for us. Someone I can trust, a confidant with whom I speak my secrets and say the things I dare not whisper to anyone else. Someone who can spot the signs, do their best and know what’s what. On the other hand; when most of us go to the train station in the morning the practice is closed. Come home in the evening it’s closed. A place that thinks an eight o’clock start is early. Saturdays, there for an emergency (whatever that is) and on a Sunday… we can only go to church, sprinkle ourselves with holy water and pray for a cure. 

A place we fiddle about with, on the phone, with a Mickey Mouse, press this for that and that for this. A place that registers us with an organisation and not a doctor, a place that no longer controls the district nurses, a place where our care is in the hands of an interested stranger.

I love primary care but hate what it has become.

Right, having got that off my chest; I wouldn’t be a PG for all the tea in China. If I had any kids, looking for a career, I’d say better to be an inspector of manure in the lion house at London Zoo, than be a GP.  

I’ve come to the conclusion that the combined resource of the NHS is ranged against them. 

Let’s start with NICE; once a trusted nimble organisation helping GPs to make sense of a complex pharmaceutical menu; what works, what doesn’t, what’s worth prescribing… what’s not? 

Now bloated and bossing everything from playground exercises to cancer drugs, it seems NICE want to punish doctors who over prescribe antibiotics. Get the GMC to strike them off.

There’s not a GP in England who doesn’t know over prescribing antibo’ts is a bad idea. Why do they prescribe?  

Because; GPs have 10 minutes to take a history, listen to the story, look up the records, give an education session and resist being brow-beaten, cajoled and pleaded with by patients for whom public health messages are meaningless. 

Because; if GPs refuse they run the risk of complaints, the CQC, the GMC and the local press. 

How about supporting GPs; meaningful PH messages and a simple nurse administered, rapid test kit that can detect the difference between a viral and bacteriological infection (like they use in Finland, Sweden, Germany and Norway); so patients can see for themselves what the score is. 

Oh and that brings me to the CQC. Their latest wheeze is to close practices. Dodgy practices we can do without. Close them? Let’s think about that. 

What happens to patient choice, what happens to practice overdrafts and commercial leases and borrowings? What happens to clinical staff and administrators and managers? Oh, and who subsumes the patients on the list. What happens to their choice? What happens if the local practice lists are choc-a-bloc? 

How about getting a team of people into the practice and help sort it out? Show them what good looks like.

There are not enough GPs and too few young doctors who want to become GPs. The direction of policy is to have more care carried out in primary care, by GPs. 

Is there anyone left in Whitehall still thinking? We need more GPs, that means making the job attractive and doable. We need to sort out quality issues because, to deal with demand, we need all the practices firing on all cylinders.

We can’t sack GPs because PHE can’t hammer home health messages that resonate with the public.  We can’t close practices because the CQC have not the wit to figure out how to keep them open. 

Regulation, neglect and stinkin’ thinkin’ is destroying the foundation of our health system and the RCGP and the BMA look to me like spectators as the wrecking ball demolishes the roof.  

Noel Coward might have been right when he wrote, in 1947; ‘Don’t put your daughter on the stage Mrs Worthington’ In 2015 the message is; ‘don’t let your daughter become a GP’. 

Have a good weekend. 

A letter in The Times 25th Aug 2015 reveals the same for A&E: Sir, As a registrar in emergency medicine, I fall into the category of doctor regarded by Jeremy Hunt as vital to keep. However, the Antipodean trio of better wages, hours and public standing are as attractive as ever. Recent governmental rhetoric has reduced optimism that job satisfaction will reverse. This lack of faith in the longevity of an NHS career is likely to be enhanced by forced contracts, and I expect the exodus will continue, albeit two years later than before.

Dr Ed Morley-Smith Taunton

All education is divisive – We must all aspire to excellence, and speak out.

An exodus because of poor planning and the shape of the job. Deprofessionalisation….

