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NHS dental charges: Stoking a hostile environment

Blog Author Charlotte Waite

Blog Date 05/09/2018

NHS 'Don't assume you're entitled' poster detail


Every year the arrival of NHS Dental Statistics provides a snapshot of current government policy on dentistry. Attendance will rise or fall, treatments delivered will change, and workforce numbers will fluctuate, often as a direct consequence of decisions made on Whitehall.


This year was no different, but what leapt out from the data, was a marked collapse in attendance among patients who are exempt from NHS dental charges.




Official figures now show a fall of two million courses of treatment delivered to exempt patients since 2013/14 – that's a staggering fall of 23% in four years. This suggests that a huge number of patients – many of whom have high dental needs – have made a choice not to attend. 


This fall has run in parallel with an energetic and aggressive approach from NHS England towards those it says are 'misclaiming', when declaring exemption from NHS dental charges. 


Over 400,000 patients a year – this will include many on low incomes and from vulnerable groups such as those with learning difficulties or dementia – have received £100 fines for making an incorrect declaration regarding their exemption status.


Since this fall in care delivered to exempt patients began, the number of fines issued has skyrocketed – a 10-fold increase from 33,887 in 2012/13 to 365,181 in 2016/17. Yet let's remember that 90% of appeals against these fines are won. Yes, we want to ensure support goes to those who need it, but the data shows the current approach is resulting in innocent patients being fined and, most importantly, it is causing a significant barrier to patient care and is contributing to oral health inequalities.


We have the "Don't Assume You're Entitled" posters which colleagues are invited to display in their practices. We also have official NHS twitter feeds saying #DontRuntheRisk. These initiatives could be seen as encouraging a hostile environment, designed to discourage claims and keep costs down.


Annual government spend on NHS dentistry per head of population has tumbled over the last five years, from £40.95 to £36, whilst at the same time the NHS patient charges that we know represent a tangible barrier to those on low incomes have surged by over 23%.


The BDA has discussed the impact of this legislation, with representatives from the NHSBSA, NHS England and DHSC, and suggested amendments which could be made to improve this situation. We have outlined the detrimental impact it is having on the public, our patients and dental teams. We have also spoken directly with a number of MPs who have raised concerns, regarding the fines, on behalf of their constituents and to a member of the House of Lords.


NHS England have informed us that that they have recently established a task and finish group - with membership from DHSC, NHSBSA and NHS England - to "explore the issues arising from existing practice and identify amendments that may be made that produce a reduction within the burden and stress of service users and practitioners". We are awaiting the outcomes of these deliberations with keen interest and hope that they will lead to a timely solution to the problems highlighted.


Sadly official data tells a similar story about children. The introduction of low impact, unfunded initiatives, still leaves 4.9 million children a year not attending an NHS dentist, whilst tooth decay remains the number one reason children are admitted to hospital.


Policy makers must make stronger efforts to engage with the dental profession. The missing piece is the political will to develop a coherent plan to engage nurseries and primary schools in a preventive approach to tooth decay in children, such as the initiatives which have already been introduced successfully in Scotland and Wales.


Prevention can save our NHS millions. It's time the government proved it has a real interest in improving the oral health of all children and people on low incomes, by tackling the issues that prevent engagement of these groups with NHS dental care.


Charlotte Waite

Chair, England Community Dental Services Committee


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