New UK government faces ‘dentist crisis’

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The British National Health Service (NHS) is one of the central themes of the election campaign for the 4 July elections. The NHS has long been a source of pride for the citizens of the United Kingdom, but it has been in crisis since the years of the Covid-19 pandemic and, also due to staff strikes, its waiting lists have grown very elongated, to include 6.3 million citizens in England alone (one of the nations that make up the United Kingdom together with Wales, Scotland and Northern Ireland). Both the Conservatives, who have been in government for 14 years, and Labour, who are about to return, have promised to intervene.

Within this general public health crisis there is a second crisis, particularly felt, which concerns dental care and treatments, that is, in short, dentists. The possibility of having a dentist affiliated with the NHS, according to a survey, is one of the four priorities of voters at local level: almost a third (28 percent) of those interviewed indicated it, more than those who cited crime or transport public. The top three priorities are the state of the roads (42 percent), the availability of general practitioners (40 percent) and affordable housing (36 percent).

So it happens that candidates, aspiring parliamentarians and ministers, find themselves in interviews more often than in any other European country having to talk about their dentistry policies, which would be the “dental policies” of their party’s program, clashing over the feasibility of the proposals. Or that the Labor leader, Keir Starmer, is photographed in a school surrounded by pupils holding toothbrushes and toothpaste.

British politicians have long been trying, in vain, to resolve the “dentist crisis”, as the media has called it. In 1999, Labor Prime Minister Tony Blair promised that everyone would have easy access to registered dentists within the next two years. In 2005, two years before the end of his term, Blair had to admit that he had not succeeded and called dentistry “the most difficult aspect of the NHS”.

The current Labor leader Starmer, whose victory in the elections is now almost certain, has made a promise similar to that of Blair. During the election campaign Starmer insisted heavily on the excellence of the NHS and https://twitter.com/PolitlcsUK/status/1805296646353219988 that his mother and sister were nurses and that his wife, Victoria Alexander, works in health and safety for a large public hospital in the capital, London.

If, as it seems, Starmer becomes prime minister, he will find himself in a very difficult situation. In January an inquiry by the Guardian has defined some areas of the country as “dental deserts”, especially rural and coastal areas, where there are no affiliated dentists, or where the affiliated ones do not take new patients. The result is that 40 percent of minors do not have access to the regular checks that they would most need during their growing years.

Not being able to go to a dentist, between 2022 and 2023 more than 30 thousand minors – and in England 70 thousand adults – went to hospital emergency rooms, which were already overloaded. In England, tooth decay is the leading cause of hospitalization for those aged between 5 and 17.

One of the problems of going to a hospital is that emergency room doctors are almost never trained specifically in dental conditions and end up prescribing painkillers or antibiotics if there is an infection. A doctor who works in a London hospital told Guardian that in some cases she and her colleagues had to treat people who had overdosed on painkillers, taken without consulting a doctor.

This situation is also due to the fact that 90 per cent of NHS-affiliated dentists are no longer accepting new patients: both because there are too few of them and because accepting patients under the NHS is not economically viable. Many dental practices only take on the children of people they are already treating, usually privately. In the coming years, among other things, 75 per cent of dentists in the UK intend to reduce the number of visits under the NHS, according to a survey published by the British Dental Association (BDA), their trade association.

In the UK, dental care is not fully covered by the NHS. In 1951 Aneurin Bevan, considered the founder of the NHS, resigned as Minister of Health in controversy with the introduction of a copay on dental care, which in his opinion should have been free.

British dentists work as independent practitioners, but around two-thirds of them are contracted to the NHS to provide a range of services. In 2022, there were around 33,000 British dentists in a population of 67.6 million; in Italy there are more than 49,000 dentists, in a smaller population.

The national contract regulating this provision has not been updated since 2006 and has repeatedly been found wanting by the Health Committee of the House of Commons, the lower house of the British parliament. One of the main limitations, according to dentists, is that it forces them to provide a certain number of services per year which, however, are identified only by type, without taking into account how long they last and how many treatments are administered during a single session. In essence, the contract is considered penalizing from an economic point of view.

NHS services have a cost, borne by the patient, which is set by law in three brackets. They range from a minimum ticket of 26.80 pounds (31.7 euros), for routine checks, to one of 73.5 pounds (86.9 euros) for other checks, up to 319.80 pounds (377, 9 euros) for the most demanding interventions. Minors, pregnant women and people in poverty are exempt.

These tickets represent 25 percent of the total cost of the service. The remaining 75 per cent is covered by the NHS, which then distributes reimbursements to dentists based on how many visits they have made each year. The total funds, however, are calculated on the basis of the 2006 needs: taking inflation into account, the funds for England have fallen from 3.56 billion pounds (4.2 billion euros) in the 2010-2011 period to £2.9 billion (€3.4 billion) between 2022 and 2023.

It is not convenient for dentists to accept so many NHS-supported appointments because they take time away from private ones, which are more profitable: for the same service, the cost in the private system can be three times that in the public system.

In an attempt to incentivize dentists, in March the Conservative government raised patients’ co-payments by 25 percent. This, however, has not solved the problem: for dentists it is still too little, and therefore they continue not to accept new patients, while those who had problems paying the regulated rates will certainly not be able to do so now that they have increased.

According to Ian Mills, Professor of Dental Care at the University of Plymouth who wrote about it on the website The Conversation, failure to update the contract is the main cause of the crisis together with insufficient investments. All this in a country that has the lowest per capita spending on oral hygiene among the G7 countries.

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Both Labour and the Conservatives intend to change the contract. The Labour platform promises 700,000 more urgent dental appointments; financial incentives for dentists who work in uncovered areas, or who decide to do so; a school supervision program to promote oral hygiene among children aged 3 to 5. However, it could take years before these measures – which are very expensive, Labour plans to fund by reducing tax evasion – take effect.

One of the stereotypes about the English, rather than the British, is that they have “crooked teeth”. In an old episode of SimpsonRalph was shown “The Great Book of British Smiles” to scare him about what would happen to him if he didn’t brush his teeth. Years ago BBC News he spoke of it as a false myth: a “cultural stereotype” that “may have had some element of truth in the past.” The article by BBC News It was 2015: before the “dentist crisis”, years of unheard reports and a problem that was considered solved became so relevant again.

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