Finding an NHS dentist ready to treat people
with HIV is hard enough but now dentists are abandoning the NHS in their droves,
is the rot about to set in? Laurence Gibson reports
Image Kenneth Williams/Jupiter images
We’re
already in the midst of a nationwide shortage of dentists but now the situation
is about to get worse. Existing NHS dentists who have chosen not to sign a
new contract proposed by the government will no longer provide NHS treatment,
making this the biggest shake-up within the dental industry since the introduction
of patient charges in 1951.
According to a British Dental Association (BDA) survey, one in ten UK dentists
have rejected the new contract, and about 60 per cent of those who signed
did so only “in dispute” and will contest the terms under an appeals
procedure. Around 2,000 dentists walked away from the NHS after not signing
the new contract.
This is particularly bad news for people living with HIV, who may have greater
need of good dental services but are more likely to be put to the back of
the list unless willing to go private for their treatment.
People living with HIV are advised to visit the dentist regularly as good
oral and dental care is important for avoiding infections. Good dentists should
be able to spot gum and mouth disorders like oral thrush or badly bleeding
gums, which can be common in people living with HIV. So it’s painfully
ironic that, under the new contract, those with the greatest dental needs
are likely to find it hardest to see a dentist.
Taking on patients
With this in mind, and in an undercover capacity, I attempted to register
as an HIV positive patient at an NHS dentist just days before the introduction
of the new contract. Although seemingly there was no problem registering for
free treatment at the Old Street Dental Clinic, when sat in the waiting room
I overheard the secretary apologising to someone on the phone: “Sorry,
we cannot take any more NHS patients.”
The dentist told me this was true. “You’re very lucky, you were
the last,” he added.
Worse still, when he noticed my HIV status, his whole demeanour changed and
he took a step backwards: “All these drugs you take. Are they all for
the same thing?’
I left the surgery without so much as a scale and polish despite not having
been seen by a dentist for two years.
Reports in the news of people queuing outside through the night when an NHS
dentist opens have already highlighted painful discrepancies between private
and NHS treatment. Now many more dentists have switched allegiance to private
practice.
Free treatment? A thing of the past
If you receive benefits like Income Support and are already registered with
a dentist, you can indeed remain with them and still be exempt from basic
charges. But this new contract means many dentists are now not taking on any
new NHS patients and any incentives for doing so have been removed. The result?
Within a generation we could reach a situation where free dentistry has become
a thing of the past and many may decide to put the health of their teeth to
the back of the list or expect to be presented with a large bill.
The new contract itself is complex. It’s estimated that under the new
agreement dentists will receive an average annual income of £80,000.
This is a rough estimate based on the amount of work they did in the test
year 2004/5. This figure is vigorously disputed by dentists who argue their
expenses, allegedly spiralling ahead of inflation, will eat substantially
into profits. In February a BDA survey showed 90 per cent of dentists were
experiencing problems with calculating the value of their new contract and,
in another analysis, found 90 per cent of local dental representatives believed
access to NHS dentistry will worsen.
NHS charges have been altered too. Previously, an NHS patient could pay any
one of over 400 different fees for varying amounts of dental treatment. But
under the new scheme there are only three fees: a basic check-up costs £15.50,
a middle figure of £42.40 for fillings, root canals and extractions,
or £189 for more complex surgery such as crowns, bridges and dentures.
Nevertheless, to many people these amounts are excessive, especially as a
trip to your GP remains free.
Dr Lester Ellman, chair of a BDA committee, said: “The chaos surrounding
the introduction of the changes to NHS dentistry is bad news for dentists
and their patients. We don’t believe the new contract will improve patient
care or access to NHS dentistry, and we also believe it’s been introduced
in a shambolic way.
“Dentists tell us they can’t plan for the future because their
local primary care trusts can’t tell them how much funding is going
to be available.”
Disclosing to dentists
HIV positive patients may already struggle to locate an NHS dentist and have
real concerns over whether to disclose their status to their practitioner.
