In November 2024, NHS England published guidelines for when it is appropriate to provide NHS dental care after patients have received self-funded dental treatments, including privately funded non-NHS care within and outside of the UK, in cases where patients have acute presentations or complications.

It represented a step in the right direction offering practitioners clear guidelines on how to proceed when faced with such patients. BDJ In Practice spoke to Chief Dental Officer for England, Dr Jason Wong, to discuss the guidelines and the increase in patients seeking dental care outside the UK.

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Why was there a need for the ‘Avoidance of doubt' clinical policy for self-funded dental treatment requiring NHS intervention, published in November?

JW We lacked guidance in this area and individual clinicians were having to make their judgement whilst worrying about the ‘you touch it you own it' narrative peddled by many colleagues on forums as well as a genuine concern that it would pull them into a more complex treatment that may even become out of scope for them. Overall, we have also seen an increase in reporting of incidences of people seeking treatment outside of the NHS and also outside of the United Kingdom.

What issues did it set out to address?

JW I was trying to address two issues that seemed to be prevailing in the dental community. As I said earlier, it was to ensure that colleagues know that where a patient has an acute need that they should try and help that patient without necessarily becoming responsible for all the treatment that the patient has previously had. The second was to give some clarity to the clinician how and in what circumstance they could seek help from the system and where their responsibility ceased.

What are the key takeaway and messages for practitioners set out within the policy?

JW When it is appropriate to provide NHS dental care after patients have received self-funded dental treatments, including privately funded non-NHS care within and outside of the UK, in cases where patients have acute presentations or complications. Patients who have previously paid for dental treatment privately in the UK or abroad but later require NHS treatment due to a complication or sudden oral health issue are entitled to access NHS dental care for assessment and evaluation to stabilise their condition. Any treatment beyond stabilisation will be assessed based on complexity and need and should be provided at the appropriate care setting, subject to existing NHS acceptance criteria.

Dental (and medical) tourism is increasing in popularity. What issues lie at the heart of this?

JW I think it is cost and aesthetics that is at the heart of this. Private dentistry is perceived as being cheaper abroad. Continuity of care is not considered to be important by the public. Lack of consideration to maintenance care is also another factor. One in four patients receiving private treatment report that is because they were unable to find a NHS Dentist. A third of adults feel that the type of treatment they receive has been affected by cost. In terms of medical we are part of a group that includes cosmetic surgeons, Bariatric surgeons and trichologists (hair transplant). For medical some may be accessing care to circumvent waiting lists.

How does the OCDO see the relationship between the profession and countries (Turkey for example) who are aiming to expand their dental tourism services developing?

‘ Patients who have previously paid for dental treatment privately in the UK or abroad but later require NHS treatment due to a complication or sudden oral health issue are entitled to access NHS dental care for assessment and evaluation to stabilise their condition'

JW I think it is important to build relationships and there are moves by government to do so. I am also keen to make sure our focus is not just on one country as even though the volumes may be higher the issue is much wider than that.

That said there are discussions between governments on the issue. One misconception is that this is all about cosmetics from all parties. Some of the countries promoting this have their governments in favour of it for economic reasons but they actually see the noise about cosmetics as unhelpful. Their real intent is to offer general healthcare but that may be politically unpalatable to many western countries though.

Moving forwards we have to build relationships but also compare regulatory systems as there is where most of the differences lie. Making the case for good regulation is perhaps the toughest task we have.

‘ Patients who have previously paid for dental treatment privately in the UK or abroad but later require NHS treatment due to a complication or sudden oral health issue are entitled to access NHS dental care for assessment and evaluation to stabilise their condition'

The late Professor Jimmy Steele said there would be the ‘heavy metal generation'. If dental tourism continues on its current trajectory, what would today's generation be left with?

JW The biggest issue we have is ageing well with people's oral health. The heavy metal generation as outlined by Jimmy will be replaced by a generation some years and possibly decades more advanced than before who have had complex treatment in their mouths. Most complex work like dental implants require maintenance and a level of manual dexterity in which to keep them healthy and it is not realistic to expect all patients to be able to do this throughout life. I also see a generation of age 90+ people accessing care and expecting to have fixed solutions which will have consequences for the future. Going back on topic the veneers carried out young patients should be avoided since regular replacements will inevitably lead to tooth loss that otherwise would not have been lost.

Read the Avoidance of doubt: Clinical policy for self-funded dental treatment requiring NHS intervention publication at: www.england.nhs.uk/long-read/avoidance-of-doubt-clinical-policy-for-self-funded-dental-treatment-requiring-nhs-intervention/