The cartoon steam train scene

Let me start by saying I'm 38 years old, and I absolutely love Looney Tunes - particularly Daffy Duck and the Road Runner. Don't ask me why, but they just tickle me. There's an inevitable hilarity to each sketch which in my view, were way before their time.

For poor old Road Runner, aka Wile E Coyote, there are many sketches where that inevitability lies in the form of a steam train, hurtling towards the helpless coyote. Except the coyote isn't helpless - Wile E is often seeing praying, raising tiny umbrellas or closing window curtains as all manner of destruction is about descend.

The revolving door of 11 Downing Street has created a sketch that is, unfortunately for this profession, all too reminiscent of these scenes. This summer, BDA Chair Eddie Crouch and Chair of GDPC Shawn Charlwood have voiced their concerns surround NHS contract reform, and often referred to the marginal changes announced in August as little more than rearranging the deck chairs on the Titanic. That was before the chaos and resulting destruction of the UK's political and financial landscape, with new Chancellor of the Exchequer Jeremy Hunt very much signalling that there's going to be pain for those working in the public sector.

Before this, you got a sense there may have been recognition that pay increases may have taken into account inflation. One can never say now with certainty, but you just had a feeling. That same feeling may not have been present when it came to meaningful contract reform, with formal negotiations yet to begin on reforming the discredited NHS contract.

If these two well-connected voices in the profession said dentistry was in last chance saloon and on its knees before the mini-budget chaos, one shudders to think where it stands now. One can only imagine dentistry is Wile E Coyote, with austerity and pay freezes and savage cuts the steam train some distance away, yet totally unable to dodge the train or get out of the way. The result? Dentistry is praying, raising tiny umbrellas and closing window blinds and curtains. It is going to take a hit, and a heavy one at that.

For those who may be able to swerve out of the way and leave their NHS commitments behind, the prospect of private dentistry may not be as appealing as it once was. The looming threat of recession - not to mention inflation and energy prices - will force the average patient to reassess budgets, and we know dentistry doesn't do well in that scenario. It's either dropped completely or cut as savagely as many expect the NHS to be. Will patients still turn to private practice if NHS dentistry is available at a fraction of the cost? I am, of course, getting ahead of myself in a dreamland scenario, because access to NHS dentistry for many is as real and likely as featuring in a cartoon. Before the chaos, access was limited at best. Now? Who knows what chaos lies in wait. NHS dentistry can only charge a certain amount per band, but if fixed overheads go up, that means pay cuts, cut backs and even redundancies, therefore exacerbating the already dismal state of NHS dentistry access.

Where does that leave the majority of the profession? The proverbial rock and a hard place? Early retirement? Leaving the profession altogether? What kind of choices are those? Those offering private services will have a decision to make: do they absorb the increase in fixed overheads, or do they pass them onto the patient, risking pricing them out of their services? Each practice owner will have a different answer, but frankly it is inconceivable that there's even a question at all. You cannot say the government and responsible departments were not warned many, many years ago. They were warned of recruitment issues leading to the availability of NHS dentistry. They were warned not to treat the service like a piggybank, where patient revenue made up the biggest share of the pie. They were warned throughout the pandemic that private practice would need support, and now all of their chickens are coming home to roost. Dentistry is about to get hit by the steam train, hurtling towards it from afar, and while we think there's plenty of time to get out of the way, the reality is we're all going to be collateral.

Whether there is a service left to recover once the forecasted cuts take place is anyone's guess. But, unlike my love of cartoons, the answer is no laughing matter. ◆