‘NHS Dentists are not capable of doing extractions any more’- The Harm of Hearsay.

I feel a true keyboard warrior this morning, somewhat enraged after watching a clip from Good Morning Britain, a popular free to view tv show.  One of the hosts shared his interpretation of a private dentist’s views on NHS dentists.  

He said:

“I was talking to a private dentist only last week, who was saying that so many people now have to go private because NHS dentists are not capable of doing extractions anymore. They are simply not trained up to that level.” 

“I’m reporting what I was told as a categorical fact by a private dentist. Tell me I’m wrong”

Well Richard, you won’t need me to tell you that, I think you’ll have plenty of direct feedback on the matter.  I’d rather focus on some of the elephants in the room that you accidentally brushed against when presenting hearsay as fact.

1. We need to be more mindful about how we talk about dentistry, particularly other dentists.  

This isn’t to say that we should ignore concerns with standards of dentistry that we might see, behaviour of colleagues or issues we have with the profession as a whole.  But a good question to ask can be: Are we helping or harming here? Is it helpful or harming to the dentist concerned? To the patient experience and their confidence in the profession? Is this a helpful or harmful context to raise these concerns?

We all know from our own patient interactions to be very careful with how we communicate; explaining treatment, consenting to risks or addressing complaints.  That we are all very good at rightly or wrongly providing our own context, importance and relevance for information. Too often are discussions about heavily emphasised risks forgotten, whilst the remembrance of more trivial information clung to out of context.

Loose lips may no longer sink ships but poorly chosen words to a poorly chosen audience can cause more damage than you might imagine.  As a profession we have been trained to be critical and judgemental rather than compassionate towards our colleagues.  We need to be more supportive of one another.

2. Our new graduates seem to be graduating with less experience and less confidence in most procedures, most notably extractions and root canal.

If this is true, how do we address it in either the context of undergrad training or postgraduate support, mentorship and training?  I don’t know if anyone’s doing any research in this area, it would be interesting to see if the evidence supports common perceptions that graduates have far less clinical experience; that more extractions and root canals are being referred than ever before: that a typical day of treatment in general practice looks very different today against that of 20 years ago.

Is the profile of the profession changing, will there only be therapists and specialists  in the years to come?

3. Fear of failure and taking risks.  

As a new graduate I was fortunate in many ways, I felt like I had a good amount of clinical experience in my undergrad years, I had great mentors and support in my early years.  I wasn’t scared to undertake difficult treatment and learn from the mistakes along the way.  Now I see fear of complaints, fear of litigation, fear of charging properly for services, fear of being judged by their patient, their peers or even their surgery assistant on their skill levels.  We need to look at how we can have our colleagues feel supported and safe, create an environment where they can continually develop the relevant skills and confidence.

4. The NHS question… will it stay or will it go? 

A political question unfortunately, but a portrayal to the public that it is dentists leaving the service not a withdrawal of funding, support and protection from the government is a disservice to the profession and those desperately trying to make it work with what they have.  For anyone who thinks that doing away with NHS dentistry is a solution needs to live abroad for a while in a country with little or no subsidised dentistry and see what that looks like.

The easy response to this public slamming of NHS dentists is to be outraged at the unprofessional behaviour of the tv host, an appropriate emotion to move through but not helpful to get stuck in.  We need to be brave enough to look at what has led to such comments, to find the hard truths behind the hearsay, to learn from our short comings and support our colleagues who are struggling. 

The future of dentistry ( including NHS dentistry) could be bright but we have to adapt to the changing pressures that our patients, our governing bodies, our communities and our economies are placing on clinicians and their teams.  Adequately preparing and supporting them to be able to continue to provide high standards of clinical care for a long, healthy career.

For those of you not UK based, The National Health Service (NHS) is a government subsidised healthcare service, that includes dentistry.  As with most subsidised dental services around the world, it is underfunded.  British Dental Association chair, Eddie Crouch notes that:

“NHS dentistry is at a tipping point and requires fair funding and real reform.”

There are plenty of private dentists in the UK and a somewhat uneasy relationship at times between the two.  The public, press and government quite happy to play the two off against each other as and when it suits.