Children who have never visited a dentist require several tooth extractions following their first visit, posing a hidden oral health problem for Britain.
Today, NHS dentist Rob Mew shares the distressing cases he has seen since he began accepting new paediatric patients every Thursday. For the first of several special features for our Dentists for All campaign, The Mirror travelled to Devon, one of the worst “dentistry deserts” in the United Kingdom. We went to Exmouth’s Fairfield House Dental Surgery, one of the few in Devon that still treats NHS patients. Rob, the owner, is a strong supporter of the NHS and its guiding ideal that patients should be cared for from “cradle to grave.”
But only because of this does his practice continue to serve NHS patients. Going private might increase its earnings by hundreds of thousands of pounds.
The NHS is currently fining Rob £150,000 as a funding “claw back” for efficiently keeping his patients healthy through preventative care and routine checkups. In order to see solely private patients, dentists are leaving the NHS in large numbers due to the highly despised NHS dental payment contract.
Every Thursday, the office makes its NHS books available to local children who haven’t seen a dentist in years, or even never.
Rob, who himself has three children aged ten, eight and four, said: “That’s one of the reasons I do it because I have young children but it’s quite emotional. We were seeing four and five year olds who had so much decay we just had to send them to hospital to get extractions. There’s such a backlog of sending these kids to have general anaesthetic to get the teeth out so we’re trying to maintain them until they get their teeth extracted.”
“One of the dentists saw a seventeen year old who hadn’t seen a dentist in ten years and needed 28 fillings. You’ve got really emotional parents that are feeling really guilty that they have got themselves into this position. One of our nurses said she couldn’t work on that list because it was too upsetting because she has kids of a similar age. It’s a really sad situation.”
For more than a century, Fairfield House Dental Surgery has operated. After another partner resigned in 2017, Rob took over as owner after joining the company as a partner in 2012. In addition to providing free supervised tooth brushing at nearby elementary schools, the clinic sends professionals to toddler and breastfeeding support groups to inform parents.
Rob, 43, said: “We’re blessed with a group of patients who’ve been with us for a long time, some have been coming here for more than 50 years. So that’s why I’m still with the NHS because it feels like the right thing to do, to keep going for them. It’s a kind of cradle to grave service which is what the NHS was supposed to be. But that’s the only reason we’re doing it – out of good will.”
Why is top dentist being ‘fined’ £150,000 for keeping his patients’ teeth too healthy?
In the midst of a dental desert, Rob Mew owns a unique example of a flourishing NHS dental business. Ten dentists are employed by Fairfield House Dental Surgery, which also provides free community outreach to promote dental health.
However, because it had not completed enough Units of Dental Activity (UDA), the surgery was in the process of repaying £150,000 to the NHS when we visited. It was required to make three months’ worth of monthly payments of £50,000.
The NHS uses UDAs in its dentistry payment contract, which the Health and Social Care Committee of Parliament has declared “not fit for purpose.”
According to the contract, practices must agree to complete a certain amount of UDAs; if they execute fewer or more, they will be fined. A patient receives one UDA for a checkup and three UDAs for a filling.
Rob told the Mirror: “We are being penalised for preventing patients requiring more UDAs. We have £150,000 ‘claw back’ this year but we have 19,000 NHS patients which is more than the practice has ever had. The clawback is for not doing enough UDAs but when patients are being looked after better they don’t have as much need for dental work.”
Fairfield surgery gives his patients a check up every 12 months whereas other practices call lower risk patients back for check ups every two years. Rob said: “We are seeing them yearly and that’s one UDA. We are preventing loss of tooth. A GP practice is paid for how many patients they have on their list. That’s how they should be funding dentistry.”
Rob says between five and ten people call the practice every day desperate to be seen by an NHS dentist. He has taken on as many as he can but has just started a waiting list. He said: “We have got patients travelling to be seen here from as far away as north Wales, Manchester and Sheffield.”
“The NHS dental contract in England only funds enough for half the population to be treated so these patients have moved away but can’t get a dentist. And the Exmouth population is exploding and we have a load of new housing but no more dentistry money to treat the people in those houses.”
Reforming the infamous NHS payment contract, which discourages dentists from serving the most vulnerable patients, is a major demand of the Mirror campaign. Dentists receive the same compensation for performing three or twenty fillings, which frequently results in a loss for the business that treats NHS patients.
The government promised that “by 2035 the NHS dental system will be transformed” in its Ten Year Health Plan, which was released last week. However, the British Dental Association maintains that contract reform needs to occur far sooner.
Rob said: “With these most vulnerable patients with high needs it’s really tricky for the practice to to make that work [financially].”
“We had a family last Thursday with three kids and they had never been seen by a dentist. There was decay everywhere and they clearly need a lot of work and the parents are saying we haven’t been able to be seen anywhere. And they’re just tired because they’ve been calling around practices trying to get in and it kind of gets put on the back burner.”
“We had a 14 year old girl come in a couple of weeks ago and she had four crowns put on her back teeth. And you’re thinking, if we hadn’t handled that soon she would have a couple of back teeth missing and then a lower denture.”