The Times reports on the exodus of doctors without looking at the reasons they leave, either the profession or the country. It is certainly not the money….The is only the beginning of the Health Service Disaster… We are just not TRAINING ENOUGH..The Leading Article is reproduced below (with apology).. See “don’t become a GP ” from managers.net

Francis Elliott & Kat Lay report in The Times 24th Aug 2015: New doctors may be forced to work in NHS for two years

Times Analysis: Doctors already think that the health secretary is against them, and the latest proposals from Jeremy Hunt will do nothing to change that (writes Kat Lay).

One of the biggest clashes is over Mr Hunt’s desire to bring in weekend working for consultants. He argues that 6,000 patients die needlessly each year because of a lack of good seven-day services.

The NHS has been promised an extra £8 billion by 2020 but, according to Simon Stevens, the head of NHS England, it will also need to find another £22 billion in savings. Holding on to the 12 per cent of medical graduates who are no longer in the NHS two years after graduation would go some way to filling the gap.

The Leading Article opines that this is justified on specious grounds. NHSreality concurs but would like to point out the conflicts.

NHSreality asks:

Why is Medical Training and different to any other training (economics, geology, hairdressing) that is subsidised by the state? There are more medical graduates from many African countries in the UK than there are in their own countries but we have not taken a stance against poaching them. Is the cost the differential? If so what is the principal?

Why not take fewer women and undergraduates into medicine? We know that these are the groups with the highest drop out rates? Other countries insist on graduate (mature) training in medicine which seems to weed out the unmotivated. And why not train enough or a small surplus?

What about the Liberal Philosophies: The European Convention of Human Rights and the freedom of movement guarantee within the EU? Doesn’t Greece need doctors more than the UK? Why stop a doctor trained in the UK from going to another and more desperate EU country?

If this Conservative administration believes in “free markets” then what is their long-term philosophy – once they mend the manpower planning? Their knee jerk response is understandable..

The longer term issues of rationing by undercapacity and the politicisation of the UKs Health Services still need to be addressed.

The references to private practice are interesting. Younger doctors are not wanted except as lackeys in private practice as they don’t have the experience. But now many services are contracted out, and training suffers unless juniors are exposed to all aspects of a speciality. This AQP (or Any Qualified Provider) “privatisation” will come home to bite a future administration.

The right of passage whereby young doctors have worked for charities and abroad in other capacities for short periods needs to be fostered.

The reason behind the unhappiness in our profession is important and explained by Rosemary Stewart:

The shape of a job We are generally over-managed, and have fewer choices and less freedom than we used to. Some of us feel standards are falling, and lack of choice and systemic honesty leads to de-professionalization.

NHSreality concurs with the idea of requiring doctors to work in the Health Services, but it is a short term measure for an emergency, not a long term philosophy for a first world nation. It is circumstantial and knee-jerk..

The NHS may be widely envied, but too many of the doctors it helps to train are using the service’s kudos as a route to employment elsewhere. The service’s poor retention rate is exacerbating acute shortages in both hospitals and primary care, and a point of principle is being violated. It is time to compel doctors trained at the expense of British taxpayers to start their careers by taking care of them.

It takes a long time to train to be a doctor: typically five years at university followed by a two-year foundation programme. Many then train in a particular specialism. Medics have to fund the first four years of their training through normal student loans, but from the fifth year onwards tuition fees are paid by the NHS. Some future doctors are also eligible for a generous scheme of means-tested bursaries to cover maintenance costs. In all it costs £500,000 to train a GP and half as much again to train a consultant.

Despite the state’s support, one in nine new doctors is not working in the NHS two years after qualification. Some are lured by the quick financial fix of private practice; others take their skills to sunnier climes. The NHS, and particularly general practice and emergency care, can ill- afford to lose these doctors.

