New ways forward for dentistry

Great changes are happening to the dental profession, and the outcomes have, until now, been impossible to predict. Dental staff shortages are worrying the Government, as is the lack of NHS dental treatment across the UK. The new NHS contract has led to mass uncertainty among thousands of dentists, who face difficult negotiations with inexperienced officials.

With the dental market in this state of uncertainy, a study has arrived at some surprising conclusions. Denplan recently commissioned the Office for Public Management to carry out a bold simulation of a complete dental market, with representatives from every relevant body playing their own roles. Dental practitioners, Primary Care Trusts (PCTs), Strategic Health Authorities, the Department of Health, regulatory bodies and patient representatives all attended, to explore the future of dentistry. The rules were simple: each participant simply needed to behave as they would normally, in a range of simulated situations. In other words, the outcomes depended on the negotiating and bargaining power of each player, in realistic scenarios set in 2005/6 and in 2008/9.

The report, \Dentistry: New Worlds, New Ways\, contains significant findings. Most importantly, the study indicates that England could be on the brink of a ‘New World’ in dentistry. Rather than a ‘roll-forward future’, with provision of similar services at different quantities, the future of dentistry requires totally new ways of thinking, funding, organising and working.

Modernisation will probably be stalled in the coming year, adds the study, when the Primary Care Trusts begin to take on their new managerial role. ‘Most of their energy and expertise’, the report notes, ‘will be taken up with negotiating new contracts with dentists: modernisation at the same time for many PCTs is a tall order.’ The author of the report, Sarah Harvey of the Office of Public Management, expanded: ‘It was clear from the outset that PCTs and dentists talk different languages, and inhabit different worlds. A major task will be to bring a common understanding in the limited time available to them.’

Further challenges include the problem of imperfect information. Patients were unsure of what NHS dentistry embraces or excludes, or indeed of its cost. Both nationally and locally there is only a high-level grasp of the dynamics of demand for and supply of dental services. According to the report, ‘this needs more rigorous analysis if dental services are to be planned effectively.’ The market cannot operate efficiently while such uncertainty exists. Roger Matthews, Denplan’s Chief Dental Officer, commented: ‘Dentists who want to get some understanding of how PCTs think ahead of the contract negotiations should read this report; and PCTs looking to gain some insight into dentistry will also find much to ponder.’

The report is useful for public planners, too, for it highlights several possible models for both the provision and funding of future dentistry. Lester Ellman of the BDA sums it up: ‘There are no second chances on this. Dentists and PCTs alike will need to think openly and imaginatively about their futures: the most successful partnerships will be those that adapt most effectively to the new dental world.’

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