A Mirror special report from one of Britain’s worst dental deserts exposes an NHS system ‘not fit for purpose’ and causing an exodus of dentists going private
Britain has a hidden oral health crisis with children who’ve never seen a dentist needing multiple teeth removed after their first appointment.
NHS dentist Rob Mew today reveals the upsetting cases he has encountered since opening his books to new child patients every Thursday. The Mirror came to Devon – one of Britain’s worst ‘dentistry deserts’ – for the first of a series of special reports for our Dentists for All campaign. We visited Fairfield House Dental Surgery in Exmouth which is one of the few in Devon still seeing NHS patients. Its owner Rob believes passionately in the NHS and its founding principle that it should care for patients from “cradle to grave”.
But that is the only reason his practice still treats NHS patients. It could earn hundreds of thousands of pounds more going private.
Rob is currently being fined £150,000 by the NHS in a funding “claw back” effectively for keeping his patients too healthy with regular check-ups and preventative work. It is an example of the widely discredited NHS dental payment contract which is causing dentists to quit the health service in their droves to see only private patients.
Every Thursday the practice opens its NHS books to local kids who have not seen a dentist in years – and in some cases have never seen one.
Rob, who himself has three children aged ten, eight and four, said: “That’s one of the reasons I do it because I have young children but it’s quite emotional. We were seeing four and five year olds who had so much decay we just had to send them to hospital to get extractions. There’s such a backlog of sending these kids to have general anaesthetic to get the teeth out so we’re trying to maintain them until they get their teeth extracted.
“One of the dentists saw a seventeen year old who hadn’t seen a dentist in ten years and needed 28 fillings. You’ve got really emotional parents that are feeling really guilty that they have got themselves into this position. One of our nurses said she couldn’t work on that list because it was too upsetting because she has kids of a similar age. It’s a really sad situation.”
Fairfield House Dental Surgery has been running for over 100 years. Rob became a partner in 2012 before becoming owner when another partner retired in 2017. The practice does free supervised tooth brushing at local primary schools as well as sending practitioners to breast feeding and toddler groups to educate parents.
Rob, 43, said: “We’re blessed with a group of patients who’ve been with us for a long time, some have been coming here for more than 50 years. So that’s why I’m still with the NHS because it feels like the right thing to do, to keep going for them. It’s a kind of cradle to grave service which is what the NHS was supposed to be. But that’s the only reason we’re doing it – out of good will.”
Why is top dentist being ‘fined’ £150,000 for keeping his patients’ teeth too healthy?
Rob Mew owns a rare example of a thriving NHS dental practice in the middle of a dental desert. Fairfield House Dental Surgery employs ten dentists and does free outreach work in the local community to improve oral health.
However when we visited the surgery was in the process of returning £150,000 to the NHS because it had not carried out enough Units of Dental Activity (UDA). It was having to pay £50,000 a month over three months.
UDAs are the metric used by the NHS in its dentistry payment contract which has been deemed “not fit for purpose” by Parliament’s Health and Social Care Committee.
The contract requires practices to agree to perform a set number of UDAs – and they are penalised if they come in below or above this. A check-up is worth one UDA while giving a patient a filling racks up three UDAs.
Rob told the Mirror: “We are being penalised for preventing patients requiring more UDAs. We have £150,000 ‘claw back’ this year but we have 19,000 NHS patients which is more than the practice has ever had. The clawback is for not doing enough UDAs but when patients are being looked after better they don’t have as much need for dental work.”
Fairfield surgery gives his patients a check up every 12 months whereas other practices call lower risk patients back for check ups every two years. Rob said: “We are seeing them yearly and that’s one UDA. We are preventing loss of tooth. A GP practice is paid for how many patients they have on their list. That’s how they should be funding dentistry.”
Rob says between five and ten people call the practice every day desperate to be seen by an NHS dentist. He has taken on as many as he can but has just started a waiting list. He said: “We have got patients travelling to be seen here from as far away as north Wales, Manchester and Sheffield.
