Before we get into this article, we want to point out that there are a lot of good things to say about the way Great Britain approaches dental care and healthcare in general. The socialist principles of the National Health Service say that anybody who is in need of medical treatment gets it free at the point of use, with no need for insurance documents to be produced. Nobody has to declare medical bankruptcy, ever. Nobody has to weigh up whether they're sick enough to go and see a doctor because they're worried about the cost of doing so. It has its critics, but it's about as close to a perfect system as you're ever likely to see.
The system doesn’t quite extend to dentistry in the same way as it does to general healthcare. The majority of people within the UK still have to pay toward their dental care, but even then, the work is heavily subsidized by the state. The average cost of dental care for an individual citizen in the United States of America is around $360 per year (although it’s significantly higher for senior citizens). In the UK, it's barely a tenth of that. For retirees, students, and those on a low income, it's provided free of charge. As with healthcare, this sounds like a perfect system - so why are we describing it as a 'postcode lottery?'
To explain that, we'll have to start by explaining what a postcode is. That's easy - it's the same as a zip code in the USA, and it covers a geographic location. NHS dentists within the UK will only accept registrations from people who live within the same (or a similar) postcode area as their office. This policy is designed to ensure that people are always seen by a dentist close to where they live and that the burden of providing dental care is shared out equally between dentists. That's an idea that works fine on paper but doesn't always work out that way in practice.
The core of the issue is that not every postcode area has a dentist in it, and some areas have significantly more dentists than others. As dentists are human beings, there are limits to how many people they can see in a day or a week. Because of this, not everyone is able to register with a dentist, because the practice they want to register with is already over-subscribed. They can go on a waiting list, but waiting lists in the worst-affected areas are over a year long. That isn't much use to someone who has a pressing dental issue and needs to be seen immediately. It isn't much more useful to someone who has degenerating teeth and needs to be seen on a regular basis for the purpose of dental maintenance.
Because access to dental care is largely determined by how many available dentists there are within a given postcode area, the situation has been described as a 'postcode lottery' by the British press. It would also be fair to compare to it an online slots game. There's a popular online slots game called 'Crazy Dentist,' and the British system is a little like that slot has come to life. Just as is the case in slot games, if luck is on your side, you'll be rewarded. If it isn't, you won't. The rewards come in the form of cash winnings when you're playing online slots, but the losers of the postcode lottery system might be looking at a cash loss. That's because the only alternative available to them is to seek a private dentist.
The fact that private dentistry exists at all within the United Kingdom is a controversial topic for some. There are those who feel that dentists who operate privately have betrayed the system, and are placing personal gain above their duty to care for the people who depend on them. If every private dentist in the country rejoined the NHS system, there would be no shortage of dental practices available, and the postcode lottery wouldn’t exist. There’s no obvious incentive for them to do so, though. In fact, the reverse might be true: there’s an increasing incentive for NHS dentists to join them.
The fewer NHS dentists there are in the system, the greater the burden becomes on those who stay within it. Every time a dentist leaves and goes private, another NHS dentist has to (at least try to) pick up the slack and take on board the patients who can no longer use the newly-private dentist's services. The obvious consequence of this is that NHS dentists have too many patients to deal with, have to work longer hours to cope with demand, and generally earn less than their private counterparts. It's not hard to understand why someone in that situation would be tempted by an offer to go private for more money and a lower workload - and every time that happens, the situation gets worse.
We don't know what the situation to the problem is. We're not politicians or policy-makers, and we don't envy those whose job it is to try to resolve the issue. The fact that public and private services exist side by side appears to be the source of the conflict, but it's highly unlikely that any current or future Government of the country would order the closure of private practices. What we do know, though, is that if you're a dentist looking for work, there's definitely no shortage of vacancies in the UK right now. The NHS is always hiring, and you won't struggle to find patients. The hours will be long, and the demand will be constant- but you didn't get into dentistry because you thought things were going to be easy! The right dentist in the right location could make a huge material difference to the quality of dental care provided in that location. If that's the reason you became a dentist, then it's a challenge waiting for you to accept it.
On the other hand, if you’re a dental patient living in an area where it’s hard to gain access to NHS dental care, there might be a more sensible way to gain access to quality care without paying hundreds of pounds every time you require an appointment. It might sound like an American idea, but there are companies within the UK who provide insurance for dental treatment. You might resent paying £10-£20 a month for it, but you’ll be glad of it when it covers a bill that would otherwise have cost £500!