Neel Kothari asks if the proposed NHS tie-in for dentistry graduates is fair and if it will work in practice.
Recently the Department of Health and Social Care (DHSC) set out its NHS 10-Year Health Plan, concluding that the NHS was in ‘critical condition’. Whilst the diagnosis is self-evident, its prescription for change regurgitates many of the usual themes, such as increased water fluoridation, increased topical fluoride and fissure sealants, additional urgent care appointments and now a tie-in to the NHS for newly-graduated dentists intended for at least three years. It hasn’t gone unnoticed that there is no upper limit to the planned tie-in.
The DHSC sets out to justify the tie-in by citing training costs of up to £200,000 to the taxpayer. However this is a logically flawed proposition as taxpayers receive the benefit of a qualified dentist regardless of whether they provide NHS care. It is absurd to think that graduates providing private dentistry are of no value to society or that dentists should be singled out to bear this additional burden which extends beyond graduation.
‘Who exactly does the NHS think it’s tying graduate dentists to?’
What is more, it’s not entirely clear how they intend to do this, because NHS associates aren’t engaged directly by the NHS and they haven’t been since 2006. Put simply, NHS dentistry is performed by those who hold an NHS contract and/or by those who work for them. While we refer to the latter as ‘NHS associates’, they are not employed by the NHS, they are not contracted by the NHS and are not subject to the NHS (General Dental Services Contracts) Regulations 2005 (also known as ‘the regs’), which specifically apply only to contract holders.
I appreciate my last point may sound outlandish. However, if one spends a few minutes reading the interpretation section of the NHS regulations, the explanatory notes at the end of the legislation and schedule three, part four, it’s plain to see that this is intended for contract holders and not their associates. So it isn’t entirely clear why there is a popular belief that associate dentists are subject to this regulation.
This begs the question – who exactly does the NHS think it’s tying graduate dentists to?
The devil is in the detail
Apologies if this sounds facetious, but there is no actual commercial relationship between associate dentists and the NHS, which is why it is erroneous for the DHSC to refer to this policy as an NHS tie-in, when in fact what they mean is a tie-in to one or more contract holders (providers).
This distinction is incredibly important, because whilst this policy may work in year one, where scores of vacant positions can easily be filled, what will happen in the following years if new graduates then struggle to find vacancies as associates stay in their positions and new contracts/practices cease to materialise? Will they then be subject to some sort of penalty? Further, what exactly makes a dentist an NHS dentist? Could a single UDA per year count? What about 1000?
With these things the devil is always in the detail, so we will need to see how the DHSC plans to carry this out, even though in my personal view I’m not entirely sure it is feasible. For the sake of argument, let’s assume it’s possible. Well, if it does happen, this appears to be huge win for corporate dentistry and many of the large contract holders who have been unable to attract NHS dentists through market forces alone.
What if dentists don’t want to work in the NHS?
However, what happens if a dentist doesn’t want to do this or wishes to work abroad soon after they qualify? Would they be asked to pay back some money to the NHS, an organisation which never actually contributed to their education in the first place? This would be preposterous.
It is noteworthy that there is no attempt to address the years of chronic underfunding that the service has been subject to. Instead, what we have is a proposal that severely restricts choices for new graduates, who are leaving university with record debts (see my last article) and are likely to now be subject to wage suppression, to prop up a failing service that is seeking to address its lack of funding by preventing people from leaving. In any other setting one may consider this a form of coercion.
Let me be clear, the plan to tie in dentists for a minimum of three years isn’t being introduced because the NHS has a claim to the early years of our newest members in the profession. It’s being introduced because it can no longer attract dentists at a price it wishes to pay and forcing this upon new graduates, in my opinion, is nothing more than a sign of desperation.
Read more from Neel Kothari:
- Are dental graduates being crippled with student debt?
- Is the dental profession biased towards water fluoridation?
- Are retention fees for departing associates being abused?
- Will 2025 be an economic disaster for the dental sector?
- The dangers of ‘bad science’ in dentistry.
