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BDA President: Tackling oral health inequalities is key

Newly installed BDA President John Milne tells us what he hopes to achieve during his year and how you can help by getting involved.

John Milne
John Milne BDA President

After spending much of my career fighting back against authority and ‘The Establishment', a good number of my contemporaries would never believe I would receive the highest honour of the BDA. Frankly, neither did I.

As a general dental practitioner, I am both humbled and proud to serve as president alongside the range of gifted and talented people who have gone before me, such as consultants, academics and even a prince.

It starts at the local level

I graduated from Leeds School of Dentistry in 1980 and started working as a General Dental Practitioner (GDP) in Wakefield. I’ve worked in that area ever since. Representing my colleagues has been an honour, a privilege but most of all a great joy, whether at local, regional or national level.

I owe so much to my local dental committee (LDC) colleagues, they have inspired me to continue working within the representative structures of our profession. The early sense of responsibility I felt as graduate remains in me, which took me to the General Dental Practice Committee (GDPC) as backbencher, executive member and finally as its Chair. Then on to the Care Quality Commission as national clinical advisor, and now back to fold as your President.

Learning alongside my colleagues at Leeds and witnessing the dreadful ravages of oral disease in post-industrial West Yorkshire, made me appreciate the profession’s valuable work in our society. We are in a unique space, able to both prevent disease and restore the consequences of that disease, while also providing cosmetic and orthodontic treatments, enhancing the self-confidence and wellbeing of our patients.

There is, however, the ever-present moral and ethical issue of oral health inequalities across society. As we emerge from COVID, oral health inequality is widening once again. Decades of progress risk being undone.

It’s time for politicians to take action

We know disease and deprivation go hand in hand, and we know there are simple ways to help such as supervised brushing, even fluoridation. Our youngest patients deserve better. The government knows, but it never seems a political priority.

This is a theme I’ve taken with me from my LDC to GDPC Chair, all the way to the CQC. I’m proudest of the work we achieved with Smiling Matters, putting the crisis in our care homes on the map. We all know care home residents are suffering the indignity of not being properly supported with basic oral hygiene. As clinicians we understand how rapidly oral health can decline in these circumstances, and the impact this has on general health and quality of life.

At the time, the BDA rightly called for a revolution. The level of commissioning of domiciliary care was barely 1% of what was needed. While we’ve seen huge progress on training and policies, access has collapsed. The proportion of care home residents who cannot access NHS dental care has leapt from 6% to 25%. COVID has changed the game.

As with the rest of NHS dentistry, long-term problems have become existential threats. And hard-won health gains risk being lost. As a citizen of one of the world’s wealthiest countries we know the issues facing the most vulnerable are the results of political choices, and that we can point to a better way.

Can anyone crack NHS dental contract reform?

Prevention lies at the heart of reform. Anyone who served on GDPC with me knows my view: a core service requires core funding. We are at a crossroads, and the prospect of further rationing seems ever more likely. If choices to reduce care are going to be made, this is the responsibility of Ministers, and government, not the dental community.

I was elected as chair of GDPC in 2009 with a mandate to reform the NHS dental contract. I believed we would finally crack the issue of NHS dental delivery. It is frustrating to see my successors continuing to wrestle with a seemingly disinterested government. The work has been done, all that’s missing is the political will.

The profession is falling out of love with the NHS. It can only progress if dentists see the service as a place to build a career. Talking with younger colleagues, I know the NHS is not where they see their future.

Speaking up

In my presidential year I’m not going to write a love letter to the NHS. But I am not going to pen its obituary. I want my presidency to support meaningful progress for groups who are the most in need of – but often don’t get – care from the NHS.

We have a system that in theory has the power to make a difference, to reduce inequalities. Negotiations on reform are in train across all four nations. I first became a BDA member in 1980 and to be elected as President feels like a joyful homecoming. Our branches and sections are the foundation of the Association. I wish to see more colleagues and their teams take part. We are stronger when we work together.

From the start of my career, I’ve never been willing to sit back and accept government’s decisions. Whether it’s contracts, funding, oral health, we only make progress when we are ready to ‘speak up’.

We need our members to be active. I will be travelling to branches to hear about the issues you’re facing and encourage more of you to fight back. There’s never been a more crucial time.

You have my assurances I will always care about the challenges you face. I’ll try my best to get progress, for my colleagues and the patients we treat. And to get the weight of political will moving in a direction that helps our profession. I hope you will join me.