The number of unfilled GP posts has quadrupled over the past three years. The west of England requires 25 per cent more GPs by 2020 to keep up with demand. In 2013 only 20 per cent of medical students chose to work in general practice after their foundation training, despite a national target of 50 per cent by 2016. Little wonder, for there is a vicious cycle at work. As fewer doctors enter general practice, the burden on those who do becomes heavier, meaning that more abandon their field prematurely and still fewer decide to become a GP in the first place. There is a similarly dire shortage in emergency care, forcing the NHS to pay inflated fees to locums for single shifts.

It may not be surprising that the response of many young doctors to a GP and A&E system in crisis and a growing clamour for a seven-day service is to steer a wide berth. Yet a simple principle is being forgotten by those young doctors who choose to get out as soon as they can. The NHS has trained them, and funded much of that training. They have an obligation to work in the service long enough to repay that investment.

Moral entreaties may not, however, be sufficient. As a result, Jeremy Hunt is right to consider requiring newly qualified doctors to stay working in the NHS for at least two years. NHS management should applaud this move, and direct as many new doctors as it can towards general practice and emergency care. Even if some subsequently decide to emigrate, be it to Australia or Harley Street, it will do their CVs no harm for them to have had experience at the front line of one of the world’s largest healthcare providers.

Mr Hunt’s aims are commendable but they have met headwinds already and he can expect more from the British Medical Association. The doctors’ union has previously argued that the NHS is losing doctors because of rising workloads and a feeling of being undervalued. For older doctors, that may be true. By contrast, those who have only just qualified cannot blame frustration at a status quo they have barely experienced. The principle is simple. If the NHS pays for your training you cannot object to being asked to pay it back.

 

Why the Assisted Dying Bill should become law in England and Wales

There is a lottery in where we are born, and the rules within that country, in addition to the Post Code lottery on options for cancer treatment (Kay Lay August 20th in The Times: Doctors’ ignorance drives cancer lottery). Where and how we die is also post-coded.

The editorial in the BMJ headlines: Why the Assisted Dying Bill should become law in England and Wales (BMJ 2014;349:g4349 )

It’s the right thing to do, and most people want it

Lord Falconer’s Assisted Dying Bill is expected to receive its second reading in the House of Lords this month. The BMJ hopes that this bill will eventually become law.

The bill would allow adults who are expected to live six months or less to be provided with assistance to end their lives.1 Two doctors must be satisfied that the person is terminally ill, has the capacity to make the decision to end his or her life, and has a clear and settled intention to do so. This decision must have been reached voluntarily, on an informed basis, and without coercion or duress. Both doctors must be satisfied that the person has been fully informed of the palliative, hospice, and other available care options.

Once both doctors have countersigned the declaration that the person wants to end his or her life, the attending doctor can prescribe the life ending medication, which would be dispensed only after a “cooling off” period of 14 days (or six days if prognosis is less than a month). The person would administer the medication themselves. This is what differentiates “assisted dying” from “voluntary euthanasia,” where the doctor administers the lethal drug(s).

What are the arguments for such a law? People should be able to exercise choice over their lives, which should include how and when they die, when death is imminent. In recent decades, respect for autonomy has emerged as the cardinal principle in medical ethics and underpins developments in informed consent, patient confidentiality, and advance directives.2 Recognition of an individual’s right to determine his or her best interests lies at the heart of efforts to advance patient partnership.3 4 It would be perverse to suspend our advocacy at the moment a person’s days were numbered.

As shown by harrowing personal accounts, some terminally ill people want the option to call “time.”5 6 7 And the majority of the British public want the option too. The 2010 British Social Attitudes survey shows that 82% of people are in favour of a change in the law on assisted dying.8

What are the arguments against such a law? People opposed to the bill cite the difficulties of establishing that someone has less than six months to live. Yet most studies suggest that doctors consistently overestimate rather than underestimate prognosis.9

Another argument is that individual choice should be limited when it has a profound effect on others. But we already accept people’s decision to reject life saving treatments, if they have mental capacity, regardless of any effects their subsequent deaths may have on those they leave behind. The Falconer Bill allows for the secretary of state to issue codes of practice on the assessment of mental capacity, “recognising and taking account of the effects of depression or other psychological disorders that may impair a person’s decision making.”

