NHS HOT TOPICS Flashcards
Should all dental appointments and procedures be free on the NHS?
Introduction:
NHS was founded on the principle of it being free, nowadays that excludes some precriptions, eye care and dental care
Few groups of public that are entitled to free health care
>Under 18/under 19 (full time education)
>Pregnant and those who were in the last 12 months
>who are receiving low income benefits
There are many treatments that are free under the NHS such as getting stitches removed after surgical treatment, dentures need repair or bleeding from mouth that won’t stop
1st Argument FOR: Quality healthcare should be accessible to all
Dental ethical pillar of justice states that all patients should be treated equally and fairly
Not providing treatment to a patient because they’re not financially able to is discriminatory
Discourages people from going to the dentist = negative effect of the wider communities oral health
Poor oral health links to increased risk of lung diseases, cardiovascular diseases and diabetes
tfore, some disorders could be prevented if the cost of medical treatment under NHS was less/free
Unethical/cruel as the person’s condition/pain could worsen and lead to something more serious when it could’ve been prevented
Goes against GDC guideline that dentist shouldn’t put patients in risk of harm
2nd Argument FOR:
Equality in taxpayers benefits
taxpayers contributes to the NHS
Should be granted the benefit to use all services they’re contributing to
1st Arguments AGAINST:
Cosmetic procedures under the NHS may be unnecessary
large portion of NHS budget used to cover cost of all dental treatments
therefore, using limited resources on treatments that aren’t urgent isn’t fair or ethical as it goes against distributive justice
Cost goes to fund other areas of healthcare which affect a larger population e.g covid 19, A&E crisis etc.
2nd Argument AGAINST:
With band system, most treatments are still significantly affordable under NHS than in private setting
e.g new patient consultation/check up costs £25.80 in NHS (falls under band one) and £40-70 in private
Dental treatment is already free for those who are on low income benefits
2nd Argument AGAINST:
> Past experiences of overwhelming demands led to crisis, necessitating charges in 1951
>prevents unnecessary visits and shortens waiting times.
Conclusion:
Balancing both sides is crucial
Free dental care promotes fairness and equality to all, also have to consider resource allocation and past historical issues
NHS Dental Bands Explained:
NHS dental care operates on a band system that categorises treatments based on their complexities and costs
> EMERGENCY DENTAL TREATMENT- £23.80
Emergency care e.g pain relief, emergency tooth removal, X-rays, temporary fillings
> BAND 1- £23.80
Examinations, diagnosis, preventive care, scale and polish, application of fluoride
> BAND 2- £70.70
Everything from band 1 + further treatments e.g fillings, non-surgical gum treatment, root canal work and tooth extractions
> BAND 3- £306.80
Everything from band 1 &band 2 + dentures, crowns, bridges and other treatment that require lab work
Price of bands increased every year in line with inflation e.g last year £65.20 for band 2
ADVANTAGES
>clear pricing for patients
>Cost efficient, same cost regardless of the number of teeth or crowns involved
NHS Dentistry vs Private Dentistry
📈 Pros of Private:
Patient’s have more flexibility when choosing treatment, their dentist and time of appointment. It’s more likely to be able to schedule a visit outside of working hours in a private setting. Similarly, it’s only possible to get a cosmetic treatment, such as teeth whitening only in a private setting.
Dentists have much more freedom when deciding how much they want to work, what treatments they want to offer and how much they should charge for them.
From a dentist’s point of view, a private setting is more profitable financially, as the pays are usually higher than in the NHS.
The quality of treatment most people get is similar under the NHS and in a private setting. However, the NHS accumulates and uses more cost-efficient materials and laboratories that are intended for mass use and private practice may have much higher quality materials (e.g. dentures) available. Essentially, how much you can afford sets the limit for quality in a private setting.
Shorter waiting times.
Patients can spend as much time with their dentist as they need (or as much as they can afford) and discuss their concerns without time pressure, which can exist in the NHS due to UDA obligations.
Principles of the free market drive the quality higher. If a dentist’s work was of poor quality in the private setting, he would quickly lose customers and be forced to close their practice. Treating patients like
📉 Cons of Private:
More expensive for patients.
The more procedures a private dentist conducts the more income they receive. Hence, some dentists in the private setting may be driven by profit and convince their patients to undergo treatments they won’t feel the necessity to do.
NHS dentists are required to work in line with the GDC’s guidelines and are held accountable to them, meaning the risk of unprofessional, immoral behaviour is smaller. No universal code of conduct like this exists in the private setting.
🦠 Covid-19 Update and NHS in Crisis:
8% of dentists across the United Kingdom have left the NHS in 2021
A common reason quoted by dentists making such a decision is the 2006 Dental contract and with it the introduction of UDA’s, which changed how NHS dentists are meant to work.
