One size to fit all

My former GP (general practitioner), like me – long since retired, has a different approach to healthcare from many of his colleagues.

When he sees a specialist for his ailments, he does not want advice on drinking (too much), smoking (a pipe), waistline (too large) or exercise (too little).

He wants the pills to cure him, not ‘advice and prevention’.

His approach to dentistry is similar.

He does not appreciate being told he drinks or smokes too much, nor that his oral hygiene regime is rubbish.

He wants his teeth fixed.

He is not alone and there are many others who want occasional rather than regular care.

There are holiday makers in Cornwall, migrant cauliflower pickers in Lincolnshire.

To be fair the Department of Health knows this and acknowledges that the new contract will need to flexible to accommodate all.

Yet the four recent consultation papers on contract change and, indeed, the chief dental officer’s speech at last week’s LDC conference, concentrated almost exclusively on the preventive care pathway aimed at the majority of patients who have no ‘new’ disease.

The pilots have shown that this approach is working for these patients, but what of those who need treatment more than prevention?

The conference was also told about new pathways being developed, such as orthodontics, oral surgery and advanced restorative care into which patients might go at various stages of their life.

Some misgivings were aired at the conference about how these pathways were being developed, especially the classification of dentists into various tiers.

We must hope, however, that they will ensure those needing advanced care from time to time will receive it.

What concerns me are those patients who need treatment, rather than prevention, every time they attend.

John Milne told the conference of a young teenager who needed a great deal of treatment and all for three UDAs (units of dental activity).

This young man will need constant monitoring and treatment for the rest of his life.

It cannot be provided for a capitation fee that is geared to the person with little or no caries and good periodontal health.

His dentist is always going to lose money treating him.

At the other end of life, those of us who have lasted the course may well have type two diabetes leading to periodontal disease, root caries and large restorations breaking down.

We too will need regular treatment and, with a fixed capitation fee, will often be treated at a loss.

Patients are individuals and have different needs.

When it comes to the NHS paying for their treatment, one size does not fit all.

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