Those who oppose a change in the law often shift their arguments to hypothetical victims, some of them glimpsed at the bottom of a slippery slope. It’s therefore important to say who will and will not be affected by the new law. The Assisted Dying Bill does not cover people with disabilities who are not terminally ill, other people with non-terminal illness, people who are not mentally competent, or children. That much mentioned victim—the elderly lady who believes she has become a burden to others and offers herself up for assisted dying—will not qualify.

Passing the law would not represent a leap in the dark: the US state of Oregon, on which the bill in England and Wales is closely modelled, has allowed assisted dying since 1997. Last year, 122 dying Oregonians were given life ending prescriptions; 71 took the life ending medication and died. Altogether, “assisted deaths” accounted for 2.2 per 1000 total deaths in the state.10

Extrapolating Oregon’s figures to England and Wales, each year about one patient per general practice of 9300 patients would discuss the issue of assisted dying; each general practice would issue one prescription for life ending medication every five or six years, and every eight to nine years one patient per general practice would take life ending medication.

Oregon’s experience confounds claims that assisted dying legislation impedes the development of palliative care. Oregon is now regarded as a national leader in palliative care.11 Tellingly, the Oregon Hospice Association, initially opposed to assisted dying, found “no evidence that assisted dying has undermined Oregon’s end of life care or harmed the interests of vulnerable people.”12 In 2011 the European Association for Palliative Care concluded that palliative care in European countries with legalised assistance to die is as well developed as it is elsewhere.13

Some doctors are unhappy about the part they would be asked to play. However, the bill makes robust allowance for conscientious objection—a provision that has worked well for the almost 50 years of the Abortion Act. Discovering what “the average doctor” thinks about assisted dying, however, has been difficult, with professional bodies going through extraordinary contortions to avoid asking individual members for their opinions.

Ultimately, however, this is a matter for parliament, not doctors, to decide. Last month the UK Supreme Court upped the ante. Its president said that unless parliament satisfactorily addresses the Suicide Act 1961, which prevents doctors helping patients to end their lives, the court could force change upon them by declaring the act incompatible with the European convention on human rights.14 Let us hope that our timid lawmakers will rise to the challenge.

Sopie Warnes for The Guardian reports 18th July 2014: How many people choose assisted suicide where it is legal? – We take a look at the rates in the places where assisted dying is legal as the issue is debated in the House of Lords

Euthanasia and assisted dying laws around the world

Ingrid Torjesen reports in the BMJ: More people opt to use assisted dying laws for greater variety of reasons (BMJ 2015;351:h4332)

Health Economics – more and more are dying in Hospital – against their wishes

Help families and employers to make it easier for patients to die at home..

Lord Darzi calls for overt rationing. We can’t afford what we are doing – but which politician will do anything about it? Stop ‘pointless’ cancer care for dying, says former minister…

Right to die at home register ‘would save cash’. Many of us would prefer to die at home, less than a third (29%) are able to do so.

Quality of death – is not talked about – General Practice is “Closing Down” …

‘My local practice was a centre of excellence. Now we face a future of depersonalised, rationed healthcare’

 

Public ‘ignorant of NHS costs’ – why not?

Why should the consumer be aware of the cost If the service is “unrationed”, free, comprehensive and cradle to grave?

Kat Lay feigns surprise at the public ignorance in The Times 21st August 2015: Public ‘ignorant of NHS costs’

The public has no idea how much common NHS procedures cost, with half of people underestimating the cost of a birth by almost three quarters.

A report has found that people in Britain have a “staggering and destructive ignorance” about how much their treatments cost the public purse.

Three quarters of people neither questioned the cost of a procedure nor worried that their free treatment could be taking help away from someone in greater need, according to the research by Benenden Health.

One in ten polled admitted either lying to their doctor, or knowing someone who had lied, about being depressed or suffering low self-esteem in an attempt to get free cosmetic surgery.