On top of that, Covid-19 has brought about extra pressures. Initial lockdowns and cancellations of planned dental treatments have created a large backlog of cases while avoiding dentists due to the fear of catching Covid-19 meant the oral health of the population has generally worsened. This means that NHS dentists have to work at an even higher pace, which amplifies stress and pressures, making them more likely to quit NHS work. In turn, this furthers staff shortages, increases pressures and the cycle continues
UDA’s & 2006 NHS Dental Contract
WHAT ARE UDAS?
>NHS dental contract published in 2006 introduced UDA (Units of Dental activity)
>Metric of number of dental procedures an NHS dental practice has to meet every year
>UDA’s are related to band of treatment
band 1 = 1 UDA
Band 2 = 3 UDA
Band 3 = 12 UDA
1 UDA = £20-35
>Dentist are paid not based on individual procedures but on completed courses of treatment/treatment plans , which may include several procedures
WHY WERE UDAs INTRODUCED ?
>Improves efficiency and cost-effectiveness of NHS practices
. Pre-2006, a fee-per-item system was in place , where patients paid for each procedure individually
.Criticised for encouraging invasive and complex work which wasn’t always necessary
> Standardised metric : UDAs help measure and compare patient turnover between dental practices
(tfore efficiency of a practice)
> Improves access to dentistry for patients: Allows dental care to be more affordable as you’re paying in courses of treatment instead of a fee-per-item basis
PROBLEMS WITH UDA’s
>Caps on how much a dentist can be paid
.If dentist completes all assigned yearly UDA’s in 10 months, then they are left with no more work for the next two months (at their NHS practice)
> Encourage healing but not prevention
.UDA’s are based on number of procedures done
.Prevention is much more significant and could save NHS a lot of funds as many dental issues are a direct consequence of poor oral hygiene
> POORLY CALCULATED
.Calculated according to number of full treatment plans completed and not number of hours worked or procedures done
. Not reflective of the dentists efforts, resources or times they have spent
.Frustrating nad insufficient
> STRESS AND BURNOUT
.studies by BDA shown the amount of stress and burnout rate have increased among UK dentists since the introduction of the contract
> PROMOTES QUALITY OVER QUANTITY
. Prompts dentists to fouces on quantity rather than quality
.Most NHS practices are struggling to hit the target of their yearly UDA’s but yet they’re determinded to do so in order to receive full pay.
Dealing cases as fast as they can rather than as good as they can and spending as much time as the patient needs
SOLUTIONS
>Upcoming dental contract reform with traffic light system
.Encourage prevention and self-management of oral health by patients
.Reward dentists for number of case prevented rather than treatments performed
>Opposition from BDA and independent reviews.
>Parliamentary health select committee has done an investigation in 2008 and concluded that UDAs were unfit for purpose
>Different remuneration system exists in Scotland and Northern Ireland
.Patients pay for approx 80% of costs of treatment and 20% by government
COVID 19 ADJUSTMENTS
.2021 increased UDA targets for NHS dentists
.65% to 85%
.Speed up dealing with backlog of dental cases created by closures and lockdown during the first wave
>New targets been condemned by BDA and numerous dentists
.Unrealistic, creates extra pressure
Why is Water Fluoridated and Is It Good?
FLUORIDATION OF WATER
>Cheap, soluble ion that prevents tooth decay
.Doesn’t affect taste, smell or appearance of water
.Considered safe if kept under 1.5 mg
>Only 5.8 million UK citizens drink water with fluoride
>2021, government introduced fluoridation water to prevent tooth decay
WHY IS WATER FLUORIDATED ?
>Aim: prevent tooth decay
.Most common chronic diseases worldwide
.Cause a lot of pain, diminishes confidence and worsens QOL
>Although fluoride is added to toothpaste and dental products, not everyone brushes their teeth as often as they should and people from lower socioeconomic background/developing countries may not be able to afford/access dental product containing fluoride
>All people drink water = works efficiently aa a measure of prevention
.Improves society’s oral health
PROS
>Studies show around 20-30% of caries are prevented by water fluoridation
>Vital for children and people from low socioeconomic backgrounds
>Easy control and standardisation
CONS
> Mass medication without consent
. Reducing personal autonomy = less trust in dentist and government
>Difficult to regulate people’s total intake of fluoride
.Receive it from various sources
>Excessive intake of fluoride = fluorosis
.White spots on tooth enamel
>Mixed quality in research on effectiveness and safety
>Risk of contamination while being fluoridated
SUMMARY
Water fluoridation prevents caries, improving society’s oral health.
