SOCIALISED HEALTHCARE

 

The sudden transfer of the administration and financing of healthcare from private enterprise to the public sector in 1948 sowed the seeds of many future problems and in particular for Dentistry. Some would say we witness today the worst of both worlds as a result of government interference in the dental market resulting in an “NHS Dental Desert”. The end of Food Rationing and termination of National Service coincided with rising NHS demands that began to emerge in the early 1970’s and are now uncontollable within the “free for all” NHS environment. Noticeable is the breakdown of the primary/secondary care service interface with the significant increase in referrals from primary care into costly secondary care. The absence of attractive NHS preventive care dental services have resulted in record numbers of young children requiring tooth extractions in hospital.

Establishing a new high street dental surgery today demands significant capital investment in excess of £100K. It is in effect a High Street edition of a hospital operating theatre with the necessary health and safety regulations. In marked contrast to general medical practice there are no NHS subsidies for dental services in recognition of this capital investment and risk.  The dental surgeon has carried out complex oral surgery operations traditionally in general practice under NHS Contracts, but not any more. Removing impacted wisdom teeth under local anesthesia as an everyday outpatient procedure in general practice requires highly skilled surgery and time. As the fixed fee NHS treatment becomes uneconomic, more and more patients are referred for secondary care surgery in an NHS Hospital with significant added costs. The same is happening in general medical practice where hospital outpatient referrals are increasing exponentially as the incentives for GP’s to provide out patient services for minor surgical procedures fail to materialize.