NHS Flashcards
What do you know about the traffic light system, and what are your opinions on it?
•initial assessment on oral health, RAG rating and then a personalised plan of prevention is made
•RAG ratings are discussed with patients to explain risks factors (reviewed to view progress)
•very vital as it will benefit the NHS in the long term = more preventative care so less need for procedure
•improves education on oral health
•in line with beneficence/veracity as patients are given honest truth to improve their oral health
What are your thoughts on the recent sugar tax? (For/against)
• the sugar tax has been introduced to combat child obesity and tackle caries = global problem. The tax aims to reduce sugar in drinks/producers can choose to make drinks more expensive = people may choose healthier alternatives
•reduces tooth decay saving nhs so is a very important public health intervention (costing NHS 3.4 billion per year)
•other countries such as mexico have implemented similar ideas = good evidence of its usefulness
•reduces tooth decay/ acidity from drinks erodes enamel and make teeth sensitive
•also increase revenue for government which can be reinvested in promoting healthy eating
•sugar in moderation is not harmful
•this tax can discriminate against those that may not be able to afford more expensive healthier options e.g Lowe income families may find it harder to go for healthier alternatives
•people should have control over what they eat (UK is becoming a ‘nanny state’)
•doesn’t consider other unhealthy foods e.g only implemented on drinks with ‘added sugars’ where fruit juices can still contain lots of sugar and can be harmful if had in excess
What are some alternatives of the sugar tax?
•educating
•reduce advertisement of sugary foods during certain times of the day
•reduce portion sizes of unhealthy foods
•reduce prices of healthy foods
What are potential outcomes for the sugar tax?
•tax could expand to other products e.g sugary milk based drinks
•more research/reports to evaluate the effects and usefulness
How should money be invested into dentistry for the NHS?
•increase pay for nhs dentists (article read stated “enough dentists in the uk but not enough in the nhs”)
•improving access to dental care e.g rural areas by setting up mobile services
•improving using hygienists as dentists can focus on procedures/more time spent educating on oral health which dentists may not be able to prioritise e.g in the traffic light system it would be useful to allow hygiene treatment plans to be set out by hygienists
•investing in preventative programmes for children which the child smile initiative in Scotland shows that this will pay for itself in reduced treatment costs even within 5 years
Should dental treatment be free on the NHS?
For:
•would help the poor and improve oral health greatly for all
•everyone should have access to care (a right)
Against:
•too costly for the NHS and would increase taxes which many especially those that do not need dental services would view as unfair
•private dentists may offer more time with patients and hence better quality care
•people could start requesting cosmetic procedures not necessary
•many things free/reduced cost =
*under 18
*pregnant/in last 12 months
*applied for nhs low income scheme
What changes have there been in dentistry over the past 100 years?
•implants/crowns
•3D printing
•patient focused care (emphasis on prevention and education= autonomous)
•digital radiography
•nylon toothbrushes
•material that is stronger and more aesthetic
Blog= https://blog.edentalsolutions.com/vital-advancements-in-dental-care-from-the-last-100-years
What are the differences between private and NHS Dentistry?
•NHS is more focused on essential care to maintain oral health/ private offers more treatments such as cosmetic and advanced (wide choices of services) e.g tooth whitening
•NHS is free or banded/private costs and more expensive for some treatments
•private may offer more flexible scheduling and shorter waiting times
•private dentists may have more time with each patient so improved quality care, where more personalised treatment plans can be made. As there is not pressure added of achieving the UDA targets
•private may have more money to fund for better tech/newer equipment
Give differences between the NHS systems in different countries in the UK
•The Scottish Dental Reference Service (SDRS) monitors the quality of NHS dental treatment by having independent dentists inspect patients before and after treatment.
•The Childsmile program is funded by the Scottish Government and focuses on prevention e.g dietary and oral advice
Ireland:
•You are entitled to emergency treatment from your dentist or another dentist
•You can refuse payment for treatment if it is unsatisfactory
*What is an NHS trust and how do they work?
•organisational unit within the NHS which serves either a geographical area or a specific service such as ambulance/hospital units
•NHS foundation trusts make quick, strategic decisions, respond to local needs and can raise money to fund services e.g for weight management and alcohol screening
How do price bands work for treatment under the NHS?
•NHS only provided treatments that are clinically necessary so will not include cosmetic reasons for dental work
NHS uses a band system to charge for dental care which can change every year
•band 1 (£26.80) covers e.g examination, diagnosis and advice
•band 2 (£73.50) covers e.g all in band 1, fillings, root canal and extractions
•band 3 (£319.10) covers e.g band 1/2, more complicated procedures e.g crowns, dentures, bridges
(However you can apply for reduced charge if low income)
•if you are in need of band 1,2,3 treatments you would only pay for band 3 treatments as they cover 1,2
Could you talk me through what would qualify as a Band 3 treatment?
