Dispatches investigation reveals Dentist overcharging

23 May 2011

***Any use of information in this release must credit Channel 4's Dispatches***

An undercover investigation by Channel 4's Dispatches into NHS Dentistry reveals that some dentists are misleading patients about their rights to NHS treatment. 

The three month investigation found that some dentists are maximising their profits by exploiting NHS trusts and over charging patients - ‘gaming' as it is known in the industry.  

Dispatches reporter Sam Lister also interviewed dentists that are critical of the complex way in which NHS dentistry is currently funded with calls for a complete overhaul.    

Finding an NHS dentist has often been considered a problem for dental patients but Dispatches (tx: Monday 23rd May 2011 at 8pm on Channel 4) has discovered getting the right treatment - at the right price - can be an issue.

Dispatches sent seven members of the public for an NHS check up at dental surgeries that do both NHS and private treatment to see if dentists are sticking to these rules.

On average our undercover patients were in the dentists chair for 15 minutes.

They went in as NHS patients but six out of seven came out having been recommended to have some treatment privately - the most common being hygiene treatment.

 

Background to NHS Dentistry

Everyone has a right to NHS dentistry.  Children, Students, the unemployed and pregnant women get treatment for free. The rest of the population pay a subsidised amount, the Government funding up to 50% of the overall fee.

There are three levels of payment for NHS dentistry: [1]

• Band 1 - £17 (£16.50 at the time of the investigation): includes an examination, diagnosis and advice. If necessary, it also includes X-rays, scale and polish and planning for further treatment.
• Band 2 - £47 (£46.50 at the time of the investigation): includes all treatment covered by Band 1, plus fillings, root canal treatment and extractions.
• Band 3 - £204 (£198 at the time of the investigation): includes all treatment covered by Bands 1 and 2, plus more complex procedures such as crowns, dentures and bridges. 

For their £16.50 our undercover patients should all have been offered a scale and polish if they needed it as part of their check up. This is the basic hygiene treatment to prevent dental decay - but none of them were offered it.

 

Gaming

Our investigation also found that some dentists are ‘gaming' - maximising their profits by exploiting NHS trusts and charging patients too much.

Root canal treatment is a long, expensive process but under their contract NHS dentists are legally obliged to offer this work to NHS patients.

Dispatches sent an undercover reporter in need of root canal treatment and a crown to three dental surgeries as an NHS patient. 

This should cost him a total of £198 pounds on the NHS but he was quoted:

• £480 pounds for a private root canal and a further £198 pounds for an NHS crown in one dental. 
• £400 for private root canal work and £198 and upwards for a crown.  
• £725 for a root canal treatment and a crown.

Dispatches showed the undercover footage to Dr Anthony Halperin, a leading dentist and expert witness in dental disputes.  

 "I have felt with all the pictures of these dentists that you've shown me that they should have been accepted as NHS patients," he says. 

"They should have had treatment under the NHS, if they wished it. Which they did seem to wish. And I'm very concerned that they all seem to have suggestions of having private treatment... If the patients go in as NHS patients and are told work is not available under the NHS which is available under the NHS then they are in breach of their contract," he adds.

 

Criticism of how NHS dentistry is funded

A new pricing structure was introduced in 2006 which changed how dentists are paid for NHS work.  Those working under the contract have agreed to provide their NHS patients with all essential dental treatment.

Some dentists argue that it's the government's lack of funding that's at fault and NHS contracts don't pay them enough to cover the cost of complex and time consuming treatment. They say it makes it hard for dentists not to game the system.

Danny Pretorius, left the NHS last year, and has chosen to speak out about why he thinks this system is unworkable. 

"When the new contract came into being 4 years ago it was just awful. It was impossible I found to do the dentistry I was taught to do, that I wanted to do and that I felt the patient deserved with the new system...If you had to do everything by the book like you should do it would be virtually impossible to earn a reasonable living," he says. 

Danny Pretorius calls for an overhaul of NHS dentistry.  "You'd have to start all over again. I believe that the government should say, right, we're going to provide an NHS service. They should then employ every dentist they want to on a set salary which is paid to them by the government or the NHS.... Those dentists should not be allowed to do any private treatment at all," he says.

Gareth McAleer gave up most of his NHS work in 2006 as he felt the contract was pushing dentists into gaming. He believes that while NHS dentists should stick to the rules, they've been put in an impossible position. 

"The public want a full comprehensive service free on the NHS and the Government don't want to admit, and politicians in general do not want to admit that this isn't feasible... The problem we have is that the politicians refuse to be honest with the general public about this issue", he says. 

Gareth argues that while the previous NHS contract paid dentists to over-treat people, the current contract effectively discourages treatment as dentists are put under such pressure they have to cut corners in patient care to turn a profit.

 "The dentist has 2 choices. When a patient has gum disease and they need to have hygiene treatment. Do they send the patient to the hygienist and make a massive loss on it. Or they've got the 2nd option. They can ignore the gum disease and the patient is unaware of the gum disease.... And in that instance people would describe that as supervised neglect, where patients are not actually having the gum treatment carried out that they need to have done. Purely because it's totally unaffordable," he adds. 

These findings will be broadcast in Dispatches: The Truth About Your Dentist on Monday 23rd May at 8pm on Channel 4.

 

The hashtag for this Dispatches is #Dentistry

 

[1] From the 1st of April 2011, the band charges increased