Liverpool interview questions - NHS dentistry & Local Area

What do you know about the local area in liverpool?

-situated on the Mersey River, settlements existed in prehistoric times and trade began around the 'pool of liverpool' in the middle ages, now buried under the city centre. eg Calderstones are older than Stonehenge

-has a rich maritime history - became one of the largest ports in the world during the 19th century, a major port during industrial revolution and slave trade

-role in the global music and culture - birthplace of the Beatles, with places like the cavern club and there are also festivals like Liverpool International Music Festival. It was European Capital of Culture in 2008

-home to several important museums celebrating the history, art and diversity of the city

What are the main challenges facing the future of dentistry in the uk?

1. NHS funding and availability - underfunding of NHS means patients have difficulty accessing NHS dental care due to long waiting times and limited availability. Particularly difficult for those with low income => health inequality

2. Private dentistry growth - increasingly expensive, leaving many people unable to afford treatment. Growing divide between private and NHS care

3. Staff shortages - leading to burnout and stress of dentists e.g working hours, administrative burdens

4. Increase in tooth decay, gum disease and oral cancer as well as cosmetic dental procedures requires dentists meet the emerging needs

5. Technological advancements - despite exciting opportunities of AI, training dentists to handle evolving dental treatments using digital dentistry requires investment.

6. Threat of litigation

7. Threat of misinformation

How does oral health differ here compared to other areas in the UK?

-in 2024 liverpool 50% of 5 year olds were found to have dental decay (a higher rate of tooth decay compared to national average) year 6 - 1/5 of the population

-areas with higher levels of poverty, inner city, often experience poorer oral health - lower access to dental care with long waiting lists, poor nutrition, higher rate of smoking and alcohol

What are the greatest challenges facing healthcare as a whole, and dentistry in particular?

1. Access to care => in rural and underserved urban areas may lack access to care providers and many are unable to afford treatment leading to health inequality

2. Rising costs of healthcare => aging population, living longer with multiple chronic conditions,

governments under pressure controlling costs of innovative and expensive medical procedures and prescription drugs for example

3. Shortages of healthcare professionals - especially dentists wanting to work in hospitals

4. An increase in mental health issues globally and there is insufficient access to mental health services so mental health services need to be integrated into mainstream healthcare

5. threat of misinformation

What can you tell me about who is eligible for treatment under the NHS?

-for free for those under the age of 18

-eligible for anyone who it is clinically necessary for

-have to meet certain criteria to qualify for treatment

*NHS is funded through taxation

Do dental implants come under the NHS?

Yes but only in certain cases

-availability is restricted to those with severe medical need e.g just having missing teeth due to decay, is not enough for a dental implant, however if it is a trauma accident, due to cancer, facial deformity, congenital conditions then it is

-if not eligible, patients may be offered dentures or bridges

Should implants be free

-too expensive

-not quick fix

-the public are more likely to abuse system

-trauma incidents would need loads of implants

pro:

-alot easier to maintain oral hygiene

-bridges can also require prep work of teeth beside it

What is an alternative to implants

-dentures, bridges

How does dentistry fit into the NHS

-NHS offers treatment that is needed to keep your mouth, teeth and gums healthy and free of pain

-An example of this is providing dentures to a patient with missing teeth

-Dentures could treat problems with eating and speach and affect a patients health

-However doesnt mean we can give treatments based on the patients request

-It is dependent on the clinical judgement of the Dentist to give treatment which is cost-effective and also beneficial for the patients health for example a plastic denture instead of a more expensive metal one

If you were a health secretary for a day and were given £1 million to improve access to healthcare, how would you invest the money?

-better education for patients and public

-fluoride campaigns

-perhaps having home visits

-increasing money spent on technology and equipment

-increasing dentists and uni positions

-marketing

-UDA system - more funding

How has dentistry in NHS changed over the last 100 years

-digital dentistry - intraoral scanners, CADCAM (3D printer)

-isolated approach to multidisciplinary approach ->individual to teamwork (less mistakes, more efficient)

-specialisation

-greater attitude towards actually helping patients - local anaesthetic, numbing cream, putting hand up during procedure

-free care and now subsidised in 1952

-introduction of GDC so everyone had same degree, same values, a regulation of the register for dental professionals, regulate the work whereas before people could do it without degrees

-preventative rather than restorative

When was the current NHS Dental Contract established?

2006

What is the UDA system?

units of dental activity - the standard measureof a piece of dental work in the NHS

-the current NHS dental contract involves working towards these targets of activity

-Since 2006, NHS dentists in England and Wales have been paid according to how many units of dental activity they do in a year. In scotland they still get paid on a "fee per item" basis.

