Problems over how dentists provide care to homeless people have surfaced in a controversial debate in the national press recently involving BDA Chair Mick Armstrong.

Armstrong sent an email to a colleague that was mistakenly copied and sent to Labour MP Stella Creasy on the subject in which he made reference to homeless people as 'no-hopers' in the context of how the current dental contract makes it difficult to treat homeless patients.

The story was covered in some parts of the media including the Guardian newspaper1 on 28 July 2018 and the Huffington Post and was also was the subject of a piece in a Nursing Times magazine's 'Heroes and Villains of the month' article,2 which referred to Armstrong in the latter capacity.

In the email, Armstrong is quoted as saying: 'These are difficult patients who rarely complete a course of treatment and attend irregularly if at all. If we took in all the no-hopers who ring us ... I suspect we'd miss our targets by a country mile.'

BDA Chair Mick Armstrong

After an exchange with Creasy, Armstrong issued a statement saying: 'I regret the intemperate wording I used in my exchange with Stella Creasy. The language was inappropriate but born of the frustration that all NHS dentists in England feel working under a contract that's decisively failed both patients and practitioners.

'I work as an NHS dentist near Wakefield, and like many colleagues, I treat homeless patients, but it is not easy under the current contract. The NHS effectively caps the number of patients we can treat and fails to cater for those most in need. Dentists are desperate for a system that will allow them to put their patients first.

'The BDA has long championed vulnerable patients, and has argued to ensure that they have access to services that are really tailored to their needs. Sadly any headway seems impossible under the existing contract.'

Groundswell, a charity that helps homeless people, published a report3 in May 2017 which said that 70% of people reported having lost teeth since they had been homeless, with 30% experiencing dental pain at the time they were being interviewed.

The BDA said the current target-driven 2006 NHS dental contract provided funding for little over half the English population and high street NHS dentists faced significant barriers in treating homeless patients in particular, for example they were required to provide the NHS with an address for a patient.

The union has called for funding of dental appointment slots, especially for homeless people, which once booked, would be funded whether patients attended or not, so dentists attempting to treat these groups were not penalised; and changes to NHS forms to enable a dentist to be paid for delivering treatment where the patient does not have an address.