Short term Aim – Maintain Patients Access and Business Continuity

The BAPD has 3 immediate objectives:

1. To restore private dental services for patients as quickly and safely as possible using a logical, evidence-based approach.

The BAPD was born out of a dire need for dentists to be able to provide a rapid and responsive service to urgently provide our own patients with urgent dental care. Each of our members have patients who have pain or swellings which cannot be managed remotely with advice, analgesics or antibiotics, but due to current circumstances we are unable to see them. Patients are trying to get help through NHS 111, but the NHS does not have the resources to provide anything other than a sparse and basic emergency dental service, so people are left in agony or resorting to trying to treat themselves.

The BAPD is urgently working with partners within UK dentistry to shape policy regarding a scientifically credible and patient-safety focused return to the full provision of UK dental services as soon as possible.

2. To address the inequities of financial support for dentists and dental businesses providing dental care for their patients outside of the NHS.

Currently, over 67% of primary dental care is provided privately through highly leveraged small businesses, yet all dental practices have been ordered to cease direct care and only NHS contract holders have been offered financial support (that too in proportion to their NHS earnings).

Dental businesses (practices, laboratories, suppliers) in the UK which depend in the main or wholly on income from the private sector to survive have been given no financial provisions or support for overheads such as rent, business rates and equipment costs. Covid-19 is a Notifiable Disease; therefore, our insurers are not prepared to pay out under any interruption of business clause. Many dentists run their businesses as self-employed professionals, ploughing back profits to invest in premises and equipment. Their self-employed tax returns therefore show earnings slightly in excess of £50K/annum in the past 3 years and so they do not qualify for the Chancellor’s Selfemployed Income Support Scheme. This has left them trying to pay rent, rates and other overheads from savings, overdrafts and loans, and one in five practices are on the brink of collapse this month (The Times, 12 April 2020)

3. To unify the dental profession through the development of robust strategic relationships with other professional groups within dentistry.

The Covid-19 pandemic has laid bare flaws within the leadership structure and functionality of UK dentistry. In 2018 total expenditure on dental services in the UK was estimated at £10.1bn, with £3.9bn (39%) spent on NHS services across primary and secondary care, and £6.2bn (61%) on private dental services in primary care (Clearwater International, 30 Jan 2020). As NHS dentistry is not free at the point of delivery, a significant proportion of the NHS spend is recouped by way of patient charges.

By 2022 the dental market is projected to grow to circa £12bn, with all growth coming from the private dental sector, yet the contribution that private dentistry makes to the physical and mental health and wellbeing of our patients remains under-represented within the profession and in the media.

BAPD’s overall aim is to change this. Our newly formed subcommittees are working hard to clarify scientific issues and liaise with key decision makers, in order to present a united front to shape future dental policy and guidelines for the good of all patients and the dental profession as a whole.

Medium Term Aim – Remodel Dental Services

The BAPD has 3 medium term objectives:

1. To campaign for clinical quality

We strongly believe that professional skills and patient care have both suffered as a result of the poorly remunerated UDA target driven system that prevails in NHS dentistry.

Advances in materials and medical/dental technology have transformed the treatments we are able to provide for patients. Private general and specialist practices provide a significant alternative referral portal for patients who need or desire access to cost-efficient, high quality dental treatment that would be very difficult, if not impossible, for the NHS to provide with its current resources. A significant element of this includes preventative dentistry.

We believe all clinicians should be able to access these advancements, as well as allocate the necessary time to carry out high quality examination, diagnosis, prevention, care planning and treatments with fair remuneration.

Quality replaces the need for repetitive treatment, is more cost effective in the long term and will therefore save time and money for our patients.

2. To assist the DOH in formulating a workable system of funding for dentistry

The Chief Dental Officer, Sara Hurley, recently said

“we should be looking to emerge from COVID-19 ready to exploit the opportunities for reforms to the current NHS dental contract. Ready to ensure NHS commissioned dental care remains a universal offer. And that it maintains the increased access for children so we continue the decline in children’s admissions to hospital for dental extractions”.

(Dentistry Magazine, 20 April 2020)

The funds required to improve access for children will require reallocation of resource from another area, and it will be impossible to make a universal offer for a £12bn dental industry with a £3bn budget (after accounting for patient charges) for NHS Dentistry.

