As a practitioner I feel hugely under-valued and often frustrated that I cannot be honest with my patients and explain to them why NHS treatment isn’t inferior to private when it so obviously is. I am unable to utilise innovations and advances in technology to provide treatment that is more comfortable and predictable for my NHS patients. There are huge advances in dental materials and technology and yet, NHS dentistry in general practice seems to remain in the dark ages.
There are also no consequence for those patients who abuse the system by failing to attend appointments and who fail to take responsibility for their own oral health. Unfortunately it is often our more responsible patients, who value and respect the profession, who suffer as they have to endure the longer waiting times for appointments because of those that fail to attend. When we try to address these issues we run the risk of receiving complaints and the threat of GDC action and/or termination of our NHS contract.
As a clinician it is my duty to be honest, act in the patients best interest, and to obtain informed consent, but I don’t see how this is possible if I am prohibited from informing and explaining to the patient why the NHS treatment is inferior, not sub-standard, but inferior when compared to the more expensive private option. When asked by patients if a private option is better, having to circumvent this with phrases like “the private treatment is not better but is has these additional benefits” can come across as disingenuous and I don’t think I helps develop trust and respect between patients and the profession and I have no doubt has contributed to the exponential increase in litigation.
This contract has also meant that I am financially penalised for having professional integrity. I personally choose to earn less than the industry average because I refuse to spend less time with my patients and I refuse to compromise my professional standards. However as my income continues to remain static as the cost of living and the cost of being a dentist increases particularly with the ever increasing cost of regulation and indemnity I can see a situation in the very near future where I can no longer justify working for the NHS in general practice. This would be a real shame as strongly believe in the NHS and its principals. I am in a fortunate position where I also work in secondary care as an oral surgeon so I can continue to work in the NHS without the pressure to compromise the quality of the care and service I provide.
This contract also fails to make provision for the changing needs and demographics for the local population. This is particularly pertinent in central London and the London suburbs where immigration has changed the demographics and needs of the local community significantly since the introduction of the contract 10 years ago. In my experience this has led to situations where the practice has the demand and capacity to treat more NHS patients but there isn’t the NHS funding and additional UDA’s available. This results in increased waiting times for our patients.
In summary this contract has meant I am financially penalised for having professional integrity. Patients are receiving care that is gradually decreasing in quality, service and materials as there are insufficient resources to meet the increasing demand.Anonymous GDP
Dental contract reform: 10 years on
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With 10 years of the 2006 contract now in place, we are keen to hear your perspectives on the current contract, please tell us what the contract has meant for you and your patients.