Ahead of this year's Local Dental Committee Annual Conference, BDJ In Practice spoke to Conference Chair Charlie Daniels to gauge his views on the intervening months since the 2024 conference and what attendees can expect

In your own words, how would you describe the landscape of dentistry as we find it today?

Most of us thought when a new government came in there would be big changes, especially after Wes Streeting kept his word and met us on Labour's first Monday in office. It was a very promising start, but I have to say, sadly, action has been slow, and all we've seen are sticking plasters across areas of high need, which does no-one any good.

Of fundamental importance is that sticking plasters of any nature don't get away from a contract universally condemned by anyone who has encountered it - the BDA, multiple Health Select Committees, politicians - all of whom agree NHS dentistry is failing. We've seen an increase in complaints because it's harder than ever to deliver UDAs because recruitment of staff - dentists, dental hygienists, dental therapists, nurses, reception staff - is really challenging. Business rates rising at a pace that haven't been reflected in DDRB uplifts is really disappointing. These problems aren't new - they've been with us for a long time and simply haven't been addressed.

I think the National Insurance hike, with no guarantee that's going to be covered as it has been for doctors, is extremely disappointing. The loss of the new patient premium is just another financial penalty at the worst possible time, which has only made it harder and harder to deliver contracts.

I know there's talk of ‘well, I can spend more time doing private dentistry', but I'm a great believer in you can only spend your time once. If you're working flat out delivering UDAs then it becomes really challenging to subsidise NHS patients by seeing private patients because you don't have the time to do it.

Conference will fall a little short of 12 months since a change of government. How would you assess the intervening months?

We all had hopes that a change of government would mean new momentum, especially as they came in and acknowledged the issues, but so far they have done little to back that up. The fact the uplift come through as late as it did - later than it ever has done - put a lot of practices under huge financial pressure. It sends out the wrong message at the worst time, and that would have been relatively easy to have delivered the news earlier. Yes, of course it should have been higher, but to have it so late just gives the impression that dentistry is not as much of a priority that the government said it would be, and that's disappointing.

There are small signs the landscape is changing, but they're simply not happening quickly enough. We can evidence that, as we're seeing more and more NHS contracts being handed back, and I think more contracts will get handed back unless more effort goes into solving these problems rather than putting a sticking plaster on them.

It's safe to say these issues will be discussed at conference. What would progress look like?

The NHS dental ship is drifting further into deep waters. Unless an effort is made to bring the ship back to shore, it's going to be too late. The government need to step up and quickly - before there is no service left to save. Is it too late? We're in extra time, I'd say. If we don't get a goal soon, there's little doubt that will be that.

Going forward, I understand there's a need for a form of monitoring system of UDAs, but a more blended contract must be the way forward. There must be more continuing care capitation, recognition of high needs patients - I am seeing patients who need 12, 13, 14 fillings, and the UDA value is not enough to even cover the lab work. I had a patient come in and it was to fit a crown. However, between appointments, they'd managed to break another crown, so that becomes one course of treatment and all of a sudden the lab fee for the two crowns means that the remuneration for that work and time spent does not add up.

There have been rumblings of ‘oh it's swings and roundabouts these things happen' but it feels like they've taken away the swings and its all roundabouts. If it was a blended contract, would I feel this way? I doubt it. High needs patients such as these I have mentioned should be cared for - that's our duty - but not to the extent it puts practices under huge financial burden. If you don't end up meeting your targets because you've seen multiple patients requiring multiple fillings, you're potentially going to face severe clawback, which means you're less likely to be able to see those patients next time around, not to mention an additional financial pressure, all for doing to right thing. That is not a tenable situation, and politicians do not seem to fully understand this yet.

All of these things put pressure on practitioners. You have previously written about resilience. Can you expand on why this theme is important, and what else can we expect from conference?

I've been a general dental practitioner for 30 odd years, and you get fatigued by the constant pressure you're under. I think we can all deal with it - to a point - but if that pressure is constant and you're constantly fighting against it, it does influence your ability to perform at your best. It influences your ability to deal with patients, complaints, your staff - it can feel like there's never a time where you can switch off, to rest and recuperate, be ready to face a day fresh because the pressure eats into your time and thoughts. There are times I've driven back to work after a long day just to check, so I can try and put my mind at ease. We shouldn't be worried to this extent, but that's the climate of litigation we operate within. Patients expect everything to meet 100% of their standards, and that's difficult managing expectations. We talk a lot about defensive dentistry and doing things we feel are going to be the safest option. That can't be right. We're here to do the best for the patients, all the time, and working under this constant worry of a complaint made against you is not right.

I asked myself whether we have the coping mechanisms to realise the level of pressure we're under and to ask ourselves how it is affecting us. If we can have an open and frank discussion about the pressures we are under, it could help to mitigate this feeling of never-ending, 24/7 pressure. What could we look at to help us understand the effect this has on us, where can we go to alleviate the pressure, what can we do to make our lives a little more bearable - these kinds of questions, which aren't easy to ask, but we can find answers. It's all well and good saying be resilient, but what does that look like? So we've got some great speakers to show some good practice, how to identify and put coping mechanisms in place, and how we can help the full oral health workforce to work accept, work through these and begin realise its potential.

On a personal note, how did it feel for your peers to nominate you as chair?

I was extremely proud and humbled. I have always enjoyed the conferences and understand it's such an important event in the calendar for the Local Dental Committees to discuss their concerns in a wider forum. I don't see my role as being ‘chair', so to speak - it's a real team approach with input from the Agenda Committee and fantastic support from the BDA. Without thee there would be no conference. Title of Chair is almost name only - it's a number of people who make it happen and make it a huge success, and I'm really looking forward to bringing everyone together to deliver what I believe will be a fantastic programme.

You've also been appointed to the GDPC exec committee. What message do you want to give conference attendees, LDC members and those of the wider profession?

I'd want to tell the profession that we do take on your concerns and take them to government. Progress might resemble a very slow-dripping tap at times, but we work tirelessly to bring about the results we all want.

I'd also like to thank Shawn Charlwood who has stepped down as Chair of GDPC, for the amazing work he did throughout his tenure. Shiv Pabary - a man I have known for more than 15 years - is absolutely the right man to take us forward.

While I cannot guarantee what the outcome of our work will be, what I can guarantee is that we will continue to fight hard to get the best possible deal for patients and profession alike. We will continue to hold the government to account for their actions - or lack of - and restore dentistry to the service it needs to be to survive.

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