DENTISTRY PROVISION IN DEVON

Report prepared by Brian Bird on behalf of the PPI Dental Working Group led by Mrs Marjorie Brace

PREAMBLE

  Prior to the formation of the Devon PCT in the autumn of 2006, NHS Dental Services and funding were managed by the various "Locality" PCTs. Involvement by the PPI varied from a watching brief to inclusion of representation in the SH & WD PCT Dental Contract Implementation Group. The Government promised access to the service for all over five years ago, but this has remained low and generally less than 30%.

  The promise of an improved service and access following the changed procedures operative from April 1st 2006 has not been seen to be a complete success by either the dentists or the public, but for different reasons. Pilot schemes were run in cooperation with dentists on the proposed changes, with plans to change from GDS contracts to the new PDS ones.

  These changes guaranteed the supporting dentists significantly higher incomes for providing full time NHS services (designated as 10 half day sessions/week). At April 2006 this was expected to pay them £80,000 plus a further £80,000 for Admin/Surgery costs etc. The Trust has confirmed that the figures quoted are averages based upon a quote by the Health Minister—dentists who moved from GDS to PDS did not get a pay rise to the above levels, their contract sum was based upon their historic NHS earnings.

  The dentists, we believe, recognised that GPs were being offered better deals and that not accepting a complete NHS contract was going to be more lucrative. In fact many dentists opted to treat only children or children plus benefit seekers, excluding other adult patients with potential for greater income generation as private patients. These dentists just informed those patients that they were de-listed as NHS patients.

  However the PCT has said that the only restricted contracts which were agreed by PCTS reflected existing practice arrangements ie changes which had been made before the contract was introduced. It has been Devon PCTs policy to award new contracts to provide services for all groups of patients. No contracts restricted to particular patient groups have been awarded since the new contract was implemented.

  The PCTs, with approval of the DOH, took the easy way out and allowed discriminating contracts, both GDS and PDS, to operate. This has led to excluding the majority of people who are paying or have already paid for over 40 years into the National Insurance Scheme.

  The effect on this group of citizens is a public disgrace, with the lower paid and pensioners unable to access and pay for dental care. The Commission for Patient and Public Involvement Dentistry Watch report confirms these views.

WHO PAYS WHAT?

  The DOH needs to provide information on how they arrived at the present charges to the public. The present charges appear to be realistic and easily understandable. However, the lowest charge, that for inspection and cleaning, meant just that. It is not being implemented as dentists invariably charge extra for cleaning, using their dental hygienists and Denplan contracts to charge extra.

  The basis on which Units of Dental Activity (UDAs) was calculated and payments made was, in our view, flawed. Our representative on the DCIG raised concerns at the time that the payment of £25/UDA was not soundly based. This payment has been questioned elsewhere as well as the case for additional UDA payments to be reviewed and paid at significantly lower rates.

OVERSEAS DENTAL RECRUITMENT

  The foreign dentists, with few exceptions, have been well received locally. Our concerns are that with open short term contracts operative, they can quickly revert to private practice, which some are reported to have done already. This needs to be confirmed as millions of pounds have been spent on recruitment.

ACCESS TO SERVICES

  The PPI Forum and members of the public believe that the Government has no real evidence, in spite of increased numbers of dentists, that access has significantly improved across the South West, which was below 30% prior to April 2006. Any claims by the PCTs and Ministers that almost all the public has access to NHS dentistry cannot be substantiated. No accurate statistics can be arrived at from the information gathered and reported by the "Information Centre for Health and Social Care" and endorsed by the Devon PCT.

DENTAL FINANCING

  The basis of Government funding, we believe, needs to be subject to closer independent scrutiny.

  Firstly, that adequate and equitable funding is made available for all residents wishing to use the service. Until sufficient dentists provide a non-discriminatory service, the Government needs to consider providing vouchers for treatment by private dentists in the UK or within the rest of Europe.

  We are frequently asked why is it that non-UK nationals (illegal entrants and visitors) can obtain free treatment as benefit seekers, while payers into the system are excluded. Perhaps this level if discrimination needs to be tested in the European Court of Human Rights.

  Report to the DCC Health Overview and Scrutiny Committee 22/10/2007 by the Devon PCT Primary Care Manager (appendix 1)

  We wish to table this report (appended) to illustrate the latest position in Devon and comment as appropriate.

Dentistry Spend

  The reported shortfall, we believe, can safely be attributed to the ready acceptance of discriminatory contracts, as already explained. It is noted that other factors that may contribute to the shortfall include under-performance against contract and closure contracts.

Dental Manpower

  The number of dentists employed does not reflect the sessions they actually work for the NHS.

Patients Accessing NHS Dentistry

  The method of generating the statistics gives little clue to the total percentage of patients accessing treatment. The 24 months' figures do not recognise the difference between the number of patients treated and patient visits which can be markedly different. This method of calculation glosses over the shortcomings, which the PCT recognises in the last sentence of Dental Manpower.

Recruitment of Dentists

  Based on the increased numbers from June 2006 (330) to March 2007 (360), you would have expected more patients to be treated in the period under review. Again, perhaps a reflection of part-time participation in providing NHS service.

Developments 2007-08

  These are sparsely placed and the waiting lists still long. Locally orthodontic service is poor. Oral Health is only being practiced for private payment.

THE WAY FORWARD

  The PPI Forum and public welcome the renewed proposed Government initiatives to improve the service and access.

CONCLUSIONS

  It may well be that our experiences of inadequate NHS Dental Services in Devon are reflected in many other rural counties, with promises that have failed to materialise to date.

  The Devon PPI Forum Dental Group would be prepared to appear before the Health Select Committee to present our case and input a balanced view on behalf of the public, whose wider views have been reported in Dentistry Watch.

Brian Bird

Devon PPI Forum member