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Is it time to walk away from the NHS?

By 2 July, 2019Members

I said a few things about the NHS in my last blog post, but let me just clarify my own personal opinion and specific opinion on the matter.

I subcontracted my time to the NHS for 22 years.  In that time, I saw how the system changed, the noose gradually tightening around the necks of practitioners.  Despite having a good UDA value and a stable patient base, I felt I could no longer do dentistry to the standards I was happy with, so I sold up to let someone younger take forward the practice I had helped build.

I will never work as an NHS GDP again.  Why?

The NHS, as an organization, is underfunded, awash with unnecessary management, compliance officers and box tickers. The hierarchy often does not care about the actual patient care, and the patients often do not care about their part in causing the institution’s downfall. It has become a bureaucrat’s dream, health care often taking second place to the diktats of the inane and the corrupt. This has resulted in a demoralised and stressed frontline workforce, sometimes being forced to deal with litigious and self-righteous patients who care only for their own convenience (and yes, I freely accept that a considerable amount of the litigation we see is justified).

No place do we see that more than in dentistry, where financial compliance, contract uncertainty, regulation, clawback and patient non-attendance are now the biggest threats to NHS practice viability. The will to fix the problem at the level of central government is not there, instead a continuous procession of ‘pilots’ are unrolled, allowing the DOH (Department of Health) to kick the HTM (Health Technical Memorandum)-0105 compliant can down the road another few years, although there is a promise that a new contract will arrive in 2020 (I’m not hopeful). And all the time the NHS system deteriorates into something that Kafka would have been proud of, with vulnerable NHS patients being fined for not understanding what benefits they are on, as well as dentists unable to verify what is and what isn’t available under NHS contract. Over ten years in, even knowing the rules on how to deliver that treatment is like trying to thread a needle in a darkened room, whilst wearing thick woolly mittens … with the windows open in a hurricane.

It is my opinion that every primary care dentist working under NHS contract should formulate an action plan to extricate themselves from the financial mess that will inevitably unfold. I also believe that those in secondary care should consider doing the same. You are underpaid, underappreciated and undervalued. And yes, I know that is easier said than done but those who do this might be in a better position several years from now.

And let us not kid ourselves that it is just dental staff that are under siege here. Whilst many in the NHS structure overseeing the NHS contract are good, honourable people (doing the best they can in a difficult situation), good people can’t survive untainted in a broken system that was never fit for purpose. Many in NHS management structures find themselves under intolerable stress, ground down by a huge bureaucratic machine that cares only about maintaining the status quo and protecting itself from criticism. I imagine the same could be said for the various insurance schemes available in America.

The NHS is filled with good people working in an intolerable situation.

The idiots (I chose that word carefully) in government do nothing to change all this because many of them really do not care about you or your patients. Those rare individuals who do give a damn and who do try to improve things only find themselves ground down by the system that cares about one thing – protecting itself.


It’s time to get out before you get crushed by the machine.

That’s the way it looks from here, and remember this is my biased opinion.  it is not to be considered advice