'I can't find an NHS dentist!'— what is the real situation out there on the street?

Key Points

In Brief

• A survey was carried out to determine the extent the public have in obtainining access to NHS dentistry.

• The personal and socio-demographic issues involved were examined.

• One in five adults in the UK are experiencing problems in their search for an NHS dentist.

• Adults experiencing problems include those using private dental services and those based in the South of England.

Abstract

Aims

The aims of this paper are first, to determine the extent of difficulties the public are experiencing in obtaining a dentist undertaking NHS dental care. Second, to describe the personal and socio-demographic details of these groups using data from a national study.

Method

The vehicle for this study was the Office for National Statistics Omnibus Surveys, undertaken in June and July of 1999. A random probability sample of 5,385 addresses was selected from the British Postcode Address File. Respondents were interviewed in their homes about how difficult they found it to obtain an NHS dentist.

Result

A total of 3739 adults took part in this study and the response rate was 69%. Nineteen per cent (705) claimed they found it difficult to get an NHS dentist. Bivariate analysis revealed that difficulty in obtaining an NHS dentist [excluding those who claimed they did not seek NHS dental care (781) and those who refused to answer or didn't know (66)] was associated with age group (P<0.01), gender (P<0.05), social class (P<0.01) and area of residency (P<0.01). Moreover, difficulty in obtaining NHS dental care was also associated with time since last dental visit (P<0.01), method of payment for last dental visit (P<0.01) and use of 'out of hours' emergency dental services (P<0.01). Further analysis revealed that among the socio-demographic variables, area of residency emerged as the most important factor in determining difficulty in obtaining an NHS dentist. Those who lived in the South of England (London, South-East or South West) were more than twice as likely to experience difficulty in obtaining an NHS dentist, OR=2.40, 95% CI 2.00–2.88 compared with those who lived elsewhere in Great Britain.

Conclusion

One in five adults in Britain claim that they are experiencing difficulties in finding a dentist who will provide NHS dental care. In particular, those using private dental services and residents of the South of England have experienced such difficulties.

Main

Who has difficulty in registering with an NHS dentist? – A national survey by C. McGrath, R. Bedi and N. Dhawan Br Dent J 2001; 191: 682–685

Comment

The evidence base that supports much of what dentists do is flimsy — and that is being kind. Many common dental procedures are not supported by evidence of their efficacy or advisability and many new materials arrive on the market with little clinical trial information to support them.

When politicians turn to matters dental, the problem gets significantly worse. Heaven forbid we should expect policy decisions based on sound evidence!

One of the biggest problems facing the dental profession today is estimating the demand for dental treatment that is present in the population. Both sides of the public health service use assumptions and perceptions as weapons with which to attack the other with little solid information to back them up.

The Government's recently published document 'Modernising NHS Dentistry — Implementing the NHS Plan' claims two million patients are unable to access NHS dentistry. This figure is deployed with a degree of conviction but little evidence. The problem for anyone who wishes to argue with it is that there is little evidence to the contrary.

The new data provided by this survey is important because it fills in some yawning gaps in the existing picture. The sample is substantial enough to demand attention, the interviews took place face to face and are likely to be more accurate as a result. A headline figure of 19% of the population having difficulty finding an NHS dentist would imply a national figure nearer to 10 million than the 2 million the Government favours.

Statistical extrapolation of this magnitude is fraught with danger and this survey alone will not provide us with the complete data set we need for future service planning but it is a big step towards it.

Questions need to be asked about the accuracy of patients' answers (the public do sometimes tell lies!) and methods of countering fraudulent responses. The sample size is impressive but is it big enough to fend off all arguments? The questions themselves may be questioned. Are they the most appropriate? Do they go far enough? Was enough information extracted for all that effort?

This study should prompt others to ask similar questions and increase our information on service demand. If we are to make progress on workforce planning and the cost effective use of public funds, the best data must be available to underpin our decisions.