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Is the NHS dental system in England unfit for purpose?

As the New Year has dawned, if you are a dentist working in the NHS you’re probably setting your sights on making sure that you hit your UDA target by 31 March. But are you also having the same thoughts as the 400 hundred dentists who signed a letter which was published in the Daily Telegraph on 4 January 2016 that, put simply, the NHS dental system in England is “unfit for purpose”?

As the letter points out, the state of children’s teeth is a national disgrace with children under 10 more likely to be treated in hospital for rotten teeth that for any other medical reason. And last year, the Health and Social Care Information Centre published data to show that half of 8 year olds, and a third of 5 year olds, had signs of decay in their milk teeth.

So what has gone wrong? In the few days since the publication of the letter, there has been overwhelming agreement amongst our dental clients that the UDA system used by the NHS to pay dentists encourages the wrong behaviours, and that this has had a large part to play in the deteriorating oral health of the nation, particularly in children.

Introduced in 2006, the UDA system was intended to address abuse of the previous regime (based upon fee per item) by a few dentists who were over-claiming from the NHS for clinically unnecessary work. However, under the UDA system, a dentist is paid the same standard fee (3 UDAs) whether the patient needs one filling or four fillings – this is the heart of the problem. Economically, this makes no financial sense for a dentist with responsibility for running a business, paying staff, investing in the business to improve patient services, complying with regulatory obligations and, oh yes, making a profit!

According to our dental clients, the UDA system encourages dentists to carry out the bare minimum of work required to achieve 3 UDAs and then move on to the next patient leaving untreated decay and disease in patients’ teeth which, combined with inadequate preventative care, is substantially responsible for the decline of the oral health of the nation, particularly in children. And in many deprived areas, it also discourages dental practices from taking on new NHS patients. These things thus render the NHS dental system “unfit for purpose”. 

Until the NHS system of payment pays dentists fairly for the work they have carried out and encourages both treatment and prevention, BBC headlines such as Dental Care in England ‘Third World’ (4 January 2016) will recur, and we will continue to let down our children.

Schofield Sweeney provides a comprehensive legal service to organisations and individuals in the dental sector, and is at the forefront of understanding the challenges facing the sector making proposals for reform, particularly to both the NHS and the CQC. If you are considering buying or selling a practice, or if you would like to discuss any other legal or regulatory matter, then please contact the head of our dental sector practice, David McEwan on 01274 377 360. 



About the Author

David McEwan

Corporate Lawyer

David has a broad, multi-specialist corporate practice including general mergers & acquisitions,…

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