The end of last month saw the somewhat delayed publication of the Office of Fair Trading's (OFT) review of the dental market [sic], its second such foray in less than ten years.1 Regular readers of the BDJ may recall my anticipatory editorial last November on the likely outcome of the report in which I made certain predictions, at least some of which could have saved an awful lot of people an awful lot of time and money.2

However, the document and its release contain several interesting observations and recommendations which indicate less about the state of dentistry and more about the way in which it is viewed by 'the powers that be'. Overwhelmingly, the prevailing attitude is that the service we offer (healthcare in case you had forgotten) is a commodity which can be compared exactly, priced equivalently and therefore traded 'fairly', as it were on a completely level playing field. This is assumed to be the case for say, a single surface restoration perhaps in Shetland or London's West End, an amalgam or a gold inlay, in a healthy adult with good oral hygiene or a special care patient who by definition requires additional attention. It might seem like a good idea on electricity price comparison websites but is not appropriate to individual healthcare based on biological variation and human individuality.

The dispiriting aspect of the publication was that the information fed to the media was about the alleged half a million people who may (my italics) have been wrongly informed about the dental treatment that was available to them and who might have paid too much as a result. But, what the OFT failed to emphasise to the press was that over 30 million other adults were not so mislead and were totally satisfied with the treatment they received. This, incidentally, backs up what the General Dental Council (GDC) found in their survey of patients only last year; that 94% were confident that their dentist had treated them 'fairly'.3

Cliché day

So the clichés rode forth as it seems they are destined to do for all time. It gave the Daily Mail the opportunity to drag out a yawningly unfunny cartoon featuring a dentist with a do-it-yourself type drill and a quip about Polyfilla set in a surgery straight out of the era currently being celebrated in the Queen's Diamond Jubilee. But, here, I think is the nub of the matter. The cartoonist had either not been to the dentist since the coronation or, more probably, chose to misrepresent it for comic effect. More likely it is the latter but in order to be funny it has to be true. And it is not. The 30+ million satisfied patients would almost certainly have viewed this and the other media coverage by running through their minds 'yes, I 'hate' (or used to hate) dentists but I'm lucky because I've got a good one'. Sound familiar to you too? Probably because it is true.

You know what? Here's the thing (as the current parlance has it). I actually think that it is starting to change in our favour. To the best of my knowledge no one set up a demonstration march for better dental care, there were no bricks launched through practice windows in retaliation and frankly, within 24 hours the subject was dropped and the world had, unsurprisingly, moved on. Some newspapers accused the profession of being very defensive about the review but then again what else are we supposed to do when, frankly, we have an excellent defence to give and about which to be proud? One wonders if the public feels it has been sold commodities by a fair trading press in the light of the daily evidence to the Leveson Enquiry. Pots, names, kettles and black come to mind.

So what of the other conclusions of the OFT review? Direct access to dental care professionals was tucked away in there, and we will be returning to that hot topic in these pages again soon; a simplified complaints process – the OFT will be working with organisations such as Which? Citizens Advice and NHS Choices on this (currently run by the GDC); and, oh yes, the NHS dental contract in England which is apparently a barrier to entry, expansion and innovation in the dental market.

At various points in the review the OFT is described as being perturbed that recommendations it made in 2003 have not been acted upon, preparing to monitor closely future activity and considering referring various matters to the Competition Commission (of which, interestingly, there is only one). Will they be in a similar state still in 2021? As I wrote previously 'fair' is a subjective term but there is little doubt in my mind as to where the overwhelming majority of 'our' patients place their trust and loyalty and where they think they are treated fairly.