Benefits such as reduced decay and universal application, problems arise with excess intake, personal autonomy and research quality
Impact of Covid-19 on Dentistry
Impact of Covid-19 on Dentists:
Positive:
TELE-DENTISTRY
Many dentists ordered remote advice and consolation using apps and tools which has been accelerated by covid-19
Boost long-term technological advancement and help manage workload more efficiently
TIME OFF BENEFITS
lockdowns reduced patients capacity and allowed dentists to have a period with lower pressure put on them
Negative:
FINANCIAL CHALLENGES
fewer patients due to cancelled appointments and fallow time (extra time between aerosol-generating procedures to ensure possible covid 19 droplets removed from the air)
Increased cost of PPE = impacted earnings
STRESS, BURN OUT AND UNCERTAINTY
Opening and closing of practices, changing measures, initial poor access to PPE, backlog of cases and increased UDA requirements
Increases exhaustion and burnout rates
Conclusion:
Impact Of Covid-19 on the NHS:
Positive:
Negative:
CANCELLED APPOINTMENTS AND BACKLOG
Adds to already high workload and UDA pressures existed pre-covid
Lack of awareness of emergency dental care worsened access to NHS dental service
Turn to private or manage problems on their own
Conclusion:
Impact of Covid-19 on Dental Students:
Positive:
Negative:
DISRUPTION TO TEACHING
Clinical placements and practical skills workshop can’t be done virtually
Not able to benefit from in-person teaching
Conclusion:
Impact Of Covid-19 on Dental Patients:
Positive:
IMPROVED SELF MANAGEMENT
Patients learned how to better self-manage their oral disease and take care of their oral hygiene
Prevented from diseases such as caries from occurring as often
Negative:
FINANCIAL CHALLENGES FOR DENTAL PATIENTS
Financial uncertainty and extra costs pushed many private dentists to increase costs fo treatment
Fewer patients being able to afford dental care or put in more financial burden
WROSENING ORAL CARE
Many patients unable/feared to see dentist
many diseases have been developing undetected = early diagnosis rates fallen
Patients experiences pain/discomfort longer than necessary
INCREASED HEALTH INEQUALITIES
GDC report shows disproportionate effect o pandemic on older people, disabled and those with BAME backgrounds
Worsens access to dental and medical care
Conclusion:
Dental Amalgam Controversy: Pros, Cons, Amalgam Alternatives
Question: What do you know about the debate surrounding amalgam?
Introduction:
What’s amalgam: Metal alloy composed of silver, tin mercury and copper and used to fill cavities caused by tooth decay
Used for over 200 years
Health Issues:
Health impact of mercury in amalgam
Concerns of it being released into our bodies
Scientific evidence shows that the mercury from amalgam doesn’t get released and the dose isn’t harmful
health-scares in the past about mercury (unrelated to amalgam) perpetrated fear and causes people till this day to believe amalgam is dangerous
High dose of mercury can affect nervous system
Environmental impact:
Mercury released in environment, spreads to ground waters and foods e.g fish and veggies
Contamination to the environment
healthcare facilities account for 5% of mercury waste
Alternatives/Future of Amalgam:
Composite resin alternative filling material made of a mixture of ceramics and plastics
White in colour
Due to controversy and health concerns, amalgam is being phased out by composite
Pros:
tooth coloured
Doesn’t contain mercury or other toxic substances (more environmentally friendly + doesn’t raise health concerns)
Cons:
lasts less than amalgam, 5-7 years
more expensive to apply, shortened durability = fillings more often (weakens tooth structure)
not available on NHS due to its cost
Question: What are the pros and cons of using amalgam for fillings?
Introduction:
What’s amalgam: Metal alloy composed of tin, mercury and copper and it has been used to fill cavities caused by tooth decay for over 200 years
Pros:
Withstand better forces/biting forces than composite : more durable, lasts 10-15 years so patients get fillings less often
Requires less time and energy to place than composite
More cost efficient: 20-30% more cheaper than composite, better suited for NHS use
Cons:
Silver appearance, more noticeable, doesn’t give good aesthetic effect
Discolour teeth and gums around fillings
Unsuitable for children, pregnant women and nerurolgical impairment
Doesn’t bind to teeth directly since made out of metal, expand and contract based on temperature
Conclusion
What Do You Know About Sugar Tax? Sugar Tax Pros & Cons:
Plaque bacteria feed on sugar and produce acid that dissolve tooth enamel and irritate gums.
Excessive sugar intake = tooth decay, cavities and gum disease
Tooth decay primary reason for hospital admission among young children = prevented
SUGAR TAX
Sugar consumption contributes to issues such as gum disease and tooth decay, primarily in young children. The UK government introduced the soft drink industry levy to tackle these problems as fizzy drinks are 30% of all sugar intake for children below the age of 18
PROS
>More expensive = less available = reduced consumption.
>Tax = increased revenue for government = Increased funding e.g NHS , more money to tackle sugar health related problems
>Lower demand
. more expensive = demand decreases= encourages business to produce healthier sugar-free alternatives
CONS
>Socioeconomic inequality , tax hits those with lower socioeconomic backgrounds
>Doesn’t cover all sweetened beverages, shifts consumption to artificially sweetened drinks which increases cravings for sugar
>Limited scope , many harmful ingredients e.g phosphoric acid cause tooth decay and gum disease but not covered by tax
RESULTS
> Article of BMJ Cambridge University studies shows that amount of sugar consumed decreased by 10% per week after 2018 sugar tax (long-term impact on general health)
.Created control group and accounted for trends e.g healthier lifestyle
>Manufacturer’s revenue remains same due to consistent demand