-the UDA is worth a set value to the dentist, negotiated in their contract - each one they get paid certain fee

-if dentists meet government targets for treatments, they are rewarded for it

Why was the UDA system set up?

to improve access to NHS dental services

What is the disadvantage of the UDA system?

-once a dentist has completed all of their UDAs before the end of the year, the NHS no longer pays you for any additional work you do

-this is why some dentists do some private work to subsidise their income to continue practice for the whole year

What are the advantages

The number of UDA's awarded per treatment depends on the 'band' of the treatment plan (either 1,2 or 3). A treatment plan can fit into the same band as another treatment plan which contains more work so you still get awarded the same number of UDA's, even if one has more work than the other..

What are the main issues with the UDA system?

-dentists may end up just fixating on completing the quotas and seeing as many patients as possible instead of actually spending the necessary time

-dental appointments may feel rushed and due to these targets, dentists dont get a chance to spend longer with patients - most useful with complex cases

-70% dentists feels it limits ability to take on new NHS patients due to demand restricting amount of time they can spend with patients

How can problems with the UDA be solved?

-reports such as one written by Professor Steele suggest it is not logical to reward dentists on activity only

-the BDA are adamant UDA's are unhelpful to patients and dentists

-BDA believe if UDA's have to exist, they should be focused on prevention and treatment that is necessary rather than seeing a certain no.of patients e.g rewards for giving advice on improvement of oral hygiene

What are the current changes to the NHS contract?

-reformed contract piloted in 2011, with department of health introducing a prototype remuneration model in 2015

In july 2022 - NHS announced first significant change to the contract since its introduction:

1. new contract rewards dentists for treatment and continuing care - so oral hygiene advice and preventative care - gain UDAs for advice or education

2. Amendments to band 2 UDAs to support higher needs patients and recognise range of treatments -now split into 2a,2b,2c

3. Minimum indicative UDA value of £23 but now it is £28

4. Maximising access from existing NHS resources through funding practices to deliver more activity in a year

5. Improving information for patients by giving more regular updates

6. NHS dentists will be paid more for complex cases

7. Dental therapists will be able to accept patients for NHS treatment

*NHS believe these changes will improve access to dental care for all patients, increase availability of dentists and reduce waiting list.

Explain price bands

-payment for treatment is split into price bands depending on the level of care given so that patients contribute to the different costs of equipment and materials used in treatment

1. emergency dental treatment = 26.80 e.g pain relief/ temporary filling

2. Band 1 = 1 UDA = 26.80 e.g examination, diagnosis, advise, scale and polish (PMPR), application of fluoride varnish

3. Band 2 = 2a = 3 UDA, 2b = 5 UDA, 2c = 7 UDA

= 73.50 e.g everything in band 1 plus fillings, root canal work or removal of teeth

4. Band 3 = 319.10 = 12 UDA e.g Band 1 and 2 plus crowns, dentures, bridges

What is the dental recovery plan, released in 2024?

-a plan to tackle access issues

-£200 million plan to deliver more than 2.5 million additional NHS appointments in 2024-2025

Plans:

-wanted to expand access so everyone can see a dentist with incentives and introducing mobile dental vans for under-served communities

-launch smile for life - promotes prevention and good oral health for young children

-supporting and developing dental workforce and setting trajectory for further contract reforms.

-'golden hello' incentive - dentists offered one off payments of up to £20000 to work in underpriviledged areas for up to 3 years

-graduates have to work in NHS after graduation

*some progress made on these but others awaiting decisions from labour

Which dental treatments are free?

-to repair dentures

-to remove stitches

-to stop bleeding from mouth

-dentist only has to write prescription

Who gets dental treatments for free?

-under 18s

- under 19s (recieving full time education)

-pregnant women or have had baby in last 12 months

-on income support, income related employment and support allowance

-NHS dental service outpatient

-staying in an NHS hospital

-have valid NHS tax credit exemption certificate

What is the traffic light system?

What is the sugar tax

What are the advantages and disadvantages of sugar tax?

Advantages:

-tackles obesity problem and dental caries problem -> if obesity and dental caries rates reduce, NHS can use money elsewhere e.g cancer

-worked in mexico for example

-firms will try to reduce

Disadvantages:

-autonomy - government are introducing something without publics consent

-discriminates against those who are from a lower socio-economic background - healthier options are more expensive

-only for drinks not food

What are alternatives to sugar tax?

make healthy food more readily available

reduce sugar content

expand sugar tax to other foods

9pm watershed

education

stop companies using so much sugar

Disadvantages and advantages of water fluoridation

Advantages:

Disadvantages:

-goes against autonomy

-some dentists claim that you can get water fluorosis however in its concentration it will not

Differences Private vs NHS

Private:

-choose your hours

-longer appointment times - quantity over quality

-better technology, better materials

-cosmetic work

NHS:

-have a contract

-more cost effective

-no cosmetic work