Dental offices incur significant overhead due to personnel and material expenditures. The current goal of Fairfield House Dental Surgery is to raise the £30,000 needed for a new dentist chair.
Rob has worked in the NHS in some form for 28 years, starting at the age of 15 in a hospital kitchen. He added: “I’ve got a lot of good will towards the NHS so yeh I try my best to make it work.”
However, NHS dentistry cannot rely solely on goodwill.
An migration of NHS dentists to lucrative private practice has been fuelled by the Treasury’s dependence on clinics that provide care at a loss, the British Dental Association warned the Public Accounts Committee earlier this year. According to the professional body, a normal practice loses £7 for each new patient examination and more than £40 for delivering a set of NHS dentures. The condition of NHS dentistry has been deemed “unacceptable in the 21st century” in a parliamentary report by the Health Select Committee.
Because the NHS contract restricts the amount of treatments a dentist can conduct annually, it essentially imposes limitations on the maximum number of NHS patients they can visit.
At the same time, the £3 billion NHS dental budget for England is only sufficient to treat about half of the population due to more than ten years of actual budgetary cuts under the Conservatives.
This week, the government will outline the steps it plans to take to improve the NHS dental contract. Before last year’s general election, Labour pledged to reform dental contracts. However, since then, doubts have been raised about whether they would actually alter the system in this Parliament, and it is unclear how much of the drastic reform will be funded by the Treasury.
According to The Mirror, the government will release some information about its plans to change the current system that discourages dentists from seeing patients who require more involved work on Tuesday.
Care minister Stephen Kinnock, who has responsibility for dentistry, told the Mirror: “It isn’t right that it’s less cost effective for dentists to take on patients who need more complex and extensive treatments like crowns and bridges. This is why this government will overhaul the dental contract to make it more attractive to offer NHS dental care, especially for those who need it most. As we deliver on the Plan for Change, we’re fixing NHS dentistry to make it fit for the future.”
The manifesto pledge to provide an additional 700,000 urgent and emergency appointments this year will also be strengthened by plans released on Tuesday. The government will suggest requiring NHS dentists to provide a certain amount annually in addition to their regular patients in order to ensure that these extra unplanned care appointments become a regular feature of NHS services.
Devon worst ‘Dental Desert’
According to data from 700,000 respondents to the GP Patient Survey conducted last year, scheduling an NHS dentist appointment is the most difficult task in South West England.
Devon may be one of the worst dentistry deserts in the nation, according to questions on dentistry that asked respondents if they had tried to schedule an NHS dental appointment in the previous two years.
Regional Integrated Care Boards (ICBs), which comprise local councils, NHS entities, and nonprofit organisations, were used to categorise survey responses. The county’s population’s health is under the purview of the One Devon ICB. In Devon, only 72 percent of those who were previously seeing an NHS dentist were able to secure an appointment. This was 84% for England overall and 74% for the larger South West region.
Everyone should have access to an NHS dentist
Last year, almost 12 million people—more than one in four individuals in England—were unable to receive NHS dental care. Simultaneously, 90% of dentist offices are no longer taking on new adult NHS patients. According to data from the House of Commons Library, 40% of kids did not have the recommended yearly physical last year.
Restore funding for dental services and recruit more NHS dentists
Of all the European countries, the UK spends the least amount of its health expenditure on dental treatment. In actual terms, government spending on dental services in England decreased by 25% between 2010 and 2020. Since the epidemic, the number of NHS dentists has decreased by almost 500, to 24,151.
Change the contracts
“Unacceptable in the 21st century” is how the Health Select Committee’s parliamentary report characterises the present NHS dentists’ contracts, calling them “not fit for purpose.” Because it restricts the number of treatments a dentist can conduct annually, the system essentially puts limitations on the maximum number of NHS patients they can see. Dentists frequently have to pay out of pocket because they receive the same compensation whether they perform three or twenty fillings. The system ought to be modified to allow dentists to treat patients according to their needs.
In Devon, only 14% of people who tried to schedule an appointment at a practice they had never visited before were successful. This contrasted with the South West’s 19% and England’s average of 33%.
The main disclaimer is that many people would not have attempted to schedule an appointment if they believed their chances were slim.
According to the research, very few dentists in Devon and the South West are accepting new adult patients.
British Dental Association chair Eddie Crouch said: “This shows why the government is right to commit to major surgery for NHS dentistry, rather than mere sticking plasters. But we need pace. This service is on the critical list, and demoralised dentists are walking away every day this contract remains in force. If we don’t make a break in this Parliament there may not be a service left to save.”
A spokeswoman for the Department of Health and Social Care said, “This government inherited a broken NHS dental system but we are getting on with fixing it through our 10 Year Health Plan.”
“We have already begun the rollout of 700,000 extra urgent dental appointments, a ‘golden hello’ scheme is underway to recruit dentists to areas with the most need and we are reforming the NHS dental contract, with a shift to focus on prevention and the retention of NHS dentists – including introducing tie-ins for those trained in the NHS.”v