We have all at some time, I imagine, returned to our car to find it unlocked or come home to discover the back door open. It instantly creates a horrible sinking feeling compounded by measures of disbelief, guilt, annoyance and usually some considerable relief that the vehicle has not been stolen nor the house burgled. Phew! Note to self to double-double-check for the next little while. What is sad is that we have to be so vigilant all the time. Watching television drama of days of yore, one is aware of a pleasing lack of security with no particular devastating consequences but that, of course, is nostalgia. It may be that nostalgia isn't what it was, but can any of us truly believe that we will ever return to a society without the need for locks? Some trends just do not go backwards.

Such trends are of particular interest in a year such as this in which there will be a general election and whatever the result, coupled with the strategy to recover from the nation's economic situation, changes will be required to many of our everyday activities. Consequently some trends will also be altered but I wonder if the 'drift' from NHS dentistry will be among them? Just as it is difficult to think of a return to a lock-less society, it seems to me that there is no expectation whatsoever that we will return to the NHS dental coverage of the UK population as, perhaps, in the 1960s or 1970s. That is not to say that we will not eventually have some type of reversion but that there is no current comprehension of how that is likely to occur. Would we ever go back to not wearing seat belts in cars, permitting smoking in enclosed public places, re-nationalising the railways? Well, never say never; but there is a large degree of the unlikely lurking here.

The activity of practitioners in the real world

I raise this because on reading the BDA's most recent Business Trends Survey I realised that I was doing so with the ingrained notion, truth maybe, that overall NHS dentistry 'as we know it' is not going to go back to what it was.1 Politicians may parley the detail, the Department of Health may seize on various statistics to argue their case, Units of Dental Activity may come and go but the idea that the trend is towards really increasing commitment to NHS dentistry does not hold water.

The data gleaned from the survey supports this thought. It does so not out of political dogma or from a philosophical slant but by presenting the evidence of the activity of practitioners in the real world. Published just before Christmas and covering the period July to September 2009, the postal survey took place in the four countries of the UK and the representative sample was limited to general dental practitioners. It finds, for example, that over half the respondents in each country plan to increase the amount of private dentistry they provide in the next three years. Conversely, less than one tenth have a similar motivation to increase the amount of NHS dentistry they offer. If, on reading this, your reaction is of the order of 'well, yes, that makes perfect sense' then you too have the same view that the trend is 'understandably' in one direction overall.

By musing on this, I am not attempting to be negative about NHS dentistry but merely pointing out that deep down the majority belief, or sense of the matter is that it is in a decline in favour of provision by private agreement. If left to its own devices it will undoubtedly reach some sort of plateau as many elements of life do but it does now seem reasonable to accept that the old days are over and to think, talk-up and plan otherwise is to live in pretence especially in the current and medium term financial climate.

What I am hoping is that acknowledging the reality of this situation will allow us to become aware of the way that we actually regard the state provision of dentistry and break out of the straight-jacketed thinking that has limited us in recent years. The survey's findings do offer some hope in this regard. With some variation by country about 80% of dentists were satisfied with their job and the majority would still recommend dentistry as a career, indicating that the profession itself is still alive, robust and optimistic. However, the details underneath these figures do throw up many issues that clearly need attention, increasing administration, variable morale and raised turnover but lower profits being among them.

By contrast, what I do not want to happen is that in due course we discover that we have omitted to pay attention to the unsecured door, by laxity or by default. By using tools such as this survey we can check and double-check our security as well as arm ourselves with the necessary knowledge to convert it to positive vision and activity.