Recently we met at a cafeteria with several friends and one of us complained about his difficult time after a sudden toothache. He visited a local NHS dentist who was able to provide an emergency treatment and resolved the acute pain;  but then he was told that he needed a Root Canal Treatment, that this is a complex procedure, and the options were limited: being referred to a public hospital, where the waiting list is of about eighteen months, or visit a private specialist at a fee of 8/900 pounds. We were all outraged and a general consensus emerged against the greed of the dental professionals.

Interestingly, one of the person sitting at the table was a dentist, and after taking his fair part of bitterness and sarcasm, he gave us all few insights about being a dentist in UK today.
More than twenty years ago it was no possible to mix NHS and private dental treatment. The huge majority of UK dentists had an NHS contract and the amount of money the government spent was enough to provide decent care to everybody. Unfortunately the trend to cut public spending, started in the eighties, hit hard the NHS dentistry, in favour of keeping the quality of service in more life threatening sector. The dentists compensated the lack of funding increasing efficiency and seeing more and more patients a day, with an inevitable decrease in the quality of treatment. At a certain points, when the business was not viable anymore, an historical barrier was broken, and NHS dentists were allowed to provide private treatments , when they were not approved by the NHS. In this way most dentists used private dentistry to somehow compensate the lack of funding from the NHS, and could still run a profitable business.
The mess started in 2006. The government, in order to plan in advance the money to be spent for the NHS dentistry, came out with a reform where the dentist is paid a fixed contract, not related to the number of treatments performed: if he does a small filling, or five root canals, plus three extraction and twelve fillings on one patient in the same course of treatment, he gets paid exactly the same. The effect was a general run away of dentists from the complex treatments, a huge boom of teeth extractions, and a situation that leaves abandoned those patients who need treatment badly. If you want to know more click here.
Of course the blame was directed at the dental profession: I watched myself a TV show where somebody claimed that the average salary of a NHS dentist is £ 160,000, when in reality this is the value of the average contract, including the cost of rent, equipment, staff salaries, and materials per year: easy to do the math.
A Root Canal Treatment is one of the procedures that, if done properly, requires long sessions, and it is paid about fifty pounds. Fortunately the market quickly adapts and a huge number of dentists left the NHS and started private practices, that now meet the increasing demand of quality dental treatments at cost that is more and more affordable. It is not impossible to find a fair Root Canal cost.
That leaves unsolved the problem of those ones who cannot afford any private dentistry and are left with no option but being let down by a system that is clearly failing.

So what can be done?
If you ask the dentists the answer is the easy and pragmatic: if we cannot afford a quality NHS for everybody let pay the private dentistry to those who can afford it ( they are already doing it anyway ), and concentrate the scarce resources on those people who do not have a choice.
But that involves a strong political choice that will not be popular with many. Who will have the guts?