“The NHS dental contract in England only funds enough for half the population to be treated so these patients have moved away but can’t get a dentist. And the Exmouth population is exploding and we have a load of new housing but no more dentistry money to treat the people in those houses.”
A key Mirror campaign demand is reform of the hated NHS payment contract which disincentivises dentists from treating the patients who need it most. Dentists get paid the same for delivering three or 20 fillings, often leaving the practice treating NHS patients at a loss.
Last week the Government published its Ten Year Health Plan which pledged that “by 2035 the NHS dental system will be transformed” – but the British Dental Association insists contract reform must happen much sooner.
Rob said: “With these most vulnerable patients with high needs it’s really tricky for the practice to to make that work [financially].
“We had a family last Thursday with three kids and they had never been seen by a dentist. There was decay everywhere and they clearly need a lot of work and the parents are saying we haven’t been able to be seen anywhere. And they’re just tired because they’ve been calling around practices trying to get in and it kind of gets put on the back burner.
“We had a 14 year old girl come in a couple of weeks ago and she had four crowns put on her back teeth. And you’re thinking, if we hadn’t handled that soon she would have a couple of back teeth missing and then a lower denture.”
Dental practices have high overheads with staff costs and materials. Fairfield House Dental Surgery is currently trying to find the funds for a new dentist chair which will cost £30,000.
Rob has worked in the NHS in some form for 28 years, starting at the age of 15 in a hospital kitchen. He added: “I’ve got a lot of good will towards the NHS so yeh I try my best to make it work.”
But NHS dentistry cannot rely on good will alone.
The British Dental Association warned the Public Accounts Committee earlier this year that the Treasury has become reliant on practices delivering care at a loss – fuelling an exodus of NHS dentists into lucrative private work. The professional body estimates a typical practice loses over £40 delivering a set of NHS dentures and £7 for every new patient exam. A Parliamentary report by the Health Select Committee has described the state of NHS dentistry as “unacceptable in the 21st century”.
The NHS contract effectively sets quotas on the maximum number of NHS patients a dentist can see as it caps the number of procedures they can perform each year.
At the same time over a decade of real terms funding cuts under the Tories means the £3 billion NHS dental budget for England is only enough to treat around half of the population.
Devon worst ‘Dental Desert’
Data from 700,000 participants in last year’s GP Patient Survey showed it is hardest to get an NHS dentist appointment in South West England.
Questions on dentistry focused on respondents who had attempted to get an NHS dental appointment in the last two years suggests Devon may be one of the country’s worst dentistry deserts.
Survey responses were grouped by regional Integrated Care Boards (ICBs) which include NHS bodies, local councils and voluntary organisations. The One Devon ICB is responsible for the health of the population in the county. Among people who were already in with an NHS dentist, Devon saw just 72% of people successfully get an appointment. In the wider South West region this was 74% while for England as a whole it was 84%.
Of those who attempted to get an appointment at a practice they had not been seen at before, only 14% were successful in Devon. This compared to 19% in the South West region and 33% as the average for England.
The big caveat is that many will not have tried to get an appointment if they thought they had no chance.
The data shows only a minority of dentists are taking on new adult patients, and in Devon and the South West, hardly any are.
British Dental Association chair Eddie Crouch said: “This shows why the government is right to commit to major surgery for NHS dentistry, rather than mere sticking plasters. But we need pace. This service is on the critical list, and demoralised dentists are walking away every day this contract remains in force. If we don’t make a break in this Parliament there may not be a service left to save.”
A spokeswoman for the Department of Health and Social Care said: “This government inherited a broken NHS dental system but we are getting on with fixing it through our 10 Year Health Plan.
“We have already begun the rollout of 700,000 extra urgent dental appointments, a ‘golden hello’ scheme is underway to recruit dentists to areas with the most need and we are reforming the NHS dental contract, with a shift to focus on prevention and the retention of NHS dentists – including introducing tie-ins for those trained in the NHS.”