Joe Sullivan considers how the vote to leave the EU might affect dentistry, in particular the introduction of a new dental contract.

Summary

  • The dental new contract is so well advanced that it is likely to go ahead.
  • An average of 160 children between five and nine years old are being admitted to hospital each day for general anaesthesia for extractions, or multiple extractions in extremely unhealthy mouths.
  • The introduction of a sugar tax will keep dentistry in the political and public consciousness.
  • Seven thousand dentists currently working in the NHS come from EU countries. Dentistry in the UK needs this source of manpower.
  • There is a risk of recession, raising concerns about job security, reduced consumer spending on dentistry, and higher costs of materials.

It would seem at first that a vote to leave the EU could have little impact on the provision of dentistry. Every day since the vote, the political fall-out has continued. This is an intriguing time of great opportunity for the country, from which a new political and business landscape appears to be emerging. But the negotiations to leave the EU will impact on the dental profession, as they will on every other walk of life.

The discussion at the July meeting of the Westminster Forum on dentistry returned frequently to the uncertainty caused by the vote to leave the EU. The Westminster Forum on dentistry is an important annual event where all those important in policy-making come together.

New dental contract

The view from the Department of Health is that planning of the dental new contract is so well advanced that it will be allowed to proceed. The new Prime Minister and her Cabinet will be so preoccupied for years with the challenges of separation from the EU that there will be less time to focus on issues such as the new dental contract. It’s not clear whether there will be the political will to see the proposed changes brought to fruition.

Government initiatives

Lord Colwyn, introducing the Westminster Forum, pointed out that the recent Queen’s speech made no mention of dentistry. That is nothing new, but may be indicative of thinking within the government. However, the subsequent debates in Parliament highlighted the very worrying fact that an average of 160 children aged between five and nine were being admitted to hospital each day for general anaesthesia for extractions – often multiple extractions in extremely unhealthy mouths. This issue is now being discussed regularly in Parliament and, with the introduction of a sugar tax, this will keep dentistry in the political and public consciousness.

Workers from EU countries

Seven thousand dentists currently working in the NHS come from EU countries. The figure for other members of the dental team was not mentioned at the Westminster Forum. As yet, the government has offered no guarantee that the status of these workers will remain the same when Britain leaves the EU. It is highly unlikely that these workers will be asked to leave, as dentistry in the UK needs this source of manpower. The freedom of movement that enabled all of these essential workers to come to the country is destined to change. This will not be an insurmountable problem. Dentists come from other parts of the world at present. But this is an area where, rather than lightening the regulatory burden, leaving the EU will add hurdles such as work permits and registration requirements for employers.

Funding

On a daily basis, the financial prospects for the country outside the EU are being talked down. The lack of any plan for the process of leaving the EU fuels the uncertainty. If Britain’s exit from the EU is not handled swiftly and with skill there is a risk of another recession. Job security is causing concern for many. Reduced consumer spending due to lost confidence, inflation and devaluation of the pound is a current risk for dental practices.

A new contract for dentists will require funding. Only 56% of the population seek regular dental care at present. It is hard to imagine funding being made available by the Treasury to treat the missing 44%. It seems unlikely that the government would intend a new oral health initiative to reach the entire population. Under current funding arrangements, any money clawed back from unused units of dental activity (UDAs) is supposed to be reused to make dental treatment available elsewhere. However, there are signs that this is not happening. Money is already tight; this is unlikely to change as the economy shrinks.

A new contract based on payment by capitation, where the state of oral hygiene of patients is the measure of value for money, is unlikely to be attractive to the Treasury, which will be looking for value from its billions of pounds. UDAs are a significant part of the prototype new contracts being tested at present. This will not please the profession, as many believe UDSs are the problem. There is talk of the new contract being rolled out as early as autumn 2017. This appears to be ambitious. When it happens, changes will be necessary in practices. Most dental equipment is imported. Since the referendum, the pound has lost its value against the currencies of the manufacturing countries. Hopefully this will correct by the time major expenditure will be needed.

For the moment, if you wish to escape from the gloom and doom and all the political back-stabbing, not to mention the depressing weather, the pound in your pocket will not go as far as it did.

In the meantime, if the vote to leave causes a delay in the introduction of the new dental contract we will all be beneficiaries. This should not distract from the very real concerns of the deteriorating state of dental health of the young in the deprived parts of our country.

About the author

Joe Sullivan photo

Joe Sullivan has provided domiciliary dental care to the elderly during all of his practising life. This service was provided as part of the normal day of a busy mixed private/NHS practice. He was also involved in ownership of a group of homes providing care across the spectrum of need, from able minded elderly needing care, to those needing nursing care and those with dementia. He now researches how best to train carers in supporting the needs of this group of patients. He was formerly editor of the GDP magazine.

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