•most expensive band which covers band 1 and 2 aswell
•it involves treatments such as crown, bridges and dentures which may need more expensive material and time e.g processed in a lab
•patients are essentially covering part of the cost of material and equipments
What dental treatments are free?
• To repair dentures
• To remove any stitches
• To stop bleeding from your mouth
• If your dentist only has to write a prescription
Who qualifies for free dental treatment?
The following patients will not need to pay for treatment at the point of delivery:
• Anyone aged under 18
• Anyone under 19 and receiving full-time education
• Anyone pregnant or has had a baby in the previous 12 months
• Anyone staying in an NHS hospital and the treatment is carried out by the hospital dentist
What are your thoughts on the current NHS Dental Contract and the system of Units of Dental Activity?
Target of activity = UDA and if government treatment target is met dentists are rewarded
Ad:
•it will be easier to see a dentist from the nhs (could make some more productive, improve time efficiency)
•cheaper than private with same quality care
Dis:
•focused on seeing many patients so not enough time for appointments and they can be rushed (may reduce quality of care, causes mistakes to be more likely)
•less focused on prevention which is not beneficial in the long term
•nhs dentists are high demand which may cause appointments to become more limited = reduced access to dental care
When would a dental appointment be free, even when patients are not exempt?
•if they are receiving treatment in an NHS hospital and the hospital dentist is carrying out the treatment
•if patient needs more treatment within 2 months of completing a treatment plan = no additional charge (same or lower band)
What are problems with the units of dental activity and how can it be solved?
•dentists may focus on completing quotas rather than focusing on patient care (may reduce quality of service as it becomes more about quantity rather than quality)
•appointments may be rushed as demand restricts amount of time that can be spent with each patient
•focus more on prevention and treatment that is necessary, rather than the no. of patients seen
E.g dentists can be rewarded on educating patients on ways to improve oral health (in new contract from the department of health this approach is being trialled + traffic light system is being used)
•steele report has described many issues with the current contract, more push to change e.g by focusing on repair and intervention rather than preventative methods, the oral health of our society will not improve but can only be managed
What are the problems with the UDA contract?
•if UDA target not met, penalised but if overachievers they will not be rewarded
•if many procedures fit in one band, they will only be paid the set amount without considering the collective time and cost of all the procedures = unfair on dentist
•does not focus on prevention as it is not rewarded so dentists may be less inclined to provide preventative care
What are the pros and cons of private dentistry?
Pros:
•usually longer appointments with patients so more targeted and personalised treatment plans/more time for people that may have specialised needs e.g dental phobias
•dentists can decide working hours and be more flexible = improved work life balance
•cosmetic treatment/better equipment provided as e.g better funding/expensive equipment
Cons:
•more expensive for patients for the same treatments given in nhs
•no nhs benefits e.g pension
•can end up overworking as your pay is based on your hours and no. of patients which can be hard to accumulate
•have to manage patients as well as own practice which can become stressful ( less time to enjoy e.g hobbies/socialise)
What are the GDC principles
1.put patients interests first
2.communicate effectively
3.obtain valid consent
4.maintain and protect patient info
5.have a clear effective complaints procedure
6.work with colleagues in a way that is in patients best interest
7.maintain/develop/work writhing your professional knowledge and skills
8.raise concerns if patients are at risk
9.personal behaviour maintains patients confidence in you and the dental profession
Have you thought about specialising in anything?
•right now I hope to get through dental school and be the best dental clinician I can be. But I am sure that if I become intrigued in something in dental school, I can explore it and get more insights into what I want to do
•however I have still read up on the different specialties and some have peaked my interest e.g
*orthodontics, one of my fave YouTubers and I’ve seen how greatly it elevates one’s confidence improving the way they perceive themselves = rewarding
*paediatric dentistry= I’ve don’t work experience in a paediatric centre and throughly enjoyed the whole environment. I love working with children and this has cemented especially when I got the opportunity to mentor young children and I enjoyed it a lot = loved teaching them and hearing their stories = you get to see them grow, again very rewarding
*special care dentistry= I’ve been part of a dementia club and understand that you need to adapt a lot of your skills to suit the needs of the patient. I believe I can work in this pressured environment as I really enjoyed interacting with the different patients and adapting my skill set to better help them e.g remaining calm and patient with all of them
What are the 4 pillars of medical ethics?