John Giles, medical director of Benenden, said: “As a nation we have lost touch with the role we should play in our own health and wellbeing, expecting the NHS to pick up the pieces.”

The National Health Report 2015 asked 4,000 people to put a figure on how much certain procedures and treatments cost. Some 47 per cent of people thought that a natural birth in hospital cost less than £500. Overall, respondents put the cost at £1,288 whereas the true figure is £1,824.

•The phenomenon known as “baby brain”, whereby expectant mothers become more absent-minded, does not exist, according to a study. Researchers at the University of Western Ontario put 54 volunteers through memory tests and found that pregnant women did just as well as other women and in some cases better. The researchers said that women’s brains may be supercharged by pregnancy to help prepare them for the challenges of motherhood.

Felicity Thistlethwaite in The Express also covers this: Do YOU know how much surgery on the NHS costs? You might be surprised…

The NHS is not safe in any party’s hands. The real swindle lies in the pretence that the NHS model works.. it is fundamentally flawed..

Patient co-payment for general practice services: slippery slope or a survival imperative for the NHS?

The English Regional Health Service intends to inform patients of costs for some drugs. Why not all goods and services? Fear of guilt is not enough..

 

 

Dentistry now outside the Health Services for most of the nation

Dentistry is now outside the Health Services for most of the nation. Nicola Harley in The Telegraph reports 21st August 2015: Half of adults failing to go to the dentist – New figures released by the Health and Social Care Information Centre reveal a drop in the number of people seen by an NHS dentist amid a rise in patient apathy

Half of adults have not been to the dentist in the past two years, it has been revealed, as health chiefs warned about limited access to NHS dentists – and a rise in patient apathy.

Figures released by the Health and Social Care Information Centre (HSCIC) showed a drop in the number of people seen by an NHS dentist.

The number of dental patients in the two years leading up to April fell by 0.3 per cent to 30.08 million compared to the previous two-year period. The total comprised some 22 million adults – 52 per cent of the adult population – and 8 million children.

The data also showed that the number of children treated by an NHS dentist in the year to March 31 was 6.9 million, just 60 per cent of the child population.

Professor Nigel Hunt, dean of the faculty of dental surgery at the Royal College of Surgeons of England, said the data revealed “a decade of inertia” in access to dentistry.

“In the past two years approximately 50 per cent of adults and a third of children haven’t seen a dentist. Routine visits to the dentist are vital to maintaining good oral health.

“It’s appalling that tooth decay remains the most common reason why five-to-nine-year-olds are admitted to hospital; in some cases for multiple tooth extractions under general anaesthetic – despite tooth decay being almost entirely preventable.“Visiting the dentist regularly is crucial in providing rapid diagnosis and treatment to prevent both children and adults from being hospitalised due to tooth decay. The new Government needs to urgently review why access is not improving and launch a national campaign to stress the importance of seeing a dentist,” he said.

Adults are advised to visit the dentist between every three months and two years but the National Institute for Health and Care Excellence recommends the maximum gap between appointments for children is 12 months.

London was the only region where the number of patients seen by an NHS dentist increased.

The South of England had the greatest number of people treated in the 24 months to the end of June, at 7.3 million – a 37.2 per cent share of all patients in England, which may be in part because the region has the highest success rate in obtaining a dental appointment.

The Royal College of Surgeoms said that the nation’s poor dental record was a combination of patient complacency about caring for teeth plus access to dental appointments, both of which need to be addressed by the Government.

Richard Lloyd, executive director of the consumers’ group Which?, said: “Our research shows just how difficult it is for patients to get an NHS dental appointment, as information about availability doesn’t reflect reality.

“The regulator must ensure the existing rules are put into practice, so people can easily find an NHS dentist.”

Dentists demand a deposit from NHS patients

NHS Dentistry &

Dental Training – There is no control

Fraud in Dentistry- a case from Scotland: ‘I’m ashamed any dentist could behave in this way’