NHS dentistry very much mirrors the trends seen in general healthcare and has historically been a forerunner for changes that have happened in the wider NHS. Currently, there is enormous pressure on the provision of all of the healthcare services and this naturally has the effect of increasing budgetary stresses.
Inevitably, the challenge for the government is how to marry up the need of healthcare that is free at the point of delivery for all people – of course dentistry has already breached this Rubicon – whilst offering a wide range of what is available, using the resources that are on offer. I think every country that aspires to offer free healthcare in a comprehensive sense is facing similar challenges, and this is going to be the big question for socialised healthcare around the world. They may be nuanced by local influences, but essentially Western economies are facing an ageing population that wants access to more sophisticated and very often more expensive treatments.
In the UK, I think the government has to decide what route it wants to take. Does it want to offer a full range of treatments to all people? Or will it reduce the list of services that are available? And how will it continue to fund those treatments?
One of the ways that it may look to continue funding is through increased efficiency and that in turn filters down through to the experience of the clinicians treating patients. In the medical environment we already see a lot of treatments being offered by nurses and senior support staff, and I think that one of the things that may increase with NHS dentistry is a rise in the use of chairside assistance. Whereas, in the private sector, I suspect that this model will not come through for a long time, and dentists will continue to be the primary source of healthcare provision.
Of course the private sector has always had to differentiate itself from the public sector, so the focus for many private practices is to make sure that patients have as much choice as possible. For a long time private practice has been concerned not just with clinical outcomes, but with the overall patient experience, investing heavily in staff training in order to provide an environment that makes the journey as enjoyable as possible.
Arguably, the increase in technology and cosmetic aspirations also has a greater effect on the private sector. We are a society that is increasingly educated and conscious of our health and appearance, and one of the demographics that the private sector is particularly well positioned to address is those who have aspirations that go beyond what can be offered in a purely socialised healthcare setting.
We are incredibly lucky to have a fantastic healthcare system, but it’s not easy for social healthcare to keep up with the expectations of those who might either want treatments that are considered to be on the cosmetic end of the spectrum, or want services that are difficult to justify on purely medical grounds.
The key is to make sure that suitable access to healthcare is available for everyone, and for the health of the public it is critical that there is a sustainable service that marries up with the aspirations and the financial realities of what the NHS can offer. The private sector must also continue to differentiate and add value for the patient, because irrespective of what happens to NHS dentistry, if the private sector fails to differentiate itself, then there is very little need for it.
Ultimately, the NHS and the private sector work hand in hand, and are always going to run in tandem. While the private sector must constantly react to what is happening in the public sector, the relationship between the two is essentially symbiotic.