Private dentistry does not compete with NHS dentistry; it is an essential adjunct in an underresourced market, and both operate in harmony. It is imperative that there is complete transparency about the complementary roles played by NHS Dentistry and Private Dentistry, in providing an integrated complete solution to meet the needs and desires of all groups of patients.

The RAINDROP (Resource Allocation in NHS Dentistry: Recognition of Societal Preferences) STUDY from Newcastle University suggests the NHS should explore the reallocation of public funds from orthodontics and the scale and polish to online urgent care triage, improved local access, oral health promotion through local authorities and dental provision in care homes. (Nature, 3 May 2019).

BAPD would welcome the opportunity to engage with the DOH to look at how foreign models in the funding of dentistry can lead to better long-term outcomes and help to provide more preventive dentistry, and more predictable results, to a wider public.

3. To provide quality education for patients and the public

It is essential to educate patients and the public to value the important health, wellbeing and economic benefits of a high-quality dental service, and to improve the profession’s (unified) image.

The growing interest in health, wellbeing, and enhancement of self-esteem have all contributed to an expanding demand for specialist treatment modalities, and the cosmetic dental treatment segment is projected to be worth £3.3bn p.a. by 2022 (Clearwater, 30 January 2020).

Not only is this segment of the market pivotal to the survival of dental businesses and ongoing investment in technological advancements in dentistry, private dental service providers remain a grossly under-utilised primary care resource for the prevention of chronic physical ailments such as obesity and diabetes, and mental health conditions which result from low self-esteem and confidence.

Long term Aim – Redesign Dental Service Frameworks

The BAPD has 3 longer term objectives:

1. To regain control of professional indemnity

We believe that indemnity costs should be both fair and transparent. Dentists must have the peace of mind that they are fully covered without the threat that indemnity cover can be withdrawn at the discretion of the provider without a sound reason being given and with the right of appeal against providers’ decisions. If there are discretionary rules applied by providers there must be a clear set of standards established that outline the details of such rules.

Where insurance based products are utilised there should be an onus to be ensure there are no gaps in cover if switching between claims made, claims occurred and discretionary products.

Also robust defending of spurious claims are imperative to ensure we mitigate the trend for defensive dentistry, which often doesn’t help patients.

2. To assist the General Dental Council (GDC) in its evolution

We support the changes the GDC have already made and believes that this evolution should continue. We would urge the analysis of successful foreign models and reflection on how these could fit within the current legislative framework. We will urge the GDC to set realistic professional standards that are based solely on the provision of the best in patient care. Their recent communications regarding their intended approach to the issues that will be facing all registrants after the Coronavirus pandemic appears to be a step in the right direction, and we welcome that approach.

3. To incorporate Private Dentistry in future dental service policy decisions

The growing demand for remedial and restorative dental care in the UK is underpinned by a population that is increasing in both size and age. The over-60s population is projected to increase from 16.1 million in 2019 to 17.8 million by 2024 (Clearwater, 30 January 2020).

Add to this the technological advances that now make it possible to mill dental restorations on site, to use lasers for impressions and treatments, to place digitally guided implants, and to align teeth using 3D printed aligners, and it is clear that Private Dentistry has to be embedded in the delivery of comprehensive and holistic services that truly meet the needs of all patient groups.

It is important to acknowledge that the costs of delivering the more complex and advanced services that are usually provided privately are significantly higher than the costs of delivering NHS care via the current UDA system or any future capitation model. This is illustrated by the higher associate, lab and materials costs associated with predominantly private practices vs predominantly NHS practices, and the correspondingly lower earnings in private practices (Cristie & Co Dental Market Review 2019).

Expenses are likely to rise across the board in the future with the development of new PPE standards as a result of the Covid-19 virus. It will be important to have a coordinated strategy for ensuring that the true costs of delivering a high-quality dental service are understood.

The time is right to ensure that the knowledge, skills and capabilities of our highly talented workforce are fully utilised, that future dentistry is fit for purpose, and that it offers patients the widest possible choice using a symbiotic system, rather than the two-tier system that currently fragments dentistry in the UK.

Organisational Structure

Our executive committee acts on the direction of the steering group. This executive committee is made up of chair persons from each subcommittee; each chairperson provides a voice for his or her committee.

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