23. Despite the problems with the remuneration system,
actual level of income is not the reason many dentists cite for
leaving the NHS. Their concern is that providing comprehensive
high quality dental care to appropriate standards has become increasingly
difficult under the GDS contract. Alan Ross commented that:
"by and large it is
the method by which we have to arrive at that remuneration [which
is the problem]; it is the treadmill. Successive governments over
30-odd years have realised that dentists will work harder and
harder and faster and faster for the same income and we are fed
up with it."
John Renshaw agreed:
"Dentists do not leave
the NHS for ideological reasons, they leave because they are over-stressed
and overworked and until somebody does something about that you
are not going to turn this situation around."
We heard that young dentists in particular are concerned
about the amount of time they are able to spend with individual
patients, and their inability to use the full range of the highly
developed skills they acquire in training (for example, advanced
crown and bridge work) within the NHS.
The BDA noted that list sizes rose by 2.2% between June 1999 and
June 2000 and many
of their members had told them that they were already working
to full capacity and could not take on any more patients, with
clear consequences for access.
24. The GDPA reported that their own research shows
that GDPs in other Western countries had a workload of 12-15 patients
per day, working a four and a half day week, compared with a workload
of 30-40 patients per day in the UK for a five day week. This
situation is not static; as we have described, the remuneration
system has the effect of making dentists work harder and harder
and faster and faster.
25. Last year, following longstanding concerns about
the pressures under which the profession was working, the DDRB
commissioned a survey which looked at the workload of GDPs.
This found that:
- about 70% felt rushed when treating NHS patients;
- about 60% said that their workload did not allow
them to provide the professional standard of care with which they
- only 16% expected to be committing 90% or more
of their time to the NHS in five years.
The survey also found that full-time dentists wholly
committed to the GDS work on average 42.3 hours per week, seeing
139 patients. This is compared with 43 hours worked and 122 patients
seen by full-time dentists doing some private work.
As the DDRB comment, the survey's findings tend to support the
profession's assertions that GDPs' reducing commitment to GDS
dentistry stems, in large part, from a desire to alleviate the
pressures under which they are working in the GDS.
26. Compounding this are increasing controls over
the type and level of treatment that can be undertaken within
the NHS, as we heard from the Eastman Hospital. Alan Ross highlighted
"I think there are access
problems within the branches of dentistry itself because dentistry
has changed and the NHS has not changed over 50 years. Dentistry
has moved on from extracting teeth and replacing them with a bit
of plastic to implants, whereas the NHS is taking away bits of
dentistry. They have taken away crowns, they have taken away prevention
and put in nothing, so there is a void there which private practice
is having to fill."