The dentist model lacks bite
The idea of GPs ‘doing a dentist’ may no longer be just a joke, but Copperfield warns that the consequences could be more unsettling than many realise
Silly me. I’ve always thought that the phrase, ‘We should do a dentist’ was simply a reflex verbal tic of the permanently disaffected and disenfranchised. And an apt one given that they are constantly grinding their molars in understandable anguished frustration at life as an NHS GP.
I’ve never thought it might be an actual, you know, serious idea. But now it is. Because the recent LMC conference in Belfast voted in favour of balloting the profession about new contractual options, such as a means-tested, subscription-based service, á la dentists.
The attraction is obvious, given that we currently have capped funding, and not just uncapped demand – but demand that is regularly cattle-prodded by the Government.
But this means giving the dental model some serious thought, something which – as per above – I’ve never done before. So, I did what any GP does now when they want to do a thought experiment but can’t, because all available headspace is currently reserved for triage. I asked AI what it thought.
And the result is interesting and, ultimately, counter-intuitive. I’ll skim over the stuff I could have worked out myself, such as that fact that dentistry involves just gobs and enamel, is less integrated with other services, is procedure-driven and is relatively de-prioritised by the public, all of which make any GP/dentist analogy decidedly dodgy.
And I won’t patronise you with the obvious but considerable obstacles of indemnity, property, pensions, admin complexity etc.
So far, so predictable.
What was interesting was AI’s suggestion that the Government ‘cares less about contractual purity than avoiding visible system failure’. And that ultimately, this could end with a salaried service or, indeed, evolve into a dental hybrid model which the Government might actually welcome – given that core could be shrunk, patients would increasingly have to fund their own healthcare bill and GPs could be blamed for forcing a two tier system and widening health inequalities.
Eeek. Careful what you wish for. AI is never wrong, right? Now even my masseters are in spasm. Is this really the way we should be going? Or maybe it was just an LMC spoof. Time to do a dentist? Only if the motion was passed at two thirty.
Dr Tony Copperfield is a GP in Essex
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READERS' COMMENTS [7]
Please note, only GPs are permitted to add comments to articles
Overheard my dentist saying to his nurse, last time I was waiting my turn, that he was about to “do a GP”…. How the roles reverse!
The government would be delighted to escape responsibility for providing primary care, someone to blame for the change would be their dream come true.
Hybrid dental model would be fine.
Multiprovider insurers.
Fee for service
It works worldwide
Errr.. isn’t dentistry mostly owned by private equity with large numbers who can’t afford it having to pull out their own teeth with string ?
I dunno mate. When I have visited family in Australia, it seems that everyone gets better medical care under their health model (and staff have better working conditions). If that’s doing a dentist- sign me up!!!
The GP model in Australia is in severe trouble – insufficient Medicare rebates and rising gap fees. Not a happy workforce. Not ruling out some sort of hybrid model at all but probably better looking at Scandinavia and The Netherlands
My friend is a GP in Australia. Those doing private only are fine. The public stuff is severely underfunded and GPs are getting out of it and going to the urgent care centres to work; probably like the darzi centres/ neighbourhood health centres. But substantial differences between here and Australia mean the government would be a lot more stressed if we did it. Firstly we have a much older population and general practice manages far more of the complexity, hospital dump, care of the elderly, etc. I worked there in A&E for 3 years. Far more coming in to A&E and minimum managed in community. So us going dental would be much better leverage on government to fund the NHS patients properly ie we would hold the negotiating angle. Secondly their GP surgeries tend to be premises, IT etc owned by large private companies with GPs using those services and taking their cut. We are independent businesses. Thirdly, the single patient record is designed for the government to become data controller and allow all the big tech and AI companies salivating over access to get it. The most useful and complete info is held in the GP record. If we dental it we would not be complying with sharing that private patient GP data. No need to. And that would seriously affect the fullness of population data set and utility. I assume if GPs go dental they stay as small businesses, use third party financial schemes for the cover equivalent of denplan, etc and take the profits. Some dentists 9and most vets) have gone in with big multinationals but there would be no reason to do that as the majority of GP businesses are small private independent. ith PCNs we even have separate buildings to follow current compliance and have a separate premises for seeing private patients. As currently patients can see a private GP and then swan back into the NHS surgery (same with consultant appts) I do not see why we can’t do the same and get extra income. Win win. I think it will provide a strong negotiating position and will work well. Lastly if the government refuses to fund the NHS patients properly and the care continues to deteriorate we can clearly communicate why and the population will know exactly why. Bring it on.