Dentistry needs ‘cultural change’

Patients are becoming increasingly selective and a sea change in attitude means the under 30s are much more like to leave practices to seek the oral health care they want.

UK dentistry came under the spotlight today (2 July) as the Westminster Health Forum played host to a four-hour seminar on 'Dentistry 2013: commissioning, access and towards the new contract'.

Jointly chaired by Lord Colwyn and MP Alison Seabeck, both vice chairs of the All-Party Parliamentary Group for Dentistry, there was an agreement amongst the panelists for a greater need for clarity with patients, too.

John Milne, chair of the BDA's general dental practice committee said that although he was 'positive about the direction of travel' that now, almost two years into the pilots, there was 'still a lot we don't know'.

He felt the 'pace of reform needs to pick up' and that 'a lack of clarity produces risks and makes patients vulnerable to exploitation'. He also warned of a need to ‘phase in’ the changes being piloted to avoid chaos, especially as the lengthy oral health assessments were currently ‘clogging up’ the appointment books of those practices trialling the new contract, something chief dental officer Barry Cockcroft also accepted needed to be addressed.

John Milne said that the profession needed to recognise that the oral health of our nation is changing and that it needed to process changes over the next 30 years

A need for patient openness was echoed throughout the speakers' addresses, among them chief dental officer for England, Barry Cockcroft, the GDC's Evlynne Gilvanny, Martin Fallowfield, chair of the BDA's principal executive committee and Tony Donaldson, of the Office of Fair Trading.

Shalin Mehra is a GDP and managing director of dental practice group, Rodericks, whose practice is participating in the pilot scheme. He reiterated the need to adapt, saying that patients 'want transparency and the pilots give them that'.

A survey of 550 patients, by dental corporate Oasis Dental Care, revealed that those under 30 who were polled, said they would more readily quit practices should they not get the dentistry they expected. This, it was suggested, would make for a more competitive market and, coupled with healthier mouths and word-of-mouth recommendations more likely to come from dental apps, it spells a massive change for the profession.

Justin Ash, chief executive at Oasis, accepted that, although this was a small sample, it was important to consider the long-term implications.

Shalin Mehra foresaw problems for practices that need to adapt to these changes but suggested that, to meet them, practices will need to take a 'much more holistic approach' than ever before. He added that this would require 'team reconfiguration' and training in skills management. He said: 'Those who embrace it [the new contract] will find it easier to get up that hill.’

Other panelists foresaw problems with the system currently being piloted that included cases of ‘cream skimming’, with dentists only treating the patients with better oral health and referring more complex cases to secondary care.

Mark Pennington, lecturer in health economics at the London School of Hygiene & Tropical Medicine, suggested there was a high risk of ‘displacement of treatment into secondary care’, a fear echoed by delegates in the Q&A session that followed. To prevent this, Dr Pennington suggested factoring in ‘incentives for practices that treated hard-to-reach patients and penalising those for inappropriate secondary referrals’.

Paul Batchelor, senior lecturer in dental public health at UCL, laid down his thoughts for what he would want to see in the new contract which included a need to be flexible, the need to develop an integrated team, the need to address economic uncertainty and a need to be able to accommodate scientific advances in oral health.

Other points made within the seminar included:

• A pledge by the Care Quality Commission’s Adrian Hughes to pare down the ‘massive tome’ of regulations dental practices need to meet (five questions instead of 28 regulations) and a move from a generalist to a specialist approach which will mean a move towards much more dental-savvy inspectors. He also mentioned a rating service for practices

• A request by the GDC’s chief executive, Evlynne Gilvanny, for a more grass roots approach to complaints handling and other important issues at practice level rather than referring to the GDC, saying that ‘a key part of patient care is resolving complaints’. Plus a pledge to redesign all GDC regulations

• A reiteration by the BDA’s Martin Fallowfield that ‘teams need to be led by dentists’ and a plea to the government for ‘protection of the NHS budget and protection in the transition period to a new contract’. He also called on the government to address the need to balance supply and demand in the training of new dentists and sought clarity on whether they will ‘get a job at the end of it’. Something echoed by Paul Batchelor who remained unconvinced the current undergraduate output ‘is fit for purpose’

• Tony Donaldson, of the OFT, suggesting that no dentist should expect ‘indefinite’ contracts to provide government services and looking to investigate a mover to short-term alternative. Also, made a call for an open approach to complaint handling and suggested a ‘single portal’ to which patients could refer to avoid the current ‘confusion’ of many agencies handling their complaints. This was counteracted by an outline by Chris Morris, a partner at Hempsons Solicitor, on how difficult and expensive this could prove to be, given the vast number of agencies that may be involved.


Wrap up

Wrapping up the addresses for the day, chief dental officer Barry Cockcroft agreed there remained some unmet demand within dentistry and, looking ahead, suggested ‘education, lifestyle and diet, and prevention in the community’ would eventually address this with an approach to care that ‘builds services around the patient’ rather than the other way round.

He championed the pilots and said that although the basis of prevention was a ‘no brainer’ of an approach, suggested that ‘implementing “no brainers” is not as easy as people might think.’

Looking ahead, he said: ‘Workforce change doesn’t happen instantly. We need to start training for 20-30 years ahead and it will need a big “cultural change”, adding ‘if we only engage the dental profession, it will take years. We have to engage a wider community’ with ‘all DCPs playing a much greater part as a team providing care.’


Panel and chairs were:

Lord Colwyn, vice chair, All‐Party Parliamentary Group for Dentistry

Dr John Milne, chair, general dental practice committee, BDA

Dr Len D’Cruz, head of practice, Woodford Dental Care

Eric Rooney, Consultant in Dental Public Health, Public Health England (Cumbria & Lancashire)

Dr Mark Pennington, Lecturer in Health Economics, London School of Hygiene & Tropical Medicine

Shalin Mehra, managing director, Rodericks

Dr Paul Batchelor, honorary senior lecturer, Dental Public Health, University College London and Board Member, Faculty of General Dental Practice (UK)

Ian Biggs, deputy director of Operations (South), CQC

Evlynne Gilvarry, chief executive and Registrar, General Dental Council

Alison Seabeck MP, vice chair, All‐Party Parliamentary Group for Dentistry

Dr Martin Fallowfield, Chair, Principal Executive Committee, BDA

Dr Mahendra Patel, executive member, East London & The City Local Dental Committee and Member, general dental practice committee

Chris Morris, partner, Hempsons Solicitors

Justin Ash, chief executive, Oasis Dental Care

Dr Barry Cockcroft, chief dental officer, NHS England


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