There are large long term risks to the population, particularly the poorest and children of lowest social groups, in not having dental care. The prediction from some dentists is that the higher rate of caries from neglect will lead to an epidemic of Rheumatic Heart Disease in 20-30 years. But then, which party or politician will care about the votes of these people in 30 years’ time? The wait for a Dentist is only part of the problem: now we have longer waits for cancer treatments and that will hit voters! Unfortunately it wont hit MPs as they will go privately, and have access to all the central London facilities, and even if they stay in the EHS, they retain choice. We have rationed dental training, and now we are rationing dentists. In most overt rationing systems those at most need would get subsidised treatment, but most British trained dentists are working in the affluent areas, and privately.
One of the country’s most densely populated cities does not have a single dentist able to take on NHS patients.
Up to 20,000 residents of Portsmouth will be without a dentist when a chain of practices closes its doors next month.
With no surgeries accepting new adult NHS patients, the nearest practices are in Gosport, which is a ferry-ride away, or Havant, a half-hour drive away, according to the NHS website.
The British Dental Association (BDA) said that “years of underfunding and failed contracts have taken their toll”, leaving practices struggling to recruit staff, and communities from Devon to Cumbria having difficulty getting access to dental care.
Research by the BDA highlighted 13 towns and cities where no dental practices were registering new adult patients, including Plymouth and Barrow-in-Furness.
It also calculated that more than a million new patients had tried and failed to find a surgery last year.
Colosseum Dental Group, which is owned by an investment company based in Switzerland, is closing three practices in Portsmouth next month. Estimates of the number of patients affected vary. Local sources have put the figure at 20,000 but NHS England suggested that it would be closer to 9,000.
Colosseum Dental blamed the closures on “longstanding and ongoing challenges in dentist recruitment”.
One Colosseum Dental patient, who did not wish to be named, said: “I received a letter saying that I would be provided with ongoing care at another surgery but when I contacted them I was told all they could do was put me on a waiting list. They said Colosseum had made a ‘business decision’ to shut the three surgeries and the staff had been made redundant.”
Stephen Morgan, Labour MP for Portsmouth South, said that poorer members of the community would be worst hit.
“The news that three dental practices in Portsmouth are set to close is deeply concerning,” he said. “How will poorer families pay for the additional transport costs? How will single parents get the time off work to travel the extra distance? What will the additional environmental cost be for our city, which is already plagued by air pollution? The government needs to answer these questions.”
He added that the situation raised questions over the use of private organisations to run public services.
Mick Armstrong, the BDA’s chairman, said: “We are seeing practices struggling to remain sustainable as vacancies go unfilled and over a million patients are unable to secure an appointment. NHS dentistry remains the Cinderella service and this is the latest evidence that its future can no longer be guaranteed.”
A spokesman for NHS England South East said: “There are more than 20 dental practices open in the Portsmouth area and patients at nine in ten dental surgeries will not be affected by these changes, while support is being offered for people to find alternative care where it is needed.”
More than a million new patients were turned away by NHS dentists last year, on top of 700,000 who could not get an appointment with their usual surgery.
Some patients have spent years hunting for a dentist, others have given up and even pulled out their own teeth.
Changes to how dentists are paid, introduced in 2006, are at the root of many of the problems.
Dentists went from being paid per treatment to being paid for a target amount of work each year under the new contract. They are now paid as much for doing ten fillings as for one.
Those who hit their quota early in the year have no incentive to do more NHS work because they will not be paid any more for it. Those who can’t make their targets face financial penalties.
NHS dentistry gets funding for only half the population, and the profession is struggling to recruit and retain staff.
Three quarters of practices had trouble filling dentist vacancies last year and six out of ten dentists say that they plan to leave the profession or cut back on their NHS work in the next five years.
Sir, The reasons that there are such problems over access to NHS dentistry are multifactorial (“Dentist closures leave thousands without access to NHS treatment”, Jun 12). Dentists are faced with working in a target-driven system: if a practice misses targets it is faced with financial clawback and the threat of contract termination. Dentists are paid the same amount if a patient needs one filling or five fillings and two root canal treatments, so the incentive of taking on high-needs patients is zero, as it could mean potential bankruptcy. Costs have risen hugely since 2006, with only small yearly increases in funding for NHS care. Care Quality Commission regulations and General Dental Council guidelines heap pressure on clinicians, meaning more paperwork and less time with patients. Dental litigation is increasing, so the fear of being sued means spending more time writing notes in case of a claim. A new contract was promised years ago but dentists are still left in the dark regarding the future.
Dr Mike O’Reilly
Prestbury Dental Practice, Cheshire