If you are lucky enough to find one and disclose your status, it is still
not unheard of for people to only be offered appointments at the end of the
day [in a misguided attempt to reduce ‘risk’ to other patients
through infection].
PN spoke to some people living with HIV about their experiences.
Andi Morgan, 36, from Holloway, London, was a patient at the Old Street Dental
Clinic (the clinic I visited) for two years:
“I was diagnosed in 2000 and had previously had a good relationship
with my dentist. I told them I was HIV positive and they told me they could
not see me again.
“Being only recently diagnosed, I was not as empowered as I am now.
It came as a real shock and I thought: ‘Well, this is what I can expect
from now on.’”
Andi went to the Mortimer Market Centre dentist, but they would only see him
if his concern was directly related to HIV.
“All I wanted was a check-up. It took me about a year to finally get
another dentist but now I am much happier at St Leonard’s dental clinic,
in Hoxton.”
Get a referral if you’re unhappy
Jeff Akers was diagnosed in 1994, and had been going to the same local dentist
for
12 years.
“After my diagnosis there were a few things I was unhappy about. I didn’t
want to disclose my status because I thought they probably wouldn’t
understand my needs. I also had serious doubts over whether they sterilised
their equipment properly.
“I asked my hospital for a dentist who knew about HIV and was referred
to the Brocklebank Health Surgery, in Wandsworth. My dentist there only treated
HIV and hepatitis patients and was incredibly understanding.
“The clinic is nice, bright and modern with excellent staff. The dentist
is aware of your viral load and CD4 and has knowledge of HIV drugs. They are
well on top of things.”
Paying
the price
But even at excellent clinics like Brocklebank, some people with HIV on low
incomes still struggle to get the care they need. Barbara, a 39-year-old African
from south London was referred to Brocklebank after her previous dentist dismissed
her for being HIV positive:
“My hospital referred me as an NHS patient while I was a student at
South Bank University, living on a small student loan. Six months ago they
told me I would have to pay for my treatment because my student loan had affected
my income support and my benefit was stopped. Because I now have to pay for
my dental care,
I don’t go. The clinic has also told me that because of a change in
law [the new
contract] my name will probably be struck off the list altogether.”
Find an HIV-friendly clinic
St Leonard’s and Brocklebank are both London dental clinics with a good
track record over confidentiality and cleanliness. But outside London these
types of ‘HIV-friendly’ clinics are few and far between.
If you’re looking for an NHS dentist it’s probably best to start
by asking your HIV clinic if they know one particularly skilled or interested
in treating people with HIV.
If you are angry about the lack of provision, you could also protest to your
primary care trust. If you cannot find a dentist to take you on as a patient,
ask to be seen as an occasional patient. You can ask your primary care trust
or local health board (in Wales and Scotland) to tell you when a place becomes
available. Special Dental Access Schemes operate in some areas and PCTs can
advise you of these.
If feel you have been discriminated against you can take action. Dentists
and all health professional are not allowed to discriminate against you because
of your health status, race, or sexuality.
How do I complain?
If you have a complaint and are dissatisfied with the response from your NHS
dentist, you can ask for a conciliator to be brought in, or for the NHS to
hold an independent review. If this fails to resolve the issue, you can ask
the health service ombudsman to follow up your complaint. Contact NHS Direct
or NHS 24 (in Scotland) for more information.
In Northern Ireland, first take up the matter with the dentist. If you’re
dissatisfied with the outcome you may write to the Complaints Officer at the
relevant Health and Social Services Board. From 24 May you will be able to
complain about your private dentist if you are unhappy with the service (but
you will not be able to complain retrospectively) to the Dental Complaints
Service (see info below) This scheme will apply across the UK.
Useful numbers
• NHS Direct: 0845 4647 www.nhsdirect.nhs.uk:
for help locating your nearest dentist and information on how to complain
• NHS 24: 08454 24 24 24 www.nhs24.com
• The Dental Complaints Service: 0845 6120 540, Visit www.gdc-uk.org
and enter ‘complaints’ into the search engine for how to complain
about
private dentists. info@dentalcomplaints.org.uk
