Dentistry DoH bows to critics

The Government has bowed to Parliamentary critics by accepting key findings
of a damning report into the NHS dental contract.

The Department of Health, responding to a report by the Commons health select committee, said it agreed with the committee’s view that ‘progress on improving access has been disappointing to date’.

It said: ‘We take very seriously the concerns of the committee about the degree of progress so far and about how some aspects of the system are working.’

The committee’s report, which was published in July, had described the 2006 reforms as ‘extremely unpopular’ with dentists and concluded that the goal of improving patient access had ‘not been realised’.

The DoH went further than before in acknowledging that more needed to be done to improve the system. It promised to work with professional and patient groups to look at how the NHS could achieve the ‘maximum benefits’ for patients.

It said work had already begun with Strategic Health Authorities to agree ‘the high impact changes that will most rapidly improve access to NHS dentistry’, with an initial report due later this autumn.

It pledged to support the NHS in raising awareness of new dental services and in addressing the ‘variable quality’ of commissioning between different areas.

The DoH said it shared the committee’s concerns about the number of referrals of patients requiring complex treatment to dental hospitals and community dentists and said it would encourage PCTs to look for ‘referral patterns that necessitate intervention’ to clamp down on inappropriate practices.

It acknowledged there was a ‘national shortage’ of dental public health specialists for PCTs to call on for advice on commissioning, and said it had asked for a review of the capacity and capability of the dental public health workforce to report by the end of the year.

In a significant U-turn, the DoH conceded that patients still want to be registered to a particular dentist, and promised the Government would ‘examine the scope and options for some form of registration in consultation with the dental profession’.

It also pledged to review the three-band system of patient charges as part of its wider study into how NHS dentistry will develop over the next five years.

However, while the Government was willing to admit improvements were needed,
it refused to budge on the main principles of its reforms and insisted patient access and commissioning would improve over time.

The DoH, setting out its case for the defence of the contract, said: ‘The evidence shows that the NHS is now commissioning a growing volume of dental services, which we are confident will feed through into higher levels of access.

‘There were 2.7% more courses of treatment in 2007/8 than in 2006/7 and the number of dentists doing NHS work increased by 655. This was before the 11% increase in dental funding allocated to PCTs in April 2008, which is supporting further expansion in services.

‘This active commissioning of new services was simply not possible under the old contract system, where dentists could choose for themselves how much or how little NHS work to do from one month to the next.‰

The DoH argued that the first year of the new system had been dominated by the ‘time-accepts consuming’ job of commissioning new services to replace those dentists who chose not to accept new contracts, and by handling cases where dentists disputed the terms of new contracts.

‘The evidence suggests that services are now beginning to expand more rapidly, which will result in more people accessing NHS dental services’, it said.

The DoH claimed that the new contract had reduced workload pressures on dentists, citing statistics from the NHS Information Centre that suggested dentists‚ working hours were shorter than they were in 2000.

It said early evidence showed an increase in the use of topical fluoride varnishes on children’s teeth – proof that the contract enabled dentists to undertake preventive procedures.

The DoH gave little sign of backing down over the retention of the controversial unit of dental activity (UDA) as a measurement of activity – but said the Government supported PCTs working with dentists to develop ‘other measures’ that could be used for contract monitoring, ‘in addition to weighted courses of treatment’.

These might include a greater range of quality indicators, including patient satisfaction measures, it said.

The DoH also rejected concerns about a reduction in complex treatments being carried out, and said its reforms, in moving away from a system that ‘over-incentivised’ treatment, were ‘always intended‰ to lead to such a reduction, which was „consistent with maintaining high standards of oral health and patient experience‰.

The British Dental Association, (BDA) recently called on the Government to engage in more constructive dialogue with the profession.

Executive Board Chair Susie Sanderson said: ‘We hope that the positive response to the BDA’s call for dialogue with the profession and patient groups signals the start of a more constructive period in the relationship between the Government and the profession. We look forward to meeting with the Chief Dental Officer to begin this process.

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