They apply to dentistry as it provided good standard of care for patients that can be deemed as ethical
1.autonomy= respecting your patients choice and always getting informed consent (where they have the ultimate decision on going ahead with treatment)
2.beneficence=acting in the best interest of your patients= providing all the options and then advising on the best outcome for that patient bearing in mind their circumstances/ seeing the whole picture holistically
3.non-maleficence= prevent harm or risk to patient e.g if a procedure is out of your skill set it would better to refer your patient to a more competent dentist and understand your own limitations.
4.justice= all your actions must be fair and justified writhing society and the law e.g you should not be up charging for any services and everyone should be treated equally with not discrimination on any grounds e.g religion/gender
What are your thoughts on ‘delivering better oral health’?
•it lays out the foundations of preventative advice and treatment for conditions such as caries and erosion. With its key aim being to prevent these problems = advice is ranked based on how important it is which inclines patients to potentially at least do the things that are the most important e.g brushing with fluoride toothpaste twice a day
•very important to provide preventative care as it can prevent problem for patients and in the long term = can reduce costs for the NHS, improve the oral health of our society and treatments can become less of a financial burden as they may not be in as much demand so the nhs may be able to cover for it
What is the structure of a typical dental appointment?
1.introduction= meeting/greeting patient and getting their name/birthday to see if it’s the right patient ( lighten the mood e.g small talk)
2.history taking and any other relevant info
3.examination to check for any oral problems aswell as systematic diseases can be detected e.g by checking lymph nodes/neck/patches
4.diagnose e.g utilising radiographs. Prognosis is then communicated with patient e.g how you think the condition will progress
5.treatment plan can be established collaboratively with patients and valid consent must be taken
6. May need to review/see patient over a long course of time to see how their treatment is progressing and if further intervention may be needed e.g not satisfied with outcome
What would you do to reduce the wait times?
•problems= inefficient scheduling (back to back booking), risings issues of preventable problems (better care to prevent e.g caries)
•focus on patient education = encourage hygiene and regular checkups so that less common problems arise
•manage time effectively so that patients don’t suffer unnecessary delays
How do you feel about care being free to the point of access?
•appreciate being able to help all
•there are still financial barriers e.g very high treatment costs/banding may help but higher bands may still be too expensive
•improve funding/education to improve oral health and it means that problems can be avoided which could have been expensive
Are you interested in working in the NHS or privately?
•as of now my interests lie more with the NHS due to the crisis of dental deserts = people’s access to care is lowering due to not being able to have access NHS services
•I still do appreciate that private care has many benefits eg more range of treatments can be given whereas the NHS focuses on cost-effective materials/methods and you can see your patients for longer with reduced waiting times and are not under pressure of seeing a certain no. of patients as with the NHS
•most dentists offer both private and NHS care which is something I would love to do
Should dental treatments be free on the NHS?
•the NHS is already underfunded and cannot sustain providing more free treatment than they do (e.g dental deserts are becoming a problem)
•NHS already provided free and cheaper treatments for e.g low income families and students
•cosmetic procedures should not be provided by NHS as it is not essential to improve oral health but more serious health problems should be prioritised
•however I do understand why some would argue the opposite e.g some low income families do not meet criteria for free treatments but are not able to pay for more complex treatments like crowns
How do you think the profession will change over the next 20 years?
•more digital and technological e.g move towards using AI more frequently/improved X-rays/more using VR headsets for dental phobias = as of now e.g CAD/CAM systems are used to make same day crowns which would normally take weeks (as time goes on it will become easier to use)
•more access to NHS care e.g dental deserts currently will be improved in future
•education in oral health is more common and more are aware from an early age of ways to improve oral health = hopefully in future there will be less cases of preventable diseases e.g caries
How are NHS dentists funded? Is it the same as for GPs?
•I understand that dentists are private contractors to the NHS= they will buy the building, equip surgery, hire staff etc. and will then provide the NHS services.
•patients do not register with a dental practice unlike GP where they are registered to their local area
•dentists are paid in UDA = units of dental activity, where they are payed based on no. of patients seen and the type of band treatment provided
When would a dental appointment be free even when patient is not exempt?
•if within 2 months of your procedure you need more treatments which are at your banding or lower then it will be free. If it is a higher band you would have to pay
•if you need to have stitched removed or need a prescription, this would have to be done free of charge
Explain the role of dental hygienist
They essentially ensure that the oral health of patients is well looked after by helping maintain it or by treating dental problems e.g clean teeth by removing harder plaque, polish teeth to prevent caries and gum disease and work in collaboration with a dentist e.g referring cases when they may be very severe
•they are also pivotal in preventing disease by educating on how to improve oral health and demonstrating how to floss and brush teeth
